Child Mental Health for Pediatric Clinicians

54. Can you hide ADHD symptoms? with Ashley and Lauren

• Elise Fallucco • Episode 54

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Dr. Elise Fallucco talks with parents and neurodiversity advocates Ashley and Lauren about the concept of 'masking' symptoms in ADHD. They discuss how children, especially girls, consciously or unconsciously camouflage their ADHD symptoms to fit into social norms, and the emotional toll it takes. Through personal anecdotes and reflections, Ashley and Lauren reveal how they identified masking in their children and the impact it has on their emotional well-being and self-esteem. The episode emphasizes the importance of recognizing strengths and the therapeutic value of a diagnosis.

00:00 Talk with Parents about Masking of symptoms in ADHD

01:25 Masking Symptoms of ADHD

02:58 Noticing Behavioral Differences at Home and School

04:39 Masking Symptoms at School

06:51 Challenges in Diagnosing ADHD

09:43 Personal Experiences with ADHD

10:51 Struggles with ADHD and Masking

12:01 Understanding Executive Functioning Challenges

12:49 The Importance of Diagnosis and Labels

13:44 ADHD Superpowers in Children

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Dr. Elise Fallucco:

Welcome back to Child Mental Health for Pediatric clinicians, the podcast formerly known as Psyched for peds. I'm your host, Dr. Elise Fallucco, child psychiatrist, and mom. And thank you for joining us as we begin part two of our series, child Mental Health Talks with Parents about A DHD. We're gonna be continuing our conversation from the previous episode with Ashley and Lauren neurodiversity advocates who share their lived experiences of raising kids with A DHD. We're gonna learn about this concept of masking, and when I say masking, I'm not referring to the actual mask that you put on your face, but more figurative masking. So what we know is that kids with A DHD can mask or camouflage their symptoms, in an effort to be more socially acceptable or to fit in better with peers. They can copy how other kids interact or even suppress their natural urges to fidget or to interrupt and this can be conscious or unconscious, but the important thing to know is that masking symptoms comes at a cost and oftentimes can contribute to low self-esteem and anxiety. So let's continue this conversation with Ashley and Lauren about masking symptoms in A DHD. You mentioned this really important thing, the concept of masking. Which is this I which is this concept that children, but particularly girls are likely to mask symptoms that they have, meaning that they either consciously or unconsciously suppress some certain behaviors to fit in with social norms and social expectations. So tell us more, how did you notice that your children were masking symptoms? How could you tell that they were masking?

Lauren:

Yeah, I actually noticed it with my daughter. I went to visit her at school one day for lunch, and I went in and she was so quiet, just shut down. Really? She was shutting down in the lunchroom, but all of her friends are having very animated conversations. And normally at home, she would be the one, just, my husband calls her chicharona, which is like Italian for Chatty Cathy and she's the one you described before she interrupts. She's constantly talkative. Yes. But now she's in a social situation at lunch and just completely quiet. What is that? Yeah, exactly. And so I actually, she ended up talking to me about it and she said she didn't feel like she could be herself at school. She's always afraid that she's gonna interrupt somebody and that's gonna make them mad. And so she's just quiet and she feels like a shell of herself. She was really describing masking. And then she would come home and both of my kids would come home and they'd be exhausted and have meltdowns. Or she would want to get all of those words out right away when she gets in the car, and so she would just talk to me about, all kinds of different things. so I noticed the big difference in her when I saw her at school versus at home. That was like my first clue. And then with learning about masking and how exhausting it is for them, it really kinda, that hammered it home made sense.

Dr. Elise Fallucco:

that must have been really odd to visit your daughter, who's normally very talkative and vivacious and gregarious, and to see her. Shut down. And for our savvy listeners, I imagine they're wondering if your daughter was on stimulant medication at the time. Because we know that treatment with stimulant medication can sometimes make kids seem more quiet or feel like they're not their typical giggly, more hyper interrupting selves. So I just wanna confirm your daughter was off of medication when you visited school and saw your sweet chatty Kathy as more of a quiet wallflower.

Lauren:

Yes.

Dr. Elise Fallucco:

And Lauren, what about you?

Ashley:

So I could tell that my daughter was masking at school because when we did the assessment for A DHD and we gave the form to her teacher it came back as being a student with no troubles in the classroom, which varied very differently from what my husband and I had put on our forms. And so we came to the realization that at school she's on her best behavior, she's working hard, trying to get grades, good grades and she would come home at the end of the night and just. Be exhausted, maybe have a meltdown or whatever else it was. So that's how I figured it out with her. And then with my son, I think the same thing happened. His forms from his teacher also showed good behavior, good grades in school and she didn't notice any issues. But then again, we would notice it at home. And so I think this reflects masking. Where our kids perform really well at school. They get good grades, they have good social relationships. Everything that a teacher would expect. And then our kids come home and totally crash from masking all day. And then we would see more of the A DHD behaviors at home

Dr. Elise Fallucco:

To follow up, Ashley, on your kids they may not even be old enough to answer this question, but are they conscious of what that is or have they ever talked about what it is like to mask symptoms?

