1. Attention Deficit/Hyperactivity Disorder
Jillian C. Schneider, Ph.D.
Pediatric Neuropsychologist
Fairfax Neonatal Associates
February

2. Background and Training
Doctoral Degree: Ph.D. in Clinical Psychology from Drexel University
Pre-doctoral training: Kennedy Krieger Institute/The Johns Hopkins University School of Medicine
Post-doctoral training (two year fellowship): Children’s National Medical Center
Previous employment: independent pediatric neuropsychology practice, contractor with Department of Defense
Publications include book chapters and articles on infectious disease and mild traumatic brain injury in peer reviewed journals

4. Commonly Asked Questions
What is attention?
What is ADHD?
How is ADHD diagnosed?
How is ADHD treated?
In preparation for this presentation, I thought about some of the more commonly asked questions about ADHD and tailored this discussion around answering these four main questions.
There may be other questions that you have and I’m happy to try my best to answer them.

5. What is Attention?
Process whereby individuals receive and process incoming information
Subtypes:
Span
Focused
Selective
Sustained (vigilance/concentration)
Alternating
Divided
In order to have a discussion about ADHD, we first need to talk about what attention is.
In general, attention refers to the process whereby individuals receive and subsequently process incoming information.
There are various subtypes of attention:
Span –passive attention to information that is lost if not rehearsed (e.g., phone number, list of instructions, etc.)
Focused –ability to direct attention towards something (e.g., listening to this presentation, looking at these slides)
Selective –choosing to attend to one set of information while ignoring others (e.g., carrying on a conversation with someone at a noisy party; ignoring a chatty classmate or construction outside window while teacher is talking)
Sustained –maintaining attention over a period of time (e.g., listening to the entirety of this presentation, working on the same task for an extended period of time -homework)
Alternating –shifting one’s attention back-and-forth between tasks (e.g., cooking dinner and then checking on children; checking answers with an answer key or filling out a scantron bubble sheet)
Divided –concentrating on more than one task at a time –multi-tasking (e.g., helping your child with homework while cooking dinner, taking notes while the teacher is talking)

6. What is Executive Functioning
Enables individuals to engage in independent, purposeful behavior
Domains:
Inhibitory control, Behavioral/emotional regulation
Mental flexibility
Initiation
Working memory
Planning, Organization, Goal setting
Abstract reasoning, Problem-solving, Hypothesis generation
Self-monitoring
I also want to briefly mention executive functioning, since it overlaps with attention and we hear a lot about this term in discussion about children with ADHD.
In general, EF enables individuals to engage in independent, purposeful behavior. It’s the “conductor” of our brain.
EF is linked to both social-emotional functioning as well as cognitive functioning. Listed on the slide are just a few domains…
Inhibitory control/Behavioral/Emotional Regulation –being able to apply the “brakes” to our actions –not run out in the middle of the street without looking both ways, to raise our hand instead of blurting out a response, reacting appropriately to events
Mental flexibility –ability to flexible shift your attention from one task to another (behaviorally, this entails the ability to smoothly adjust to change) –kids with these difficulties tend to “hyperfocus” or perseverate on topics and have trouble shifting their attention and thought process; behavior, they have trouble adjusting to changes in routine
Initiation –initiation of activities –children with initiation difficulties often need to be told to start something (not due to a lack of motivation or attempt to avoid an activity)
Working memory –ability to actively maintain or manipulate information in mind (e.g., remember a series of instructions, perform mental calculations)
Planning, organizing, goal setting –being able to set short term goals in order to achieve a long-term goal, organize materials, etc. –kids with these weaknesses tend to procrastinate, have messy desks/lockers/rooms, and approach tasks in a haphazard way
Abstract reasoning, problem-solving, considering and testing hypothesis and adjusting strategies based on whether the test passed/failed
Monitoring –observing your own behavior or performance on tasks (e.g., knowing when to speed up/slow down) and behavior
As you can tell, there is a lot of overlap with attention (inhib. Control, mental flexibility, working memory). BUT, not every child who has attention difficulties has EF weaknesses and vice-versa.

7. What is ADHD? What are the symptoms?
What’s the difference between ADHD and ADD?
Can a gifted child be diagnosed with it?
Is it different in girls vs. boys?
Do children grow out of it?
How common is it?
What causes it?

