A narrative review of stigma and masking in ADHD: insights from English-language research and the Japanese cultural context

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition associated with impairments across educational, occupational, and social domains. Individuals with ADHD are often exposed to misunderstanding and negative evaluation, which can contribute to stigma and psychological distress. Recently, "masking"-efforts to conceal or compensate for ADHD-related characteristics to meet social expectations-has been discussed as a potential behavioral response to stigma, yet empirical research on this phenomenon remains limited. This narrative review synthesizes English-language research on public stigma and self-stigma related to ADHD and examines how stigma may be associated with masking behaviors in ADHD, drawing on conceptual insights from the literature on autism spectrum disorder (ASD) and other related fields. In addition, the review situates these processes within the Japanese cultural context, highlighting how cultural characteristics may intensify stigma and contribute to distinctive patterns of masking. By integrating cross-cultural perspectives and highlighting gaps in the current literature, this review underscores the need for ADHD-specific conceptual frameworks, culturally sensitive research, and longitudinal studies to clarify the mechanisms linking stigma and masking. These insights highlight the need for ADHD-specific and culturally sensitive frameworks to inform future research and intervention development.