The ADHD Iceberg: Visible And Invisible Symptoms
Attention-deficit/hyperactivity disorder (ADHD) can be a relatively common condition affecting approximately 129 million children and adolescents and 366 million adults worldwide. It is often associated with symptoms like hyperactivity and distractibility. While these may be among the most obvious, they tend to be a small representation of the broader spectrum of challenges faced by individuals with ADHD.
The ADHD iceberg metaphor can serve as an insightful representation of the complexities surrounding the seen and unseen symptoms of this disorder. The tip of the iceberg generally represents the overt symptoms that may catch immediate attention, such as hyperactivity, inattention, and impulsivity. Beneath the surface may lie deeper, often overlooked aspects, including executive function challenges, emotional dysregulation, and low self-esteem. Therapy, whether in-person or online, can help individuals with ADHD address both the visible and invisible symptoms they may experience.
Types of ADHD
ADHD is typically categorized into three main types based on the predominant symptoms exhibited.
1. Predominantly inattentive presentation
Formerly known as ADD, this type of ADHD is usually characterized by struggles with attention and concentration. People with this type of ADHD might:
- Be easily distracted
- Have difficulty focusing attention on single tasks and following directions
- Make careless mistakes and miss details
- Have difficulty organizing tasks and lose items needed to complete tasks
- Have trouble performing activities that require sustained mental effort
- Appear "detached" and preoccupied with internal thoughts
2. Predominantly hyperactive-impulsive presentation
People with this type of ADHD primarily display hyperactive and impulsive behaviors that might contribute to challenges at school, work, and in social interactions. These might manifest as:
- Restlessness and fidgeting
- Excessive talking or interrupting others during conversations
- Problems with engaging in quiet activities
- Impatient or impulsive behaviors
- Hasty decision-making
- Impulsive exclamations or inappropriate comment
- Difficulty waiting in line or waiting for one's turn
3. Combined inattentive/hyperactive-impulsive presentation
Individuals with combined ADHD typically exhibit a combination of both inattentive and hyperactive-impulsive symptoms. They may struggle with attention and concentration while also displaying hyperactivity and impulsivity. For a combined diagnosis, individuals usually must exhibit six or more symptoms each of inattentive and hyperactive-impulsive ADHD.
External characteristics of ADHD
External characteristics may be just the tip of the iceberg, so to speak, and they generally refer to the visible symptoms of ADHD that are more likely to be noticeable in one's behavior. Common visible ADHD symptoms can include the following:
- Marked distractibility
- Irritability and angry outbursts
- Extreme impatience
- Forgetfulness
- Impulsivity
- Frequently losing items
- Being overly disorganized or organized
- Poor planning or overplanning
- Excessive restlessness and fidgeting
Internal characteristics of ADHD
Invisible symptoms of ADHD may include, but aren't limited to, the following:
- Emotional irregularities and mood swings
- Irritability and low frustration tolerance
- Intrusive, self-defeating thoughts
- Low self-esteem
- Feelings of guilt or shame
- Hypersensitivity to criticism or rejection
- Frequent overwhelm
- Choice paralysis
- Racing thoughts
- Restlessness
- Lack of awareness regarding time
- Fatigue
- Sleep issues
Executive functioning and ADHD
Executive functions can be thought of as the cognitive and mental abilities that fuel motivation, control behavior, and direct how we achieve goals. While most people have natural strengths and weaknesses in these areas, there may be a direct link between ADHD brain functioning and executive dysfunction.
However, it can be important to note that executive dysfunction and ADHD are not necessarily the same thing, and some other conditions, such as neurological disorders, types of brain trauma, and post-traumatic stress disorder (PTSD), may also come with symptoms of executive dysfunctionality as a result of differences in brain function.
