My Daughter Was Exhibiting Concerning Behaviors At School. No One Knew Why — Until Her Teacher Shared An Unexpected Observation.

In the Fall of 2022, I stood barefoot on my deck, phone in my ear, brown leaves gathered 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’d had my own suspicions for years. I’d often seen her staring blankly at the lengthy math equations, unsure of what to do. She frequently doodled in the column of her spiral notebook and complained that she didn’t know how to do her assignments.

I flashed back to the draining late nights we’d spent sitting at the dining table, sorting through her homework assignments, which became a long list of unchecked boxes on her iPad to-do list. Her grades had been rapidly declining, going from B’s to C’s and D’s. No one knew how to fix or how to help her. Whatever “it” was, I’d felt helpless for so long, wanting to repair the invisible problem she’d been battling 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.”

Until that moment, for the last six years, I’d felt as though it would always be this way. That my daughter would never be like me and enjoy going to school, or writing, or doing math, and that she’d always have a hard time keeping 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.

This conversation was an unexpected gift from a caring and observant teacher. She was able to recognize behaviors that she also saw in students who’d been diagnosed with Attention Deficit Hyperactive Disorder (ADHD). It had occurred to me that Ella might have an issue, but I didn’t even consider it could be ADHD.

Before Mrs. Barlow, Ella’s other teachers had reassured me she was “fine,” that she needed to practice the lessons more often, that it was “nothing.” What I didn’t know then was that most girls with ADD present without the hyperactivity part. Their inattentive behaviors and challenges often go unnoticed because they don’t resemble those of the stereotypical hyperactive ADHD boy. This makes them more difficult to diagnose, and often results in later diagnoses for adolescent girls.

According to a study released this year, the rate of children being 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.

After finishing my call with Ella’s teacher, I left a message for our pediatrician, and a few hours later she called me 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 though she’d given the instructions hundreds of times.

My husband, Ryan, and I printed and filled out the document separately, to be sure not to influence one another. Then, days later, the doctor called to give me the results.

“It’s not a black-and-white answer. She’s in the middle; she’s showing signs of distractibility, difficulty following instructions and some other processing concerns, but in other areas she’s fine.”

She continued, “I know you want a definitive direction, but she’ll need to undergo a formal assessment. I’ll send you a list of providers that offer it.”

I knew what it meant: more waiting, more unknowns.

Over the course of the next week, I must have called more than 50 providers, leaving brief messages on their voicemails, detailing the outcome of the form we’d filled out and what I was looking for. When they did answer, I begged their administrative staff for an opening, explaining how long it had taken us to get to this point. Even when I spoke to a few 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 do the testing over winter break. In the months leading up to the testing, the dynamic between Ella and I shifted.

Before, I’d often blamed her when she didn’t like school and couldn’t focus. It started every morning after breakfast. She’d slam her door and holler, “I don’t want to go! I hate school.” After a few minutes, I’d sit down on her bed, my hand on her shoulder in a half-hug, trying to reassure her. “Everything will be OK.” Then, she’d slump to the floor, wiping her face, and then we’d 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 she had been acting this way that wasn’t her choice or her fault, I was more easily able to 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 and she did not have ADHD, I felt like there had, at least, been a breakthrough for me.

At school, things changed, too. Before the testing was done, her teacher began seating her up front, closer to her desk, to capture her attention and make sure she understood what was happening in class. Every Friday, she went through each assignment, step by step, to make sure she had what she needed to complete it. The teacher did daily check-ins with her at her desk, and offered to stay after school often to help when she was stuck.

During regular email check-ins, her teacher asked me how she was doing at home, encouraging both me and her at once. It felt like we had our own personal cheerleader. It helped me get through it ― until we got the answer we needed to formally put those changes in place at school.

That December, the psychiatrist welcomed us in for testing. Afterward, Ella was drained. The stress of trying to answer questions and keep focus for hours at a time in a high pressure situation came with a weight. For weeks, we waited and finally confirmed she did have ADD. But it wasn’t just non-hyperactive ADD—which is more common among females. She also had anxiety as a comorbidity. I was not familiar that term before her assessment, a reference to a patient experiencing two conditions at the same time.

A BMJ Mental Health Journal article about causal relationships between ADHD and other mental health conditions reported that there’s a “prevalence of about 25–50%” of anxiety disorders among patients with ADHD. I saw signs of anxiety in Ella, but I never thought it would be more complicated or that it could be related to ADHD.

Ella’s ADHD indicators included things like a lack of focus in class, getting frustrated easily, heightened anxiety around test time and organizational challenges. Some of her symptoms of ADHD mirrored anxiety, like a need for things to be perfect or being easily distracted and unable to finish a task. Sometimes she exhibited multiple symptoms at once.

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 that changed Ella’s life, that 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 would give her more time for tests, to have more time for homework, to get the help she needed so she could improve her grades, stay on course and feel supported in her diagnosis.

She became more willing to go to school, with fewer meltdowns in the mornings. She began exuding a confidence I hadn’t seen before, a willingness to ask for help at home and at school. That year, she began cognitive behavioral therapy to address her fears and concerns about school and the rest of her stressors. She also implemented more organizational tools she’d learned, and got extra time on assignments and extra help when she needed it.

Before long, her grades came up and she started to love school. Her grades went from C’s and D’s to almost all A’s at the end of the final quarter. Last year, as she entered sixth grade — thanks to her fifth grade teacher paving the way for her and laying the foundation for her to be prepared 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 7th grade in a few weeks, I know she’s anticipating the workload and wondering how it will all go. I feel the anxiety rising up inside me, too. But now we have a formal plan in place, accommodations for her 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 all those years she struggled, as well as my own frustration with her. If I’d 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 a little deeper into what she needed and believing in her. She left an indelible mark on Ella’s life, a gift she will carry with her forever.

This article originally appeared on HuffPost.