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.
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.
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]
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.
That said, you don’t have to navigate these internal 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.
While ADHD medications may help with some symptoms, non-drug therapy can also enhance the efficacy of your management plan. This may include counseling, cognitive behavioral therapy (CBT), or working with an ADHD coach.
ADHD presents many unique challenges, but they don’t have to hold you back from achieving your goals and ambitions. With the proper support, tools, and strategies, you’ll be well-equipped to navigate both the external and internal struggles of ADHD.
If you’re concerned that you may have ADHD, getting a proper diagnosis is the first step toward getting help. Check out ADDA’s ADHD test for adults. This screening test provides a checklist of symptoms that helps you to understand ADHD better and make an informed decision on what to do next.
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