Examples of executive dysfunction can include the following:
- Trouble with memory
- Problems starting or completing activities or tasks
- Difficulty focusing on one task at a time
- Difficulty keeping track of time or estimating how long a task will take
- Trouble with planning and organization
- Excessive "zoning out "or "daydreaming"
- Impulse control problems
- Chronic forgetfulness
- Emotional dysregulation
Signs of comorbidities
Some symptoms of ADHD may indicate co-occurrence with another disorder one might wish to conceal from others. As such, it might be difficult to classify these symptoms as either external or internal. They may fall under both categories. Still, these symptoms may not be externally evident until the comorbid condition shows physical or behavioral signs.
For example, there may be a link between ADHD and addiction.
Other studies indicate that there may be a relationship between ADHD and eating disorders, such as binge eating disorder.
Obsessive, repetitive body-focused conditions, such as trichotillomania and dermatillomania, may also be associated with ADHD.
It can be prudent to note that not everyone will develop comorbid conditions like these, and not everyone manifests ADHD symptoms in the same way. If you or someone you know shows signs of having ADHD or another mental health condition, it can be best to seek guidance from a licensed mental health professional.
ADHD treatment options
ADHD treatment typically involves a combination of behavioral interventions, psychoeducation, and, in some cases, medication. The effectiveness of treatment can vary from person to person, and a personalized approach is often recommended. Several standard methods for treating ADHD include the following:
Psychoeducation
Education about the condition is often part of the therapeutic process for children and adults with ADHD. Healthcare professionals may provide in-office education and resources to take home. This can also be helpful for families and loved ones to understand the symptoms of ADHD and how they can offer support.
Parental training
Parents of children with ADHD can learn techniques to manage their child's behavior, set clear expectations, and provide positive reinforcement.
Individualized education plans (IEPs)
In some cases, children with ADHD may receive a personalized plan called an IEP to accommodate and support them in the educational setting. This may involve accommodations like extended test times, preferential seating, or additional breaks.
Behavioral therapy
Behavioral therapy generally involves working with a therapist to develop coping strategies, improve organizational skills, and address specific behaviors associated with ADHD.
Cognitive behavioral therapy (CBT)
CBT is often used to treat adults with ADHD, as it usually focuses on a combination of the cognitive, emotional, and behavioral aspects of ADHD.
In CBT, individuals typically work with a therapist to gain awareness of cognitive distortions and associated emotions that may contribute to ADHD-related behaviors. Once recognized, individuals can challenge and restructure those cognitive distortions into more balanced, constructive thoughts to then shift their emotions and behaviors.
Medication
Pharmacological treatments for ADHD can include stimulant and non-stimulant medications. Always consult your doctor or psychiatrist regarding medication questions and speak to them before starting, stopping, or changing the way you take medication.
Lifestyle modifications
Regular physical activity, nutrient-rich food choices, and adequate rest can all be essential for managing ADHD symptoms. Regular exercise can increase dopamine levels and promote overall well-being, and eating foods that supply necessary nutrients may support brain health.
People taking stimulant medications prescribed to treat ADHD often have difficulty falling asleep or staying asleep. It can be vital for individuals experiencing these types of sleep problems to speak with a physician who can assist in managing side effects or exploring options to aid in getting restful sleep.
Mindfulness and relaxation techniques
Mindfulness-based interventions, like meditation, deep breathing exercises, and guided visualization, may benefit individuals with ADHD by improving attention, impulse control, and self-awareness.
Support groups
Joining support groups for individuals with ADHD or their families can provide emotional support, practical advice, and the opportunity to discuss and learn from shared experiences.
Benefits of online therapy
With the rise of telehealth services like BetterHelp, it may be easier than ever for individuals to obtain convenient, accessible, quality care from a licensed mental health professional experienced in treating ADHD. Online therapy generally empowers individuals to attend appointments from the comfort of their homes, eliminating the need for travel and potential distractions associated with in-person treatment. Clients may have the flexibility to speak to a therapist on their schedule via video chat, online messaging, or phone call.
Effectiveness of online therapy
Virtual therapy is often more affordable than traditional therapy without insurance, and studies indicate that it can serve as an effective form of treatment for ADHD, particularly in improving attention deficit and social function.
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