When you hear about ADHD, you may start thinking about trouble concentrating, impulsivity, or hyperactivity. While it’s completely true, these are just visible symptoms of attention-deficit/hyperactivity disorder that don’t completely explain its complexity.
To better understand the visible and hidden sides of ADHD, the ADHD iceberg analogy was created. This article explores the depths of the disorder and how the ADHD iceberg can change your understanding of this condition in a whole new light.
What is the ADHD iceberg?
The “ADHD iceberg” is an analogy that represents visible and invisible symptoms of the disorder. While inattention, hyperactivity, and impulsivity are just the tip of ADHD, there is much more hidden underneath. Executive dysfunction, time-management challenges, racing thoughts, and rejection sensitivity have a strong impact on daily life.
The ADHD iceberg was originally created in 1998 by school psychologist and longtime ADHD advocate and trainer Chris A. Ziegler Dendy. Her model explains that ADHD may be misunderstood, as many of its most challenging aspects are internal. As a result, people with ADHD may appear “fine” on the outside while constantly managing mental overload beneath the surface.
For example, your coworker with ADHD gets upset over a seemingly minor suggestion you make. You might think they’ve overreacted, but in reality, it could be a manifestation of Rejection Sensitive Dysphoria (RSD). People with RSD feel intense emotional pain in response to real or perceived rejection, but others aren’t likely to see this internal struggle. This is what the ADHD iceberg illustrates: what looks like a simple emotional response is often connected to deeper experiences.
External symptoms of ADHD
Visible symptoms of ADHD can be divided into three categories: inattention, hyperactivity, and impulsivity. These categories correspond to the three main presentations of ADHD: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined. Let’s explore some of the key ADHD symptoms from all three categories.
Inattention
1. Difficulty focusing and executive dysfunction
People with ADHD brains get sidetracked easily due to neurological differences in the brain’s “executive function” centers, specifically involving lower levels of dopamine and norepinephrine. It can be especially challenging for them to stay committed to routine or repetitive tasks they don’t find particularly interesting. This is why one minute, they may be working on a project, and the next, they can be checking their phone.
2. Challenges with staying organized
A space where a person with ADHD lives or works might be a bit chaotic, which stems from challenges in bridging cognitive and mental abilities with the physical steps required to complete tasks. The ADHD brain may lack “working memory” [1], so it can be difficult to keep multiple steps in mind at once.
If you experience similar challenges, try Breeze’s custom routines. Choose a habit you want to build, set up notifications, and follow gentle reminders. This can help you reduce mental load and avoid remembering everything at once.
3. “Head in the clouds”
People with attention-deficit/hyperactivity disorder may have trouble staying focused in conversations, miss instructions easily, or seem distracted even when someone is talking to them. It stems from the brain’s difficulty in filtering out background noise and internal thoughts, which is why the person can engage in daydreaming.
4. Hyperfixation
If the task is particularly interesting, a person may engage in ADHD hyperfixation. It means that one minute you’re starting a project, and the next thing you know, the sun’s coming up. People with ADHD can enter a state of “flow” particularly well and may find it challenging to switch off.
Hyperactivity
5. Fidgeting, restlessness, and feeling constantly “on the go.”
Another visible symptom of ADHD is that you might have a lot of energy that can cause trouble sitting still. You may tap your feet, click a pen, shift positions often, or feel an urge to move all the time through a quiet movie, a chill hangout, or a long line at the store.
6. Excessive talking
Some people with ADHD struggle to wait for others to finish their sentences and may talk a lot themselves. They might jump between topics or share thoughts as soon as they arise out of fear of forgetting them.
Impulsivity
7. Interrupting others
You might blurt things out, complete other people’s sentences, or interrupt others before your turn, especially when overwhelmed by intense emotions.
8. Acting before thinking
Poor impulse control is one more external symptom of ADHD. [2] This is why you may do something without fully considering the risks, like saying hurtful comments or speeding in the car suddenly.
Not everyone with ADHD experiences all of these symptoms. Furthermore, some of these symptoms may overlap with other conditions. But if you feel like some of these ADHD symptoms are familiar to you, consider visiting a mental health professional for an accurate diagnosis.
