What to Ask Your Child’s Teacher to Help Unmask Hidden Struggles

ADHD can look very different from child to child. Sometimes it's easy to spot — a child who can't sit still or constantly calls out in class. Other times symptoms of ADHD is masked — hidden behind quietness, compliance, and even good grades. When ADHD goes unrecognized and untreated, children may face long-term challenges like low self-esteem, academic struggles, anxiety, depression, and difficulty managing responsibilities later in life.

As a pediatrician I often ask about behaviors I notice during office visits and am surprised when parents report absolutely no problems in school. I’m not sure if the teacher isn’t noticing or isn’t clearly reporting what they observe to the parent, if the child is masking symptoms of ADHD at school, or if they’re just having a really bad day. Unfortunately it is not uncommon for this to go on for years without any further assessment and treatment, leading to significant anxiety, depression, or unhealthy coping skills by the teen years.

What things do I notice that raise my concerns in school aged children?

• Not able to answer questions due to getting distracted during the few minutes of their visit.

• Hesitating to answer as if they’re afraid it will be wrong, even for questions that have no wrong answer — like their favorite activity or food.

• Not able to talk due to being “shy” — they may answer so softly I can’t hear them or they may turn to answer to the parent and make the parent tell me what they said.

• Repeatedly doing a behavior after the parent or I have asked them to stop.

• Siblings irritating one another despite multiple redirections or threats from the parent.

• Moving around the exam table or room rather than sitting for the 15 minute visit.

Not all of these indicate that there is an underlying problem with ADHD or other conditions. I only get a snapshot of a child’s life during short office visits. Maybe they had a particularly difficult day before they saw me. Perhaps they’re not feeling well. Maybe they’re on edge coming to a medical office, but in all other aspects of life they’re fine. I can only raise questions and encourage parents to learn more about these behaviors and what may be going on behind them. If kids are struggling, I want us to team up to help them.

As a parent, you are in a powerful position to help. One of the best first steps? Having intentional conversations with your child’s teacher. Teachers see your child in an environment full of expectations, structure, and peer interactions — all situations that can either bring ADHD struggles to the surface or allow them to stay hidden. Don’t rely on “good grades” to reflect that a child is not struggling internally to get their work done. There are some bright and motivated students who work really hard to hide or mask their struggles.

Masking isn’t the same as managing symptoms. It involves hiding symptoms or over-compensating for them to try to appear like everyone else and avoid negative attention. Children and teens may mask ADHD traits they think bother other people or that their parents ask them to stop doing. In some ways, masking can help children with ADHD navigate social situations and academic expectations – but these are generally short term wins with long term consequences. Masking can lead to feelings of anxiety, stress, and exhaustion over time.

Masking symptoms and behaviors may include or lead to:

• Purposefully saying less so that they do not talk too much or interrupt people

• Holding back emotions or being very emotional

• Hiding excess energy or needing to play hard to get energy out

• Putting a lot of effort into stopping movement and fidgeting

• Using many tools to help with organization and time management

• Fearful of being late

• Struggling to estimate time for tasks

• Taking time before starting classwork to organize

• Re-writing or re-doing assignments because they aren’t good enough

• Struggling to transition from one thing to another

• Rushing through tasks

• Spending more time than classmates on assignments

• Appearing to procrastinate until the last minute

• Irritable when interrupted doing a task or when speaking

• Having perfectionist standards for themselves

• Trying to say or do what they think is the one “right” thing, even when there are many acceptable options

• Upset when others don’t follow rules or acting bossy

• Mirroring the way other people act in social situations to “fit in”

• Avoiding group activity participation

• Headaches and stomachaches before school or other activities or at bedtime

• Trouble sleeping

Masking these traits and behaviors can be exhausting and lead to significant problems. For more on the risks of not treating ADHD, see 10 Ways ADHD Can Shorten Your Lifespan.

Ultimately, masking ADHD symptoms can prevent a young person from getting effective support, developing healthy coping strategies, and realizing their true potential. Many children with ADHD are misunderstood as lazy, careless, or simply "bad at school." If the underlying brain-based differences aren't recognized, kids internalize these struggles, leading to long-term harm to their self-worth and future motivation.

Early identification means we can provide support before a child starts believing they are "bad" at learning or behaving. It opens the door for skill-building, appropriate accommodations, and a greater sense of pride and resilience.

Here’s what you should ask to help uncover potential issues early*

*Click here if you want these as a pdf to easily print and use.

1. Managing tasks and transitions

• How does my child manage tasks and transitions compared to classmates?

• Does my child seem to procrastinate or rush through tasks?

• Does my child need a lot of reminders to stay on track?

