She answers emails at eleven at night. She remembers every client's preferences, rebuilds the presentation the evening before so it is flawless, and stays composed through the meeting that runs forty minutes over. Her performance reviews say "reliable", "detail-oriented" and "a natural leader". Her manager has never had a reason to worry about her.
Many women like her are autistic, have ADHD, or both, and do not find out until their thirties, forties or later. Until then, they spend a large share of their daily energy on something nobody sees: masking.
My doctoral research examined how late diagnosis affects learning and cognitive load in neurodivergent women. I see the same pattern in my coaching practice and in the workshops I run for companies, schools and public institutions. High performance can hide a very high cost, and the people around these women rarely see the bill until it arrives as burnout.
What masking looks like
Masking, also called camouflaging, means hiding or managing neurodivergent traits in order to fit in. When Laura Hull and colleagues at University College London interviewed autistic adults about it, participants described the effort as exhausting, and many said it left them unsure who they were underneath it.
In my book Unmasking: The Silent Struggle of Neurodivergent Women, I describe three mechanisms that appear again and again in women's lives: mimicry, adaptation and overachievement. At work, none of them look dramatic. Mimicry looks like studying a colleague's expressions and borrowing her phrases. Adaptation looks like scripting small talk before a meeting, or holding eye contact while losing track of what is being said. Overachievement looks like staying late to finish work the open-plan office made impossible during the day, and rebuilding a presentation three times so nobody can find a flaw.
From the outside, all three look like professionalism. That is why they get praised instead of noticed.
Why women are identified so late
The diagnostic criteria for autism and ADHD were built largely on studies of boys. A 2017 meta-analysis by Rachel Loomes, Laura Hull and William Mandy estimated the male-to-female ratio in autism at about 3:1, lower than the commonly quoted 4:1. The authors pointed to a diagnostic gender bias: girls who meet the criteria are less likely to receive a diagnosis.
ADHD in girls often looks like daydreaming and quietly falling behind rather than disrupting the class, so it is easy to miss. Social expectations add another layer. Girls are rewarded early for being polite, agreeable and easy to manage, so many learn to watch, copy and rehearse long before anyone asks how they are coping. By adulthood, the mask is often convincing enough to fool teachers, doctors, managers and the woman herself.
The cost that never shows up in a performance review
Working memory has limits. For a woman who masks, monitoring her own face, voice, timing and word choice runs in the background all day, like a laptop with forty tabs open and a fan that never stops. In Unmasking, I describe masking as a full-time cognitive occupation. The same report, meeting or lesson costs her more than it costs the colleague beside her. She still delivers, so nobody sees the difference.
Over time, the deficit builds. Drawing on autistic adults' own accounts, Dora Raymaker and colleagues defined autistic burnout as long-term exhaustion, loss of skills a person once had, and lower tolerance for noise, light and social contact. Women often describe it as suddenly being unable to do things that used to be easy. Because masking hides distress so well, the signs appear late, and from the outside they get read as a bad attitude or a lack of commitment.
When diagnosis finally comes, many women feel two things at once: relief at having an explanation, and grief for the years spent believing they were lazy, too sensitive or simply not trying hard enough.
Organisations pay as well. These women take sick leave, turn down promotions they are qualified for, or resign without giving the real reason. A company can lose one of its strongest people and record it as a personal decision.
What leaders, schools and colleagues can do
In Neurodivergent, Not Broken: A Practical Guide to Work, Boundaries, and Energy, I argue that energy, not motivation, is the resource most neurodivergent adults run short of, and that a well-designed workplace protects it. None of the steps below requires a diagnosis or a disclosure, and each one helps everyone on the team.
- Check on your strong performers, not only the ones who are struggling. Swap "How are you?" for a question that invites a real answer, such as "What is taking more energy than it should right now?"
- Make clarity the default. Share agendas before meetings, put instructions in writing, and say what "done" looks like. Guessing is expensive for a brain already working overtime.
- Offer flexibility without asking people to explain themselves. Quiet spaces, cameras off, flexible hours and a choice of written or spoken communication help many people who will never ask.
- Judge the work, not the performance of being normal. Eye contact, small talk and visible enthusiasm say very little about ability or commitment.
- Learn the early signs of burnout. When a reliable person starts missing deadlines or withdrawing, respond with curiosity and support before reaching for a performance plan.
- In schools, watch the quiet girl with good grades. If she holds everything together in class and falls apart at home, that gap is worth taking seriously.
Checking on her
The woman in the first paragraph does not need rescuing. She needs an environment where she can stop spending half her energy on looking fine. When schools and workplaces lower the cost of being different, they keep people who were never failing; they were simply running out of fuel.
So check on her, and make it safe for her to give an honest answer. The person everyone relies on may have been waiting a long time for someone to ask.
About the Author:
Dr. Annmarie Elizabeth Mendoza Hernandez is a cognitive psychologist, executive coach, and founder of NeuroBridge Learning Center. She advocates for neurodivergent inclusion in education and workplaces, with research focused on masking and late diagnosis in neurodivergent women. She is the author of several books, including Unmasking, Neurodivergent, Not Broken, and The Inclusive Language Classroom.
References:
Hull, L., Petrides, K. V., 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. https://pmc.ncbi.nlm.nih.gov/articles/PMC5509825/
Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013
Mendoza Hernandez, A. E. (2026). Neurodivergent, Not Broken: A Practical Guide to Work, Boundaries, and Energy. Mendoza Hernandez Neyra Publishing. https://www.amazon.com/dp/B0GMG6B9C6
Mendoza Hernandez, A. E. (2026). Unmasking: The Silent Struggle of Neurodivergent Women. Mendoza Hernandez Neyra Publishing. https://www.amazon.com/dp/B0GBB45855
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079