The ADHD Iceberg Explained
Main themes:
What is the ADHD Iceberg?
Hidden symptoms of ADHD
How to cope with hidden ADHD symptoms
Next steps and working with a professional
When most people think of ADHD (Attention Deficit Hyperactivity Disorder), they may picture challenges with focus and hyperactive behaviour, as the name suggests.
While this is accurate, ADHD is a complex condition that encompasses many other traits. While some characteristics may be more noticeable to others, many symptoms often go unnoticed—even by the person experiencing them—which can lead to misunderstandings or misdiagnoses.
There are three main subtypes of ADHD outlined in the DSM-5 (the diagnostic manual used for mental health diagnoses): predominantly hyperactive/impulsive, predominantly inattentive, and combined (a blend of both symptom types). ADHD symptoms can vary widely in severity for each individual.
Some visible symptoms of ADHD include fidgeting, forgetfulness, interrupting others, or frequently losing items. However, these outward behaviours only show part of the picture. Beneath the surface, hidden symptoms can significantly impact a person’s life. The ADHD iceberg metaphor is a helpful way to illustrate these hidden aspects of ADHD.
Hidden Symptoms and Their Impacts
Executive Functioning
People with ADHD often struggle with executive functioning, which includes essential cognitive skills like planning, organizing, managing impulses, and regulating emotions. These challenges are linked to lower dopamine levels, a neurotransmitter that affects motivation and reward processing.
Emotional Regulation
ADHD can make it challenging for individuals to manage their emotions, often leading to emotional dysregulation. This may appear as mood swings, low frustration tolerance, and reactions that seem disproportionate to the situation at hand.
Rejection Sensitive Dysphoria (RSD)
RSD is an intense emotional response to perceived or actual rejection or criticism. For someone with ADHD, even minor rejections can feel devastating, leading to anxiety, social withdrawal, or behaviors like people-pleasing or avoidance.
Hyperfocus
While distractibility is common in ADHD, so is hyperfocus—an intense concentration on something of interest. Although hyperfocus can be beneficial, it often leads to neglect of other important tasks, which can strain personal relationships and responsibilities.
Sleep Disturbance
A high percentage of adults with ADHD experience sleep disturbances, including trouble falling or staying asleep. The level of disruption can vary but significantly affects daily functioning and overall quality of life.
Time Blindness
People with ADHD often have difficulty perceiving and managing time. This may result in missed deadlines or showing up late to appointments, which can be frustrating for both the individual and those around them.
Anxiety
While not a formal ADHD symptom in the DSM-5, many people with ADHD also experience anxiety, often due to the daily challenges of managing their symptoms. This ongoing anxiety can exacerbate issues with focus, emotional regulation, and executive functioning.
Sensory Processing
Some people with ADHD process sensory information differently, leading to hypersensitivity (feeling overstimulated by sensory input) or hyposensitivity (seeking additional stimulation). This can impact self-regulation and cause difficulties in managing distractions.
ADHD Paralysis
ADHD paralysis refers to the feeling of being “stuck” when trying to complete tasks or make decisions. This experience can feel like overwhelming indecision and may prevent individuals from starting or finishing tasks, even when they want to.
Procrastination
While procrastination is common, it’s a particular challenge for those with ADHD due to difficulties with executive functioning, time management, and initiating tasks. The ADHD brain’s unique reward system can create a greater incentive to act when under pressure, sometimes reinforcing last-minute work habits.
Masking
Masking involves using coping strategies to hide ADHD symptoms and conform to societal expectations. For some, masking is a conscious choice; others may do it unconsciously, especially those diagnosed later in life. Over time, masking can lead to burnout, anxiety, or feelings of inadequacy.
Perfectionism
Perfectionism can be a coping mechanism to manage executive functioning challenges. However, the desire to meet high standards, combined with societal expectations, often leads to increased stress, fear of failure, and heightened anxiety.
What May Help:
Externalizing tasks and reminders through visuals and lists can keep them visible and prevent them from slipping out of mind. Something like placing sticky notes around frequently visited areas of your home or keeping a whiteboard on your desk can help.
Chunking tasks into smaller and more manageable steps can help make large tasks feel less overwhelming. Break it down into smaller steps, or start with a small amount of time to make them feel more approachable. For example, starting with just 5 minutes of cleaning, or 3 deep breaths can feel less daunting.
Reward yourself for motivation. Small rewards can help with routine tasks, while larger rewards can celebrate milestones, providing dopamine boosts for accomplishing goals.
Establish routines to reduce decision-making fatigue. Anchor points, like designated mealtimes, can add predictability and make daily life smoother. While routines can feel restrictive, they often help manage executive functioning challenges. Additionally, breaks can provide an opportunity to pause and slow down.
The Pomodoro Technique is a method that some people swear-by, which involves working in short, timed intervals (like 25 minutes), followed by a break. There are some apps (both paid and free) and physical timers that can help with utilizing this technique.
Practicing self-compassion and acceptance, like being kinder to yourself, is part of navigating ADHD. Sometimes things can take longer or do not go as planned, and that is okay. Our capacity can change from day-to-day, and certain parts of our brain can get tired sooner.
Next Steps: When to Seek Professional Help
If you recognize some or many of these symptoms in yourself, remember that both ADHD and non-ADHD individuals may experience them.
Visual timers, reminders, and task management tools can be helpful for some challenges, such as time blindness. However, for more complex issues like rejection sensitive dysphoria, working with a trained professional can offer additional insights and coping strategies.
If you feel like you’ve tried different strategies but still find certain aspects challenging, connecting with a therapist could be beneficial. Therapy can help you explore your unique experiences with ADHD and develop tailored approaches for better day-to-day management.
Key Takeaways
The ADHD iceberg metaphor highlights the deeper challenges of living with ADHD. While the visible symptoms are more widely recognized, hidden symptoms can also cause significant disruptions in daily life and relationships. Understanding these more concealed traits can help individuals with ADHD, along with their families, establish more effective coping strategies, leading to improved overall well-being.
If you’re interested in working with a therapist who specializes in ADHD, reach out for more information. I offer a free 15-minute consultation for individuals in North America to discuss how therapy for ADHD can support your journey toward managing symptoms and improving daily life.
