Different Settings, Different Kids
Why "masking" isn't always the right explanation
Maya brought her son Ethan in for a neuropsychological evaluation when he was eight. She described meltdowns, emotional outbursts, and what she described as an almost total inability to transition between activities at home. She was also convinced of the diagnosis: ADHD, and possibly autism.
Unsurprisingly, on behavior rating scales, Maya’s ratings were significantly elevated across almost every domain: inattention, hyperactivity, emotional regulation, flexibility, working memory. But Ethan’s teacher, Ms. Reyes, rated him squarely within normal limits on every scale.
This kind of discrepancy isn’t uncommon. Parents and teachers see kids in very different environments with different demands. Even though they describe very different behaviors, both reporters may very well be right.
So I went to observe Ethan in his classroom.
He wasn’t particularly easy to find; nothing about him stood out. He was seated with a small group during a math activity, engaged, taking turns, raising his hand. When the class transitioned to reading, he moved with them without incident. He chatted appropriately with a classmate during a brief break. Ms. Reyes redirected him once, gently, when he got a little silly, and he pulled it back. Nothing I saw was outside the range of a typical third grader.
Direct testing told the same story. Ethan’s cognitive profile was unremarkable. His processing speed was fine. His working memory was fine. His attention was fine. Qualitatively, he looked good, and his social skills during our sessions seemed age-appropriate.
So he didn’t meet criteria for either of Maya’s suggested diagnoses. ADHD and ASD both require that symptoms be present and impairing in multiple settings. They weren’t, so the diagnostic thresholds simply weren’t met. And lowering the bar to accommodate a single-setting presentation would mean the diagnosis explained nothing, because it would apply to almost any child who struggles at home.
What the evaluation did reveal was a child who did well in high-structure environments. School, with its predictable schedule, clear expectations, consistent adult presence, and built-in transitions, was working for Ethan. Home, with its more open-ended rhythms and fewer external organizers, was asking him to provide his own structure, and that was difficult for him.
This is not how a kid with ADHD or ASD would present. They don’t get to leave their difficulties at the classroom door. Sure, structure helps these kids, but they continue to show signs of their disorders when provided typical school supports. Ethan, on the other hand, was indistinguishable from his peers.
When I shared this with Maya, I was careful. I didn’t tell her the behaviors at home weren’t real. They were. I didn’t tell her there was nothing to address. There was. But I asked her to reframe: not “Ethan is masking a disorder at school,” but “Ethan is responding to supports and structure at school, and home he needs more of both.”
That reframe opened the door to solutions. It stopped the search for a diagnosis that didn’t fit and started a conversation about what this particular kid actually needed, which, in this case, was a more predictable after-school routine, an earlier and more consistent bedtime, and a lot less unstructured time between school pickup and dinner.
It wasn’t what Maya came in expecting to hear, but it was the more honest answer, and the one that actually pointed somewhere useful.
Thanks to my mom for sending me this one!