What Does the ADHD Iceberg Mean?
The ADHD iceberg may be a helpful analogy for highlighting the visible (external) and invisible (hidden) symptoms of ADHD. An iceberg is a block of ice that floats on water, and the tip of the iceberg is visible above the surface. However, most parts of the iceberg remain hidden underwater.
The ADHD iceberg is a visual analogy that helps represent the experience of having attention deficit hyperactivity disorder (ADHD). The visible symptoms of ADHD that others can see are just the tip of the iceberg, while the internal experience of having ADHD, or the invisible symptoms, is so much more than that.
The iceberg analogy is meant to show people the whole experience of having ADHD since much of it is invisible to others. The comparison helps people in mental health treatment understand how the internal experience of ADHD differs from other people’s lives in both quality and intensity.
Attention deficit hyperactivity disorder (ADHD) is a mental health condition that affects people of all ages, genders, and races. From the outside, ADHD may look like it’s just fidgeting and daydreaming — but there’s a lot more to this condition than what meets the eye.
ADHD is more than visible behaviors like hyperactivity and inattention. What people see from the outside is just the tip of the iceberg, precisely where the ADHD iceberg analogy comes from. Many other symptoms go unnoticed because they’re internal, like social anxiety, sensory sensitivity, shame, and executive dysfunction.

Skip To:
- What Does the ADHD Iceberg Mean?
- Attention Deficit Hyperactivity Disorder Statistics
- ADHD Iceberg Facts Sheet
- Visible ADHD Symptoms
- Invisible ADHD Symptoms
- The Tip of the ADHD Iceberg
- ADHD Iceberg Adults Executive Dysfunction
- Supporting Someone With ADHD
- Popular ADHD Iceberg Frequently Asked Questions
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FREE 24/7 Dual Diagnosis Mental Health Services HotlineAttention Deficit Hyperactivity Disorder Statistics
According to the National Institute of Mental Health (NIMH), approximately one-third of children diagnosed with ADHD retain the diagnosis into adulthood. Nearly half of all ADHD cases showed severe impairment (4.2%), and the estimated lifetime prevalence of ADHD in U.S. adults aged 18 to 44 years was 8.1%. [1]
8 Million
It’s estimated that adult ADHD affects more than 8 million adults (or up to 5% of Americans).
Source: NIMH
5.4%
Adults ADHD prevalence was higher for males (5.4%) versus females (3.2%).
Source: NIMH
8.7 Million
In 2019, the number of visits to physician offices with attention deficit disorder as the primary diagnosis was 8.7 million.
Source: NIMH
ADHD Iceberg Facts Sheet
The iceberg illustrates that what you see on the surface doesn’t always fully capture a person’s experience with ADHD. Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Diagnosis
A complete evaluation by a trained professional is the only way to know for sure if you or a loved one has ADHD. Treatment may include medication to control symptoms, therapy, or both. Family training may also help.
For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for their age. Stress, sleep disorders, anxiety, depression, and other physical conditions or illnesses can cause similar symptoms to ADHD. Therefore, a thorough evaluation is necessary to determine the cause of the symptoms.
Causes
Researchers are unsure what causes ADHD, although many studies suggest that genes play a significant role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that might raise the risk of developing ADHD and are studying how brain injuries, nutrition, and social environments might play a role in ADHD.
ADHD is more common in males than females, and females with ADHD are more likely to have inattention symptoms primarily. People with ADHD often have other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance use disorder.
Treatment
While there is no cure for ADHD, currently available treatments may reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
Several specific psychosocial interventions have been shown to help individuals with ADHD and their families manage symptoms and improve everyday functioning.
Behavioral therapy is a type of psychotherapy that aims to help a person change their behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
- Monitor their behavior.
- Give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting.

[2] Source: Attention-Deficit/Hyperactivity Disorder – NIMH/National Institute of Mental Health

