What if my child masks during the assessment?
How to explain a difference between clinic, school and home without claiming that one calm appointment proves or rules out masking.
The short answer
Tell the team that your child's presentation varies and give specific examples of the conditions, support and before-and-after impact. Do not claim that a calm, talkative or compliant appointment proves masking, and do not assume it rules out diagnosis. Explain what the child does in clinic, what happens in other settings, what effort or recovery they report, and who observed each part. NICE autism guidance says clinicians should consider additional information or observation in another setting when reported signs and assessment findings differ. Ask how the team will investigate the discrepancy.
What helps, in short
- Describe variation before assigning the masking explanation.
- Include context, support, effort, recovery and source of each observation.
- A single clinic presentation should be interpreted with the wider assessment.
- Ask what further information or observation would clarify the difference.
Some children consciously or unconsciously change how they communicate, move or respond around other people. Families often call this masking. A child may also look different in clinic because the session is structured, brief, novel, one-to-one or based on an interesting task.
The useful point is variation. The explanation still needs assessment.
Describe both conditions
Write what happened in clinic:
S answered direct questions, made eye contact several times and completed every activity with one clinician in a quiet room.
Then add other sources:
S says they watched the clinician's face to work out the expected response and did not understand two questions. At school, staff report participation in structured lessons but no eating in the dining hall. At home, the family observed silence and sleep for four hours after the appointment.
Label each source. The child's report of effort is valid information, but it is not the same as a clinician's observation.
Do not coach a performance
Tell your child there are no special answers and they can say they do not know, ask for a pause or correct an adult. Do not ask them to suppress eye contact, stop using learned strategies or demonstrate distress. That would replace one unrepresentative performance with another.
Provide natural access support. Communication adjustments help the child participate and allow the clinician to record what support was needed.
Ask how discrepancy will be investigated
NICE autism guidance says that when reported signs and assessment observation differ, clinicians should consider more information from other sources or further observation in another setting [1]. ADHD assessment similarly draws on observer reports and impairment across settings, not one observation [2].
Ask:
- Which difference does the team consider important?
- What evidence from school, home or development is available?
- Would another observation or informant help?
- How are support, novelty and recovery being considered?
- What remains uncertain?
Do not demand that the team accept masking as the conclusion. Ask it to explain how the wider evidence was weighed.
Include the time before and after
The appointment window may miss preparation and recovery. Record sleep, repeated questions, physical symptoms, communication changes or recovery only where they occurred, with dates and sources.
For example: "The evening before, C asked the same appointment question 18 times; counted by parent. During clinic, C spoke fluently. Afterwards, C reported a headache and used no speech for two hours." The assessor can decide how this fits the wider formulation.
Include occasions when the child did not show the same cost. Balanced evidence is more credible and may reveal which conditions matter.
The full assessment guide explains how sources are combined, while the school information guide helps staff provide context rather than a verdict.
A calm appointment neither proves that the child has no difficulty nor proves that they masked it. Specific examples across conditions give the team something it can examine.
If the written report later describes only the clinic presentation, ask the team to confirm how it considered the other sources. Correct factual omissions without asking clinicians to state masking as fact when they did not reach that conclusion.
Keep the request narrow. You are not asking the team to ignore what it observed. You are asking it to interpret that observation alongside development, impairment, other settings and the child's report of effort.
If the team needs an additional informant, choose someone who knows the relevant setting and can provide examples. Do not recruit several people to repeat the family's conclusion.
Sources
- NICE, Autism spectrum disorder in under 19s: recognition, referral and diagnosis
- NICE, Attention deficit hyperactivity disorder: diagnosis and management
Sources and further reading
- [1] NICE. Autism spectrum disorder in under 19s: recognition, referral and diagnosis (accessed 4 August 2026).
- [2] NICE. Attention deficit hyperactivity disorder: diagnosis and management (accessed 4 August 2026).
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