ADHD Iceberg Visible vs. Invisible Symptoms

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 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]

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Visible 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

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:

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:

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.

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.

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.

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