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Module 5 — AAMM — ADHD Masking and Compensation
Why camouflaging was mapped in autistic research first, what the ADHD evidence actually shows now that it exists, the seven kinds of effort this questionnaire names, and an honest account of an instrument nobody has validated.
ADHD Self-Discovery · Part Three — How ADHD Actually Shows Up · 14 min read, about 28 min with the workbook
The big idea
If you have ever rehearsed a sentence in the car before you said it, set three alarms for one appointment, or started an email with an apology for something nobody had noticed yet — this module is about the work you do so that other people never see the work. It is also about a questionnaire that tries to count it, and about how little anybody has checked that questionnaire.
Both findings are real and they are not actually contradictory. They are different questions asked with the same tool: who camouflages across a whole population, versus what predicts camouflaging among people already diagnosed — measured, in both cases, with a questionnaire written about autistic traits. The authors of the second study concluded that the field needs general camouflaging measures rather than autism-specific ones. The AAMM is an attempt at exactly that. It is an attempt, not an answer.
Step 1 — The lesson
A. A word borrowed from somewhere else
The idea that a person might spend their whole day performing a version of themselves that costs them everything and shows nothing was not first described in ADHD research. It was described in autistic research, and not very long ago.
In 2017 a team asked 92 autistic adults what they actually did in social situations and why. The answers came back as a three-part model — the motivations, the mechanisms, and what it costs afterwards.1 Two years later the same group turned that into a questionnaire, the Camouflaging Autistic Traits Questionnaire, validated across 832 adults.2 If you have taken the autistic course, that is Module 5 there, and it is worth reading alongside this one.
Nothing equivalent existed for ADHD. For years the word masking circulated in ADHD support groups, in comment threads, in the things people said to each other at two in the morning — and almost nowhere in the journals. The experience was not new. The research was simply not there.
Diagram — A · How late this idea arrived. Every date on this line is recent, and the last three are the ones that matter for ADHD. A field that is two years old has not yet had time to be wrong in public, which is a different thing from being right.
Then, in 2024, something genuinely interesting happened. A study of 972 US adults, sampled to be representative of the general population rather than recruited from a clinic, gave everyone the camouflaging questionnaire that had been written entirely about autistic traits — and then asked which traits actually predicted the scores. ADHD traits predicted camouflaging more strongly (beta = 0.27) than autistic traits did (beta = 0.21).3
Read that carefully, because it is easy to over-read. It does not say ADHD people mask more than autistic people. It says that on a measure built from autistic accounts, in a general population sample, the ADHD signal was the stronger of the two. The authors' own conclusion was that the instrument measures camouflaging across neurotypes rather than something specifically autistic.
The AAMM is New Path's attempt to write the ADHD version properly rather than borrowing the autistic one. Twenty-eight questions, about five minutes, a total between 0 and 112. It has no published validation, no normative sample and no independent replication, and this module is going to keep saying so.
B. Seven kinds of effort
The useful thing about the AAMM is not the total. It is that it splits the work into seven kinds, and the seven are specific enough to be recognisable.
Emotional Suppression is flattening the reaction so it arrives at the size other people expect — not showing the twelve out of ten, so nobody learns you have a twelve. Social Camouflaging is the rehearsed anecdote, the mirrored posture, the sentence you tried out three times on the drive over. Compensatory Organization is the three calendars, the alarms stacked in fives, the list of the lists. Overcompensation & Perfectionism is doing it four times so that nobody ever sees a first draft with your name on it.
Physical Masking is the leg that goes still the moment someone looks over, hands under thighs, the deliberate stillness that costs more than the movement did. Time Anxiety is arriving forty minutes early because being late once, years ago, is still doing damage. Attention & Apology is "sorry, could you say that again" — the apology that opens the sentence rather than ending it.
Diagram — B · Seven named areas, one number. Every one of these seven is named and described on the live screener. None of them is scored separately. The seven headings are a vocabulary, and a good one; the number underneath them is a single total.