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Hotline (855) 940-6125Visible ADHD Symptoms
ADHD is characterized and diagnosed based on a set of externally visible symptoms that are grouped into two categories: inattention and hyperactivity.
Symptoms of Inattention
These are some of the symptoms of inattention a person with ADHD may display:
- Difficulty paying attention
- Tendency to get distracted and leave tasks unfinished
- Avoidance of tasks that require prolonged attention
- Lack of attention to detail
- Difficulty paying attention to conversations and following instructions
- Poor time management and organization skills
- Forgetfulness
- Tendency to lose things
Symptoms of Hyperactivity
These are some of the symptoms of hyperactivity a person with ADHD may display:
- Squirming or fidgeting while seated
- Moving around or standing instead of staying seated
- Often feeling restless
- Constantly being on the go
- Being loud while participating in activities
- Talking a lot
- Finishing others’ sentences
- Answering questions before they’ve been completed
- Having difficulty waiting for one’s turn patiently
- Butting in on or interrupting others’ conversations or activities
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Invisible ADHD Symptoms
Many “hidden” ADHD symptoms often go unseen and are ultimately misunderstood. The visible symptoms of ADHD are behaviors that others see. However, they are merely a fraction of the ADHD Iceberg experience. The internal experience of ADHD can include the following:
- Emotional Dysregulation: People with ADHD may have trouble managing and expressing strong emotions.
- Mood Swings: ADHD can cause people to experience drastic fluctuations in mood.
- Decision Paralysis: Decision-making requires several skills and can be challenging for people with ADHD, causing them to experience decision paralysis.
- Executive Dysfunction: In addition to decision-making, people with ADHD may struggle with executive functioning tasks like planning, organizing things, or anticipating consequences. While tasks like doing taxes or planning a wedding are challenging for most people, they can be significantly harder for people with ADHD.
- Motivation Problems: People with ADHD have lower dopamine levels in the brain, leading to lower motivation levels. As a result, they may be less likely to take the initiative or to complete tasks, as they may not always be rewarded with the rush of satisfaction one feels upon completing a task.
- Frustration: People with ADHD may often experience restlessness and boredom and have a low frustration tolerance.
- Hypersensitivity: People with ADHD may experience emotions more intensely and be more sensitive to criticism. They may also be more prone to feeling overwhelmed by sensory stimuli.
- Time Blindness: Most people develop an innate sense of time. However, people with ADHD may experience time blindness, resulting in a distorted sense of time.
- Inflexibility: Some people with ADHD can sometimes be inflexible because they get stuck on one idea and have trouble seeing other ideas that might be helpful.
- Discouragement: ADHD can cause people to struggle with work, academics, and relationships, which can be highly discouraging. They may often feel ashamed or embarrassed about who they are.
- Low Self-Esteem: Unable to meet expectations—others and one’s own—despite best efforts can lead to a persistent sense of failure and low self-esteem.
- Disciplinary Issues: People often mistake ADHD for disciplinary issues, but people with ADHD may be incapable of doing what they’re expected to do. This can be particularly hard for people at school or work because it can be difficult for them to study/work, sit, and eat when they’re supposed to.
- Complications: People with ADHD are more likely to have other mental health conditions such as bipolar disorder, depression, anxiety, and learning disabilities. These conditions can add to the difficulties of living with ADHD.
The Tip of the ADHD Iceberg
ADHD is more complicated than many believe, with a wide range of symptoms that can be very challenging. There’s a famous analogy about ADHD being like an iceberg in that what you can see on the surface, the tip of the ADHD iceberg, is just a glimpse of what is hidden below. Many posts on their social media about “ADHD iceberg meme,” “ADHD iceberg posters,” etc. But what is the iceberg of ADHD?
There’s a misconception that ADHD merely means someone can’t concentrate and is hyperactive. What isn’t as widely considered is how ADHD can impact a person’s life. Sometimes, the issues below the tip of the iceberg lead someone to seek a diagnosis. Comorbid conditions of ADHD share many of these features concealed below the water, which can lead to a preliminary diagnosis when other conditions remain unidentified. You can download the ADHD iceberg pdf below:
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ADHD Iceberg Adults Executive Dysfunction
Executive dysfunction (or executive functioning disorder) may uniquely affect people with ADHD. Executive dysfunction describes the scope of different cognitive, behavioral, and emotional challenges resulting from a specific disorder, brain injury, or history of trauma (PTSD or C-PTSD). Everyone has executive functioning strengths and challenges, which is why some adults can be skilled at some things and not others. But executive functioning challenges can be more severe and impactful for adults with ADHD.
Executive functions are cognitive and mental abilities that help us take and direct actions, control our behavior, and motivate us to achieve our goals. Examples of executive functioning skills include:
- Planning
- Problem-solving
- Self-motivation
- Self-restraint or inhibition
- Self-awareness
- Working memory
- Emotional regulation
Dopamine levels in the brain play a key role as well. Dopamine, the neurotransmitter responsible for feelings of pleasure and reward, helps regulate our emotions and impulses, two main components of executive functioning. Dopamine levels may be low among those with ADHD.
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Supporting Someone With ADHD
If someone in your life has ADHD, it’s essential to understand that the symptoms you’re seeing are merely the tip of the ADHD iceberg; they’re probably going through a lot you’re unaware of.
Try to Understand the Person’s Experience
It’s crucial to make an effort to understand the person’s internal experiences so you can figure out how to support them. However, you might be unable to ask them what’s happening inside them, as not everyone can express it. You can try showing them the ‘ADHD iceberg’ and have them tell you which of those problems they experience. Alternatively, there are also checklists you can use. You can ask the person to tell you which symptoms they experience and how often or how severe they are.
Treat the Condition as a Whole
ADHD treatment is focused on the parts of the condition that are inconvenient for parents, teachers, or bosses. It’s essential to seek treatment from a qualified professional, preferably one who specializes in treating ADHD or has ADHD, as they may be better equipped to understand the internal experiences someone with ADHD may experience.

