The Drake Institute now offers remote treatment for ADHD, autism, and other brain-based disorders. With the help of our trained clinicians, you can get the help you need from the comfort of your home.
Learn More >>The Drake Institute now offers remote treatment for ADHD, autism, and other brain-based disorders. With the help of our trained clinicians, you can get the help you need from the comfort of your home.
Learn More >>An iceberg is a huge chunk of ice floating in the ocean. And if you’ve ever heard the phrase “just the tip of the iceberg” you know that there’s even more ice underneath the water that can’t be seen.
The ADHD iceberg is similar. Just like we can’t see most of the iceberg under the water's surface, we also don’t usually see the whole ADHD experience. Although the symptoms of ADHD are visibly behavioral, such as hyperactivity, impulsivity, or distractibility, you must look under the surface of the scalp by analyzing brain functioning to identify and understand what’s causing the symptoms.
The symptoms are coming from the brain, so it’s only common sense that we need to look at brain functioning to be able to best help the patient. At the Drake Institute, this is why our standard intake procedure involves a qEEG brain map to see what’s going on below the surface.
Therapist and ADHD-certified clinical services provider Julia Edwards uses the iceberg analogy in the context of ADHD to emphasize that the “toughest internal battles are usually unseen by others.” [i] Indeed, internal struggles such as sleep issues, emotional dysregulation, executive dysfunction, and other symptoms often go unnoticed.
The iceberg analogy can be useful for those without the disorder, helping them to be more compassionate and understanding of the struggles experienced by people with ADHD. At the Drake Institute, we see how families are relieved when they understand the brain map findings because it is a neurophysical explanation of why their family member is having difficulty. In essence, they’re less likely to blame their child or themselves as the reason for the problem.
For decades, the Drake Institute has used advanced treatment technologies to create customized treatment protocols for patients with ADHD and other brain-based conditions. Brain map-guided neurofeedback and neurostimulation help our ADHD patients reduce their symptoms and lead better lives.
For more information about how the Drake Institute treats ADHD and several other brain-based conditions, please fill out the consultation form or call us at 800-700-4233.
The tip of the ADHD iceberg includes the visible external symptoms of hyperactivity, impulsivity, inattention that individuals with ADHD are struggling with. Although it’s not a core symptom of ADHD, emotional dysregulation is also very common in children with the disorder. These symptoms are the most noticeable symptoms of ADHD, but these do not include the negative impact on the person’s self-esteem and self-confidence. In addition, the patient could also be suffering from anxiety and/or depression as a result of not meeting age-appropriate expectations and being criticized for behavior or inadequate performance that they really could not help.
Hyperactivity refers to an excess of physical movement that isn’t appropriate for the setting. Because this symptom is so outwardly visible, it is one of the most identifiable symptoms at the tip of the ADHD iceberg. These children tend to get diagnosed earlier. Fidgeting, talking too much, constant running or climbing, and seeming to be always on the go are signs of ADHD hyperactivity.
Impulsivity is when a person does something without thinking about it. Common examples of impulsivity within ADHD include blurting out answers, interrupting others, impatient with not waiting their turn, and striking out when frustrated. These children also tend to get diagnosed earlier because their symptoms are not only visible, but also can be very disruptive.
Inattention often presents as inability to sustain focusing long enough to complete a task. These individuals become very easily distracted and may go from one incomplete task to the next. They often have difficulty with executive functioning, poor organization, time management and prioritizing. They can be mischaracterized as lazy or unmotivated, but to a large extent they really can’t help it due to brain dysregulation that is not visible on the surface, but it is identifiable on the brain map similar to the example of the ADHD iceberg.
While there are several visible ADHD symptoms, there are also unseen symptoms or side effects from having ADHD.
For example, learning difficulties often accompany ADHD, as well as difficulty with time management and prioritizing and low frustration tolerance. These symptoms may not be recognized as core symptoms but are part of the additional difficulties that ADHD individuals struggle with.
Some of the most common ADHD iceberg symptoms include:
Executive functioning includes the cognitive processes that make decisions, manage time, prioritize tasks, and organize thoughts.[ii] Executive dysfunction occurs when there is dysregulation or weakness within these processes.
Sleep disturbances are a common unseen symptom of ADHD. An estimated 25%-50% of people with the disorder experience some type of sleep irregularity.[iii] This could include difficulty getting to sleep or staying asleep, or both, and getting too much sleep.
Exhaustion and chronic fatigue are other hidden symptoms in the ADHD iceberg. The individual may feel constantly drained physically, emotionally, and mentally. When the frontal part of the brain is under-activated, you have to work so much harder to get tasks completed, which leads to fatigue. As a result, ADHD burnout often leads to increased irritability, mood changes, and sometimes depression.
Due to the constant strain of coping with symptoms, ADHD individuals often experience emotional dysregulation. These individuals may appear over reactive, irritable, or having a short fuse.[iv] This dysregulation can lead to mood swings and emotional reactions that seem overblown or disproportionate to the situation.[v]
ADHD meltdowns can occur when one’s frustration tolerance is exceeded. Meltdowns can present as temper tantrums, anger outbursts, shouting, and/or crying.[vi]
People with ADHD often have time management difficulties. These individuals may struggle to turn in assignments on time, be late for events or appointments, or get lost in a certain activity without noticing time passing. These issues relate to challenges with impaired executive functioning. Procrastination is another possible negative effect from poor executive functioning.[vii]
Memory deficits are a common hidden symptom of ADHD. It may appear as simple forgetfulness, but its impact can be profound. Missing important appointments, losing keys and other items, and forgetting to turn in assignments can all be common occurrences to those struggling with ADHD.