Ashley:

They don't know the term for masking. But I do think, at least with my older child, she has described being at school in a way that I know she's describing that. Like it's a lot harder for her to just be who she wants to be. And to be herself. And I think that gets to what you mentioned is trying to fit in with certain social situations. So yeah, I think she's like conscious of it, but doesn't have the language for it. Now that I think about it with my son, it was less about the difference between school and home, but also being at home, but in different settings with different people. So if you were to describe some of my son's. Behaviors or how he acts in certain situations to family members. They would probably be totally shocked. They'd be like, what are you talking about? He never does that when we're with him or if he sleeps over our house or anything like that. So just even the difference between how he acts around people that he's super comfortable with. Not that he's not comfortable with other family members, but there's a difference between your nuclear family in your own home versus being at somebody else's house or being at a party somewhere, right? And so he's always on his best behavior there, trying to not show certain emotions or behaviors. And then when we get home, it all comes out

Dr. Elise Fallucco:

and that, it's gotta make things hard. For you guys and for clinicians to figure out what's going on. Because one of the major criteria for A DHD is to be able to show that these behaviors are present in more than one setting. And it's usually school plus home, but if there's a lot of masking going on, if kids have learned, on some level that people don't like it when they interrupt or some the teachers get mad when you blurt out answers in class, and if they're able to have some level of control over the symptoms, then you wouldn't see as much at school as you would at

Ashley:

home. Yeah. And we actually weren't able to get his full a DH ADHD diagnosis until we had a therapist come into our house and see him in his own home environment. Running around, comfortable with what he does in our own home. Where she just looked at me and was like, is he always like this? And I was like, yep. But right outside of that house, he might not be running around like that, where people would pick that up as hyperactivity.

Lauren:

And some people might even think, oh, they're able to hold it together, that's good. But then it comes at a cost, right? There's this exhaustion and it's difficult. And I started to notice that my daughter was experiencing symptoms of anxiety because she was having to constantly self monitor and make sure she wasn't misstepping in a social environment or and so then it became like even with the clothing, I don't wanna wear the wrong thing. I'm gonna get made fun of, or I'm gonna this or that. And not having experienced bullying or anything like that, that would cause that concern, but just constantly seeing am I fitting in? Am I doing the right things? So I don't know for any parents that might be listening and being like, oh, that sounds like they're good at solving their problems. But that kind of, that anxiety, that heightened anxiety and exhaustion from masking also created emotional volatility when she would get home from school and difficulty regulating her emotions.

Dr. Elise Fallucco:

Yeah. You brought up a really good point about what does it mean if they're able to have some degree of control over their symptoms at school? Does that mean that there's even a problem? That if we're saying that A DHD is defined by deficits in executive functioning and in impulse control and yet this child, your daughter can keep herself from interrupting people at lunch and make herself super quiet, what does that say? And I think. This is yours is a really great example of how every child is very complicated. And a DHD is not like a light switch on or off. Like you either have all of the symptoms or you have none of the symptoms, but there still is some degree of control. Just like with anything like when you're highly motivated to do something, you may be able to make subtle adjustments, but as you put it so well, Lauren, it comes at a cost and it's also not something that can be sustained for long periods of time. Exactly. On your own. Yeah. And I don't think that they, even, like you said, your daughter maybe doesn't have the language to explain this looking back at my childhood and seeing myself retro retroactively saying, oh, I, I was shutting down because I was afraid to be too much. That was the message, right? You're too much, you need to calm it down. And so I would just shut down and it really affected my sense of identity of who I am. And it impaired me from being able to explore that in a safe way. When you're too much for everybody. You don't, make friends easily, so. Right. And, I think girls, are more motivated to have friendships and maintain friendships than boys. So girls are very motivated to mask, try to fit in even at that personal cost. Thank you for sharing that.

Lauren:

Oh yeah.

Dr. Elise Fallucco:

Did you know you had a DHD when you were growing up?

Lauren:

No. Okay. So I was recently diagnosed after my kids got diagnosed. Yes. Pretty typical. I was gifted A DHD. But the disorganization, I forget that I had homework when I got home because it was out of context. And then I'd be walking to school and I'd be like, oh, shoot, I had homework because now I'm back in the context of school. Things like that.