12 hidden symptoms of the ADHD iceberg
The term “hidden” refers to the manifestations of ADHD that can be difficult for others to notice. Some of the invisible symptoms may include low frustration tolerance, sleep disturbance, sensory overload, and poor time management. Here’s how they can manifest in real life.
1. Emotional dysregulation and low frustration tolerance
Sudden mood swings and intense emotional reactions stem from the brain’s difficulty in moderating the intensity of feelings. Because the prefrontal cortex is less active, a small setback or a need to wait for a minute can feel like a massive catastrophe. This is why your emotions may go from zero to sixty in a heartbeat.
2. Losing track of time
While “time blindness” and chronic lateness are common ADHD symptoms, it’s more difficult for others to notice or immediately connect them to ADHD. For example, you think cleaning your room will take 30 minutes, so you start right before leaving for a friend’s party. But you may still be cleaning three hours later and finally get to that party significantly late.
3. Racing thoughts
For a person with ADHD, it may be difficult to complete tasks because their thoughts move faster than they can act on them. “I need to write that email… Wait, did I feed the cat? Oh no, that report is due tomorrow. Laundry! Why can’t I remember to do laundry? Maybe I should start a podcast…” This is how living with an ADHD brain can feel.
4. Sensory processing sensitivities
Sensitivity to sensory stimuli, closely linked to ADHD, can cause you to perceive lights as too bright, noises as too loud, and certain clothes as too scratchy. When exposed to excessive sensory input, people with ADHD might also experience overstimulation, when the nervous system becomes overwhelmed. This, in turn, can lead to irritability, anxiety, and difficulty concentrating.
5. Intrusive thoughts
People with untreated ADHD may tend to jump to the worst possible outcomes (e.g., “If I’m late for this meeting, I’ll get fired”). This stems from decreased connectivity between the prefrontal cortex and the amygdala.
In a neurotypical brain, the prefrontal cortex acts as a “logical filter” to talk the amygdala down from panic. However, in an ADHD brain, the “alarm” stays on at full volume, which leads to constant catastrophizing.
6. Fear of rejection and social anxiety
Rejection Sensitive Dysphoria involves worrying about how others perceive you. This fear of judgment can make you avoid social interactions and cause hidden challenges in communication with others when someone’s tone or a delayed text message triggers a “shame spiral” you dwell on for months.
7. ADHD paralysis
You may feel overwhelmed by small decisions and procrastinate on them for a long time. For example, an unanswered email might sit for a week because the thought of answering induces anxiety.
8. Rigid thinking
People with ADHD can see things as black and white, with little room for flexibility. Some examples may include:
- Thinking that there’s only one right way to do the task.
- Believing that people may only like or hate them.
- Perceiving feedback as 100% good or 100% bad.
9. Sleep issues and constant fatigue
People with ADHD may experience difficulty falling asleep, poor sleep quality, and constant fatigue due to circadian rhythm delays, heightened reactivity to stress, and fragmented sleep patterns. [3] Even when you think you’ve had enough rest, you may feel constantly drained or need frequent naps.
10. Lack of motivation
You can feel like you just can’t get the energy to do anything, even if you know you should. This lack of motivation may stem from differences in dopamine regulation, which affects how the brain experiences reward, interest, and urgency. This phenomenon makes tasks that feel boring especially hard to start.
How often do you experience lack of motivation?
11. Low self-esteem
A person with ADHD may seem to cope particularly well, but years of coping with executive dysfunction can influence how they see themselves. It may lead to self-doubt when it comes to challenging tasks, fear of making mistakes, and the belief that they’re “not good enough.”
12. Masking symptoms
ADHD masking means that people hide their symptoms and consciously or unconsciously try to behave like neurotypicals. For instance, they may:
- Double-check everything they do
- Mimic how others behave in conversations
- Create strict routines to handle all the tasks
13. Perfectionism
Perfectionism can act as a coping strategy to handle anxiety and imposter syndrome. People with ADHD symptoms may try to do everything smoothly, as they believe that even one small mistake will prove that they aren’t competent enough.
14. Comorbid conditions
According to Frontiers in Psychiatry, about 70% of adults with ADHD also experience another mental health issue. These can include:
- Bipolar disorder
- Anxiety disorders
- Personality disorders
- Schizophrenia
- Substance use disorders [4]
5 ADHD strengths inside the iceberg you may not notice
Among the seen and unseen symptoms in the ADHD iceberg analogy, there are many strengths that empower people with the disorder.
