An increasing number of adults are receiving diagnoses related to neurodivergence, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and sensory processing differences—traits that may have been misinterpreted or overlooked during childhood. Neurodivergence refers to natural variations in how people think, feel, and perceive the world, often differing from what is considered ‘typical’ in areas such as attention, communication, or sensory experience.
For many, finally receiving a diagnosis in adulthood brings relief and clarity—but it can also raise new challenges when trying to find professional support. Many neurodivergent adults enter psychotherapy only to discover that conventional clinical approaches are invalidating, insufficient, or even stigmatizing. A key contributor to the disconnect in the therapy office is the phenomenon of masking—a behavior that is highly common among neurodivergent individuals yet underexplored in therapy.
Understanding Masking in Neurodivergent Adults
Masking in neurodivergent adults is a learned behavior used to conceal neurodivergent traits to appear more neurotypical, thereby avoiding judgment and discrimination from others. It can involve rehearsing conversations, forcing eye contact, mimicking body language, or minimizing sensory needs to avoid being judged in social situations. This behavior often begins in childhood due to pressure to fit in or negative responses neurodivergent individuals receive from their environment.
While masking may help individuals navigate social settings or achieve professional success, it often comes at a significant psychological cost. Research and clinical observation link chronic masking with heightened anxiety, identity confusion, feeling emotionally drained, and dissociation. In therapy, clients who mask may appear self-aware and insightful while experiencing deep internal distress, leading clinicians to underestimate their needs or invalidate their experiences.
Misdiagnosis in Therapy: Why Neurodivergent Adults Are Often Overlooked
Masked neurodivergent traits frequently resemble diagnostic features of other mental health conditions. Emotional dysregulation, executive dysfunction, or social withdrawal may prompt clinicians to diagnose mood disorders, anxiety disorders, or personality disorders. These misdiagnoses can lead to treatment plans or prescribed medications that don’t get to the root of the person’s neurological differences.
Systemic biases in diagnostic frameworks compound this issue. Diagnostic criteria are often developed from studies centered on white, cisgender males. As a result, the signs of neurodivergence in women, BIPOC individuals, and LGBTQ+ populations may be overlooked or misattributed. For example, when most people think of ADHD, they visualize a young boy who is hyperactive and disruptive. This stereotypical idea of ADHD makes it easy to overlook neurodivergent adults who’ve spent years masking their traits.
Not being aware of the impact that masking has on how individuals present leads to continued misdiagnosis and distress. People may feel misunderstood or marginalized. Incomplete diagnostic knowledge causes a cycle of therapeutic invalidation. Clients may feel unseen, judged, or ignored, causing them to disengage from therapy. This deepens providers’ lack of awareness, often leading them to mislabel clients as ‘resistant’ to treatment. When someone is treated this way in a space where they expect compassion and support, they may begin to internalize the misunderstanding—seeing themselves as ‘damaged’ or ‘broken.’
Late Diagnoses in Adulthood: Clarity and Challenges
Receiving a diagnosis of ADHD, autism, or another neurodevelopmental condition in adulthood can be validating, helping individuals gain a better understanding of personal behaviors previously labeled as ‘weird’ or ‘inappropriate.’ However, receiving a diagnosis later in life can result in disappointment or grief due to lost opportunities, problems in friendships or relationships, and the absence of resources that could have been made available to them sooner.
After being diagnosed, it is common for individuals to reassess their narratives. Neurodivergent adults may begin to reinterpret past therapeutic experiences and coping strategies through their new understanding of themselves. Often, prior therapeutic interventions—designed for neurotypical clients—may be perceived as inappropriate or ineffective in retrospect, further eroding trust in the mental health system.
Creating a Neurodivergent-Affirming Therapeutic Framework
To support neurodivergent adults effectively, mental health professionals must adopt neurodiversity-affirming and trauma-informed practices. This requires reframing neurodivergence not as pathology but as a valid cognitive profile with distinct needs and strengths. Practical strategies for clinicians include:
- Education: Learn about neurodivergent behaviors and how they are commonly masked.
- Maintaining clinical neutrality: Avoid judging or stigmatizing behaviors based on neurotypical norms. Challenges with relationships or executive functioning can be adaptive responses—not just signs of a disorder.
- Conducting holistic assessments: Include questions about sensory experiences, masking behaviors, and how the individual functions in different settings.
- Identifying camouflaged distress: Recognize that self-awareness or insight may be a masking behavior rather than immediately ruling out neurodiverse diagnoses.
- Validating personal narratives: Neurodivergent clients often carry trauma from invalidation. Affirming their experiences without assumptions or preconceived notions promotes psychological safety, identity confidence, and therapeutic alliance.
- Committing to cultural humility and continued education: Engage with emerging research, attend specialized training, and advocate for neurodivergent individuals.
Facilitating Unmasking and Self-Advocacy in Clinical Spaces
For neurodivergent individuals, therapy can become a safe space to be themselves. Unmasking doesn’t happen all at once. It shifts depending on the environment and how safe a person feels. This may begin with clients expressing discomfort around social expectations, revealing sensory preferences, or initiating conversations about self-diagnosed identities.
The process of unmasking varies for each individual. Some may retain specific masks in settings that lack psychological safety while gradually relaxing in therapeutic or affirming environments. The clinician’s role is to support this process without imposing neurotypical expectations or rushing the client. Encouraging experimentation with self-expression, exploring adaptive tools, and fostering connections among neurodivergent peers can significantly improve self-concept and resilience.
For those seeking neurodivergent-affirming care, there are therapist directories that highlight providers committed to creating safe, inclusive spaces grounded in an understanding of neurodivergence.
Conclusion
The evolving understanding of neurodivergence challenges the traditional foundations of clinical psychology and psychotherapy. Masking and misdiagnosis are not merely diagnostic oversights—they are caused by underrepresentation in research of neurodivergent individuals and a deficit in continuing education that fosters new insights into the mainstream framework of mental health.
To bridge this divide, clinicians must address gaps in their training and understanding, deepen their cultural and neurodivergent literacy, and adopt flexible, individualized approaches. By affirming neurodivergent individuals and addressing the systemic factors that contribute to individuals not receiving the treatment they deserve and need, therapy can evolve into a more inclusive, ethical, and accessible resource. In doing so, it becomes a way to heal, fostering liberation and empowerment for those whose minds have historically been underrecognized or misunderstood.
If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Mental Health Resource Specialists can assist you in finding expert help and support in your community. Contact us now for more information on this free service.
About the Author: Sarah Denkert is a Licensed Professional Counselor based in Wisconsin, who brings personal insight to her work through her own experience of being diagnosed with ADHD at age 28. She is deeply passionate about raising awareness around neurodivergence and is committed to promoting inclusivity and advocacy in both her professional and personal life. https://www.discoveryourpathllc.com
Photo by cottonbro studio: https://www.pexels.com/photo/man-in-black-sweater-and-black-pants-sitting-on-gray-couch-4100646/
The opinions and views expressed in any guest blog post do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in the article or linked to therein. Guest Authors may have affiliations to products mentioned or linked to in their author bios.
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