Camouflaging, ADHD and the Problem of Having Two Diagnoses

If everybody camouflages, what exactly are we talking about?

In Camouflage and Autism (1), I've made what may seem like a rather inconvenient observation: Everybody camouflages. Not just autistic people. Not just people with a diagnosis of some kind or without any diagnosis. Everybody.

We adjust our behaviour according to where we are, whom we are with and what is expected of us. We suppress things we would otherwise say. We imitate behaviours that seem to work for other people. We learn which expressions, gestures and conversational conventions are expected in particular situations. We sometimes pretend to be more interested, more confident, more sociable, more relaxed or considerably less annoyed than we actually are. That is part of being human.

So when I came across Marios Adamou's recent editorial, ‘Camouflaging in ADHD: the need for construct validation before clinical adoption’ (2026), I found myself both agreeing with the question and wondering whether there is another question underneath it.

Adamou argues that the concept of camouflaging, as developed in autism research, does not simply transfer to ADHD.[1] In particular, he questions the practice of taking compensatory behaviours in ADHD and relabelling them as "camouflaging" without an ADHD-specific theory, operational definition and validated measure. He also points out an intriguing problem: sustained concealment of ADHD symptoms may require precisely the executive functions that are impaired in ADHD.

That is a perfectly reasonable challenge. But it leaves us with a rather awkward question: If autistic people camouflage, why shouldn't people with ADHD do something similar? And perhaps an even more awkward one: If people with other disorders can modify their behaviour, (and people without any diagnosis do it too), what exactly makes something "camouflaging"?

Is camouflage really an autism thing?

There is already evidence that complicates the idea: van der Putten et al. (2024) compared adults with autism, ADHD and neither diagnosis. Adults with ADHD scored higher on the CAT-Q measure of camouflaging than the comparison group, although lower than autistic adults. The authors concluded that camouflaging did not appear to be unique to autism.

But there is an important clarification here: The CAT-Q is the Camouflaging Autistic Traits Questionnaire. In other words, it was designed to measure strategies used to appear less autistic. It was not designed to measure whatever camouflage might look like in ADHD. The researchers, therefore, made a rather sensible recommendation: more general measures of camouflaging are needed before we can reliably compare the phenomenon across different disorders.

And this becomes even more interesting when we step outside diagnostic categories altogether. Ai, Cunningham, Lai (2024) examined the CAT-Q in a representative U.S. general-population sample of 972 adults. The same three-factor structure found in previous autism-enriched samples was also found in the general population, and the authors interpreted their findings as evidence that camouflaging may represent a shared social coping experience overlapping with the older concept of impression management. So perhaps the question is not: Who camouflages? Perhaps it is: What are they camouflaging, and why?

Camouflage isn't necessarily the same thing as compensation

This is where terminology gets particularly interesting. Adamou's argument is not simply that people with ADHD never modify or conceal their behaviour. His point is that we should not automatically take a behaviour that looks like compensation and declare it to be the same construct as autistic camouflaging.

This is where terminology gets particularly interesting. Adamou's argument is not simply that people with ADHD never modify or conceal their behaviour. His point is that we should not automatically take a behaviour that looks like compensation and declare it to be the same construct as autistic camouflaging. And that distinction is worth taking seriously.

Suppose somebody with ADHD develops an elaborate system of reminders, lists, alarms and calendars because otherwise they repeatedly forget appointments and deadlines. – That is compensation.

Or suppose somebody learns to sit on their hands during meetings because they know they interrupt people when they are excited. – Again, compensation seems like a reasonable description.

But now suppose an autistic person develops strategies for navigating a social situation – consciously monitoring gestures, rehearsing conversations, copying other people's conversational style or suppressing behaviours that might reveal their autistic characteristics. – The autism literature may describe these strategies as camouflaging. So far, so good. Except that the terminology is not quite as tidy as it first appears.

Compensation is already part of the autism camouflaging literature.

The original CAT-Q, for example, conceptualised camouflaging in three dimensions: masking, assimilation and compensation. Compensation refers to strategies that enable someone to navigate social situations despite underlying difficulties. So we cannot simply construct a neat little equation:

Autism = camouflage ADHD = compensation

The research terminology itself doesn't allow such a clean division.

And then there is AuDHD

What happens when someone has both diagnoses? Autism and ADHD.

Do they camouflage because they are autistic and compensate because they have ADHD? Perhaps. But it isn't necessarily that simple. Imagine somebody who:

• rehearses conversations before entering unfamiliar social situations;

• monitors facial expressions;

• deliberately stops themselves interrupting;

• uses elaborate calendars and reminders;

• prepares excessively for changes in routine;

• copies the conversational style of other people;

• develops rigid systems for organising everyday life;

• consciously suppresses behaviours that other people find unusual.

Which diagnosis does each behaviour belong to?

Some might be associated with autistic characteristics.

Some might be responses to ADHD-related executive-function difficulties.

Some might involve both.

And some might simply be things that any person does because they have learned what is expected in a particular environment.

