The Unexpected Gift of a Teacher's Observation
In the fall of 2022, I stood barefoot on my deck, phone pressed to my ear, brown leaves scattered around my feet, listening to my daughter's fifth-grade teacher, Mrs. Barlow. 'I think there's something going on with Ella,' she said gently. My stomach dropped, as I had harbored my own suspicions for years. I often saw Ella staring blankly at lengthy math equations, unsure how to proceed. She frequently doodled in the margins of her spiral notebook and complained about not understanding her assignments. I flashed back to the draining late nights spent at the dining table, sorting through homework that became a long list of unchecked boxes on her iPad to-do list. Her grades had declined rapidly, dropping from B's to C's and D's. No one seemed to know how to fix it or help her. Whatever 'it' was, I had felt helpless for so long, wanting to repair the invisible problem she battled in silence behind swollen, tired eyes.
'She's been distracted in class. I'm not a doctor, but you may want to consider having her evaluated,' Mrs. Barlow said. Until that moment, for the past six years, I had felt as though it would always be this way—that my daughter would never enjoy school, writing, or math, and would always struggle to keep up. It had become our dark reality. I was desperate for change, for her to not feel so lost and worn down. It had taken a toll on me, too.
Recognizing the Signs of ADHD in Girls
This conversation was an unexpected gift from a caring, observant teacher. She recognized behaviors she had seen in students diagnosed with Attention Deficit Hyperactive Disorder (ADHD). It had occurred to me that Ella might have an issue, but I never considered it could be ADHD. Before Mrs. Barlow, Ella's previous teachers had reassured me she was 'fine,' that she needed more practice, that it was 'nothing.' What I didn't know then was that most girls with ADHD present without hyperactivity. Their inattentive behaviors and challenges often go unnoticed because they don't resemble the stereotypical hyperactive ADHD boy. This makes them harder to diagnose, often resulting in later diagnoses for adolescent girls.
According to a study released this year, the rate of children diagnosed with ADHD increased by 1 million between 2016 and 2022. Melissa Danielson, a statistician with the CDC's National Center on Birth Defects and Developmental Disabilities and lead author of that study, noted that ADHD in girls often looks like 'daydreaming,' being unable to focus, or being hyper-focused on the wrong tasks.
The Diagnostic Journey
After finishing the call with Ella's teacher, I left a message for our pediatrician. Hours later, she called with instructions: 'You need to fill out a Vanderbilt questionnaire, a form that will give us guidance about her behaviors,' she said in a monotone, as if she had given the instructions hundreds of times. My husband, Ryan, and I printed and filled out the document separately to avoid influencing each other. Days later, the doctor called with results. 'It's not a black-and-white answer. She's in the middle—showing signs of distractibility, difficulty following instructions, and other processing concerns, but in other areas she's fine.' She continued, 'I know you want a definitive direction, but she'll need a formal assessment. I'll send a list of providers.'
I knew what it meant: more waiting, more unknowns. Over the next week, I called more than 50 providers, leaving brief voicemails detailing the outcome of the form and what I sought. When they answered, I begged their administrative staff for an opening, explaining how long it had taken to reach this point. Even when I spoke to doctors directly, they all said the same thing: 'We're booking about six months out.' Another said, 'It's around April of next year for the next opening.'
Finally, I found a doctor to conduct testing over winter break. In the months leading up to the testing, the dynamic between Ella and me shifted. Before, I had often blamed her when she disliked school and couldn't focus. It started every morning after breakfast: she would slam her door and holler, 'I don't want to go! I hate school.' After a few minutes, I would sit on her bed, hand on her shoulder in a half-hug, trying to reassure her. 'Everything will be OK.' Then she would slump to the floor, wiping her face, and we would go. It was a constant cycle of arguments, every morning and every night.
Now, as we inched toward clarity and I realized there might be a reason for her behavior that wasn't her choice or fault, I could more easily empathize with her. My frustration and impatience turned to quiet listening as she searched for answers in her schoolwork. Even if the test came back negative for ADHD, I felt there had been a breakthrough for me.
School Support Before Diagnosis
At school, things changed too. Before testing was complete, her teacher began seating her up front, closer to her desk, to capture her attention and ensure she understood class material. Every Friday, she went through each assignment step by step to make sure Ella had what she needed. The teacher did daily check-ins at her desk and offered after-school help when she was stuck. During regular email check-ins, the teacher asked how Ella was doing at home, encouraging both of us. It felt like we had our own personal cheerleader. It helped me get through it—until we got the answer we needed to formally implement those changes at school.
The Diagnosis and Comorbidity
That December, the psychiatrist welcomed us for testing. Afterward, Ella was drained. The stress of trying to answer questions and maintain focus for hours in a high-pressure situation came with a weight. For weeks, we waited and finally confirmed she had ADD. But it wasn't just non-hyperactive ADD—more common among females—she also had anxiety as a comorbidity. I was unfamiliar with that term before her assessment, which refers to a patient experiencing two conditions simultaneously. A BMJ Mental Health Journal article about causal relationships between ADHD and other mental health conditions reported a 'prevalence of about 25–50%' of anxiety disorders among patients with ADHD. I had seen signs of anxiety in Ella, but I never thought it could be related to ADHD or more complicated.
Ella's ADHD indicators included lack of focus in class, easy frustration, heightened anxiety around test time, and organizational challenges. Some symptoms of ADHD mirrored anxiety, such as a need for perfection or being easily distracted and unable to finish tasks. Sometimes she exhibited multiple symptoms at once.
Implementing a 504 Plan
The formal document was in my hands, and that January, I sat down with the school's administrative team, special education team, and her teacher—the one who changed Ella's life, who saw her for who she was. We put in place a 504 plan, a formal written plan that would allow Ella to get what she needed to be more successful in school. It provided extra time for tests and homework, and the help she needed to improve her grades, stay on course, and feel supported in her diagnosis.
She became more willing to go to school, with fewer morning meltdowns. She began exuding a confidence I hadn't seen before, a willingness to ask for help at home and school. That year, she started cognitive behavioral therapy to address her fears and concerns about school and other stressors. She also implemented organizational tools she had learned and received extra time on assignments and extra help when needed. Before long, her grades improved, and she started to love school. Her grades went from C's and D's to almost all A's by the end of the final quarter.
A Lasting Impact
Last year, as she entered sixth grade—thanks to her fifth-grade teacher paving the way and laying the foundation for this major transition—she found her way again. She finished the year on a high note with almost straight A's. As we approach seventh grade in a few weeks, I know she is anticipating the workload and wondering how it will go. I feel anxiety rising inside me too. But now we have a formal plan, accommodations, and a supportive framework at home and school to start another year. It feels a little less daunting.
As her mom, it is frustrating that it took so long to figure it out. I wish I could erase those years of struggle and my own frustration with her. If I had known about the signs of ADD in girls and comorbidities, I could have helped her earlier. But in the end, it took just one observant and caring person—her teacher—seeing who she really was, taking the time to look deeper into what she needed, and believing in her. She left an indelible mark on Ella's life, a gift she will carry forever.
This piece was previously published on HuffPost and is being shared again as part of HuffPost Personal's 'Best Of' series.