That is the first honest limitation, and it belongs here rather than in a footnote. The live page names the seven areas and gives no range, no band and no separate score for any of them. So the questionnaire hands you one number between 0 and 112 and seven headings with nothing underneath. Use the headings. Do not go looking for a profile that has not been built.
There is also a real distinction buried in that list which the total flattens. Keeping three calendars is not the same act as keeping your face still. The autistic literature calls the first kind compensation — strategies that genuinely do the job another way — and distinguishes deep compensation, which actually works, from shallow compensation, which holds up until the situation changes.4 Suppression is a different animal entirely. The AAMM adds them together. That is a design choice, not a finding.
C. The room sees the result, not the work
Masking is expensive precisely because it succeeds. The performance lands, and so nobody — including, often, you — ever prices the rehearsal.
Diagram — C · One Tuesday, two columns. Nothing in the left column is a lie. That is what makes this hard to explain to anyone. Both columns are true, and only one of them has ever been visible to the people who assess you.
This is one of the clearest explanations available for why ADHD gets missed in people who are coping. A UK expert consensus on girls and women with ADHD records clinical referral ratios ranging from 3 to 1 up to 16 to 1 in favour of boys, against a community ratio of around 3 to 1 — and names compensatory behaviour, compliance and socially adaptive coping explicitly among the reasons for the gap.5 The masking is not incidental to the under-recognition. It is one of the mechanisms of it.
The nearest actual measurement of that pattern is, again, autistic rather than ADHD. On the camouflaging questionnaire, autistic women score higher than autistic men — 124.35 against 109.64, a moderate difference — while non-autistic men and women do not differ from each other at all.6 That is an analogue for the ADHD picture rather than evidence of it, and it is worth being clear which one you are being shown.
The ADHD-specific evidence on what this costs is thin but it is no longer absent. A 2026 study of 329 women with ADHD used a set of camouflaging questions modelled on the autistic instrument but rewritten for ADHD — the same design logic behind the AAMM. More camouflaging went with lower life satisfaction and more depressive symptoms, and the association held after controlling for demographic variables.7 That is a correlation in a self-selected online sample, not a causal finding, and it is currently one of the better pieces of evidence that exists on ADHD masking at all. Which tells you something about the state of the field.
The autistic literature, being further ahead, offers the finding that matters most practically. In 277 autistic adults, camouflaging was described as exhausting and tied to anxiety, depression, loss of identity and delayed recognition — and also as the thing that got people employed and kept them safe from bullying. What participants identified as most damaging was not camouflaging itself but the amount of time spent doing it.8 A separate study of 305 autistic adults found the relationship with anxiety and depression was linear, with no threshold: there is no safe level below which it stops mattering.9
And the exhaustion has a name. Community-led research defining autistic burnout identifies masking as a prominent, cumulative stressor, warns against teaching people to mask better, and finds unmasking among the routes back out.10 All of that work is autistic. Whether it transfers cleanly to ADHD has not been established, and this module is not going to pretend otherwise.
What is documented on the ADHD side is what happens when recognition finally arrives. Twenty-one adults diagnosed with ADHD in adulthood, interviewed at length, described the diagnosis as an answer to many years of wondering and a source of self-knowledge, held in the same breath as real worries about identity, stigma and what the label might close off.11 Relief and unease together is the ordinary response, not a sign you have read yourself wrong.
D. What a number between 0 and 112 can honestly tell you
Less than the number looks like it is telling you. Here is the full account.
The AAMM has never been validated. We searched for a validation study while writing this and found none — no normative sample, no reliability coefficient, no factor analysis, no sensitivity or specificity figure, no independent replication. The five bands you get back are editorial judgements about where a description stops being one thing and starts being another. Nobody has tested whether 68 means something different from 67.
Diagram — D · What is known about the AAMM. Three of these are properties of the page you take the test on. Five are properties of a research programme that has not happened. The blanks are not hidden failures; they are simply blank.
