The Hidden Cost of Masking: Neurodiversity in Girls and Women

Sometimes neurodiversity is not missed because it isn’t there.Sometimes it is missed because someone has become very good at hiding it.

In my clinical work, I have been undertaking neurodiversity and attachment assessments for many years. During that time, one pattern has become increasingly clear: many girls and women are not identified early because they become highly skilled at adapting to the world around them.

In conversations about ADHD and autism, many people still picture a particular stereotype: a child who is visibly struggling in school, who finds social interaction very difficult, or whose behaviour stands out in obvious ways.

But for many girls and women, the story looks quite different.

What Is Masking?

In clinical conversations we often talk about masking - and I have written about masking in children on this blog before.

Masking is the process of carefully observing social behaviour and learning how to copy it. It might involve rehearsing conversations in advance, closely watching how other people behave in social situations, or suppressing natural responses in order to fit in.

From the outside, someone who is masking may appear socially capable, organised, or even high-achieving. Teachers might describe them as “quiet” or “well behaved”. Friends might see them as thoughtful and empathetic.

But internally, the experience can be very different.

Many people who mask describe feeling as though they are constantly performing or translating the world around them. Social situations require enormous concentration. Sensory environments such as busy classrooms or workplaces can feel overwhelming. By the end of the day, exhaustion sets in.

Masking allows people to navigate environments that are not designed for them. But it often comes at a cost.

Why Girls Learn to Mask

Girls are often socialised from a young age to be attentive to relationships and social expectations.

They are encouraged to be cooperative, considerate, and emotionally aware. Society wants good girls, not messy ones. 

A girl who carefully watches others and imitates their behaviour may appear to be coping well. She may even be praised for being mature or socially sensitive. As professionals and parents, we are all guilty of praising our girls for getting on with things and being ‘no trouble’, whilst we may expect our boys to be, well, boisterous. For many girls, this means their emotional and cognitive needs become hidden, pushed down and this can mean that their neurodivergence is not recognised until much later—sometimes not until adolescence, adulthood, or even middle age.

The Cost of Masking

Although masking can help someone navigate social environments, maintaining it over long periods of time can be exhausting.

Many girls and women describe:

• chronic exhaustion after social interaction

• anxiety about saying the wrong thing

• feeling different but not knowing why

• burnout from trying to keep up with expectations

• a sense of never quite being able to relax into themselves

  
  

Because masking can make someone appear outwardly “fine”, these internal struggles are often misunderstood.

Some women arrive in therapy after years of feeling that something about life seems harder for them than it appears to be for others. They may have developed sophisticated ways of coping, but these strategies often require constant effort.

When Women Begin to Recognise Themselves

Increasingly, many women are beginning to explore the possibility of neurodiversity later in life.

Sometimes this happens when a child is assessed for ADHD or autism and a parent begins to recognise familiar patterns in their own experiences.

Sometimes it arises through therapy, when long-standing patterns of overwhelm, exhaustion, or social effort begin to make sense in a new way.

For many women, this realisation can be both surprising and deeply validating. Experiences that once felt confusing or personal failures may begin to look different when understood through the lens of neurodiversity.

How Therapy and Assessment Can Help

Working with a therapist can provide a space to explore these experiences with curiosity and compassion.

Assessment can also be an important part of this process. For some people, receiving a thoughtful neurodiversity assessment can bring clarity to experiences that have felt confusing for many years. Patterns that once felt like personal shortcomings can begin to make sense in a new way.

Therapy and assessment together can help people understand their own patterns, recognise the impact of long-term masking, and slowly develop ways of living that are more aligned with how their mind actually works.

Rather than constantly performing a version of themselves designed to fit the expectations of others, many people begin the process of discovering what authenticity might look like.

This is not about removing the strengths that masking may have helped someone develop. Many people who mask have exceptional empathy, insight, and observational skill.

Instead, the work often involves reducing the cost of those adaptations so that life becomes less exhausting and more sustainable.

A Question to Sit With

If you recognise some of these experiences, you might gently ask yourself:

When do I feel most able to be myself without carefully monitoring how I appear?

And what might it look like to approach those experiences with curiosity rather than self-criticism?

Would I like someone to support me in understanding my experiences?

As always, you can get in touch with me here, on my socials or at info@musictherapyhere.com