WHAT IS THE ADHD ICEBERG?
Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder that can impact people in many ways, at home, school and work. The latest available stats reveal that 9.4 percent (over 6 million) of children in the US have been diagnosed with ADHD. Recently, the diagnosis rates of ADHD in adults have been rising - growing four times faster than among children in the US, leading to a consensus among the scientific community that ADHD is underdiagnosed in adults. It is a commonly misunderstood condition due in part to the reason that many of its symptoms are also experienced by those without ADHD, such as forgetfulness, procrastination, or being easily distracted.
It is important to have empathy when trying to understand a person with ADHD because it changes how one sees the world completely. It is a hidden disability because the people suffering from it do not look sick or injured. So most cannot see their daily struggles with ADHD.
The ADHD Iceberg helps remedy this lack of understanding of the majority of issues that are out of sight (1).
The top of the iceberg represents the symptoms of ADHD that we can see (the 10%)—things like hyperactivity, inattention, and impulsivity. Underneath the waterline is where you’ll find the less obvious symptoms of ADHD (the 90%), like low self-esteem, poor money management skills, and substance abuse issues (1).
What most people do not understand is that ADHD is a serious neurodevelopmental condition that has a significant impact on one’s ability to function in society (2).
In children, ADHD affects the parts of the brain that help with time management and emotions, getting started on and completing tasks, and many more. The executive function impairments common among people with ADHD cause significant difficulties in completing tasks and meeting expectations on the personal, academic, and professional fronts (3).
ADHD can leave sufferers frustrated. Therefore, it makes a big difference when people around you understand the debilitating impact ADHD can have on your life (3). This also enables those with the condition to focus more on their recovery.
Thus, understanding the ADHD iceberg is vital for success with the condition.
But what is the ADHD iceberg? Why is it so important? And why do so many people struggle with successfully using it?
What is the ADHD Iceberg?
The ADHD iceberg theory is an analogy that compares the outward signs of attention deficit hyperactivity disorder (ADHD) with an iceberg floating in the ocean. The tip of the iceberg is visible above water whereas most of the ice (and its weight) is hidden below. Although some people with ADHD have obvious symptoms, many others have milder symptoms that are harder to detect (4).
The tip of the iceberg shows what most people may think about when they hear about ADHD or the classic symptoms of ADHD (4). People often associate ADHD with hyperactive behavior, talking fast, acting quickly, and being an inability to sit still. But these symptoms tend to appear only in young children and are less common in teens and adults.
Below the surface are other issues, like difficulties making friends or sticking with a job, that are also related to ADHD but often go unnoticed by others.
The ADHD iceberg is a way of thinking about the condition that helps you realize there is more to it than just the behavior that you might notice as a parent or teacher. Understanding the iceberg will help you realize how important it is to consider the possible causes of ADHD symptoms and to get your child’s ADHD diagnosed and treated.
Importance of understanding the ADHD iceberg
The iceberg model shows how seemingly unrelated difficulties can stem from a single cause: untreated ADHD.
The biggest obstacle to understanding ADHD is that it's not just one thing. It's a complex condition, with multiple symptoms and subtypes.
The ADHD iceberg illustrates the difference between observable behavior and symptoms below the surface that may be causing the behavior. It is one of the strongest tools used to describe what ADHD is, and the impact it has on different people in different ways. And, it is a useful metaphor for many other conditions as well.
The ADHD iceberg cues users to look for hidden clues about the origin and nature of the ADHD symptoms in a person. This means that one needs to look beyond what a person with ADHD does since a lot happens below their conscious awareness. So, if you really want to understand someone with ADHD, you need to think about things from their perspective, not just your own.
Some of the invisible symptoms that can be noted from the ADHD Iceberg are:
- Emotional dysregulation
- Social anxiety
- Time blindness
- Rejection sensitive dysphoria
- Intrusive or self deprecating thoughts (5)
And many more.
When we don't know what lies beneath the surface, it's difficult to see why someone might be acting in a particular way or having difficulties coping with tasks that appear simple to everyone else.
When we understand what lies beneath, we can develop and implement strategies to overcome those difficulties and help them become more confident and self-aware and in turn be able to live with ADHD (5).
How to use the ADHD iceberg to understand ADHD patients
The ADHD iceberg is a model popularized by Dr. Russell Barkley to help people understand that the parts of a person's diagnosis that are above water are just the tip of the iceberg (6). What you can't see in a person with ADHD is all the internal working memory struggles, emotional regulation issues, and executive function deficits that make up what we call "ADHD."
If you’ve ever worked with children, adolescents or adults with ADHD, you have probably noticed the ADHD Iceberg in action (6). You see it when a child can’t keep up with his classmates or when a teenager can’t get his homework done, or when an adult struggles to complete her to-do list (6).
In each of these scenarios, it’s easy to see the surface-level symptoms. But what about the underlying characteristics that contribute to those symptoms? The ADHD iceberg can be used to educate the people who interact with those with ADHD.
It is an easy to understand method for those with ADHD as well as some may not know why they feel the way they do.
- Jerome L. ADHD & Driving: A Guide for Parents of Teens with ADHD. The Canadian child and adolescent psychiatry review. 2003 Nov;12(4):120.
- Rief SF. The ADHD book of lists: A practical guide for helping children and teens with attention deficit disorders. John Wiley & Sons; 2015 Jun 15.
- Furman L. What is attention-deficit hyperactivity disorder (ADHD)?. Journal of child neurology. 2005 Dec;20(12):994-1002.
- Kutscher ML. ADHD-living without brakes. Jessica Kingsley Publishers; 2008 Feb 15.
- Frick PJ, Nigg JT. Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Annual review of clinical psychology. 2012 Apr 27;8:77-107.
- Dengsø MJ. Wrong Brains at the Wrong Time? Understanding ADHD Through the Diachronic Constitution of Minds. Advances in Neurodevelopmental Disorders. 2022 Mar 14:1-2.
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