What's the ADHD Iceberg?

ADHD is a common condition, but it continues to be highly misunderstood. People with ADHD are using the analogy of an ADHD Iceberg to explain to others that living with ADHD is not what it may seem on the surface.

In this article, we’ll explain exactly what the ADHD Iceberg means and give you tips on how to support someone with ADHD.  

What Does the ADHD ‘Iceberg’ Mean?

Here’s an interesting scientific fact: around 90% of icebergs are underwater. What we see as a huge mound of ice floating on the ocean’s surface is only a small portion of the complete mass. That means that we can’t begin to fathom how enormous an iceberg really is by simply looking at the part that’s visible to us above water.

This fact about icebergs is often used as an analogy to help people understand various health conditions, including ADHD.

The ‘ADHD Iceberg’ analogy paints a clear picture of how complex ADHD really is. What other people can see of ADHD is just a small portion of the complete experience of actually living with ADHD. As cliche as it may sound, what others see and understand about ADHD is really just the “tip of the iceberg.”

The external symptoms of ADHD, or what other people see, make up the 10% of the iceberg that floats above the surface. But 90% of the ADHD Iceberg — the internal symptoms — are hiding underwater. By learning about and trying to understand the full iceberg (the complete picture of what it means to live with ADHD), we can be more supportive of the people we love who live with this condition.

External Symptoms of ADHD

The external symptoms of ADHD, or the 10% of the ADHD Iceberg that’s above water, are what other people see of the ADHD experience. 

How people view ADHD could depend on the type of ADHD that the person has. There are three presentations of ADHD: the primarily hyperactive-impulsive presentation, the primarily inattentive presentation, and the combined presentation (people with combined-type ADHD have features of both presentations).

But, in general, some of the most visible external symptoms of ADHD include:

• Constantly fidgeting, like tapping pens or shaking a leg
• Blurting things out or interrupting people
• Losing things
• Talking too much
• “Bouncing off the walls” or constantly running, climbing, and playing (for kids)
• Having emotional “meltdowns” or angry outbursts
• Not following instructions
• Always being late
• Forgetting important appointments
• Using drugs or alcohol (to cope)

What these external symptoms have in common is that they are ADHD behaviors. In other words, other people are more likely to notice this outward expression of ADHD symptoms. But often, they don’t know about everything that’s happening on the inside that causes people with ADHD to behave in these ways. 

Sometimes, this lack of understanding causes people to become frustrated with their loved ones with ADHD.

Internal Effects and Experiences of ADHD

These external behaviors that make up the tip of the ADHD Iceberg are only a small portion of what it’s like to experience life with ADHD. These behaviors don’t come out of nowhere — they’re caused by internal processes, symptoms, and experiences that people with ADHD face every day. Some of these internal symptoms of ADHD are caused by neurodivergence (differences in the brain). Others are secondary effects of living with ADHD.

Again, people with ADHD are unique individuals, and their internal experiences may vary. But generally, the internal (and usually hidden) symptoms of ADHD include:

• Challenges with executive functions like planning, motivation, and decision-making
• Emotional dysregulation
• Lack of self-esteem
• Racing thoughts
• Feeling overwhelmed
• Sensory over- or under-stimulation
• Hyperfocus
• Sensitivity to criticism
• Sleep issues
• Feelings of shame
• Time blindness
• Problems with motivation
• Masking symptoms to fit in
• Social rejection
• Forgetting basic self-care tasks like eating and bathing
• Symptoms of comorbid conditions like depression
• Social anxiety or feeling rejected

This gives us a clearer picture of what it’s like to actually live with ADHD, and start to understand the other 90% of the iceberg. And the external symptoms listed above start making a lot more sense when put into the context of internal experiences and brain differences.

For example, externally, you might be able to see that your loved one with ADHD is always late. You might know that this is due to their ADHD, but not understand why this happens. Without understanding, you might feel frustrated with your loved one. You could have thoughts like, “I know she has ADHD, but why can’t she just get it together and check the time to make sure she isn’t late?”

But chronic lateness in people with ADHD can be caused by what doctors call “time blindness”. Time blindness means that often, people with ADHD are unable to mentally track the passing of time. What they estimate as 10 minutes by their internal clock could actually be 3 hours, and vice versa.

The problem is that time blindness and poor working memory is a hidden symptom of ADHD, which means that most people don’t know about it. 

By digging deeper and learning more about the internal symptoms of ADHD, we can start to get a better sense of why people with ADHD behave the way they do. Perhaps more importantly, we begin to understand that it isn’t their fault.

How to Support Someone with ADHD

If your child, or another loved one, has ADHD, then try to remember this analogy of the ADHD Iceberg. What you’re able to see as an outside observer is only a fraction of their experience. Their internal life with ADHD is much more complex — and usually a lot more difficult to live with.

Here are some ways to support your loved one with ADHD using the ADHD Iceberg.

Be patient

First of all, try to be as patient as possible. Remember that although your loved one’s behaviors may at times appear confusing or even nonsensical to you, there is almost always an internal symptom of ADHD that’s causing them to act this way. Allow this knowledge to help you have more compassion for your loved one’s challenges.

Ask questions

Make a real effort to learn about all of the ADHD experiences that are part of the ADHD Iceberg, not just the visible symptoms. A great first step is to ask the person what they think about and experience their condition. You can also ask your child’s doctor or therapist about some of the more unknown symptoms of ADHD and learn about the condition together.

Target the Underlying Symptoms

When working with your child or loved one to better manage ADHD symptoms, try to use methods that target the “unseen” or internal symptoms that influence the behaviors.

This can include visual charts to help with executive functions like getting ready for school in the morning, setting timers to help children understand when it is time to transition to a new activity, or providing a standing desk at school to allow a child to fulfill the movement impulse while still learning.

There are many other modifications for ADHD people that can be made to school, work, and home environments to help life flow more smoothly. A licensed therapist with special knowledge of ADHD would be an excellent starting place to learn more about these strategies. 

Validate and affirm

It’s likely that your loved one with ADHD has feelings of shame or guilt about the way ADHD makes them behave. Affirm your loved one’s strengths without invalidating their feelings. Remind them of the ADHD symptoms that cause them to act this way, but don’t tell them how they should or shouldn’t feel. Let them know that whatever they feel is valid.

Takeaway

The ADHD Iceberg analogy gives us a great glimpse into the complexities of living with ADHD — and how misunderstood people with ADHD often feel. The behaviors that people with ADHD typically exhibit are barely scratching the surface of what it’s like to have ADHD.

This analogy can help people with ADHD feel more validated in their experiences as well as help others understand that life with ADHD is much more multifaceted than it may seem.