The ADHD Iceberg, Explained

Source: Naomi Booth / Pixabay

“ICEBERG! Right ahead!!!”

Perhaps you remember this famous line from the iconic 1997 movie, “Titanic.” Panicked, the ship's captain alerted the passengers and crew that they would soon strike a nearby, mostly invisible iceberg with 90% of it obscured underwater. Within 30 seconds of sighting the iceberg, the ship made impact, sending everybody scrambling for safety amid the frigid waters. Had they been able to see more than only 10% of the iceberg and adjust their course, disaster might have been averted.

The lessons learned from the ship’s collision with the iceberg also offer a glimpse into the seen and unseen challenges of ADHD. The tip of the iceberg — the 10% we can see — represents behaviors and symptoms that are characterized as being “external”. Often these are seen in the hyperactive/impulsive type of ADHD. Meanwhile, the largest portion of the iceberg (what we can’t see) — represents those hidden symptoms and challenges that go unseen, characterized as being “internal”. These tend to be associated with inattentive ADHD or are evident in the combined type of ADHD.

As we enter a busy fall season, let's explore the visible and hidden ways ADHD may impact your life, work and relationships. By understanding the ADHD iceberg model (first coined and depicted by Chris A. Ziegler Dendy), you'll be better prepared to create tools to manage its challenges, avoid unforeseen dangers and have smoother sailing.

The Iceberg We Can See — The External

Externalizing behaviors are frequently seen in the classroom, at the workplace and at home. They are easily observable and measurable, typically manifesting in inattention, impulsivity, and hyperactivity. They are related to conscious executive functioning skills such as verbal, behavioral and emotional impulse control, organization, time management, initiation and prioritizing. In children and teens, we see this tip of ADHD more in boys than girls in common behaviors such as fidgeting, talking too much, interrupting others, moving around the classroom and physical aggression.

In adults, externalizing behaviors can manifest as missed deadlines, trouble with finances, tardiness, disorganized living spaces, difficulty remembering important dates or events, interrupting others, talking too much, job instability and strained relationships.

The Iceberg We Can’t See — The Internal

Internalizing ADHD behaviors are characterized as being less observable to others and frequently rely on someone’s self-report of their challenges in managing them. These internal traits include a restless or wandering mind, low self-esteem, distractibility, inability to sustain attention, trouble with shifting or flexibility, overwhelm, limited self-awareness, poor working memory and shame.

Both types of these challenges exist in some form for everybody with ADHD. What’s under the surface of the water often shows up in combination with anxiety or depression, especially in girls and women with inattentive ADHD. Dealing with all of these issues requires patience, sensitivity, and a genuine desire to understand the “whole person.”

Masking and the ADHD Iceberg

When the symptoms of ADHD remain hidden within the ADHD iceberg model, people rely on a coping response called “masking.” Both children and adults can engage in masking behaviors. Masking allows the person to conceal how their condition affects and limits their functioning.

ADHD masking is about conforming to neurotypical standards to avoid the shame and stigma related to being neurodivergent. It typically develops as a coping tool in childhood that continues into adulthood, even though it may no longer be useful. Over time, masking becomes tough to maintain and prevents people from sharing who they really are. Cady, age 36 (concealed identity) says: “I appear very organized to the outside world but underneath I’m a hot mess.”

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Some of the consequences of masking can be serious and negatively affect your daily life, relationships and work. These can include:

1. Delayed Diagnosis: ADHD masking may delay or sabotage a formal diagnosis, especially in girls and women. Internalized conditions, including anxiety or depression, might develop as a consequence of undiagnosed and untreated ADHD.
2. Worry, Stress, and Burnout: Masking symptoms of ADHD can lead to increased worry and stress, as well as burnout. Keeping aspects of ADHD submerged and pretending they don’t exist increases worry about possible exposure, social anxiety and rejection sensitive dysphoria.
3. Perfectionism and Imposter Syndrome: ADHD masking is often tied to feelings of inadequacy and can be linked to perfectionistic tendencies. Many individuals who cover up their symptoms of ADHD try exceptionally hard to please others, seek outside approval and dismiss compliments. They aim to distract others from their perceived inadequacies and attribute their successes to good luck rather than their hard work.
4. Distorted Sense of Self: Years of intentional or unintentional masking can muddy one’s sense of self. Trying to cover up what’s really going on and trying to blend in with others can lead to losing track of who you really are. This type of behavior is often referred to as camouflaging and it goes hand in hand with masking.

5 Tips to Navigate the ADHD Iceberg

Now that you have a better understanding of the ADHD Iceberg and what it represents, let's explore the steps you can take to address emotional dysregulation, masking and low self-esteem while promoting healthy well-being and authentic acceptance.

1. Use my STAR approach for emotional control: Take a STOP in the action when you are becoming triggered and use a TIME-APART to regroup and rebalance. Decide in advance what helps you slow down and write these options in your phone. Move into ACTION when you are regulated and have decided what the next right step is. RECOVER while you engage in that activity.
2. Shift Your Focus: The negative self-talk that often accompanies masking can be shifted by paying attention to what is working. There’s interesting research from the University of California that noticing three good things that happened in your day can improve positivity. Each night before going to sleep, write or dictate these three items and keep them simple, such as I wore my favorite shirt today or I got the kids to school on time.
3. Celebrate Strengths: When you focus on your strengths, you increase self-worth and embrace your neurodivergence. I see many positive traits in my clients, such as creativity, curiosity, intelligence, enthusiasm and humor, to name just a few. What do you do well? What do you like about yourself?
4. Investigate masking: Masking and camouflaging reflect insecurity and shame about who you are. They may be old coping mechanisms from childhood that no longer serve you. Perhaps you have unrealistic personal expectations that help maintain the submerged parts of the ADHD iceberg. Making small, genuine choices in your behaviors or responses to others can pave the way for sharing more of your true self.
5. Practice self-compassion: Instead of judging yourself harshly, talk to yourself the way you would treat a friend or a third grader with a skinned knee. Be kinder and more forgiving of your own humanity. Everybody makes mistakes or needs to pivot sometimes. Put on your cloak of courage and learn to love your challenges instead of submerging them.