Understanding ADHD

Diagnoses are the on the rise, but the disorder has more than one form, and the symptoms aren't always obvious.

Nadine Asef-Sargent’s eldest daughter, Chloe, couldn’t sit still. Not even to eat. Teachers at her Arlington elementary school often rated her behavior as “red” or “yellow” instead of a compliant “green.” Her mother remembers sitting with her for hours to keep her on track with homework.

When Chloe was in fourth grade, they finally had a reason why. She was diagnosed with attention deficit/hyperactivity disorder and started getting help, both in and out of school.

“[Having the diagnosis] gives you that official understanding that your child is not just a bad kid and you’re not crazy,” says Asef-Sargent, who lives with her family in East Falls Church. “No. The child has a disability—there’s a reason this happens.”

But figuring out that a child has ADHD isn’t a simple process like a strep swab or blood test. It’s more like following a trail of breadcrumbs to a destination unknown.

It’s the in-law’s comment at the family picnic about how your child is a little different. The math test score that doesn’t jibe with her actual knowledge. That second trip of the day to the principal’s office for disrupting class.

In retrospect, Asef-Sargent says that she and her husband, Jorge, saw clear signs of ADHD in Chloe. But it wasn’t until their younger daughter, Adriana, ripped a leg off a coffee table in frustration that they noticed a second trail of breadcrumbs. In 2012, Adriana received a diagnosis similar to the one her older sister had gotten five years earlier.

ADHD affects about 11 percent of school-age children, according to the Centers for Disease Control and Prevention (CDC). It’s manifested in symptoms such as frenetic behavior, difficulty paying attention, impulsiveness and problems with executive functions like prioritizing and organizing.

It comes in three main forms. The hyperactive version is the most recognizable, while the inattentive type can be harder to pinpoint. The third form is a combination of the two.

School can be a Herculean effort for kids with ADHD. Long hours in the classroom are tough on many children, but for those with ADHD it’s even more mentally exhausting as they cope with the demands of paying attention and sitting still. Catherine McCarthy, a child psychiatrist in McLean, likens the child’s experience to an adult who has taken a red-eye flight and then drives home from the airport. “What it feels like to have ADHD is how adults feel when we are sleep deprived,” she says. “Our frontal lobes are not as engaged, so we have to compensate with adrenaline to make sure we don’t screw something up.”

Boys are twice as likely as girls to be diagnosed with ADHD, and girls are often diagnosed at a later age. That was certainly the case with Adriana, who was an angel in school and managed good grades, but bottled up her stress until it exploded on a coffee table. School officials didn’t see a problem until an evaluation by a neuropsychologist and a psychiatrist came back with a diagnosis of ADHD, anxiety and dyslexia. With that understanding, Adriana’s next five years at H-B Woodlawn became easier. Her mother says the school was helpful and understanding, which “is everything.”

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