At the mention of ADHD, what comes to mind? It could be the constant movement and fidgeting or the inability to stay focused and pay attention.
Those symptoms form a core part of ADHD. But there’s so much more to ADHD than what meets the eye.
The ADHD iceberg is an analogy representing the visible and invisible symptoms of ADHD.
Above the water, the tip of the iceberg represents the external symptoms of ADHD many people recognize. Meanwhile, a much larger piece lies unseen beneath the water, representing the hidden struggles and challenges of ADHD that many aren’t aware of.
Visualizing an iceberg can help loved ones understand the full impact of ADHD on someone’s life.
If you have ADHD, the iceberg can be a good reminder to practice self-compassion when facing the unique challenges related to this disorder.
ADHD is complex and goes beyond inattention, hyperactivity, or impulsivity.
[wpcode id=”471443″]
Originally published on January 9th, 2023, this article was updated and republished on May 29th, 2024.
The External and Visible Symptoms of ADHD
These tell-tale signs of ADHD are what specialists look out for when diagnosing someone.
The external symptoms of ADHD are grouped into two main categories: inattention and hyperactivity/impulsivity.
Symptoms of inattention in adults with ADHD include the following:[1]
- Difficulty remaining focused (especially during routine or repetitive tasks)
- Missing details and making careless mistakes
- Trouble listening in conversations
- Difficulty organizing and prioritizing tasks
- Lacking time management skills
- Failing to meet deadlines
- Trouble following through with instructions and completing tasks
- Avoiding tasks that require maintained focus
- Losing important items needed for work, school, or tasks
- Easily distracted by unrelated stimuli
Symptoms of hyperactivity and impulsivity in ADHD include:[1]
- Fidgeting, squirming while seated, tapping hands and feet, and other forms of stimming
- Leaving seat when inappropriate (e.g., in meetings and lectures)
- Moving all the time
- Blurting out answers and completing other people’s sentences
- Interrupting others
- Trouble waiting for their turn
- Intruding in other people’s conversations or activities
- Talking excessively
There are three types of ADHD:
The symptoms you experience depend on how your ADHD presents. For example, someone with predominantly inattentive ADHD will show more signs of inattention, including trouble with focus, organization, and prioritization.
All three types of ADHD can be disruptive in various areas of life.
For example, ADHD can cause a person to miss deadlines, forget meetings, and make careless mistakes at work.
At home, ADHD can make it challenging to complete house chores, pay bills on time, and keep the house organized and neat.
The external symptoms of ADHD can also manifest in relationships. Interrupting people in conversations and forgetting special dates may cause relationship issues.
These core symptoms are often quickly noticed and linked to ADHD. However, there are many other aspects of ADHD that other people may not see or recognize.
The Invisible and Internal Symptoms of ADHD
ADHD is widely associated with being hyperactive and impulsive. This is common in children with ADHD, but the same may not apply to adults.
As a person ages, symptoms of hyperactivity and impulsivity can become more internalized. For example, external fidgeting may turn into inner restlessness and an inability to relax.
The ADHD iceberg explains the symptoms and struggles that non-ADHDers may not see or understand. These are represented by the lower portion of the ADHD iceberg hidden beneath the water.
The following are some of the internal and invisible symptoms of ADHD:
- Poor emotional regulation: Adults with ADHD may have a low frustration tolerance, higher irritability, and regular mood swings.[2] They may also have a short fuse and lose their temper quickly.
- Time blindness: Time blindness makes it difficult to estimate time. Due to this, ADHDers may struggle with estimating how long it takes to complete their tasks and show up either late or too early for events.
- Decision paralysis: Also known as ADHD paralysis or analysis paralysis, decision paralysis happens when too much information, noise, or clutter overwhelms the ADHD brain. This causes the person to freeze when faced with a decision.
- Hypersensitivity: ADHD hypersensitivity may be physical or emotional. Adults with ADHD feel their emotions very strongly and may be more affected by negative comments or rejection.Physical hypersensitivity happens when a person with ADHD cannot filter out surrounding sounds, lights, or stimuli. As a result, everything around them can become a distraction.
- Low self-esteem: People with ADHD may feel unable to meet expectations in their work, school, or relationships. This, in combination with discouraging comments and criticism, could lead to lower self-confidence.[3]
- Sleep problems: Many ADHDers deal with sleeping problems, such as difficulty falling asleep and waking up frequently in the middle of the night. They may also experience restless sleep, breathing difficulties, nightmares, shorter sleeping times, daytime sleepiness, and anxiousness around bedtime.[4]
- Co-existing conditions: Research estimates that up to 80% of adults with ADHD have one or more co-existing mental health issues. Examples include depression, anxiety, mood disorders, and personality disorders.[5]
- Weaker executive functioning: Executive functions refer to the mental skills that help us think flexibly, remember details, control our focus, and juggle multiple tasks. People with ADHD may have weaker executive functioning, leading to trouble with organizing, prioritizing, and planning. They may also have trouble recalling details and solving problems.