The live page also does not state what response scale the 28 items use. A total range of 0 to 112 across 28 items is arithmetically consistent with a five-point scale scored 0 to 4, but the page does not say so, so neither will we. That matters more than it sounds: without knowing the scale you cannot say what any individual answer contributed.
The construct itself is contested in ADHD, not just this instrument. A 2026 paper in the British Journal of Psychiatry argues directly that camouflaging in ADHD needs construct validation before it is adopted clinically.12 That is a reasonable position and it is worth knowing that it is being argued in a major journal while you are reading a questionnaire that assumes the answer.
The two strongest studies on ADHD masking also point in different directions, and it would be dishonest to give you only the one that flatters this module. The general-population study found ADHD traits predicting camouflaging more strongly than autistic traits.3 But a preregistered 2024 study comparing adults with ADHD, autistic adults and a comparison group — 105 people per group, matched on age and sex — found that adults with ADHD scored higher than the comparison group but lower than autistic adults on total camouflaging. And in the larger sample of 477 adults with an autism and/or ADHD diagnosis, autistic traits predicted camouflaging while ADHD traits did not.13
For scale, consider the comparison. The CAT-Q has a published validation, an internal consistency of 0.94 and a decade of independent replication behind it — and its own developers published guidance in 2026 saying clinicians should refrain from using its scores in diagnostic decision-making or as an outcome measure.14 If the well-validated instrument should not carry that weight, an unvalidated one certainly cannot.
What the AAMM can honestly do is give a diffuse experience a shape and a vocabulary. A high score is a statement that you recognise a lot of these behaviours in yourself. That is not nothing. It is simply not a measurement.
INSIDE THE INSTRUMENT
AAMM — the Adult ADHD Masking Measure
Where it came from
Built in-house by New Path. It is not a licensed or commercial instrument and it has no publication of any kind. Its conceptual parentage is the camouflaging literature: the 2017 qualitative model derived from 92 autistic adults1 and the CAT-Q that followed it.2 An independent Polish group took the same approach in 2026, writing CAT-Q-inspired items tailored for ADHD, which is evidence that the design logic is reasonable rather than idiosyncratic.7
What it is made of
Twenty-eight items, roughly five minutes, producing a single total from 0 to 112 read against five bands: Very Low, Low, Moderate, High and Very High. Seven areas are named and described — Emotional Suppression, Social Camouflaging, Compensatory Organization, Overcompensation & Perfectionism, Physical Masking, Time Anxiety, and Attention & Apology — but the live page publishes no range, no band and no separate score for any of them, so no subscale scoring appears anywhere in this course. The item response scale is not stated.
How well it performs
Unknown. No reliability coefficient, no test-retest interval, no factor structure, no convergent or discriminant validity against the CAT-Q or any other measure, no sensitivity, no specificity, no ROC analysis, no cut-off derivation. A literature search for the instrument name returns no validation study. The band boundaries at 22, 44, 67 and 89 are editorial.
Where it was validated
Nowhere. There is no normative sample, so a raw total cannot be positioned against any reference group by age, sex, diagnosis or culture. Nothing in this instrument is standardised.
What it cannot do
It cannot indicate ADHD, and a high score is not evidence of it. Effortful self-presentation is common across autistic adults, ADHD adults, socially anxious adults, people managing stigma and people in burnout. In a representative sample of 972 US adults, camouflaging was predicted by ADHD traits (beta = 0.27), autistic traits (beta = 0.21) and social anxiety together, with the authors concluding the construct operates across neurotypes rather than marking one.3
The direction of the ADHD-specific evidence is genuinely unsettled. A preregistered comparison of age- and sex-matched groups (N = 105 each) found adults with ADHD camouflaging more than a comparison group and less than autistic adults; in the wider sample of 477 adults with an autism and/or ADHD diagnosis, autistic traits predicted camouflaging and ADHD traits did not.13 That study used the Dutch CAT-Q, which measures camouflaging of autistic traits, and its authors identified the absence of general camouflaging measures as the limiting factor.
