Written by Tara Boustany on
November 11, 2021
Reading Time: 8 minutes

Medically Reviewed by our Medical Affairs Team

Written by Tara Boustany on:

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder usually diagnosed in childhood. It is mainly characterized by inattention, impulsivity, and/or hyperactivity. 

However, there’s much more to ADHD that people don’t know about. There’s actually an entire world of struggles that people with ADHD face every day.

The symptoms they experience are often hidden from view but can be just as debilitating as those we see on the surface. There’s a popular analogy about ADHD being like an iceberg: what you can see on the surface is only a fraction of what lies hidden beneath.

In fact, the tip of the iceberg represents only 10% of the hallmark symptoms of ADHD: inattention, impulsivity, and hyperactivity. Yet, the remaining 90% of the iceberg is hidden underwater. It represents ADHD symptoms that are invisible to people.

Your child may be hyperactive and inattentive during their time in school. Yet, these symptoms are merely the tip of the iceberg.

This article will explore what the ADHD iceberg is, including what lies below the waterline of this iceberg analogy. It will also tackle the most common ways to manage the disorder.

If someone you love has been diagnosed with ADHD, it’s important to understand what lies beneath the surface so you can get the help and support they need.

Continue reading if you want to learn more about what the ADHD iceberg is and how it is characterized. 

What is the ADHD iceberg?

If ADHD were an iceberg, the majority of its manifestations would actually be hidden from sight. So if you were thinking of that as a metaphor for what living with ADHD is like, it’s not the worst analogy – even though we might think it’s a little trite.

The analogy of the iceberg is a good one for a few reasons, but especially because it helps us understand that ADHD really does touch almost every aspect of our lives in some way or another.

Some examples of this are that ADHD can affect your work-life (both where you end up working and how well you do your job), family relationships, sleep, and general outlook on life.

Sometimes it’s hard to see the ADHD iceberg in these areas because we don’t have a name for the difficulties that arise from having ADHD. For example, without a label, you might not think of a tendency to be disorganized as stemming from your disorder – even though this very well could be the case.

The best way to think of it is that ADHD is like an umbrella term for a whole host of related symptoms and struggles, some more obvious than others.

That’s why it’s important to understand ADHD in adults, especially if you’re currently struggling with the disorder yourself or just trying to understand and support someone who is.

Layers of the ADHD Iceberg

The ADHD iceberg is composed of many different “layers.” These show how ADHD can affect any area of your life, not just the most obvious ones like school and work.

To understand more about these layers, you first need to know that there are three subtypes of ADHD: inattentive, hyperactive-impulsive, and combined.

Each of these subtypes actually represents a completely unique set of symptoms and experiences. Sometimes, ADHD appears as if it’s primarily one type or another – but even then, there is variation within those categories, so keep that in mind.

All three types share the core symptoms of impulsivity and hyperactivity, but obviously, each subtype has its own specific struggles.

The next thing to understand is that ADHD varies in severity from person to person, which means that some of us will experience more or less of the different “layers” than others.

For example, if your ADHD is the primarily inattentive type, you might not struggle too much with hyperactivity and impulsivity, but your sleep problems might be much more severe than someone who has the combined type.

Remember that you don’t have to struggle with every single symptom on this list. Your ADHD iceberg may come complete with only a couple of these issues, or it could be more like an ice cube tray full of them!

ADHD Tip of the Iceberg

Many people link ADHD to impulsiveness, inattention, and/or hyperactivity. While these symptoms are the hallmarks of ADHD, they don’t capture the entire picture.

In fact, they only represent 10% of what ADHD is, and thus, only the tip of the iceberg. The three different types of ADHD that people know include:

ADHD, Hyperactive/Impulsive Type

This is the least common type of ADHD. It is characterized by impulsive and hyperactive behaviors without inattention.

ADHD, Inattentive and Distractible Type

This type of ADHD is mainly characterized by inattention and distractibility without hyperactivity.

ADHD, Combined Type

This is the most common type of ADHD. It is characterized by impulsive and hyperactive behaviors as well as inattention.

Hidden Beneath the Surface 

As we said earlier, 90% of the iceberg is not visible to the human eye. Correspondingly, there is far more than what meets the eye happening internally in someone affected by the disability.

Many people confuse these traits with personality defects or moral deficits. They’re not any of those things. They’re part of the ADHD brain.

In this case, parents must pay close attention to their children and be consciously aware of their symptoms. Let’s now take a look at these hidden layers of ADHD.

Skill Deficits 

Because ADHD is a developmental disorder, skill deficits are common. The most common skill impairment in children with ADHD include:

Some of these lagging skills can be taught and improved; others will be a lifelong struggle.

Developmental Delays 

School can be a challenge for children who suffer from ADHD due to slower development. In fact, children with ADHD develop 2 to 3 years more slowly than their peers.

This can impact their maturity, social skills, executive functioning, emotional dysregulation, and self-control. Parents should keep this in mind as they set reasonable expectations for their children.

Executive Functioning Deficits 

Executive function is the cognitive process that organizes thoughts and makes decisions. Executive function skills help manage day-to-day planning, emotional regulation, and time management.

When someone lacks executive function skills, daily tasks will be harder to perform. As a parent, it is important to assess your child’s level of executive functioning and to compensate for areas of weakness at school and at home.