When there isn’t a proper understanding of ADHD, individuals with the disorder may face criticism from parents, teachers, and peers. This negative feedback can impact the person’s self-esteem, especially when they internalize it.[viii] They may feel like they aren’t good enough or will never succeed.
Inflexibility is another hidden aspect of ADHD that can cause significant challenges. Unlike someone who can easily adapt to changes in plans or routines, individuals with ADHD may struggle to adjust to changes and transitions. This could partly be due to poor cognitive flexibility,[ix] which is trouble switching gears mentally.
It is estimated that 50% of people with ADHD also have an additional disorder that requires different treatment. Common coexisting conditions include mental health disorders like depression, anxiety, and OCD. Sensory processing disorder, a condition that impacts the brain’s ability to receive and process information from the senses,[x] is also seen in some ADHD individuals.
Racing thoughts, more common with ADHD with anxiety, can be overwhelming and debilitating for some individuals with ADHD. These racing thoughts sustain the anxiety and prevent one from focusing on relevant tasks and can even cause ADHD paralysis.
The ADHD iceberg analogy is helpful for the person with the disorder and for people who interact with them regularly, like family, friends, teachers, and doctors. This is particularly important for adults with ADHD, where the hidden symptoms of the disorder aren’t well understood, especially in women.[xi]
Understanding the ADHD iceberg allows others to have compassion and empathy for the individual with the disorder. Likewise, recognizing hidden symptoms can help those with ADHD have compassion for themselves and encourage them to seek appropriate treatment.[xii]
The conventional approach to ADHD treatment is typically stimulant medication and psychological counseling.[xiii] These stimulant medications can be helpful in certain circumstances, but they carry unwanted side effects. Additionally, drug effects are typically short-lived, and they only address symptoms of ADHD, not the underlying cause of a dysregulated brain linked to symptoms.
Over the last 40 years, the Drake Institute has clinically pioneered the use of advanced treatment technologies to treat a variety of brain-based medical disorders such as ADHD, Autism Spectrum Disorder, PTSD, anxiety, panic disorder, depression, insomnia, and more. Using a combination of brain map-guided neurofeedback and sometimes neurostimulation, our Medical Director creates customized treatment protocols to address each patient's needs.
To develop our individualized treatment plans, we first complete a qEEG brain map analysis for each patient. Brain mapping helps us identify which specific regions or networks of the brain are dysregulated and linked to symptoms.
To collect this data, 19 sensors are placed around the scalp in areas of the brain responsible for language, focus, memory, executive functioning, social/emotional understanding and behavioral/emotional regulation. The 19 sensors measure and record brainwave activity that is processed through a normative database of neurotypical individuals.
When we compare the patient's results with those of neurotypical individuals, we can identify regions or networks of the brain that are dysregulated and causing symptoms. This information also allows us to determine how these areas are dysregulated so that we can develop specific treatment protocols that help improve brain functioning and reduce symptoms.
During neurofeedback training/treatment, sensors are once again placed on the scalp. The sensors record and display instantaneous brainwave activity visually in real-time on a computer screen with simultaneous auditory feedback as well.
During neurofeedback sessions, the patient is seeing the results of how their brain is working and with this information, they learn to improve their brainwave activity by guiding it toward healthier, more appropriately functional brainwave patterns.
We do not administer any drugs or perform invasive procedures during this process. Instead, the patient is improving their own brain functioning, guided by visual and auditory feedback.
As an adjunct to neurofeedback, we may also use neurostimulation guided by qEEG brain map findings to gently stimulate the brain into healthier functional patterns. In our experience, some patients may benefit even more from neurofeedback if we also use neurostimulation. We have found this particularly helpful for lower-functioning children on the Autism Spectrum.
In the last forty years, Drake has helped thousands of patients with various disorders such as autism, ADHD, PTSD, anxiety, panic disorder, depression, insomnia, migraine headaches, irritable bowel syndrome, and hypertension reduce or resolve their symptoms and thereby achieve a better quality of life. Call us at 1-800-700-4233 or fill out the free consultation form to get started.
[i] https://psychcentral.com/adhd/the-adhd-iceberg#definition
[ii] https://www.additudemag.com/what-is-executive-function-disorder/
[iii] https://www.sleepfoundation.org/mental-health/adhd-and-sleep
[iv] https://www.apa.org/monitor/2024/04/adhd-managing-emotion-dysregulation
[v] https://www.additudemag.com/emotional-dysregulation-adhd-video/
[vi] https://adhdaware.org.uk/what-is-adhd/adhd-symptoms
[vii] https://chadd.org/attention-article/adhd-rarely-on-time-its-not-just-about-time-management/
[viii] https://www.webmd.com/add-adhd/features/adhd-and-child-self-esteem
[ix] https://www.additudemag.com/cognitive-flexibility-adhd-children/
[x] https://www.webmd.com/children/sensory-processing-disorder
[xi] https://psychcentral.com/adhd/the-adhd-iceberg#definition
[xii] https://www.webmd.com/add-adhd/adhd-mindfulness-meditation-yoga
[xiii] https://www.mayoclinic.org/diseases-conditions/adult-adhd/diagnosis-treatment/drc-20350883
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Interview with Dr. David Velkoff
Seth's Story
Interview with Dr. David Velkoff
Spanish News Feature
“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Neurophysical Medicine and received his initial training in biofeedback/neurofeedback in Neurophysical Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Neurophysical Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Neurophysical Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”