The construct's validity in ADHD is under active challenge. A 2026 British Journal of Psychiatry paper argues that camouflaging in ADHD requires construct validation before clinical adoption.12 Any clinician using an ADHD masking measure should hold the construct loosely.
Even the validated equivalent is not for diagnostic use. The CAT-Q's own developers published guidance stating that clinicians should refrain from using its scores in diagnostic decision-making or as an intervention monitoring or outcome tool, and noting how little research has examined it in clinical settings.14 The AAMM has strictly less warrant than that.
It cannot separate compensation from suppression. Deep compensation, shallow compensation and emotional suppression are conceptually distinct and plausibly carry different prognoses;4 the AAMM sums them into one total. Two people with identical scores may be doing very different things.
Its outcome evidence is borrowed. The linear association between camouflaging and anxiety and depression with no threshold effect,9 and the identification of masking as a driver of burnout,10 come from autistic samples. The one ADHD-specific outcome study available is a cross-sectional online survey of 329 women.7 Transfer is plausible and unproven.
What a clinician does with it
Use it as a structured interview schedule and discard the number. The seven named areas are a serviceable prompt list for a domain that patients routinely fail to report spontaneously, because masking is by definition the material they have been trained not to present. It is particularly worth asking in adults presenting late, in women, and in anyone whose childhood history looks unremarkable while their adult exhaustion does not — referral ratios of up to 16 to 1 against a community ratio near 3 to 1 are not explained by prevalence.5 Record the content. Do not record the total, and do not place it in any diagnostic formulation.
Validity tier: 4 — built in-house by New Path, not normed, no published validation. The underlying construct has a growing but young and contested evidence base; this particular instrument has none of its own, and every number it returns should be read as a prompt rather than a measurement.
Diagram — E · One high score, many roads. This is the caveat that matters most. A high masking score says the effort is real and it is costing you. It does not say where the effort comes from, and six roads lead to the same reading.
STRENGTHS LENS
Every one of those seven areas is a system you built yourself, without a manual.
Nobody taught you the three calendars. Nobody sat you down and explained that you would need to rehearse a sentence before saying it, or leave forty minutes early, or check the work four times. You worked all of that out alone, usually as a child, usually without knowing why it was necessary — and a great deal of it works. The compensation literature is clear that some of these strategies genuinely do the job another way rather than merely hiding the difficulty.
The costs in this module are real and it does not minimise them. But the finding worth carrying is the one from 277 autistic adults: what did the damage was not camouflaging, it was the sheer number of hours spent camouflaging, and the same people described it protecting them at work and keeping them safe. That means the target is not to dismantle everything you built. It is to stop paying for it around the clock.
F. What helps
Unmasking is not one decision and it is not all-or-nothing. Everything below is about reducing the hours and the reach, not about becoming a different person on Monday.
1. Sort the scaffolding from the performance.
Go through the seven areas and mark each thing you do as either a system that genuinely works or a performance that only hides something. Three calendars that keep your life running are scaffolding — keep them, and stop apologising for them. Flattening your face so nobody sees a reaction is a performance, and it is the expensive one. The AAMM adds them together; you do not have to.
2. Count the hours, not the habit.
The most useful single finding in this whole literature is that the damage tracked the amount of time spent masking rather than whether people masked at all. So the question is not whether you mask. It is how many waking hours a week you are on, and which of those hours nobody is actually asking you to pay for.
3. Pick one room to be forty per cent yourself in.
Not the whole life, not the workplace where the mask is load-bearing. One relationship, one evening, one group where you let the leg move and do not apologise for asking twice. Unmasking is a skill that has to be practised somewhere low-stakes first, because for most people it has been out of use since primary school.
4. Name one specific cost out loud, once, to one person.
Not "I find work tiring". Something like "I rehearse every meeting in the car and I am done by three". Masking survives on being invisible, and one accurate sentence to one person who will not use it against you does more than a high score on any questionnaire will.