• Does my child seem messy or disorganized?

Children with ADHD often struggle with starting tasks, staying organized, or switching gears. They may appear slow to begin assignments, lose track of instructions, or take longer than peers to transition from one activity to another. A teacher’s perspective can highlight subtle patterns you might not see at home.

2. Maintaining and directing attention

• Does my child easily get bored and distracted?

• Does my child move or fidget more than expected?

• Does my child frequently forget what was said or need instructions to be repeated?

• Does my child stay engaged without close supervision while working?

• Do they seem frustrated, anxious, or overwhelmed by longer assignments?

• Does my child take excessive time to complete tasks or assignments?

• Does my child skip questions or make careless mistakes?

• Does my child forget to turn in assignments or need additional reminders to do so?

• Does my child do preferred activities rather than assigned tasks, such as reading a favorite book when they’re supposed to be doing a math worksheet?

A student who seems fine during favored or hands-on activities may quietly struggle when asked to work independently or during times they are expected to listen and learn. Kids masking ADHD might appear daydreamy, overly perfectionistic, or find ways to avoid work without drawing much attention.

3. Impulsivity

• Does my child interrupt others?

• Does my child struggle to wait their turn?

• Does my child talk at inappropriate times?

• Does my child do silly things to get attention?

• Does my child act aggressively towards other children?

Impulsivity refers to acting without thinking about the consequences. This can lead to a lack of self-control and difficulty delaying gratification. It can lead to interrupting conversations, blurting out answers, getting injured frequently, or engaging in risky behaviors. While some degree of impulsivity is normal — especially in younger children, persistent or excessive impulsivity can be a sign of an underlying issue.

4. Social interactions

• Does my child seem easily frustrated with peers?

• Are they included in group activities or do they seem isolated?

• Does my child understand how their words or behavior affect other people?

• Does my child understand the consequences of their actions?

• Does my child seem bossy?

• Does my child seem shy?

• Does my child struggle to finish lunch due to excessive talking?

ADHD can affect social skills. Some kids interrupt, miss social cues, or have trouble with impulse control in conversations. Others withdraw because keeping up with social dynamics feels exhausting or confusing. A previously outgoing child may become reclusive or struggle to maintain friendships.

5. Emotional regulation and sensory issues

• Have you noticed any emotional outbursts?

• Does my child seem particularly sensitive to corrections or comments?

• How does my child react to challenges or unexpected changes?

• Does my child overreact to their mistakes?

• Does my child seem overwhelmed in loud activities or environments?

• Does my child ask to go to the nurse for frequent complaints?

Masked ADHD can show up as emotional dysregulation. A child might get disproportionately upset over small mistakes, criticism, or changes in plans. Headaches, stomachaches, and other physical concerns may be related to anxiety or becoming overwhelmed trying to “act normal”. Teachers may see meltdowns, sudden tears, or signs of shutting down that parents don’t witness at home — or parents may see frequent meltdowns at home if children hold it all in during school. Parents may notice problems getting to school due to frequent physical complaints, especially after several days off school or when a test or project is due. They may also recognize significantly picky eating or troubles getting dressed or going places due to sensory issues.

6. Classroom supports

• What supports seem to help my child thrive in the classroom?

• What strategies have you noticed that make a positive difference?

• Are there accommodations that seem to level the playing field for my child?

When teachers recognize that a child benefits from tools or supports, they may begin to use them to help the student. While these supports are beneficial, they do not remove the underlying issue, and it is important that parents are aware of their use and share this information with the child’s physician. These accommodations may include sitting close to the teacher, using checklists, or working in quieter spaces. The supports they need can uncover hidden struggles and provide a roadmap for home use. Getting these formally written down in the form of a 504Plan can help with future educational supports.

Click here if you want these as a pdf to print and use.

Final Tip:

Approach the Conversation as a Team Effort — Include Your Child’s PCP on the Team

Teachers often appreciate when parents approach concerns with curiosity rather than judgment. You’re not asking if something is "wrong" — you’re exploring whether your child’s needs are being fully seen and met. Together, you can create a plan to help your child succeed not just this academic year, but throughout their school years.

When parents share this information with the child’s physician, it can help to bring awareness of a need for further assessment. Standardized surveys may fail to identify ADHD despite a child’s internal struggles if they mask well. A physician or psychologist who is experienced with ADHD will use this information in addition to the surveys to fully evaluate the situation. If they say there is no ADHD yet a child seems to be significantly affected by the above, it may be helpful to question their reasoning or ask for a second opinion from an ADHD-aware clinician. Proper identification allows for comprehensive treatment and management to help prevent long term consequences.

Remember, you’ve got this!