- Missing motivation: Because of a difference in the chemistry of an ADHD brain, ADHDers may struggle with finding the motivation to start or complete tasks they’re not interested in. This makes it harder for a person with ADHD to feel that rush of excitement or sense of accomplishment when they successfully finish a task.[6]
How ADHD Symptoms Evolve From Childhood To Adulthood
It’s natural for your ADHD symptoms to evolve. The symptoms of ADHD in childhood can look very different from those experienced as an adult.
Children are more likely to show external symptoms of hyperactivity, which is why ADHD is easier to spot in younger kids than adults.
In the late teenage years and adulthood, there will be a decline in these obvious symptoms of hyperactivity, making ADHD harder to recognize.
On top of that, adults with ADHD are more likely to experience the “hidden” symptoms of ADHD compared to children. These include sleep problems, low self-esteem, and co-existing depression or anxiety issues.[7]
Why Adult ADHD Is Complex: The Uniqueness of Adult ADHD
There are several reasons why adult ADHD is tricky to recognize and diagnose:
- Adult ADHD falls on a spectrum, meaning that this condition can look very different from one adult to another.[8] Some adults struggle more with focus and memory, while others struggle to regulate their emotions.
- Adult ADHDers may have developed coping mechanisms to make up for their lack of focus, which can mask their symptoms.[8]
- Apart from this, co-occurring conditions, such as anxiety and depression, are more likely to affect adult ADHDers. Some of these conditions share overlapping symptoms with ADHD, complicating its diagnosis.[8]
As you learn more about adult ADHD, it becomes easier to spot this condition in yourself or your loved ones. If a diagnosis is made, adult ADHD is highly treatable with various options, including medications and therapy.
Internal Struggles of ADHD Should Not Be Overlooked
ADHD can lead to internal challenges that those around you may not see. These invisible struggles are just as real and important to tackle.
In general, there are several ways to address both the internal and external symptoms of ADHD. They are as follows:
- ADHD medications: The first line of treatment typically includes stimulant medications. These medications help balance the levels of chemical messengers in your brain, reducing symptoms.
- Non-drug therapy: Certain ADHD therapies can also enhance the efficacy of your management plan. This may include cognitive behavioral therapy (CBT), a form of talk therapy that helps you replace unhealthy thinking patterns with better ones.
- Coaching: An ADHD coach can help you develop life skills and strategies to overcome daily challenges. For instance, they can guide you in creating a daily routine for better time management.
You don’t have to navigate your ADHD struggles alone. If you haven’t already, talk to your healthcare provider about diagnosis and treatment. Then, check out our resources for adults with ADHD.
The ADHD Iceberg: Unveiling Hidden Challenges And Superpowers
ADHD presents many unique challenges, but they don’t have to hold you back from your dreams and ambitions. With the proper support, tools, and strategies, you’ll be well-equipped to navigate both the external and internal struggles of ADHD.
Plus, the ADHD iceberg doesn’t only refer to challenges. There are many hidden ADHD superpowers that many people—including yourself—haven’t discovered yet.
Empathy, hyperfocus, problem-solving, and entrepreneurship are just a few of the hidden strengths many ADHDers possess. By exploring and nurturing these strengths, you can leverage them to achieve your life goals.
Dealing with ADHD may feel like a lonely path. But you can change this. Through ADDA+, you can connect with other adult ADHDers in support groups who understand both the external and hidden struggles of ADHD.
ADDA+ also offers many valuable resources designed by experts to help you regain control over your life.
References
[1] Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/
[2] Beheshti, A., Chavanon, M. L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7
[3] Cook, J., Knight, E., Hume, I., & Qureshi, A. (2014). The self-esteem of adults diagnosed with attention-deficit/hyperactivity disorder (ADHD): a systematic review of the literature. Attention deficit and hyperactivity disorders, 6(4), 249–268. https://doi.org/10.1007/s12402-014-0133-2
[4] Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. Attention deficit and hyperactivity disorders, 7(1), 1–18. https://doi.org/10.1007/s12402-014-0151-0
[5] Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
[6] Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J. S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C., & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA, 302(10), 1084–1091. https://doi.org/10.1001/jama.2009.1308
[7]Franke, B., Michelini, G., Asherson, P., Banaschewski, T., Bilbow, A., Buitelaar, J. K., Cormand, B., Faraone, S. V., Ginsberg, Y., Haavik, J., Kuntsi, J., Larsson, H., Lesch, K.-P., Ramos-Quiroga, J. A., Réthelyi, J. M., Ribases, M., & Reif, A. (2018). Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology, 28(10), 1059–1088. https://doi.org/10.1016/j.euroneuro.2018.08.001
[8] Mahadevan, J., Kandasamy, A., & Benegal, V. (2019). Situating adult attention-deficit/hyperactivity disorder in the externalizing spectrum: Etiological, diagnostic, and treatment considerations. Indian journal of psychiatry, 61(1), 3–12. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_549_18