5. Take the seven headings into the assessment, not the number.
Assessors ask about symptoms. They rarely ask what you do to stop the symptoms showing, and that is exactly the material that gets people missed — particularly women and particularly adults who coped for decades. Bring two concrete examples under each heading that applies. The total between 0 and 112 has no clinical standing and does not need to be mentioned at all.
Step 2 — Take the screener
Twenty-eight questions, about five minutes, free and confidential. You will get a single total between 0 and 112 and one of five bands. Read section D before you read the band: this questionnaire was built in-house, it has never been validated, and the seven areas it names are worth far more to you than the number is.
Before you start
The AAMM was built in-house by New Path. It is not a licensed or commercial instrument and it has no published validation, no normative sample, no reliability figures and no independent replication — its bands are editorial judgements about where one description stops and another starts. The seven areas it names are described on the live page but are not scored separately, so there are no subscale results. Effortful self-presentation is common across autistic adults, ADHD adults, socially anxious adults and people in burnout, so a high score does not indicate ADHD. It is a structured prompt, not a test, and only a clinician working from a full history can diagnose.
Step 3 — Your workbook
Your answers save to this device only — we cannot see a word of what you write. This module records the one total the AAMM produces, then does the part the number cannot: sorting which of the seven areas apply to you, separating the systems worth keeping from the performances that only cost you, and building the concrete examples an assessor will actually ask for.
Your AAMM result
Took the screener? Put your total in below. There are no subscale scores to record — the live page names the seven areas but does not score them separately. Entirely optional — skip it if you would rather just read.
Score bands: 0–22 = Very Low; 23–44 = Low; 45–67 = Moderate; 68–89 = High; 90–112 = Very High
Fields: AAMM · Adult ADHD Masking Measure; Total score (0–112); My total (enter 0–112); What I thought while answering the questions
Which of the seven
Section B. The seven named areas are the useful part of this instrument. Tick the ones you recognised, then make them concrete — a vague heading helps nobody, including you.
Fields: Tick: Emotional Suppression; Tick: Social Camouflaging; Tick: Compensatory Organization; Tick: Overcompensation & Perfectionism; Tick: Physical Masking; Tick: Time Anxiety; Tick: Attention & Apology; One concrete example under each area I ticked
The two columns
Section C. What the room saw on an ordinary recent day, and what it actually cost to produce it. Both are true. Only one has ever been visible.
Fields: The day I am thinking of; What the room saw; What it cost to produce that
Scaffolding or performance
Section F, item 1. Some of what you built genuinely works and should be defended. Some of it only hides something and is where the money goes. Sorting them is most of the work.
Fields: Systems that genuinely work — keep these; Performances that only hide something; Which list was longer: The systems that work / The performances / About even / I could not tell them apart
The hours
Section F, item 2. In one study of 277 adults it was the amount of time spent masking, not masking itself, that people identified as most damaging. So: how many hours, and which ones is nobody asking you to pay for?
Fields: Roughly how many waking hours a week I am 'on'; Hours nobody is actually asking me to pay for; One room I could be forty per cent myself in
The sentence, and the assessment
Section F, items 4 and 5. One accurate sentence for one person, and the material to take into an assessment — where the seven headings are worth far more than the total.
Fields: Who I would say it to; The exact sentence; Two examples per heading, for the assessor; Tick: I have an assessment booked
Appendix — Research companion
Peer-reviewed research
3. Ai W, Cunningham WA, Lai M-C (2024). The dimensional structure of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and predictors of camouflaging in a representative general population sample. Comprehensive Psychiatry, 128, 152434. DOI 10.1016/j.comppsych.2023.152434. View the paper A representative general-population sample of 972 US adults completed the CAT-Q alongside trait measures. The three-factor structure replicated, and camouflaging was predicted by ADHD traits (beta = 0.27) more strongly than by autistic traits (beta = 0.21), with social anxiety also contributing; the authors conclude the CAT-Q captures camouflaging across neurotypes rather than something specifically autistic. This is the single most important empirical warrant for an ADHD masking measure existing at all. Limitation: all measures were self-report and cross-sectional, traits were measured dimensionally rather than by diagnosis, and the design says nothing about how effective camouflaging actually is.