Be Kind and Patient
You may never fully understand the experience of someone with ADHD, so it’s vital to be kind and patient with them. Remember that ADHD isn’t a discipline issue; a person with ADHD may be incapable of doing what you expect them to do. For instance, if you have a loved one who has ADHD and is throwing a tantrum, rather than getting angry, upset, or frustrated with them, remind yourself that they are probably much more frustrated with their difficulties than you are.
Try to calm yourself down and be patient while you teach them to do the same. Instead of seeing their symptoms as failures, think of them simply as differences or symptoms of a condition. Focus on their strengths and teach them to do the same.
The ADHD iceberg helps demonstrate that the person may be going through a lot more than that. It’s crucial to keep this in mind and offer personalized treatment and support for their internal experiences.
ADHD Treatment and Therapies
While there is no cure for ADHD, currently available treatments may reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
Medication
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely by their prescribing doctor.
- Stimulants. The most common medication used for treating ADHD is a “stimulant.” Although it may seem unusual to treat ADHD with a medication considered a stimulant, it works by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention. Under medical supervision, stimulant medications are considered safe. However, like all medications, they can have side effects, especially when misused or taken more than the prescribed dose, and require an individual’s healthcare provider to monitor how they may react to the medication.
- Non-stimulants. A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant when:
- A person has bothersome side effects from stimulants
- When a stimulant is not effective
- Or in combination with a stimulant to increase the effectiveness
Doctors and patients can work together to find the best medication, dose, or medication combination.
Psychotherapy and Psychosocial Interventions
Several specific psychosocial interventions have been shown to help individuals with ADHD and their families manage symptoms and improve everyday functioning.
- Behavioral therapy is a type of psychotherapy that aims to help a person change their behavior. It might involve practical assistance, such as help organizing tasks or completing work, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
- Monitor their behavior.
- Give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting.

Parents, teachers or bosses, and family members can also give feedback on specific behaviors and help establish clear rules, chore lists, and structured routines to help people control their behavior. Therapists may also teach individuals with ADHD social skills, such as how to wait their turn, share things, ask for help, or respond to challenges. Learning to read facial expressions and the tone of voice in others and how to respond appropriately can also be part of social skills training.
- Cognitive behavioral therapy helps one learn to be aware and accepting of one’s thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting or resisting the urge to take unnecessary risks.
- Family and marital therapy can help family members and spouses find productive ways to handle disruptive behaviors, encourage behavior changes, and improve interactions with the person with ADHD.
- Stress management techniques can benefit you and your loved ones with ADHD by increasing their ability to deal with frustration so they can respond calmly to their loved one’s behavior.
- Support groups can help parents and families connect with others with similar problems and concerns. Groups often meet regularly to share frustrations and successes, exchange information about recommended specialists and strategies, and talk with experts.
Individuals diagnosed with ADHD might struggle with behavioral issues or their performance in school or work. Even more concerning, the risk-taking tendencies associated with ADHD can lead some to use drugs or alcohol, leading to dependency and substance abuse.
We Level Up FL offers an ADHD treatment program at our mental health treatment center in Florida. Here, clients participate in clinical and experiential therapies as part of our comprehensive curriculum. If your loved one is struggling with their ADHD diagnosis, we can help them understand their disorder and teach them the skills they need to reach their full potential.
Popular ADHD Iceberg Frequently Asked Questions
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Who created the ADHD iceberg?
The ADHD iceberg is a model popularized by Dr. Russell Barkley to help people understand that the parts of a person’s diagnosis above water are just the tip of the iceberg.
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Who first came up with the concept of ADHD?
In 1902, the core symptoms of ADHD were first described by Sir George Frederick Still, a British pediatrician, in a lecture series at the Royal College of Physicians. He observed that twenty “behaviorally disturbed” children were easily distractible, inattentive, and unable to focus for long.
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Is ADHD a mental illness or a neurological disorder?
Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder. It interferes with a person’s ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral).
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What does severe ADHD look like in adults?
Adults with ADHD may find it challenging to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience in waiting in line or driving in traffic to mood swings and outbursts of anger.
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What happens to untreated ADHD in adults?
The negative consequences of untreated ADHD go beyond the inability to focus — some of the consequences can shape your life. For example, you may be unable to maintain healthy relationships and succumb to anxiety and depression, all because of an untreated behavioral condition.
Search We Level Up FL ADHD Iceberg & Mental Health Topics & Resources
Sources:
[1-2] Attention-Deficit/Hyperactivity Disorder (ADHD) – NIMH/National Institute of Mental Health
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[6] National Collaborating Centre for Mental Health (UK). Common Mental Health Disorders: Identification and Pathways to Care. Leicester (UK): British Psychological Society (UK); 2011. (NICE Clinical Guidelines, No. 123.) 2, COMMON MENTAL HEALTH DISORDERS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92254/
[7] Krystal JH, State MW. Psychiatric disorders: diagnosis to therapy. Cell. 2014 Mar 27;157(1):201-14. DOI: 10.1016/j.cell.2014.02.042. PMID: 24679536; PMCID: PMC4104191.
[8] National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20369/
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[10] About Mental Health – Centers for Disease Control and Prevention