What is Masking? And how can you help?

Introduction

“The school reports that everything is fine but at home my child is exhausted, emotional and has meltdowns!”  If this sounds familiar to you then you are not alone.  Masking is a very common strategy used by neurodivergent children to appear “normal.”

Masking can obscure a child’s true needs, delay diagnosis, and contribute to emotional distress if not recognised and supported appropriately.

What is Masking?

“Masking” or “camouflaging” can be described as consciously or unconsciously hiding one’s true self or suppressing one’s natural behaviours to fit in with friends or peers, to meet societal expectations or to avoid negative attention.

Masking is not lying or pretending nor deception. “Masking behaviours” are a set of adaptive strategies that children with neurodivergent difficulties adopt or put on consciously or unconsciously.  Masking means a child hides their true personality, behaviours, mannerisms, opinions or feelings in order to fit in with his or her peers.

Masking helps these children to comply with what is expected of them in certain settings such as school, family gatherings and social events.  It is a coping response to an environmental pressure. While masking may help a child “get through the day,” it comes at a considerable emotional and psychological cost to the child.

Masking can involve:

• Minimising or hiding stimming, tics or self-regulation movements.
• Imitating peers’ social behaviours or scripting conversations.
• Forced eye contact, rehearsing social responses, or controlling sensory needs to appear “normal.”
• Adopting roles (e.g. “quiet helper,” “angel,” “class clown”) to manage social expectations.

 

How common is it?

Since Masking is not a diagnostic marker, but a behavioural response, it has been understandably difficult to carry out studies to find out the exact prevalence of “masking” in neurodivergent children because of a number of variables.

Nevertheless, there is an increasing awareness into this common, yet not well researched aspect of neurodiversity.  Many reports and qualitative studies indicate that 60 – 70% of children with Autism Spectrum Disorder might be masking, especially in out-of-home settings such as school or social gatherings.

Some reports indicate that up to 9 in 10 girls with Autism Spectrum Disorder are likely to be masking from time to time. Hence, girls often go unnoticed, undiagnosed or are diagnosed much later than boys.  Children with other neurodivergent conditions such as Attention Deficit Hyperactivity Disorder are also likely to mask their difficulties in formal settings.

In my clinical practice, masking is more commonly observed in children who have stronger verbal and cognitive abilities, as these skills allow them to develop compensatory strategies. It is seen less often in children whose communication and learning needs are more significant.

Why Do Children with Neurodivergence Mask?

Children may learn to mask because very early on they learn through observation or experience that:

• Certain behaviours such as stimming or hand flapping can attract negative attention and can result in name calling or exclusion by peers.
• Appearing “different” can lead to bullying, harassment or shame.
• Praise and acceptance are linked to appearing “normal” and being compliant.
• Common motivations also include wanting to belong, avoid attention from others, avoid embarrassment, fear of being misunderstood, desire to please adults and peers etc.

 

Many children mask without realising that they doing so while others are acutely aware they are masking and could describe school as “acting all day.” Consequently, a child can become emotionally exhausted and thus display dysregulated behaviours once they are in the comfort of their home settings or once they are no longer being watched, such as in car on the way home.

These dysregulated behaviours may involve tantrums, meltdowns, shutdowns or withdrawal from social activities.  This explains why the school may report “no cause for concern” while parents are at the end of their tether and describe their life as constantly “walking on eggshells.”

Where Does Masking Happen and Why?

As one can imagine, masking is more common in school settings and formal gatherings. Since schools are structured, predictable, adult-led and rule-based environments –masking is often most effective in schools.

Moreover, there is an inner desire of the child to appear included and not to appear “odd or difficult.”  Hence children learn to hold themselves together during the school day using all their available energy to meet expectations placed on them, resulting in release of accumulated stress and tension quite aptly labelled as “coke bottle effect.”

However, just because the school is not reporting any difficulties that does not mean concerns about your child are incorrect.  As one can imagine, different settings show different sides of the same child.  Sadly, a small proportion of staff may mistakenly believe that since your child has difficulties in the home setting i.e. these are situational; that this is likely to be parent-related.

What is the Impact of Masking?

In the short and medium term, the child returning home emotionally exhausted can result in meltdowns, anger, tears and social withdrawal. This in turn can have an impact on the emotional and social wellbeing of the family. A significant number of schools can fail to see the impact it has on the family’s functioning as a consequence of relentless effort on the child’s part to appear normal.

In the longer term, masking has been reported to contribute to development of anxiety, low mood, poor self-esteem and “burnout.”  Masking can also result in chronic fatigue, identity confusion, and can delay access to appropriate support, since these individuals “appear normal.”

It’s important to note that the DSM-5 acknowledges that “autistic” traits may be hidden by learnt coping strategies especially in older children and adolescents.  Although masking can be adaptive in the short-term, it’s sustained presence is understandably associated with poorer mental health outcomes.