6. Hull L, Lai M-C, Baron-Cohen S, Allison C, Smith P, Petrides KV, Mandy W (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352-363. DOI 10.1177/1362361319864804. View the paper Survey of 306 autistic and 472 non-autistic adults. Autistic women scored higher on the CAT-Q than autistic men (124.35 versus 109.64, d = 0.65), with no gender difference among non-autistic adults, and the effect survived controlling for autistic traits. It is the closest published analogue to the gender pattern this module describes in ADHD, and it is an analogue rather than evidence. Limitation: an autistic sample only, so it establishes nothing about ADHD, and the non-binary subsamples were underpowered at 16 autistic and 27 non-autistic participants, with the authors stating the CAT-Q has not been psychometrically validated in non-binary populations.
9. Hull L, Levy L, Lai M-C, Petrides KV, Baron-Cohen S, Allison C, Smith P, Mandy W (2021). Is social camouflaging associated with anxiety and depression in autistic adults?. Molecular Autism, 12, 13. DOI 10.1186/s13229-021-00421-1. View the paper Survey of 305 autistic adults aged 18 to 75. Higher CAT-Q scores predicted greater generalised anxiety, social anxiety and depression after controlling for age and autistic traits, with effects that were small but consistent, and the relationship was linear with no threshold effect - there is no level of camouflaging below which the association disappears. Limitation: cross-sectional, so the authors state they cannot determine which came first, and the sample is entirely autistic, so the linearity finding is not established for ADHD masking.
2. Hull L, Mandy W, Lai M-C, Baron-Cohen S, Allison C, Smith P, Petrides KV (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819-833. DOI 10.1007/s10803-018-3792-6. View the paper The original CAT-Q validation, in an online sample of 354 autistic and 478 non-autistic adults, giving a total-scale alpha of 0.94 and a three-month test-retest correlation of 0.77 drawn from only 30 autistic adults, which the authors themselves describe as preliminary. It is the benchmark this module measures the AAMM against: this is what a validated masking questionnaire looks like, and the AAMM has none of it. Limitation: participants were largely diagnosed in adulthood with self-reported and unverified diagnoses, the authors state it is not a diagnostic tool, and no cut-off score is published.
1. Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai M-C, Mandy W (2017). 'Putting on my best normal': social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534. DOI 10.1007/s10803-017-3166-5. View the paper Qualitative thematic analysis of open-ended survey responses from 92 autistic adults, and the study every subsequent camouflaging instrument descends from. It produced the three-stage model of motivations, mechanisms and consequences that the CAT-Q items were later written from, and which the AAMM's seven areas informally follow. It is included here because the ADHD masking literature has no equivalent founding qualitative study of its own. Limitation: a self-selected online sample, 55 per cent British, entirely autistic, with no behavioural verification and no ADHD participants, so nothing in it was established for ADHD.
4. Livingston LA, Happe F (2017). Conceptualising compensation in neurodevelopmental disorders: reflections from autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 80, 729-742. DOI 10.1016/j.neubiorev.2017.06.005. View the paper Theoretical review introducing the distinction between deep compensation, which achieves the outcome by a genuinely different route, and shallow compensation, which holds up only until conditions change. It also argues that behaviourally defined diagnostic criteria can be met despite persisting underlying differences, which is the mechanism by which a well-compensating adult goes unrecognised for decades. Cited here for the claim that the AAMM's Compensatory Organization and Emotional Suppression areas are not the same kind of act. Limitation: a conceptual review with no empirical test, developed within autism research, and not a validation of any instrument or a study of ADHD.
