The Higher the Role, the Higher the Cost. What Masking Is Really Doing to Women With ADHD

For twenty years I looked like the most prepared person in the room.

I held the room. I juggled competing priorities across a complex organisation and still found time for my team. I answered emails promptly and presented as composed under pressure. What nobody saw was what it cost me to look that way or the crying in the car on the way home that I couldn't explain even to myself.

That's masking. And if you're a woman in a senior role with undiagnosed or unsupported ADHD, it isn't an occasional effort. It's a full-time, invisible second job that runs alongside everything else you're doing.

It's also, more often than not, the reason the wheels come off at exactly the point in your career when you can least afford it. Because there's something else that tends to arrive around the same time as seniority. Perimenopause.

What masking is and where it comes from

Masking is the process of consciously or unconsciously suppressing, managing or compensating for neurodivergent traits to meet the expectations of an environment that was never built with your brain in mind.

It usually starts early. Girls with ADHD learn quickly, from family and school and the social feedback of their peers, that the way their brain naturally works isn't what's expected. The impulsivity, the distractibility, the emotional intensity and the difficulty with routine and transitions all draw correction or concern. So you learn to contain them. You watch. You mirror. You build workarounds. You become bright but disorganised, capable but scattered, a bit too sensitive, a bit too much.

By the time you reach a senior role, masking isn't something you consciously do any more. It's simply how you function. The effort is so deeply embedded that it's become invisible, even to you.

What isn't invisible is the cost.

Why leadership makes it worse

Masking in any workplace is exhausting. Leadership amplifies almost every part of it.

Senior roles bring visibility. There's more scrutiny, higher expectation and far less margin for the inconsistency ADHD can produce. A junior colleague who loses track of a task or needs a deadline moved can usually absorb it. When you do the same, you're doing it in full view of your team, your peers and your board. The stakes of being seen to struggle are considerably higher.

Leadership also brings a heavier cognitive load. Strategy, people, relationships, organisational politics and constant decision-making, often quickly and with incomplete information, all lean hard on the executive functions ADHD affects most directly. Working memory. Task initiation. Prioritisation. Emotional regulation. The ability to shift focus when you need to.

And senior roles tend to contain more of what an ADHD brain finds hardest. Back-to-back meetings with no clear agenda. Unstructured time that demands self-directed focus. Rapid context-switching between completely different demands. Reading the room and managing relationships, which takes sustained cognitive and emotional attention. I sat perfectly still through three hour meetings while my mind pulled in six directions. I had it down to an art form!

So you're managing the role while also managing yourself, your presentation and the gap between how your brain works and how the environment expects you to perform.

That gap doesn't shrink with seniority. It grows.

Why perimenopause is often when the mask slips

Here's the part that doesn't get talked about nearly enough in conversations about leadership.

The years when many women move into senior roles are often the years perimenopause begins. Oestrogen plays a direct role in how dopamine works in the brain. Dopamine is central to attention, motivation and executive function. As oestrogen fluctuates and then drops, the systems ADHD already makes harder to regulate can become almost unworkable.

The strategies that just about held everything together stop working. The brain fog becomes relentless rather than occasional. The emotional intensity feels bigger and takes longer to come back from. The exhaustion stops responding to rest. And the effort of masking, which was already enormous, suddenly costs more than you have.

That was my experience. Everything that had ‘just about worked’ for years stopped working. It felt sudden. It wasn't. Perimenopause didn't create my ADHD. It removed the scaffolding that had been hiding it.

This is where it so often gets missed. Because the timing lines up with a known hormonal transition, everything gets put down to menopause alone. The two can look very similar from the outside, which is exactly why it's so easy to look for one and never think to look for the other. The difference is that ADHD doesn't come and go. It's been there since childhood. It just may not have been visible because you were masking so well.

If you've found yourself googling at 11pm asking why this has suddenly become so much harder, why you can't stop crying or why you're so angry all the time, you're not losing your mind. This isn't a personal failure. It's biology meeting years of compensation.

If any of this sounds familiar, it's worth taking seriously and worth raising with a clinician who understands both.

What the cost actually looks like

The impact of sustained masking in leadership shows up in recognisable patterns, though they're rarely identified as masking at the time.

A chronic sense of fraudulence. Imposter syndrome is common in leadership generally but with undiagnosed ADHD it has a particular texture. It isn't only the fear of being found out as less capable than people think. It's the very specific awareness that the version of you people see at work isn't the full picture. Keeping it up is getting harder.

Disproportionate exhaustion. You may be producing excellent work and delivering strong results while the energy it costs you is far higher than the output suggests. The colleagues who seem to manage the same demands with more ease aren't working harder than you. They just aren't carrying the invisible load you are.

Difficulty switching off. Masking isn't a conscious choice so it doesn't clock off when you leave the office. The self-monitoring and the vigilance about how you're coming across carry on in social situations and at home and in conversations that should feel easy. There's very little space where you're not, on some level, managing yourself.

Delayed collapse. Women who mask well in leadership often hold everything together for a very long time before anything visibly breaks. When it does, it can feel sudden and bewildering, to you and to the people around you. It isn't sudden. It's the end of a very long accumulation. Perimenopause is often what finally tips it.

What organisations are missing

The organisational cost of unrecognised masking is significant and largely unmeasured.

Talented women leave senior roles, not because they lack capability but because staying has become unsustainable. Others step back from leadership, not because they don't want it but because they can't find a way to lead that doesn't require performing a version of themselves they can't maintain indefinitely.

Organisations tend to read this through the frameworks they already have. Work-life balance. Wellbeing. Burnout. Retention. Menopause support is rightly becoming more common too, which is welcome. But when menopause is the only lens, the neurodivergent driver underneath is never named and the same pattern repeats with different women.

Neurodivergent women aren't lacking in capability or ambition or commitment. Many are operating at a level of effort that goes entirely unrecognised because the effort is invisible by design. The masking that made them successful is also what makes the difficulty impossible to see.

Reasonable adjustments, neuroinclusive management and a genuine understanding of how ADHD presents in senior women aren't soft interventions. They're not about giving anyone an advantage either. They're about levelling the playing field, much like handing someone a pair of glasses. And they're the difference between retaining exceptional people and losing them to an environment that was never built for how they think.

What changes when the mask comes off

The women I work with often describe understanding what masking has been costing them as one of the most significant moments of their professional lives.

Not because it resolves everything immediately. Because it reframes everything that came before it. The exhaustion finally gets an explanation. The fraudulence gets a context. The gap between how hard you're working and how it looks from the outside finally makes sense.

It changes the question too. It stops being “why can't I just do this?” and starts being “what would actually help my brain do this?”

And with that comes the possibility of something different. Not performing a version of yourself that costs more than you can afford but building a way of leading that's grounded in how your brain actually works. That isn't a lower standard of leadership. It's a more sustainable one. And for the women who get there, it tends to be more effective too.

If this is landing

If you're a woman in a senior role who's carrying more than anyone around you realises, you don't need a formal diagnosis to start making sense of it. A free 30-minute discovery call is a good place to start.

Book here: https://docs.leadwithadhd.com/widget/booking/Z49zwZ44I6HY4VLhbsaM

Or if you're still in the wondering stage, comment START and I'll send you my free guide, Holding It All Together at Leadership Level with ADHD, here: https://leadwithadhd.com/holdingitalltogether

I also work with organisations that want to better understand and support their neurodivergent leaders. To explore corporate training and workshops, visit: https://leadwithadhd.com/corporate-training-workshops