The Hidden Struggles of Neurodivergent Teens Who “Seem Fine”
It’s sophomore year. I’m sitting in my elective class. It’s a new classroom. I don’t know my classmates. I don’t want to be there. I feel my hands shaking and try to hide it.
Something about this memory has helped it survive all these years. It now serves as a reminder of how hard every day used to be for me in high school, lest I forget.
I grew up in Northern Virginia. My high school, Robinson, was and still is considered a “good school.” Still, every day being there felt like a pressure slowly building inside of me. If that feeling could speak, it would say “This isn’t right. This feels wrong.” That feeling wasn’t the problem. It was telling me something important. I just didn’t know how to listen yet.
On the surface, I seemed fine. I got good grades and was a “good kid” with no behavioral problems. But underneath, I was painfully lonely and confused.
My older brother’s struggles were easy to see—impulsivity, learning challenges, constant trouble at school. He was evaluated young. I wasn’t.
Instead my parents found me a therapist. I’m glad they did. But by looking only at mental health, a major piece of the puzzle was missed.
When School Feels Overwhelming Even If You're Doing Well
Northern Virginia schools are no joke. Falls Church, Arlington, and Fairfax County school districts are especially strong and well-resourced. Advanced diplomas are actually the norm for the majority of students in Fairfax County Public Schools. Some students may not even be aware that there is another option (a standard diploma).
The pressure doesn’t just start in high school. Many middle school students I work with are stressed about high school, college, and their future career. It was high-pressure when I went to high school, and it’s only gotten more intense.
Student competition. Strict deadlines. Overwhelming workloads. APs. IBs. SAT prep.
And all the while, for many students, pressure slowly building up inside.
And it’s not just classes for most teens. Many students have multiple commitments after school. It’s common for teens to tell me that by the time they finish everything for the day, it’s time for dinner and bed.
This won’t surprise many parents: according to the Fairfax County Youth Survey, only about one-third of students reported getting at least eight hours of sleep on school nights.
Neurodivergent teens are often chronically exhausted. Many need more time to recover from the demands of the day than their neurotypical peers. It makes sense that the first thing most of my teen clients say at the start of the session is “I’m so tired.”
Middle and high school is also a time of huge social development. Starting at the end of elementary school, friendships start getting much more complicated. For many neurodivergent teens, “fitting in” seems to be slipping out of reach.
Some teens are able to focus on academics. Many simply enjoy their studies, and some may lean on academic success for a sense of accomplishment. Either way, it usually keeps parents from worrying too much. Teachers’ expectations are often simpler and more predictable than the vague and changing expectations from peers. You don’t need to be cool or even have any rizz. Grades provide clear positive feedback with no guesswork required.
Others find a sense of belonging and accomplishment from diving into something they love (sports, video games, marching band, creative arts, DnD, etc.) outside of school. Again, the expectations are often clearer than with unstructured socializing. In band, you know where you stand (literally). In theater, you have lines. In DnD you know your role. And you share a common interest with other participants. It’s like a built in friend group.
When teens have a full schedule, parents are less likely to wonder why their kid never sees friends on the weekends. Sometimes it’s about passion, and sometimes being overscheduled can be a way of coping or camouflaging.
For some neurodivergent teens, school challenges go even deeper.
What Pathological Demand Avoidance Looks Like at School
Pathological Demand Avoidance (PDA) is a profile within autism characterized by extreme anxiety about and avoidance of everyday demands. Demands can be external (e.g. being told to brush their teeth) or internal (e.g. needing to use the bathroom). PDAers have a strong, innate need to feel in control and equal to those around them.
While PDA is not an official diagnosis in the United States, it is increasingly recognized and considered a subtype or profile of autism. Many PDAers and neurodivergent-affirming advocates prefer the term Pervasive Drive for Autonomy, which shifts away from pathologizing and towards understanding this neurotype.
Demands are not always easy to identify. PDAers sometimes struggle with praise or rewards as this suggests unequal power in the relationship. Internal demands, like needing to urinate or eat, can cause stress especially when someone is already overwhelmed.
I often ask parents to imagine demands as drops of water in their child’s “cup.” It’s not any one demand that causes distress. Instead, it’s the cumulative effect of perhaps hundreds of small demands each day.
For PDAers, school aversion is extremely common. The average school day is an onslaught of demands on the nervous system. There is still limited research on PDA, but it seems many (if not most) PDAers struggle to attend traditional school settings. This is true even for schools specifically designed for neurodivergent students.
Many parents of PDAers explore low-demand parenting and consider unschooling. Unschooling is a type of homeschooling that emphasizes child-led learning rather than a formal curriculum. In unschooling, the child’s learning is driven by their interests, curiosity, and real-life experiences instead of structured lessons.
Masking: The Hidden Work of Fitting In
Masking is a strategy used by neurodivergent people, consciously or unconsciously, to appear non-autistic in order to blend in and be more accepted in society. Masking often happens without the person even realizing it, so it’s not something we can just turn on or off like a light. Maybe it’s more like a dimmer switch (already very autistic-coded).
Masking is a defense mechanism (like denial or projection) and serves to protect and camouflage neurodivergent people in spaces where it doesn’t feel safe to be our authentic selves.
Masking takes a huge, unseen effort from the masker. High masking is associated with poorer mental health. It’s not surprising that many exceptional neurodivergent teens often burnout and don’t “live up to their true potential.” Ugh — can we please retire that phrase forever?