Poor Self-Esteem and Self-Confidence 

Children who suffer from ADHD may have low self-esteem. Parents should assist them in gaining confidence by providing activities that allow their kids to succeed.

Whether these activities are small or big ones, the child will gain confidence in his or her abilities to succeed.

Emotional Dysregulation

Children with ADHD have a hard time controlling their emotions in a way that is suitable for the situation and/or their age. They may have poor self-regulation or communication skills. This impacts how they function at home, at school, and in social situations with peers.

Inflexibility

A lot of people who suffer from ADHD have a harder time managing their emotions than people without the disease. This leads them to be seen as stubborn in the eyes of others.

However, this is because people with ADHD, especially children, do not have the skills to see more than one way or to manage their emotions.

Intensity

When a child with ADHD gets stuck and inflexible, they tend to feel extreme emotions. They may also experience hypersensitivity; which means they feel their feelings more deeply.

In moments of big emotions, ask your child, “How can I help you?” That is an excellent way to start a discussion about what’s bothering them. It will also help them understand that you are there for them.

Co-Existing Conditions

Most individuals with ADHD also have one or more coexisting conditions. These conditions can include mood disorders, conduct disorders, and more. It is critical as a parent to keep an eye out for signs of distress to understand and help your child.

Time Blindness

Adults generally acquire a sense of time and the ability to track its passing. People with ADHD often have a distorted concept of time and are more time-blind than others.

They can miss appointments, or play games for hours without realizing they haven’t eaten dinner. Time blindness can profoundly impact someone’s life if they can never keep deadlines or make It to social events.

Meltdowns 

A tantrum is an uncontrolled outburst of anger and frustration that a child throws to get what they want. In general, a child that throws a tantrum is conscious of their safety and will not jeopardize it. Also, if the child gets what they want, the tantrum will stop immediately.

A meltdown is different than a tantrum. In fact, during a meltdown, the child is no longer in control of what they are saying and doing. A meltdown can be triggered by a tantrum, as well as a sensory overload, feeling misunderstood, or not feeling heard.

During a meltdown, a child might harm himself or others. They’re not able to go through their actions and rationalize properly. A meltdown will not stop if the child is given what they originally wanted.

School Incompatibility

Students with ADHD may have a harder time in school than students without the condition. This is because, in school, all tasks are not individually tailored to their needs.

In school, children must sit still, keep quiet, and pay attention for extended periods. However, children with ADHD may find it difficult to remain still for lengthy periods.

Most of the time, teachers and parents don’t realize that it is due to ADHD. As a parent, being flexible with your child is crucial when you know they suffer from ADHD. Your definition of academic success can and should be different.

ADHD Management 

Medications

5 types of medication that may be used for the treatment of ADHD:

  • methylphenidate
  • lisdexamfetamine
  • dexamfetamine
  • atomoxetine
  • guanfacine

Medications are not a permanent cure for ADHD, but they may help deal with ADHD symptoms. Medications can help a child focus a little better and for long periods. It may even calm their hyperactivity.

However, it’s only one part of a proper ADHD treatment as it doesn’t address the hidden layers. To do that, a parent must focus on building up their child’s self-esteem, emotional dysregulation, skill deficits, time blindness… Medication alone does not, and cannot, teach these skills.

Supplements

Today, supplements are being prescribed more than ever to treat different types of disorders, and ADHD is one of them. The main supplements used in ADHD are:

  • Vitamins (vitamin B, vitamin C, vitamin D)
  • Minerals (Zinc, Iron, Magnesium)
  • Herbs (Ginkgo Biloba, and Brahmi, Gotu Kola, Korea red ginseng, ​​Valerian root and lemon balm, Pycnogenol, St. John’s wort)
  • Hormones (Melatonin)

Yet, all studies on these supplements are still in their early stages, and extra research needs to be done. Also, these supplements aren’t regulated by the FDA, which means that there is no guarantee that what’s on the bottle is actually in the bottle.

Some of them might also interact with ADHD medications. This is why ADHD supplements might be helpful but they need careful consideration with your doctor first.

Therapy

In addition to drugs, various forms of therapy may help with ADHD in children, teenagers, and adults. Therapy is also useful for treating the additional issues that appear with ADHD like conduct or anxiety disorders. Some of the therapies that may be used are:

Concluding Thoughts

People believe that ADHD is only characterized by impulsiveness, hyperactivity, and/or inattention. These symptoms are the hallmarks of ADHD, but they don’t capture the entire picture. There is an entire set of symptoms hidden below the surface worth knowing.

If you don’t go deeper into the mass of the iceberg that’s under the surface, it can be quite harmful. If your child suffers from ADHD, focus on keeping an eye on their daily actions and emotions. This will not only strengthen your relationship with your child, but it will help them flourish mentally as well. ​​

Always consult your doctor before starting an ADHD drug or supplement or making any changes to an existing treatment. Always let them know about any side effects from the ADHD drug or supplement. Your doctor will discuss how long the treatment should last.

But, in many situations, treatment is maintained as long as it is helpful. Click here to see whether you or someone you know has ADHD, anxiety, or depression and get an individualized breakdown of what to do about it. 

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