How to Identify Children Who Mask?

The most common indicator is the “behavioural discrepancy.”  A child who is a “perfect angel” at school but explodes with emotional meltdowns or shutdowns the moment they come home or in the car on the way home.

Other signs might include:

• Social mimicry: i.e. copying the gestures and interests of their friends/peers.
• Scripting: i.e. rehearsing conversations or over-preparing for social events.
• Psychosomatic symptoms: such as frequent headaches, stomach aches, extreme tiredness after school.
• Suppressing sensory difficulties such as from loud noises or certain textures until they are home alone.
• School refusal or frequent absence from school.

 

Can Masking be Beneficial?

Masking can be a double-edged sword with certain advantages in the short term or medium term and come with certain disadvantages in the longer term.

Advantages of masking are likely to be:

• Since they help avoid negative attention, they prevent bullying, stigma or rejection by peers.
• Masking helps navigate expectations of school and academic expectations.
• It helps in making and maintaining friendships.
• The praise and acknowledgement they get from their teachers and parents for their good behaviour can help in maintaining masking.

The disadvantages of masking are likely to be:

• Constant awareness, hyper-vigilance and attention to detail in social settings can lead to “autistic” burnout.
• Emotional exhaustion persisting for significant length of time can result in anxiety, low mood, depression even suicidal ideation.

Masking can result if identity loss as children may lose touch with their authentic selves.

How could adults around the child help?

Parents of a child could do the following:

• Create a “low demand” zone after school.
• Create “demand free” time to give “me” time to their child.
• Allow for “sensory” breaks.
• Giving child their own space, and solitude can help in unmasking their true self.
• Avoid pushing child to fit-in or try harder socially.
• Advocate for recognition of “hidden needs” not just “visible behaviour” at school.
• Reassure child that masking is understandable.
• Support authenticity and emotional expression.
• Maintain a home-school dairy to monitor of behaviour and functioning.
• Seek CBT (Cognitive Behaviour Therapy) from a Clinical Psychologist.
• Seek assessment for neurodivergent condition when needed

 

The teachers and school could support your child by doing the following:

• Be aware of the child who is “quiet and compliant.”
• Provide quiet areas where the child can retreat with minimal fuss.
• Allow access to fidget toys and sensory tools.
• Becoming aware that an “angel” student may still be struggling internally.
• Becoming aware that “coping” does not mean thriving.
• Support should be based on the child’s need not disruption.
• Provide safe spaces, flexibility with routine and opportunities to decompress.
• Cooperate with home-school dairy for seamless communication and monitoring.

 

For health professionals and SENDCo’s:

• Listen to parents when school reports conflict with home behaviour. A “mismatch” in presentation or “behavioural discrepancy” can be a clinical indicator of masking.
• Pay close attention to “developmental history” not just current presentation.
• Explore the effort involved in social functioning and outward behaviour the child displays in the home setting.
• Being aware that autistic features may be masked by learnt strategies especially in a cognitively able child or children with “Level 1” or minimal needs.
• NICE Guidance recognises that any assessment must include parental history and explore functional impact.
• The SEND Code of Practice emphasises that support should be “needs-led” and not “diagnosis-led.” It also places an emphasis on exploring the impact on home life and to take note of parental views.
• A child does not need to be disruptive to require support.
• Understanding that emotional exhaustion, anxiety and social overload are valid needs.

 

Conclusion:

As you can see from the above, masking explains why absence of school concerns does not mean that a child has no needs or difficulties. Seek assessment for neurodivergent conditions such as Autism/Autism Spectrum Disorder (ASD) and or Attention Deficit Hyperactivity Disorder (ADHD), when your child’s difficulties are impacting on his/her social functioning and academic learning.

Better understanding of masking can help appreciate why support is necessary despite good academic grades or compliant behaviour.  Recognising masking especially in girls allows one to be move beyond surface impressions and visible behaviours. Providing timely, compassionate and appropriate support to the child can improve the outcomes not only for the child but also help improve the psychological and social wellbeing of everyone around the child and family.

Further Reading and Support:

1. Understanding Camouflaging as a Response to Autism-Related Stigma: A Social Identity Theory Approach. Journal of Autism and Developmental Disorders. Published: 31 March 2021.
2. Hull L et al. (2017). “Putting on My Best Normal”: Social camouflaging in autism.
   Journal of Autism and Developmental Disorders
3. MC Lai, S Baron-Cohen. Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2015. thelancet.com
4. Guide to Masking: In depth clinical and lived experience perspectives. National Autistic Society (NAS) of UK. autism.org.uk
5. Making sense of neurodivergence in schools – Masking: Neuroinclusive Education Network. nen.org.uk (Formerly Autism Education Trust).
6. Masking in neurodivergent children. www.raisingchildren.net.au