In nature there are different adaptations, camouflage is one of the forms of generalized anti-predator defense that prevents the prey from being detected by its hunter (Skelhorn J. and Rowe C., 2016). The RAE (Royal Spanish Academy) defines the action of camouflage as “disguising the presence of weapons, troops, war material, ships, etc., giving them an appearance that can deceive the enemy.” and/or “disguise by giving something the appearance of something else.” We humans are not left out, it also happens in a more subtle way and the life at stake is the social one. It happens among people with neurotypical development and in those who have a neurodevelopmental condition such as autism and/or attention deficit disorder (neurodiversity).
Neurodiversity includes development with particular strengths in its trajectory (Boot, N., Nevicka, B., & Baas M., 2020) not necessarily as something outside the norm or as exclusive of dysfunction (Sonuga-Barke, E. , & Thapar, A., 2021). It is understood that it surpasses the concept of neurodivergence where people would have a cognitive profile that differs from an established cognitive norm, a norm that is not an objective statistical fact of human neurological functioning but a standard established and maintained by sociopolitical processes. (Legault M. et. al., 2021).
Many people experience stigma that could lead them to suppress aspects of their identity (Miller et. al., 2021). Both adolescents and adults with autism would do it to fit in, to avoid social judgments (Bernardin CJ, et. al., 2021). Within autism, the camouflage phenomenon occurs more frequently in women but it is important to remember that it also occurs in the male population. Camouflage as a set of self-control strategies and skills would be used by autistic women who are more aware of their autistic symptoms. This also explains why camouflage is positively correlated with college education.
Within neurodivergence, camouflage takes the name of masking in autism and mirroring in ADD(H) – Attention deficit disorders with or without hyperactivity (APA, 2014).
In a study (Bradley L. et al., 2021) of 346 adults with autism, 300 reported experiencing camouflage throughout their lives and understood that the risks this entails are exhaustion, its lead to mental health disorders, that others would not be accepting their autism while creating unrealistic perceptions and expectations. As for its positive aspects, they included: a way to access the social world, prosper or develop, building and protecting resilience. And to the question of why I don’t need to camouflage myself like I used to? It would be dispensable after having received a diagnosis and receiving understanding and acceptance from the environment.
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Time spent camouflaging is what appears to be most detrimental to mental health. The main reason for spending so much time camouflaging would be society’s lack of awareness and acceptance of autism. As short-term negative effects, it results in extreme exhaustion and anxiety; Although camouflage objectives are frequently achieved, in the long term there are also serious negative consequences that affect people’s mental health, self-perception, self-esteem and access to support. (Hull et. al., 2017). Autistic masking (also referred to in the literature as camouflage, compensation, and more recently, adaptive transformation) is the conscious or unconscious suppression of natural responses and adoption of alternatives in a variety of domains including social interaction, sensory experience, cognition, movement and behavior – expressions, sense of dress and speech – (Pearson A. & Kieran R., 2021).
ADHD masking describes how a person acts when trying to cope with the symptoms. Some people try to mask attention deficit hyperactivity disorder (ADHD) to avoid the social stigma their symptoms can cause. They may not want people to know about their condition. Other people mask undiagnosed ADHD. They may not be aware of its presence and mask their symptoms to cope. It involves hiding symptoms or overcompensating for them (masking is not the same as managing ADHD).
The rate of ADHD diagnosis is higher in men than in women (Biederman et al., 2002; Gudjonsson et al., 2014). Masking could be one of the reasons for this difference. Women with ADHD may develop better coping strategies than men to compensate for their ADHD-related difficulties, such as working hard to maintain performance in the classroom. As a result, they are better able to mitigate or mask the impact of their difficulties (Quinn, PO & Madhoo M., 2014) Symptoms in women often lead to a referral bias in favor of men, meaning that men are diagnosed more frequently. This is also the case when other conditions exist alongside ADHD. Boys are more likely to show signs of oppositional defiant disorder (ODD) or conduct disorder, which have outward behaviors such as disruption and aggression. While these are not signs of ADHD, they do lead to evaluations where ADHD can be identified. Women with ADHD, on the other hand, tend to have more internalizing disorders such as anxiety (Hinshaw et al., 2012) along with their ADHD that are not as disruptive in the classroom.
