What the critique of ADHD camouflaging as a construct actually argues
A guest editorial in the British Journal of Psychiatry argues that camouflaging — as developed in autism research — does not transfer coherently to ADHD. The author, Marios Adamou, contends that the rapid clinical adoption of ADHD camouflaging has outpaced any empirical foundation supporting its validity, measurement properties, or clinical utility.
The critique operates on three levels. First, motivational incompatibility: the presumed role of stigma awareness as a driver of strategic symptom concealment does not account for how ADHD-related stigma actually operates. Second, neurocognitive incompatibility: the executive function deficits characteristic of ADHD directly contradict the computational demands that Bayesian models of impression management require. Third, construct validity deficits: the measurement instruments used, the sampling strategies underpinning them, and the theoretical boundaries of “ADHD camouflaging” remain insufficiently defined.
The core claim is stark. In autism, camouflaging arises from clearly conceptualised awareness of difference. Autistic people recognise specific features — reduced eye contact, monotone speech, repetitive gestures — for which negative external feedback has been given, and can then consciously modulate behaviour in anticipation. This fits Bayesian models where stigma awareness operates as a high-level prior guiding predictive modelling and iterative refinement of self-presentation.
In ADHD, Adamou argues, behavioural changes do not have this metacognitive structure. They originate not from explicit real-time prediction of others’ judgements but from affective conditioning shaped by chronic criticism. People repeatedly characterised as careless or unreliable develop enduring anxiety regarding competence and control. The compensatory behaviours that result — over-preparation, overcompensation, hypervigilant self-monitoring — are reactive attempts to prevent disorganisation or reproach, not strategic acts of hiding symptoms.
The distinction matters because it determines whether “camouflaging” describes something real and ADHD-specific, or whether it misapplies autism-derived terminology to phenomena already explained by compensatory strategies, anxiety, and perfectionism.
The neurocognitive paradox: can you mask what disables your ability to mask?
The most provocative element of Adamou’s critique is what he calls the executive dysfunction paradox. The proposition that people with ADHD can effectively camouflage the condition’s core symptoms — sustained inattention, impulsivity, hyperactivity — is incompatible with the accepted neurocognitive architecture of the condition.
Meta-analytic evidence confirms medium to large deficits across executive domains relevant to behavioural control: response inhibition, working memory, planning and organisation, vigilance, and reaction time variability. These findings demonstrate that ADHD is characterised by instability in the cognitive control system responsible for sustaining attention and regulating action over time.
From a computational perspective, sustained symptom concealment would demand four sequential executive operations in real time: conscious recognition of one’s behaviour as socially undesirable; maintenance of that representation in working memory while monitoring ongoing performance; inhibition of the prepotent response; and adjustment of behaviour in response to feedback. Each operation, according to the evidence base, is impaired in ADHD.
Working memory impairments reduce the ability to maintain self-representations across time. Inhibitory deficits impair suppression of impulsive responses. Attentional inconsistency fragments self-monitoring. Planning deficits impede anticipatory structuring of behavioural strategies.
The argument, then, is self-refuting: the mechanisms required to hide ADHD are the same mechanisms the disorder disables. What may appear as camouflaging is short-lived, effortful modulation of general behaviours rather than genuine suppression of core symptoms. When ADHD symptoms are present at diagnostic threshold, Adamou contends, they will inevitably manifest during a competent clinical assessment and cannot be claimed to have been hidden.
This is a direct challenge to the clinical framing that late diagnosis reflects successful masking. It suggests instead that late diagnosis reflects assessment failures, clinician bias, or symptom misattribution — not patient concealment.
Where ADHD camouflaging research currently stands after conflicting findings
The Adamou critique does not exist in isolation. Earlier this month, research published in Research in Neurodiversity documented that 91.6% of 202 adults with ADHD report camouflaging behaviours. That study — by Mylett, Boucher, and Iarocci at Simon Fraser University — replicated autism camouflaging methodology and identified ADHD-specific patterns.