Dr. Elise Fallucco:

Mm-hmm. Um,

Lauren:

Forgetting to turn homework in after you've worked all weekend on the project. And I would just redo the homework Or I would overcompensate with my giftedness for the A DHD and mask and shut down socially a lot.

Dr. Elise Fallucco:

But not knowing what that was. You know, At the time, as you're growing up, you are, you're gifted and you're a DHD, you don't know it's a DH, adhd. No. You just know that there's something about you let's say the talkative or the interrupting or some part about you, that you're getting feedback socially that people don't like that, that maybe other girls or other people are giving you looks or communicating somehow that is not acceptable. And being the savvy human that you are and somebody who is seeking social connection and relationships, you are smart enough to internalize that and say, okay, let's shut that down. But exactly. But the internalizing is hard, right? It makes you, it develops like a shame of oh, you are this way and you need to not be this way.

Ashley:

It doesn't allow you to be authentic. Right. And at peace with yourself and what you normally do.

Lauren:

And constantly, I think there was this feeling of, I am I'm really smart. I should be able to do this. And those easy things of like staying organized or remembering that you have to wear your coral outfit today or this or that. Those things were really hard for me. And then the hard things, the things that were supposed to be hard were really easy. So it was like people were like, how come you can do all of this but you can't, stay on top of when this project is due or you have poor time management skills or whatever. And so That was my thing was like, how come I am not able to do these? It just always felt like something's wrong with me. And I think that's what, like I see in my daughter, she was constantly feeling like there's something wrong with me. And I think that's something that whenever these kids are masking, that they're really internalizing a lot. There's something wrong with me. And so I think having the label of A DHD helps to explain like, you have these struggles with executive functioning, but that doesn't mean anything's wrong with you, it's just the way your brain is wired. And so being able to put a label on it and talk about it in a positive way, and I love that you talked about the A DHD superpowers. It's not even putting a positive spin on it, it's talking about the strengths and weaknesses that we all have. Yeah.

Dr. Elise Fallucco:

Getting a diagnosis in some parts can be therapeutic in and of itself. I've seen this in some of our patients. There's this sense of relief when you get a diagnosis and somebody explains, Hey, this is why you are the way you are. It helps you understand yourself better, and it helps your family and your teachers and other people. Better understand the strengths and weaknesses that make you you.

Lauren:

Yeah, exactly. Speaking of A DHD superpowers, what do you think is one of your kids' A DHD superpowers and how does that, what does that look like?

Ashley:

Good question. For my son, it's definitely his creativity. He makes amazing art pieces, drawings that are very detailed and he has incredible visual spatial reasoning. So we always like to tell him we think he's gonna be like an architect someday, or an engineer because he has that math ability. But then the way he can draw and build things all at once is just really something to see. And for my daughter, I think her superpower is that chatting that we talked about. So she. Is in particular very gifted at talking to adults. And it's really neat to see how she can interact with people across ages. And also her empathy. She really is in tune with her own feelings. And since we talk about her A DHD and how that can manifest in her, she has the language about feelings and can now recognize it in others, including kids. So she will help kids at school who are struggling with different feelings and. I'll get text messages from some of her friend's parents saying that she's helped a kid through the loss of a pet or things like that. And so really her empathy and ability to talk to people is awesome. I think she'll be a therapist one day.

Dr. Elise Fallucco:

Oh yeah,

Ashley:

you do. I really do. Aw,

Dr. Elise Fallucco:

that's awesome. I

Lauren:

would say for my son, he's incredibly creative. He, I've always said he has stories inside of him, so he is constantly writing stories and world building and thinking of multiple things all at once. So I think in Webs, he thinks in webs, he thinks in like multiple things all going on at one time, and he can see how they're all connected and how they're all gonna piece together. So I think he'll be a writer one day. Wow. And then my daughter, I think her superpower is. Honestly, socially, she is really good at making friends and because she is, I think, so talkative and excited by things. And so she's just that bubbly Labrador retriever, personality. So that's definitely one of her superpowers. But also like creative problem solving. She's really good at coming up with solutions for things that are very out of the box. So I don't know what she will do, but she definitely has that empathy going as well. She is always there to come up with a solution. That's amazing. Yeah.

Dr. Elise Fallucco:

I'm so glad to hear both of you recognize all of your children's many superpowers, and even as you just list all of them, you're setting such a great example for all of our clinicians to remind them to take a strength-based approach to kids with all types of mental health issues. And while medicine tends to be very problem oriented, it's a good reminder that we need to take a step back and recognize and integrate strengths into our understanding of who a child is or a teenager is, and of course into their treatment plan. We're gonna take a pause in this conversation. And continue. Next episode in part three, talking with parents about A DHD, where Lauren and Ashley are gonna share what they wish everyone knew about kids with a DHD. Thanks for listening. Hope you'll join us next time.