1. Creative thinking and advanced problem-solving skills
People with ADHD can approach typical tasks in a unique way, as their minds tend to make unusual connections between unrelated ideas. As a result, they think outside of the box and notice possibilities where others see limits. Among famous creative people with ADHD are:
- Greta Gerwig
- Justin Timberlake
- Emma Watson
- Ed Helms
2. Hyperfocus
The ability to excessively concentrate on something may be a strength. When someone with ADHD finds a topic or an activity they’re interested in, they can spend most of their time researching it or practicing it. This deep-dive ability might make them experts in their chosen fields in a very short time.
3. High level of energy
Some people with ADHD may seem like they never get exhausted. This is because their brains constantly seek dopamine to reach a baseline level of stimulation. To compensate for lower dopamine transporter density, the body produces extra adrenaline and physical movement to keep the brain awake and engaged.
4. Adaptability
Because their prefrontal cortex is less dominant, people with ADHD symptoms are less likely to get stuck in rigid rules and only possible decisions. They can easily adapt to the situation and generate multiple solutions for one problem.
5. Empathy
Attention to subtle nonverbal cues is another superpower of those with ADHD. They might pick up on small changes in tone, body language, or mood that others overlook, which lets them approach others with a better understanding.
Stephanie Palacios, PsyD, MFT, comments, “People with ADHD may move through their day differently and perceive and respond to their experiences in unique ways. Sure, ADHD does present challenges, but it also presents a whole host of qualities and strengths as well. Don’t forget that the majority of successful entrepreneurs and multipassionate people exhibit traits found among those with ADHD. It’s a matter of turning your traits into your own personal superpowers.”
How to live with adult ADHD symptoms
If you find managing ADHD symptoms difficult, it can be helpful to reach out for support and focus on building a routine that works for you. Here’s what to begin with.
1. Reach out for professional guidance to check yourself for attention-deficit/hyperactivity disorder
Only a licensed professional can set a diagnosis. If you think you have ADHD, discuss your symptoms and their onset with your doctor. A professional can help assess whether your experiences align with ADHD, rule out other conditions, and choose treatment options.
2. Learn to create structured routines and stick to them
One of the most effective coping mechanisms to deal with ADHD inattentiveness and impulsivity is to build a predictable routine. Use tools like digital calendars, phone alarms, or physical planners to map out your day. This can help you reduce decision fatigue and avoid procrastination.
3. Make tasks more manageable
Big projects may feel overwhelming because people with ADHD experience executive dysfunction and can find it hard to start doing something. This is what you can do.
- Turn one big goal into five tiny “micro-tasks” that take less than 10 minutes each.
- Try working with someone, as having another person in the room (even virtually) can help you stay on task.
- Tell yourself you will only do the task for five minutes. There’s a high chance that you’ll want to continue working after this time.
4. Get support from close ones
Share your worries with people you trust. This will enable you to request specific help when needed, avoid conflicts related to emotional dysregulation or decision fatigue, and feel that others can assist you in managing daily challenges and provide support when necessary.
Sources
- Kofler MJ, Singh LJ, Soto EF, Chan ESM, Miller CE, Harmon SL, Spiegel JA. “Working memory and short-term memory deficits in ADHD: A bifactor modeling approach.” Neuropsychology. 2020
- Rosenthal EA, Broos HC, Timpano KR, Johnson SL. “Does Emotion-Related Impulsivity Relate to Specific ADHD Symptom Dimensions, and Do the Effects Generalize Across Comorbid Internalizing and Externalizing Syndromes?” J Atten Disord. 2024
- Hilal Uygur. “Unraveling the insomnia puzzle: sleep reactivity, attention deficit hyperactivity symptoms, and insomnia severity in ADHD Patients.” Frontiers in Psychiatry. 2025
- Xinyu Fu, Weige Wu, Yuru Wu, Xiaofu Liu, Wanting Liang, Rongchuan Wu, Yun Li. “Adult ADHD and comorbid anxiety and depressive disorders: a review of etiology and treatment.” Frontiers in Psychiatry. 2025
Disclaimer
This article is for general informative and self-discovery purposes only. It should not replace expert guidance from professionals.
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