What is the ADHD Iceberg? Visible Vs. Invisible Symptoms

What Is the ADHD Iceberg?

The attention-deficit/hyperactivity disorder (ADHD) iceberg is a lens to help individuals understand the complexities of ADHD better. The tip of the iceberg represents all ADHD symptoms that are visible to everyone. This includes seeing someone act on impulse, seeing them not paying attention, or seeing the mess around the home. What is not seen is the depth of the iceberg that is beneath the surface of the water or the symptoms that lead to those actions.

Visible ADHD Symptoms

Visible symptoms of ADHD are placed into three categories: inattention, impulsivity, and hyperactivity. Inattention is the difficulty of focusing. Impulsivity is acting without thinking through consequences. Hyperactivity refers to restlessness and fidgeting with an inability to remain still. The severity of these symptoms can range from person to person.

It is also important to note that girls with ADHD and women with ADHD will have different visible signs than boys with ADHD and men with ADHD. It is typically noted that boys tend to be more impulsive and hyperactive, while girls might tend to have more inattention. Inattention is often less noticed, and therefore, girls and women with ADHD often go undiagnosed.¹

Common visible symptoms of inattention include:

• Easily distracted
• Constantly losing things
• Lack of organization
• Daydreaming
• Avoiding tasks

Common visible symptoms of hyperactivity include:

• Excessive fidgeting
• Sudden emotional outbursts
• Restlessness
• Difficulty staying quiet
• Impulsive behavior

Common visible symptoms of impulsivity include:

• Sudden emotional outbursts
• Difficulty waiting for one’s turn
• Frequent spending
• Oversharing personal information
• Interrupting others

Invisible ADHD Symptoms

Invisible symptoms of ADHD are the symptoms that cannot be seen by other people but hugely impact the emotional and cognitive well-being of people living with ADHD. Invisible symptoms can have a substantial impact because they can affect relationships, work, and overall mental health. People with ADHD might seem to be doing well, but internally, they might be struggling.

Invisible symptoms of ADHD tend to increase stigma because the outward appearance of a person will not match their internal actions or thoughts. Often, others will perceive people with ADHD as lazy or unmotivated because they cannot understand why their external symptoms are occurring. People with ADHD tend not to seek accommodations because of this stigma.

Common invisible symptoms of ADHD include:

Executive Dysfunction

Executive dysfunction is an invisible symptom that impacts people with ADHD the most. It is the inability to carry out cognitive processes, including everyday tasks such as keeping organized, time management, and even making decisions. A person with ADHD will struggle to break up tasks into smaller parts and won’t complete responsibilities.²

Below the surface, a person who struggles with executive functioning will feel internal chaos and overwhelm. This might mean they also struggle with problem-solving, which can make life difficult when handed various moments that require in-the-moment problem-solving.

Dopamine Deficiency

ADHD dopamine deficiency is a large piece of what lies beneath the surface. Dopamine is a neurotransmitter used for regulating emotions, encouraging motivation, and feeling rewarded after doing something. Dopamine is disrupted in people with ADHD, making it challenging to remain focused or feel accomplished.³

When people lack dopamine, they will not be chemically rewarded for good work or choices. This hinders their motivation and can cause a person to make poor decisions and choices in the moment, which later lead to potential detrimental consequences.

Time Blindness

Time blindness is characterized by not accurately perceiving time or knowing how much time a person has in order to complete a task or engage with others. A person who experiences time blindness will become frustrated with scheduling or over-committing and can potentially miss deadlines or activities because of a lack of awareness of time.

Time blindness can have a negative impact on a person’s career and relationships. It can cause others to feel like they cannot rely on the individual with ADHD. At work, team members may avoid working with them, or at home, their partner may feel frustrated at their inability to show up.

Racing Thoughts

ADHD racing thoughts are the continuous stream of thoughts that come often and are disorganized in a person’s mind. These thoughts can be overwhelming and might bring a person from one thought to another without any connection in between. The irrelevancy of the topics to one another can cause a person to become easily flustered and make it more difficult to engage with those around them.

Racing thoughts impact more than just thinking. These thoughts often impact the way in which a person can make decisions if they feel that they are bouncing from one outcome to the next. This provides internal chaos and can cause a person not to make decisions at all.

Sleep Problems

Several ADHD sleep problems impact a person below the surface. Lack of sleep impairs the brain’s function and can cause issues in various areas of life.⁴ Disrupted sleep can increase the severity of symptoms such as emotional dysregulation and executive dysfunction. This will have a ripple effect and impact on one’s relationships, work, and overall health.

Sleep problems often stem from a person struggling to be able to have a nighttime routine and, therefore, also struggling to get up and feel well-rested in the morning. This may add to the stigma of others finding them to be lazy or unmotivated.

ADHD Paralysis

ADHD paralysis occurs when a person is so overwhelmed that they struggle to function because they cannot process their next move. It is an overwhelming feeling of being stuck and unable to complete a task even when they want to. Examples include the pile of laundry not being completed or dishes not being put into the dishwasher.

ADHD paralysis can cause emotional and functional disruptions in a person’s life. Even when a person tries to interact or engage, they often find themselves stuck and frustrated, which can limit their ability to grow in their career, their relationships, and overall functioning. Recognizing this is crucial to working through the day-to-day.

How the ADHD Iceberg Can Be Helpful

Understanding the ADHD iceberg can be helpful to the individual with ADHD as well as their loved ones. When an individual with ADHD becomes aware of the iceberg, it can ameliorate their self-criticism and help them recognize how to overcome day-to-day challenges. Invisible symptoms can become amplified when the person with ADHD does not recognize them or tend to their needs.

At the same time, it can help loved ones recognize the misconceptions and stigma they carry about ADHD. It will allow family, friends, and coworkers to feel less frustrated. Additionally, uncovering the challenges that a person with ADHD faces gives a person the opportunity to feel more supported and less lonely.⁵ It also helps to encourage inclusive spaces as more people become aware of ADHD and the visible vs. invisible signs.

When to Seek Professional Support

A person should consider seeking professional help when their ADHD symptoms are impacting their day-to-day functioning. It is important that a person find a neurodiverse-affirming therapist so that they feel validated when explaining their signs and symptoms. An online therapist directory is a helpful tool for finding a therapist specializing in ADHD treatment because you can filter by the therapist’s specialties.

If a person notices that they are struggling to function, finding a psychiatrist might be a viable option. An online psychiatrist can be a good choice for finding ADHD medication management because it offers flexibility in scheduling.

In My Experience

In my experience, it’s important to look at an ADHD diagnosis and recognize what signs and symptoms might be present at various times in life. Taking an approach to find a treatment that is right for you is crucial to have a more positive outlook and impact on life. A person will be able to function better once they have recognized their symptoms and be able to have a treatment plan that is right for them.

It is helpful to find resources that will support a person with exploring more of their needs. This might include finding other agencies that would be helpful in treatment, books for education, or podcasts that provide tips and tools for living with ADHD. You should not feel alone and isolated and deserve to get the support you need.