The key finding there was cognitive interference. Pretending to pay attention consumes the cognitive resources needed to actually pay attention. Suppressing fidgeting removes a regulatory mechanism that aids focus. The study documented a vicious cycle: camouflaging worsens ADHD symptoms, which increases the perceived need to camouflage further.
How do these findings coexist with Adamou’s critique?
One interpretation: both are correct, but they describe different phenomena. Mylett et al. documented self-reported effortful behaviour modification and its costs. Adamou argues that what’s being reported isn’t camouflaging in the technical sense — it’s compensatory behaviour, anxiety-driven hypervigilance, or perfectionism relabelled through autism-derived terminology.
Van der Putten and colleagues tested this directly. Comparing adults with autism, ADHD, and neurotypical controls using an autism-based camouflaging measure, participants with ADHD showed greater camouflaging than controls but less than those with autism. Crucially, autism traits were stronger predictors of camouflaging scores than ADHD traits. The variance captured by autism-specific instruments appears driven predominantly by autistic characteristics rather than ADHD symptoms.
This raises an uncomfortable possibility. Much of what’s being measured as “ADHD camouflaging” may actually reflect undiagnosed or subclinical autistic traits in ADHD populations — or the instruments may simply be measuring social effort and anxiety rather than anything specific to either condition.
Adamou invokes Hacking’s concept of looping effects: once a morally appealing but empirically uncertain construct enters clinical circulation, it shapes how people interpret their own behaviour, respond to the label, and consequently modify the very phenomenon the classification was meant to capture. Clinicians begin asking questions framed by the new construct. Patients internalise the framework and articulate experiences through its vocabulary. Researchers design instruments calibrated to detect these newly articulated experiences. The resulting data appear to confirm the construct — not because it demonstrates validity but because the classification has already shaped what is noticed, expressed, and measured.
Why contested constructs matter for neurodivergent diagnosis, research, and self-understanding
This is not an abstract methodological dispute. Whether ADHD camouflaging is a valid construct has direct implications for clinical practice, research priorities, and how people understand their own experiences.
For diagnosis: If camouflaging is real and effective, it could explain late diagnosis and justify more intensive assessment approaches that probe beneath surface presentation. If camouflaging is a misapplied autism construct, it risks encouraging clinicians to infer hidden ADHD from reported effort and exhaustion — potentially overdiagnosing or misattributing anxiety-driven compensatory behaviour.
For research: If ADHD camouflaging lacks discriminant validity from social anxiety, trauma-related hypervigilance, and perfectionism, studies using autism-derived instruments are measuring something other than what they claim. Research resources would be better directed toward understanding compensatory behaviours on their own terms rather than importing constructs that may not transfer.
For self-understanding: Many adults with ADHD have found the camouflaging framework validating. It names the exhaustion, the effort, the sense of performing competence while struggling internally. Adamou does not dispute that this experience is real. He disputes whether “camouflaging” is the right label — and whether applying it creates the illusion of explanatory precision where none exists.
The clinical implication Adamou draws is specific: when people state that they camouflage ADHD symptoms, they are usually describing strain, shame, or overcompensation — not deliberate suppression of core symptoms. These reports indicate burden and threat sensitivity rather than concealed diagnostic-level impairment. They should inform formulation by identifying pressure points and emotional cost, but should not be treated as evidence that ADHD symptoms exist but are intentionally hidden.
The field has not yet resolved this.
Two papers published in the same period reach substantially different conclusions about whether ADHD camouflaging is a phenomenon worth documenting or a construct borrowed without validation. The honest position is that both warrant serious engagement — and that anyone invoking “ADHD masking” as settled science is ahead of where the evidence actually stands.
Citations
Adamou, M. — Camouflaging in ADHD: the need for construct validation before clinical adoption
Mylett, Boucher & Iarocci — “I wish I could just be myself”: Experiences of social camouflaging in adults with ADHD
The Neurodiversity Directory — Neurodivergent camouflaging: ADHD masking makes symptoms worse