7. Wicherkiewicz F, Gambin M (2026). Relations between social camouflaging, life satisfaction, and depression among Polish women with ADHD. Journal of Autism and Developmental Disorders, 56(7), 2875-2883. DOI 10.1007/s10803-024-06410-6. View the paper Online survey of 329 Polish women with ADHD using the ASRS-v1.1, the Satisfaction With Life Scale and the PHQ-9, plus a novel set of camouflaging items inspired by the CAT-Q but tailored for ADHD - the same design logic as the AAMM, arrived at independently. Social camouflaging was significantly negatively associated with life satisfaction and positively associated with depressive symptoms, and both associations held after controlling for demographic variables. Limitation: cross-sectional, self-selected online recruitment, women only, one country, and the ADHD-tailored camouflaging items were novel and are not themselves an independently validated instrument.
13. van der Putten WJ, Mol AJJ, Groenman AP, Radhoe TA, Torenvliet C, van Rentergem JAA, Geurts HM (2024). Is camouflaging unique for autism? A comparison of camouflaging between adults with autism and ADHD. Autism Research, 17(4), 812-823. DOI 10.1002/aur.3099. View the paper Preregistered study (AsPredicted #41811) of adults aged 30 to 90 completing the Dutch CAT-Q, the ADHD Self-Report and the Autism Spectrum Quotient. In an age- and sex-matched subsample of 105 per group, adults with ADHD scored higher than the comparison group on total camouflaging and on assimilation, but lower than autistic adults on total camouflaging, compensation and assimilation; in the wider sample of 477 adults with an autism and/or ADHD diagnosis, autistic traits but not ADHD traits predicted camouflaging independently of diagnosis. The authors call for general camouflaging measures rather than autism-specific ones, which is the case for building something like the AAMM. Limitation: it measured ADHD camouflaging with an instrument written to capture camouflaging of autistic traits, which the authors identify as the study's central constraint, and the age floor of 30 excludes younger adults.
Clinical frameworks and position statements
14. Hannon BR, Hull L, Lai M-C, Magiati I, Mandy W (2026). The use and misuse of the Camouflaging Autistic Traits Questionnaire in autism research and clinical practice: issues, considerations, and suggestions. Autism in Adulthood, published online 26 March 2026. DOI 10.1177/25739581261435868. View the source Guidance paper co-authored by the CAT-Q's own developers on how the instrument should and should not be used. It states that clinicians should refrain from using CAT-Q scores in diagnostic decision-making or as an intervention monitoring or outcome tool, and notes that very little research has examined the CAT-Q in clinical settings at all. It is the ceiling this module reasons from: if the validated instrument carries this much caution, an unvalidated one carries more. Limitation: published online first, so volume, issue and page range are not yet assigned, and it addresses the CAT-Q specifically rather than masking measures in general.
5. Young S, Adamo N, Asgeirsdottir BB, Branney P, Beckett M, Colley W, Cubbin S, et al (2020). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404. DOI 10.1186/s12888-020-02707-9. View the source UK ADHD Partnership consensus statement on identifying and treating ADHD in girls and women across the lifespan. It records clinical referral ratios ranging from 3 to 1 up to 16 to 1 in favour of boys against a community ratio of around 3 to 1, and attributes the discrepancy partly to lack of recognition and referral bias. It names compensatory behaviours, compliance and socially adaptive coping among the barriers to referral, which is the masking argument stated in a clinical guidance document. Limitation: expert consensus rather than a systematic review or meta-analysis, so the ratios are drawn from a heterogeneous literature and are not pooled estimates.
Lived experience
8. Bradley L, Shaw R, Baron-Cohen S, Cassidy S (2021). Autistic adults' experiences of camouflaging and its perceived impact on mental health. Autism in Adulthood, 3(4), 320-329. DOI 10.1089/aut.2020.0071. View the source Thematic analysis of open-ended survey responses from 277 autistic adults. Camouflaging was described as exhausting and linked to anxiety, depression, loss of identity and delayed diagnosis, while also enabling employment and offering protection from bullying, and participants identified the amount of time spent camouflaging rather than camouflaging itself as the most damaging factor. That distinction is the basis of section F, item 2. Limitation: qualitative, self-selected, mixing formally diagnosed and self-identified autistic participants, with no ADHD sample, so the time-dose finding is not established for ADHD masking.