The behaviour itself cannot necessarily tell us. The same behaviour may have different functions in different people, and sometimes several functions in the same person. A calendar, for example, might compensate for ADHD-related problems with memory and organisation. But an elaborate timetable might also reduce the uncertainty associated with autistic insistence on predictability. Or perhaps it does both. Trying to assign the strategy to one diagnosis may, therefore, be less informative than asking what problem the strategy is solving.

The problem with looking only at the behaviour

This brings us back to Adamou's argument: If we see somebody behaving in a socially acceptable way, we cannot automatically conclude that they are camouflaging. And if we see somebody using a compensatory strategy, we cannot automatically conclude that they are camouflaging, either. The behaviour is only the visible part. What is happening underneath it matters:

Why is the person doing it?

What are they trying to prevent?

What are they trying to achieve?

What would happen if they stopped?

And (perhaps most importantly) – What exactly are they compensating for or concealing?

This is particularly important because the concept of camouflaging itself is not as settled as the increasingly confident (and popular) use of the word might suggest. Arnold, Bitsika and Sharpley's 2026 critical review examined 389 studies of camouflaging in autism and found considerable inconsistency in terminology, definitions and the way related concepts such as masking, compensation and impression management were treated. They also questioned the autism-specificity of some measures, including the CAT-Q, and noted substantial limitations in the populations represented in the existing research. (That doesn't mean that autistic camouflaging is imaginary. It means that we should be careful about treating a relatively new research construct as though its boundaries were already carved in stone.)

So, do people with ADHD camouflage?

The question is probably too broad. People with ADHD clearly modify their behaviour, develop compensatory strategies and may conceal difficulties from other people. There is also empirical evidence that adults with ADHD report behaviours captured by an autism-derived measure of camouflaging. But that finding does not, by itself, establish that ADHD has the same camouflaging phenomenon as autism.

And this is exactly where Adamou's argument is useful. Rather than simply importing the autism construct into ADHD, we could ask whether ADHD has its own form or forms of behavioural adaptation, what functions those behaviours serve, and how they should be defined and measured. That seems much more scientifically interesting than deciding whether people with ADHD are "really" camouflaging.

And what about everyone else?

There is another reason not to treat camouflage as a diagnostic marker:

If a person suppresses a yawn during a job interview, that is not autism.

If somebody smiles politely at a boring story, that is not autism.

If a person remembers not to swear during a formal meeting, that is not autism.

If someone learns to behave differently at work than they do at home, that is not autism.

We don't usually need a diagnosis to explain these things. They are ordinary human adaptations. The interesting question, therefore, is not whether adaptation occurs. It clearly does. The interesting question is when ordinary behavioural adaptation becomes clinically meaningful camouflage, and what makes it different from other forms of adaptation, compensation, impression management or social learning.

One person, several mechanisms

For someone with both autism and ADHD, this distinction becomes particularly difficult. They may camouflage. They may compensate. They may do both. They may use one strategy for several different reasons. And they may sometimes do exactly the same thing as everyone else. There is no reason to assume that every behaviour has a single diagnostic explanation.

Perhaps we have become too accustomed to asking: Is this an autistic behaviour or an ADHD behaviour? Sometimes the more useful question is: What is this behaviour doing? That question does not make diagnosis irrelevant. Quite the opposite. Understanding the underlying difficulties may help us understand why a particular strategy exists in the first place. But it does remind us that diagnoses are not little boxes containing behaviours neatly labelled AUTISM and ADHD. Human behaviour does not always fit neatly into diagnostic categories.

So where does that leave camouflage?

Perhaps with a more modest definition. Camouflaging may be a human phenomenon: people modify their behaviour in response to social expectations. Autistic people may camouflage autistic characteristics. People with ADHD may also modify or conceal ADHD-related difficulties. People with other diagnoses may do something similar. People without any diagnosis do it too.

But these observations do not automatically mean that all of these behaviours are manifestations of one single clinical construct. And perhaps that is the point Adamou's argument helps us see. The question isn't whether people with ADHD are allowed to camouflage. Nor is it whether autistic people have somehow claimed exclusive rights to the word. The question is whether we have actually defined the phenomenon well enough to know what we are talking about.

And when the person in front of us has both autism and ADHD? Perhaps we should be particularly cautious about deciding in advance whether what we are seeing is camouflage, compensation, both – or simply ordinary human adaptation. After all, if everybody does some version of it, the interesting question was never really: "Who camouflages?" It was: "What are we actually looking at?"

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[1] Despite the limited empirical base, the concept of "autistic camouflaging" has rapidly extended to the realm of ADHD. Adamou (2026) introduces two concepts that take the discussion beyond the scope of ADHD: Michael Derksen’s idea of ​​"human engineering" and Ian Hacking’s concept of "looping effects." The first helps explain how scientific language, personal testimony and moral concerns can reinforce one another. A concept describing exhaustion, stigma, social rejection and the effort involved in appearing competent is naturally compelling. It evokes empathy and fits comfortably with contemporary concerns about inclusion. But being compelling is not the same as being empirically established.

Then there is the looping effect. Once a new classification becomes available, people may begin to understand themselves through it; clinicians may ask questions based on it, and researchers may develop measures to capture it. Eventually, the resulting research may appear to demonstrate the existence of the phenomenon. It means that categories can influence the very experiences they are supposed to describe. And that is precisely why construct validation matters.