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 characteristics 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.

This article explores the external characteristics of ADHD vs. the internal experience of people with this type of neurodivergence and suggests some ways to support someone with ADHD.

External Characteristics of ADHD

ADHD is characterized and diagnosed based on a set of externally visible traits and characteristics that are grouped into two categories, inattention, and hyperactivity.

Inattention

These are some of the characteristics 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 following conversations and instructions
• Poor time management and organization skills
• Forgetfulness
• Tendency to lose things 

Hyperactivity

These are some of the characteristics 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

Internal Experiences 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 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: Because ADHD brains process information differently, 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 more challenging for people with ADHD.
• Motivation problems: People with ADHD have lower levels of dopamine in the brain, which leads 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.
• 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. However, this is due to the fact that expectations are centered around neurotypical society, and people with ADHD are not accommodated and supported appropriately.
• Complications: People with ADHD are more likely to have mental health conditions such as bipolar disorder, depression, anxiety, and learning disabilities. These conditions can add to the difficulties of living with ADHD.
  

ADHD Strengths

It is important to recognize that while ADHD may have hidden challenges, people with ADHD brains also have many strengths. Such strengths can also be part of the ADHD iceberg, since these capabilities are often unappreciated or not supported.

ADHD is a form of neurodivergence. Many of the challenges people experience are caused by the fact that we live in a society made for neurotypical people.

Some of the strengths that people with ADHD possess include:

• High energy levels
• Creativity
• Spontaneity
• Self-awareness
• Resilience
• Conversational skills
• Enthusiasm
• Empathy
• Persistence
  

Supporting Someone With ADHD

If someone in your life has ADHD, it’s important to understand that the traits 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 characteristics they experience.

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.

Take a Holistic Approach

ADHD support is focused on the parts of the condition that are inconvenient for parents, teachers, or bosses. 

It’s important to seek treatment from a qualified professional, preferably one who specializes in supporting ADHD, or has ADHD themselves, as they may be better equipped to understand the internal experiences someone with ADHD may have.

Be Kind and Patient

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. Focus on staying calm and figuring out how to support their needs in the situation.

A Word From Verywell

ADHD can have challenges, but it is important to be aware that many of these challenges stem from a lack of adequate support and neurotypical-centered expectations. While ADHD is diagnosed based on a set of observable external symptoms, the ‘ADHD iceberg’ helps demonstrate that the person may be going through a lot more than that. It’s essential to keep this in mind and offer the person support for their internal experiences as well.