11. Hansson Hallerod SL, Anckarsater H, Rastam M, Hansson Scherman M (2015). Experienced consequences of being diagnosed with ADHD as an adult - a qualitative study. BMC Psychiatry, 15, 31. DOI 10.1186/s12888-015-0410-4. View the source Twenty-one adults diagnosed with ADHD in adulthood were interviewed in open-ended exploratory interviews and analysed phenomenographically. Positive experiences dominated, with the diagnosis described as an answer to many years of wondering and a source of self-knowledge, alongside concerns about identity, stigma and restricted life possibilities, and accounts clustering around school failure, job transitions, relationships, self-blame and relief. It is included as the ADHD-specific lived-experience counterpart to the autistic camouflaging accounts used elsewhere in this module. Limitation: 21 participants from a single Swedish clinical setting, self-selected, interviewed once, with no comparison group and no measure of masking, so it describes the experience rather than its frequency.
10. Raymaker DM, Teo AR, Steckler NA, Lentz B, Scharer M, Delos Santos A, Kapp SK, Hunter M, Joyce A, Nicolaidis C (2020). Having all of your internal resources exhausted beyond measure and being left with no clean-up crew: defining autistic burnout. Autism in Adulthood, 2(2), 132-143. DOI 10.1089/aut.2019.0079. View the source Community-based participatory research conducted with autistic co-researchers, drawing on 19 interviews and 19 public social media sources. It identifies masking as a prominent life stressor producing cumulative exhaustion, warns explicitly against interventions that teach autistic people to mask more effectively, and identifies unmasking among the factors supporting recovery. Limitation: qualitative and self-selected, it does not quantify the relationship between camouflaging and burnout, uses no standardised masking measure, and includes no ADHD participants.
Emerging or contested
12. Adamou M (2026). Camouflaging in ADHD: the need for construct validation before clinical adoption. British Journal of Psychiatry, 1-4. DOI 10.1192/bjp.2026.10577. View the paper A short British Journal of Psychiatry paper arguing, as its title states, that camouflaging in ADHD requires construct validation before it is adopted in clinical practice. It is cited here only for that title-level position, to establish that the construct this module is built on is being actively contested in a major journal at the time of writing rather than settled. Limitation: we could not obtain the full text or abstract through an open route while writing this module, so no specific argument, figure or claim from inside the paper is used anywhere in the lesson.
Further reading — general background
Cook J, Hull L, Crane L, Mandy W (2021). Camouflaging in autism: a systematic review. Clinical Psychology Review, 89, 102080. DOI 10.1016/j.cpr.2021.102080. View the paper Systematic review of 29 empirical studies covering both measurement traditions in camouflaging research, sex and gender differences, and the association between higher self-reported camouflaging and worse mental health outcomes. Offered as further reading for anyone who wants the full state of the autistic literature that the ADHD version is roughly nine years behind. Limitation: the review covers autistic samples only, and the authors note that the studies reviewed cannot be generalised to the whole autistic community, let alone to ADHD populations.
Peer-reviewed = checked by independent experts before publication. Clinical model = an established professional framework, not a single study.
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Module 6 - BIS-11 — Impulsiveness, Measured Three Ways
All modules in ADHD Self-Discovery
The work you hide is still work. This course was built by clinicians who are part of the New Path family of therapy centers. Working out which parts of your masking are load-bearing and which parts you could put down is slow, specific work, and it goes better with someone who has watched other people do it. Therapy for clients in California, coaching worldwide, all by telehealth. A conversation costs nothing and there is no pressure. Saving this for later counts too. Talk with the New Path team