The invisible performance of 'masking' ADHD symptoms is exhausting

by Grace Iarocci, The Conversation

edited by Gaby Clark, reviewed by Andrew Zinin

Gaby Clark

Scientific Editor

Meet our editorial team
Behind our editorial process

Andrew Zinin

Chief Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

written by researcher(s)

proofread

The GIST Add as preferred source

Attention-deficit/hyperactivity disorder (ADHD) is often discussed in terms of visible traits: fidgeting, distractibility, forgetfulness or restlessness. But those are just the traits we can see.

ADHD is a complex developmental condition rooted in the brain's motivational, attention and executive-function systems. Much of what looks like "disruptive behavior" from the outside is evidence of a profound, ongoing internal struggle.

Because the brain's attention and motivational systems function differently, many people with ADHD struggle to filter out background noise, prioritize routine tasks and put the brakes on sudden impulses. This can cause challenges with executive functioning, like initiating tasks, staying organized and managing one's time. But ADHD can also bring remarkable strengths.

When a person with ADHD finds a task they genuinely connect with, they can focus for long periods and bring out-of-the-box creativity and high-energy problem-solving to it.

ADHD is a neurotype that requires accommodations, including a better study environment, flexible workplace hours and understanding from loved ones. Research suggests that, for many who live with these challenges, the struggle is far more complex and profoundly internal.

It can also involve a struggle to perform. It can mean maintaining a constant state of "masking" that can be just as debilitating as the symptoms themselves, if not more so. Think of masking not as choosing to be polite or make a good impression, but as a survival strategy. It's what people do when they fear being judged, misunderstood or discriminated against.

My research with my colleagues illuminates this often-invisible struggle faced by many adults diagnosed with ADHD: the exhausting need to mask. This process involves sustained, intense mental effort that can lead to deep emotional burnout and feelings of chronic isolation.

The vast majority of adults with ADHD who participated in our online study—over 90%—reported that they mask their symptoms in social situations. This masking doesn't happen only at school or in professional settings; it also happens on public transit, with family and even when they are alone. It becomes a constant state of being.

What is camouflaging?

Social camouflage refers to the conscious, laborious attempts a person makes to monitor, control and alter their natural behaviors, thoughts and emotional responses to fit into perceived social norms and appear "neurotypical."

Masking is an attempt to achieve basic acceptance, belonging and emotional safety. It's a shield built against a world that doesn't understand neurodiversity.

For adults with ADHD, who often experience differences in executive function and emotional regulation, along with lapses in attention (such as tangential thought or impulsivity), this camouflage requires a massive reallocation of cognitive resources simply to keep up appearances.

The person must continuously self-monitor: "Am I too loud? Did I just interrupt someone inappropriately?" This constant internal policing is like running two parallel streams of consciousness, one for living authentically and one for curated performance. Researchers have likened this to a duck gliding smoothly on the surface while paddling frantically underwater.

For many people, masking is a safety measure. They describe it as "walls being built around them." It is an act of self-protection designed to minimize the risk of mistreatment or discrimination.

One adult with ADHD in our study said, "When you live with a chronic condition and feel fundamentally misunderstood, your primary goal shifts from authentic expression to survival. And survival, in this case, means conforming."

The high toll of masking

This constant effort to perform comes at a steep cost, including mental exhaustion, physical pain and damaged relationships.

Our study details the immense cognitive cost associated with masking. Unlike simple social anxiety, camouflaging involves actively suppressing behavior. Every interaction becomes an exhausting exercise in management: suppressing natural enthusiasm, pausing before impulsive remarks and actively mimicking behaviors learned from observing others.

For many, this sustained effort leads to measurable psychological distress. The consequences may include:

Chronic exhaustion (burnout): Because social interaction becomes a depleting task rather than an engaging experience, people often report profound fatigue following even relatively minor social events.

Increased anxiety: The underlying fear of "being found out"—of having the mask drop and their true ADHD-related behaviors become visible—creates pervasive and heightened anxiety.

Identity confusion: By spending so much time performing a role that is not authentic, adults with ADHD can develop a fragmented sense of self. They may struggle to identify what they genuinely want or what their reactions feel like without the external pressures of masking.

There is also a physical toll. The strategies people use, such as clenching their jaws, suppressing urges until they feel pain or biting their tongues, are evidence of real self-inflicted harm.

Masking can interfere with relationships, connection and overall mental stability. It creates a cycle in which the struggle itself becomes another source of distress.

Implications for understanding ADHD

The study's findings challenge common misconceptions about ADHD symptoms. The research suggests that struggles with focus or emotional regulation are symptoms of a system under immense stress and strain from constant self-suppression.

Support systems, like families, workplaces and academic environments, need to shift their perspective. They need to understand these difficulties as signs of extreme effort, rather than failures of will.

We cannot ask people to stop masking. Instead, we need environments—schools, workplaces and communities—that are built on understanding and acceptance.

Systems need to make accommodations. This means recognizing ADHD in professional settings and creating low-stakes, predictable environments. The most compassionate response is to create and advocate for environments that reduce the pressure to perform.

We need education to shift the narrative away from deficit models that focus on what people can't do and toward strength-based models that recognize the unique way a neurodivergent brain processes information.

We need to create cultures where being different is not viewed as a threat, but simply seen as part of the human experience.

Key medical concepts

Attention Deficit Hyperactivity DisorderAnxietyExecutive Function

Clinical categories

PsychiatryPsychology & Mental healthNeurology Provided by The Conversation Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Citation: The invisible performance of 'masking' ADHD symptoms is exhausting (2026, September 29) retrieved 29 September 2026 from https://medicalxpress.com/news/2026-09-invisible-masking-adhd-symptoms-exhausting.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.