Masking may help a teen fit in, but it doesn’t guarantee acceptance. As Devin Price talks about in his book Unmasking Autism, neurotypical people often react negatively when they detect masking. Research also suggests that when neurotypical people know they are meeting an autistic person, they may actually be more understanding of our communication differences.
Signs of masking in yourself and/or your teen:
carefully observing others’ behavior and copying it
rehearsing conversations ahead of time
forcing eye contact or finding strategies to tolerate it
pretending to understand a joke
not laughing at a “joke” because you’re not sure if the person is making fun of you
stimming in a hidden way (e.g. tracing your fingertips)
forcing yourself to stay in sensory overload situations
not asking for help to avoid criticism
perfectionism and constant checking
fawning or excessive agreeableness in public, then “crashing” at home (e.g. unable to eat, sleep, shower, etc.)
frequent physical complaints, such as requesting to stay home for stomach aches
Masking has many costs. One impact that isn’t talked about as much is that it can make it harder to find your neurokin (a deep sense of kinship between neurodivergent people). When you reject who you are, it blunts self-exploration and blocks authentic connection and belonging.
Why ADHD and Autism Are Often Missed in Girls, People of Color, and Queer Youth
As a society, we have much to learn about ADHD and autism. Many people continue to imagine these neurotypes with a narrow lens. Only in the past 10–15 years have scientists begun to seriously study how gender, race, and socioeconomic factors influence who gets identified and who gets missed.
Girls are diagnosed much later on average than boys. One reason may be that girls may mask more effectively than boys. The consequences for neurodivergent girls can also be higher for girls, so girls may feel more pressure to actively camouflage their traits.
Children of color are often diagnosed with autism later than white children and may see multiple providers before receiving an accurate diagnosis. Children of color are also more likely to be initially diagnosed with behavioral disorders (e.g. conduct disorder) before autism is recognized. These differences can be compounded by multiple factors, including access to care, socioeconomic barriers, and bias in healthcare systems.
New research suggest that trans and gender diverse people are more likely than cisgendered people to be autistic. There isn’t a single agreed-upon explanation, but there are a few theories. One is that autistic people may feel less pressure to conform to traditional gender roles. Another is that autistic people may spend more time trying to understand themselves than their neurotypical peers.
When we talk about neurodivergence, it is important to consider the whole person in context. After all, we all live our lives in connection, not isolation. For many neurodivergent people, race or gender can’t be clearly separated from neurotype. As we continue to understand the ways our different aspects of our identities interact, we can more accurately recognize, affirm, and support the diverse neurodivergent community.
Support for Neurodivergent Teens Who Are Struggling Quietly
Teenage years can look very different on the outside than they feel for neurodivergent young people. Due to gaps in professional training and historically biased research, neurodivergent traits have often been misunderstood or missed. This is especially true for girls, students of color, queer youth, and other marginalized groups.
For people who go undiagnosed or unidentified until adulthood, it can mean decades of misunderstanding themselves, adapting without support, and carrying unnecessary shame.
I’ve worked with many teens and adults who were diagnosed either shortly before or during the course of therapy. Although there is often a period of “deconstruction,” where a person’s previously held view of themselves and world shifts or breaks down, what follows is a period of greater clarity and self-understanding.
Everyone has their own experience and journey, but I strongly believe that self-knowledge is power.
If you’re a parent or caregiver and some of this resonates with you about your teen (or yourself), do not despair. You are taking an important step toward learning about the more nuanced presentations of autism that are often missed. You may also be starting your own journey as well, as you learn about neurodivergence. It is not uncommon for parents to get diagnosed after their child’s diagnosis.
For Parents and Caregivers
Look beyond your teen’s grades. Teens can be high achieving and still deeply struggling.
Notice patterns. Frequent headaches, stomachaches, shutdowns, irritability at home, or exhaustion after school can signal overload.
Ask gentle, open questions. Many teens don’t know how to talk about their experiences. For example:
“What feels hardest about school right now?”
“Where do you feel most relaxed?”
Take concerns seriously, even if they seem subtle. Teens often hide or minimize challenges.
Give yourself permission to need support too. You or your teen struggling doesn’t mean you are doing anything wrong or failing.
Consider evaluation if questions persist. A high quality evaluation can help identify developmental differences as well as possibly co-occurring mental health diagnoses. Accurate diagnosis helps to find more effective supports and treatment.
Advocate for accommodations. A 504 plan or (ideally) an IEP can reduce strain. Coping skills are usually not enough for a neurodivergent teen to thrive.
Validate identity and experience. Whether it’s neurodivergence, gender identity, or cultural identity, affirmation reduces the need to hide.
Normalize downtime after school. Neurodivergent teens often especially need quiet, low-demand time immediately after school.
Make home more sensory-friendly. Consider soft or dimmable lighting, make weighted items available, explore different fidgets your teen might enjoy.
Shift focus from productivity to regulation. Try a “nervous system check-in” to see how they are feeling.
Don’t push for eye contact or physical affection. Consider alternative ways to express affection that your teen appreciates.
Allow breaks when needed (including during family time).
Reconsider screen time through a regulation lens. Screen time may be tied to a special interest that helps your teen regulate, connect, and feel competent.
Learn about your teen’s special interests. This is one of the best ways to show you love and accept them as they are.
Educate yourself. Try following autistic and ADHD content creators, reading work written by neurodivergent writers, and listen to your teen with curiosity.
Suggested Resource:
Final Thought
Struggling doesn’t always look like we expect. Sometimes it looks like perfectionism, exhaustion, or silence. By listening carefully and offering flexible support, we can help neurodivergent teens feel safer, more understood, and more themselves.