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Early Childhood Masking: Why Early Childhood Therapy Must Account for Neurodivergent Coping

In the growing conversation around neurodiversity in therapy, much has been said about the ways in which neurodivergent adults and teens mask their true feelings, suppress needs, and adapt their personalities to fit societal norms. But less often do we hear this conversation applied to young children—especially toddlers and preschoolers. Some therapists argue that masking and emotional pain from rejection are “too advanced” to affect young children. But current research into attachment, trauma, autism, ADHD, and sensory processing differences paints a very different picture.

Masking Begins Early

Masking, at its core, is a self-protective behaviour. It’s a way of navigating environments that feel unsafe, overwhelming, or socially demanding. We most often associate it with autism or ADHD, but in fact, masking is also widely recognised in young children with disrupted attachment, trauma histories, or sensory sensitivities.

One clear example is Reactive Attachment Disorder (RAD), which can be diagnosed in children as young as 12 months. A 2004 study found that nearly 38% of maltreated toddlers in foster care (aged 12–36 months) showed symptoms consistent with RAD (Gleason et al., 2011). These symptoms include emotional withdrawal, failure to seek comfort when distressed, and disorganised social behaviours—signs that these children are already altering how they show emotion in response to chronic environmental stress.

Another longitudinal study by Zeanah et al. (2005) followed toddlers aged 19–30 months and found that many continued to show disturbed social and emotional behaviours well into middle childhood. These early adaptations to inconsistent or unsafe caregiving environments are clear examples of masking—long before a child can articulate their needs in words.

Early Autism and Masking

Research on autism shows that signs of masking can emerge surprisingly early. While the term “camouflaging” is more often applied to older children and adults, even preschoolers may consciously or unconsciously suppress stimming behaviours, hide distress, or imitate peers in order to avoid negative attention.

Studies have demonstrated that some autistic children as young as 3–4 years already show significant differences between how they behave at home versus in clinical settings, suggesting an early awareness of social expectations (Hull et al., 2017). This early masking can contribute to delayed diagnosis, increased anxiety, and later difficulties with self-understanding.

A review by Livingston et al. (2020) also highlights that camouflaging in autism is linked to poorer mental health outcomes and begins in early childhood, not adolescence.

ADHD, Emotional Sensitivity, and Rejection

Although the concept of Rejection Sensitive Dysphoria (RSD) is most widely discussed in adolescents and adults with ADHD, foundational traits like heightened emotional reactivity and sensitivity to criticism are present in young children.

Children with ADHD often exhibit:

• Intense distress when corrected or reprimanded
• Avoidance of tasks they fear they will fail
• Sudden outbursts after perceived rejection, even in preschool settings

Shaw et al. (2014) note that emotional dysregulation is a core feature of ADHD across the lifespan. These children may not have the language to describe rejection sensitivity, but their behaviours—clinginess, withdrawal, or over-compliance—are adaptive responses to repeated negative feedback.

Sensory Processing in Early Childhood

Sensory Processing Disorder (SPD) and sensory integration difficulties are also evident in infancy and toddlerhood. Babies and toddlers with sensory sensitivities often:

• Startle easily
• Avoid touch or certain textures
• Become distressed in noisy environments
• Show extreme responses to minor discomfort

Over time, these children may mask or suppress their reactions to avoid drawing attention or being labelled “difficult.” By preschool age, many have already developed coping strategies that look like compliance or withdrawal.

Miller et al. (2007) found that 5–16% of children in the general population exhibit significant sensory processing challenges. Early intervention can help prevent these children from internalising the belief that their natural responses are “wrong.”

Why This Matters for Therapists Working with Young Children

Some therapists may assume that because young children are preverbal or “too young to remember,” they are also too young to develop protective mechanisms like masking. But neurodevelopment doesn’t wait until adolescence. Children learn early—through experience, tone of voice, caregiver availability, and environmental predictability—whether their authentic selves are safe to reveal.

When we assume that masking or emotional suppression is “too mature” for a toddler, we risk missing early signs of distress that can otherwise be addressed preventatively. These children may appear compliant, shy, overly friendly with strangers, or emotionally flat. In reality, they are already adapting in the only ways they know how.

If we want to offer neurodivergent-affirming therapy that honours the lived experience of all clients, we must begin in early childhood. Masking is not an adult behaviour—it is a survival strategy that can emerge in the earliest years of life.

If you’d like to deepen your understanding of how masking, sensory differences, and rejection sensitivity show up in young children, our course Therapy Unmasked offers in-depth guidance for therapists, counsellors, and professionals. You’ll learn practical strategies to recognise and respond to early neurodivergent coping, build safer therapeutic relationships, and adapt your approach to better support children with autism, ADHD, and sensory processing differences. This training is designed to help you feel more confident and informed when working with clients of all ages—including toddlers and preschoolers.

References

• Gleason, M. M., Fox, N. A., Drury, S., Smyke, A. T., Egger, H. L., Nelson, C. A., & Zeanah, C. H. (2011). Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child & Adolescent Psychiatry, 50(3), 216–231.e3. https://doi.org/10.1016/j.jaac.2010.12.012
• Zeanah, C. H., Scheeringa, M. S., Boris, N. W., Heller, S. S., Smyke, A. T., & Trapani, J. (2005). Reactive Attachment Disorder in Maltreated Toddlers. Child Abuse & Neglect, 28(8), 877–888. https://doi.org/10.1016/j.chiabu.2004.01.008
• Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. V. (2017). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6
• Livingston, L. A., Shah, P., & Happé, F. (2020). Compensatory strategies below the behavioural surface in autism: A qualitative study. The Lancet Psychiatry, 6(9), 766–777. https://doi.org/10.1016/S2215-0366(19)30224-X
• Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966
• Miller, L. J., Nielsen, D. M., & Schoen, S. A. (2012). Sensory processing disorder: Implications for multidisciplinary care. Journal of Multidisciplinary Healthcare, 5, 55–62. https://doi.org/10.2147/JMDH.S24168
• Mayo Clinic (2023). Reactive attachment disorder. https://www.mayoclinic.org/diseases-conditions/reactive-attachment-disorder/symptoms-causes/syc-20352939