The ADHD iceberg may be a helpful analogy for highlighting the visible (external) and invisible (hidden) symptoms of ADHD.

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Attention deficit hyperactivity disorder (ADHD) is a mental health condition that affects people of all ages, genders, and races.

In fact, around 2.8% of the global population lives with ADHD, reports 2018 research.

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.

Enter: the ADHD iceberg analogy.

Picture an iceberg. A chunk of ice is visible above the water, but there’s even more below the surface.

The ADHD iceberg is a way to help folks understand the external symptoms that others see versus the internal experiences of those with ADHD.

The iceberg analogy is a helpful tool that highlights the many ways in which ADHD may affect people with this mental health condition.

The iceberg illustrates that what you see on the surface doesn’t always fully capture a person’s experience with ADHD, according to Julia Edwards, LMHC, a therapist and ADHD-certified clinical services provider in Iowa.

“The iceberg is a good reminder that ADHD isn’t just about getting distracted and being hyperactive,” Edwards says.

“The effort that we put in life to function in a society that’s not designed for neurodivergent people and our toughest internal battles are usually unseen by others, which can make us feel alone and misunderstood,” she adds.

Different communication styles

When you’re looking to improve communication, it’s important to note that each person’s style and manner of communication are different. This article explains the neurotypical styles of communication.

Neurodivergent folks, including those with ADHD and autistic people, may communicate in different ways. For instance, avoiding eye contact and fidgeting may help them concentrate better or feel more comfortable in conversations. These behaviors don’t always mean they’re uninterested.

Using different communication styles doesn’t necessarily mean the communication is less effective, though it often requires communicating with greater thoughtfulness and intention.

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According to Edwards, ADHD, especially in adults and women, can be minimized or dismissed because of a lack of knowledge and understanding.

“The iceberg can be validating and encouraging of self-compassion, especially on days where we tend to be hard on ourselves or minimize our own feelings and experiences because we’re overwhelmed with life,” she adds.

Edwards believes the ADHD iceberg can be a useful analogy for mental health professionals, doctors, teachers, and loved ones to learn about ADHD and increase compassion for what it means for those who have this condition.

“As a therapist, I utilize the ADHD iceberg with family members, spouses, and friends of people with ADHD because they also face a unique set of challenges when they’re supporting their loved ones,” Edwards says.

“Learning more about [the ADHD iceberg] and having that perspective is helpful and validating for them.”

There are three types of ADHD:

  • hyperactive-impulsive
  • inattentive
  • combined

The presentation of ADHD in children, adolescents, and adults will depend on which type of ADHD they have.

According to Edwards, common visible ADHD symptoms include:

  • excessive fidgeting
  • rushing or being late or too early
  • body-focused repetitive behaviors (e.g., skin picking, nail picking or biting, hair pulling or twirling, leg bouncing)
  • getting easily distracted by external stimuli
  • anger outbursts (e.g., road rage or meltdowns)
  • overplanning or poor planning
  • being overly organized or disorganized
  • impatience
  • constantly losing items (e.g., phone, keys, wallet, etc.)
  • forgetfulness
  • substance use or addictive behaviors
  • binge eating disorder

“What other people tend to see are behaviors. For ADHD, it’s usually the hyperactivity, impulsivity, or distractibility, which can present in fidgeting, interrupting others, constantly moving, etc.,” Edwards says.

“What other people never see is that those behaviors are usually the result of the internal experiences and symptoms that are the larger part of the iceberg that’s underneath the surface,” she explains.

There are many “hidden” ADHD symptoms that often go unseen and are ultimately misunderstood.

Edwards lists some of the invisible internal ADHD symptoms below:

  • emotional dysregulation
  • time blindness, or not being aware of time
  • racing thoughts
  • intrusive or self-defeating thoughts
  • sensory processing disorder
  • overwhelm due to sensory sensitivities
  • rejection sensitive dysphoria or sensitivity to criticism
  • social anxiety
  • choice paralysis
  • sleep issues and disturbances
  • fatigue
  • restlessness
  • low self-esteem
  • guilt and shame

“Executive functions are cognitive and mental abilities that help us take and direct actions, control our behavior, and motivate us to achieve our goals,” Edwards says.

Examples of executive functioning skills include:

  • planning
  • problem-solving
  • self-motivation
  • self-restraint or inhibition
  • self-awareness
  • working memory
  • emotional regulation

Executive dysfunction (or executive functioning disorder) may have a unique effect on people with ADHD.

“Executive dysfunction describes the scope of different cognitive, behavioral, and emotional challenges that can result from a specific disorder, brain injury, or history of trauma (PTSD or C-PTSD),” Edwards explains.

She notes that everyone has executive functioning strengths and challenges, which is why some people can be skilled at some things and not others.

But executive functioning challenges can be more severe and impactful for people with ADHD.

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.

“From my own learning and experience, I see executive dysfunction in ADHD as a self-regulation issue and not a deficit or inability to execute these skills,” says Edwards.

People with ADHD may experience challenges regulating:

  • attention and focus (distraction vs. hyperfocus)
  • emotions (emotional hyperarousal vs. hypoarousal)
  • impulses

ADHD is more than visible behaviors like hyperactivity and inattention.

What people see from the outside is just the tip of the iceberg, which is precisely where the ADHD iceberg analogy comes from.

There are many other symptoms that go unnoticed because they’re internal, like social anxiety, sensory sensitivity, shame, and executive dysfunction.

If you live with ADHD or want to support a loved one who does, consider speaking with a mental health professional to learn more about this condition and how to manage it.