Camouflage, mirroring in ADHD, is when a person observes and copies the behavior of another person. It is a way to gain social acceptance and connect with other people. It imitates behaviors and replaces them with more socially acceptable alternatives.
As children, people living with ADHD learn what behaviors separate them from others. They may hear repeated requests like “pay attention” and “stay in your seat” from parents and teachers. Since masking is an effort to enhance social experience, the symptoms that people may try to mask are those that they believe might bother people around them (e.g., making noise with a pen or tapping legs, impulsivity). , body restlessness, speaking quickly, difficulties with concentration, etc.).
Forms of “disguising” these uncomfortable behaviors of attention deficit can be saying less than desired on purpose so as not to talk too much or interrupt people, writing everything down to be able to remember it later, repressing strong emotions, difficulties concentrating due to the effort to hiding excess energy, feeling unable to relax before an upcoming appointment because you might lose track of time, feeling the need to organize a task or project instead of working on it, experiencing irritability from having to concentrate on a low-stress activity interest, maintaining perfectionistic standards to hide self-perceived flaws, or imitating other people in social situations to fit in.
There are disadvantages to masking ADHD. The stress of masking the untreated or undiagnosed condition could contribute to anxiety and depression, similar to what happens in people with autism (Hull et. al., 2021). People may not believe they need help if It is effective in masking, which could actually delay or prevent the diagnosis of ADHD – untreated there would be a greater probability of developing substance use disorder (Hamed, AM, Kauer, AJ, & Stevens, HE, 2015) –
In conclusion, some masking strategies, such as organizational tools, can be useful. Others, such as suppressing emotions, can be harmful. One of the best ways to reduce the effect of less effective masking behaviors is to receive diagnosis and treatment. If health and education professionals are familiar with camouflage, it will be beneficial in diagnosing autism/ADHD in adults, particularly in those who camouflage, thus decreasing the long-term impact of the consequences of lack of diagnosis or misdiagnosis (Alaghband-rad J., et al., 2023). Treatment could help reduce symptoms, which could make masking seem less necessary along with a kinder, diversity-aware community.
References:
- Alaghband-Rad J, Hajikarim-Hamedani A, Motamed M. Camouflage and masking behavior in adult autism. Front Psychiatry. 2023 Mar 16;14:1108110. doi: 10.3389/fpsyt.2023.1108110. PMID: 37009119; PMCID: PMC10060524.
- American Psychiatric Association – APA. (2014). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). Madrid: Panamericana Medical Editorial.
- Bernardin CJ, Mason E, Lewis T, Kanne S. “You Must Become a Chameleon to Survive”: Adolescent Experiences of Camouflaging. J Autism Dev Disord. 2021 Dec;51(12):4422-4435. doi:10.1007/s10803-021-04912-1. Epub 2021 Feb 15. PMID: 33590426.
- Boot, N., Nevicka, B., & Baas, M. (2020). Creativity in ADHD: Goal-Directed Motivation and Domain Specificity. Journal of Attention Disorders, 24(13), 1857–1866.
- Hamed AM, Kauer AJ, Stevens HE. Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Front Psychiatry. 2015 Nov 26;6:168. doi: 10.3389/fpsyt.2015.00168. PMID: 26635643; PMCID: PMC4659921.
- Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi:10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.
- Hull, L., Levy, L., Lai, M.C. et al. Is social camouflaging associated with anxiety and depression in autistic adults?. Molecular Autism 12, 13 (2021).
- Legault, M., Bourdon, JN. & Poirier, P. From neurodiversity to neurodivergence: the role of epistemic and cognitive marginalization. Synthese 199, 12843–12868 (2021). https://doi.org/10.1007/s11229-021-03356-5
- Miller D, Rees J, Pearson A. “Masking Is Life”: Experiences of Masking in Autistic and Nonautistic Adults. Autism Adulthood. 2021 Dec 1;3(4):330-338. doi: 10.1089/aut.2020.0083. Epub 2021 Dec 7. PMID: 36601640; PMCID: PMC8992921.
- Pearson A, Rose K. A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice. Autism Adulthood. 2021 Mar 1;3(1):52-60. doi: 10.1089/aut.2020.0043. Epub 2021 Mar 18. PMID: 36601266; PMCID: PMC8992880.
- Quinn, P.O., and Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim. Care Companion CNS Disord. 16:PCC.13r01596. doi:10.4088/pcc.13r01596
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