ADHD Symptoms What Does the 'ADHD Iceberg' Mean? Differentiating the visible and invisible symptoms of ADHD By Sanjana Gupta Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness. Learn about our editorial process Updated on April 27, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Shaheen Lakhan, MD, PhD, FAAN Medically reviewed by Shaheen Lakhan, MD, PhD, FAAN Shaheen Lakhan, MD, PhD, is an award-winning physician-scientist and clinical development specialist. Learn about our Medical Review Board Print Paul Souders/Stone/Getty Images What Does the 'ADHD Iceberg' Mean? An iceberg is a block of ice that floats on water. While the tip of the iceberg is visible above the surface, the majority of it remains hidden underwater. The ‘ADHD iceberg’ is a pictorial analogy that helps represent the experience of having attention deficit hyperactivity disorder (ADHD). The external symptoms of ADHD that others can see are just the tip of the iceberg, while the internal experience of having ADHD is so much more than that. This analogy shows people how much ADHD affects people beyond just fidgetiness, hyperactivity, and limited attention, says Aimee Daramus, PsyD, a licensed clinical psychologist and author. Aimee Daramus The iceberg analogy is meant to show people the full experience of having ADHD, since a lot of it is invisible to others. The comparison helps people understand how the internal experience of ADHD is so different from other people’s lives, in both quality and intensity. — Aimee Daramus This article explores the external symptoms of ADHD vs. the internal experience of the condition, and suggests some ways to support someone with ADHD. External Symptoms of ADHD ADHD is characterized and diagnosed based on a set of externally visible symptoms that are grouped into two categories, symptoms of inattention, and symptoms of 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 How to Live Your Best Life When You Have ADHD Symptoms of Hyperactivity These are some of the symptoms of hyperactivity a person with ADHD may display: Squirming or fidgeting while seatedMoving around or standing instead of staying seatedOften feeling restlessConstantly being on the goBeing loud while participating in activitiesTalking a lotFinishing others’ sentencesAnswering questions before they’ve been completedHaving difficulty waiting one’s turn patientlyButting in on or interrupting others’ conversations or activities Noticing the Small Differences of Children With ADHD or High Energy Internal Experience of ADHD The external symptoms of ADHD are behaviors that others see. However, they are merely a fraction of the ADHD experience. According to Dr. Daramus, the internal experience of ADHD can include: 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 a number of 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 ahead, organizing things, or anticipating consequences. While tasks like doing taxes or planning a wedding are hard for most people, they can be significantly harder for people with ADHD. Motivation problems: People with ADHD have lower levels of the chemical dopamine in the brain, leading to lower motivation levels. As a result, they may be less likely to take 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 may 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 be inflexible at times, 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 extremely discouraging. They may often feel ashamed or embarrassed about who they are. Low self-esteem: Being 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 simply 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 as well. These conditions can add to the difficulties of living with ADHD. Like a lot of disorders, each individual with ADHD experiences a different mix of these and other challenges, says Dr. Daramus. Supporting Someone With ADHD If someone in your life has ADHD, it’s important to understand that the symptoms you’re seeing are merely the tip of the iceberg; they’re probably going through a lot that you’re unaware of. Below, Dr. Daramus shares some tips that can help you support someone with ADHD. Try to Understand the Person's Experience It’s important to make an effort to understand the person’s internal experiences so you can figure out how to support them. However, you might not be able to just ask them what's going on inside of 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 of the symptoms they experience and how often or how severe they are. Some people with ADHD can also express themselves through story, character, or fandom. You can ask them about their favorite characters or stories that relate to their experiences. Treat the Condition as a Whole ADHD treatment is focused on the parts of the condition that are inconvenient for parents, teachers, or bosses. Aimee Daramus, PsyD One of the most important messages of the ‘ADHD iceberg’ is that you can't just treat the visible symptoms, the ones that are inconvenient to others. It’s equally important to understand the person’s internal experiences that are below the surface of the iceberg and help manage those. — Aimee Daramus, PsyD It’s important to seek treatment from a qualified professional, preferably one who specializes in treating ADHD, or has ADHD themselves, 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 important to be kind and patient with them. Remember that ADHD isn’t in fact a discipline issue; a person with ADHD may simply be incapable of doing what you expect them to do. For instance, if you have a child who has ADHD and is throwing a tantrum, rather than getting angry, upset, or frustrated with them, remind yourself that they are probably a lot more frustrated with their difficulties than you are. Make an effort 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. A Word From Verywell ADHD can be a difficult and frustrating condition to live with. However, the condition is defined, diagnosed, and treated based on a set of symptoms that are externally visible and inconvenient to others, such as the person’s family, teachers, or colleagues. The ‘ADHD iceberg’ helps demonstrate that the person may be going through a lot more than that. 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