8. What is ADHD? Hyperactivity Inattention Impulsivity
ADHD is a neurobehavioral disorder characterized by symptoms of inattention and/or hyperactivity and impulsivity.
-it’s diagnosed based on various behavioral symptoms exhibited by the individual
All children (and adults) have problems in each of these areas from time to time, so, as I go through the next couple of slides don’t start diagnosing yourself or others, for individuals with ADHD, these symptoms are constant and they interfere with regular life

9. Inattention Inattention to detail, makes careless mistakes
Trouble staying focused and on task
Not listening
Not following through with instructions or tasks
Disorganized
Avoids and dislikes tasks that require sustained effort
Loses things
Easily distracted
Forgetful
Children who have symptoms of inattention may:
-have trouble focusing and become bored with a task after only a few minutes, unless they are doing something enjoyable –this latter part is key because many children with ADHD can focus on activities that are enjoyable
-be easily distracted, miss details, forget things, and frequently shift from one activity to another (lots of unfinished projects/tasks)
-have difficulty focusing attention on organizing and completing a task or learning something new, particularly challenging tasks (trouble sustaining effort/attention)
-have trouble completing or turning in homework assignments, often losing things needed to complete tasks or activities
-not seem to listen when spoken to, struggle to follow instructions (attention and/or working memory), or seem forgetful
-daydream

10. Hyperactivity Fidgets or squirms in seat Trouble sitting still
Runs or climbs at inappropriate times
Trouble playing quietly
Often “on the go,” acts as if “driven by a motor”
Talks excessively
Children who have symptoms of hyperactivity may:
-fidget and squirm in their seats
-talk non-stop
-dash around, touching or playing with anything and everything in sight
-have trouble sitting still during dinner, school, and story time
-be constantly in motion
-have difficulty doing quiet tasks or activities

11. Impulsivity Blurts out answers Difficulty waiting his/her turn
Interrupts or intrudes on others
Children who have symptoms of impulsivity may:
-be very impatient
-blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
-have difficulty waiting for things they want or waiting their turns in games
-often interrupt conversations or others’ activities

12. ADHD Subtypes Predominantly Inattentive Presentation
6 (5 in adults) or more symptoms of inattention
Predominantly Hyperactive/Impulsive Presentation
6 (5 in adults) or more symptoms of hyperactivity or impulsivity
Combined Presentation
at least 6 (5 in adults) symptoms of inattention AND 6 (5 in adults) symptoms of hyperactivity or impulsivity
ADHD is divided into three subtypes –Inattention Only (ADD), Hyperactivity/Impulsivity Only (ADHD), or Combined Inattention and Hyperactivity/Impulsivity (ADHD)
So, the difference between ADHD and ADD is the H (Hyperactivity). Though, we don’t use the term ADD anymore. It’s been replaced by ADHD: Predominantly Inattentive Presentation.
In order to receive a diagnosis of ADHD, children must experience at least six symptoms of inattention and/or six symptoms of hyperactivity and/or impulsivity. Only five symptoms are needed for adults.

13. ADHD Diagnostic Criteria
Several symptoms of inattention and/or hyperactivity and impulsivity are present before age 12 years
Symptoms are present in two or more settings
Symptoms interfere with or reduce the quality of social, academic, or occupational functioning
Symptoms are not better accounted for by another disorder
In addition to experiencing a significant number of symptoms:
ADHD must be present before age 12 years
-ADHD is considered to be a neurodevelopmental disorder, meaning it has to do with problems in the way the brain is developing, and that these problems emerge during childhood.
-Adults don’t suddenly develop ADHD unless they have some other neurologic or medical condition that interferes with attention
Symptoms must be present in two or more settings
-This is to rule out the effects that one particular environment may have on an individuals ability to regulate their attention and/or behavior
-While symptoms should be present in at least two settings, they do not have to be present in ALL settings or situations. For example, children may be better able to focus in situations/activities that are highly interesting (e.g., sports, videogames, etc.), where they are under close supervision, and where they receive frequent positive reinforcement for appropriate behavior
Symptoms interfere with or reduce the quality of social, academic, or occupational functioning
-Children with ADHD often have difficulty establishing appropriate peer relationships or they may struggle in school or later at work. Often times, parents and teacher describe children with ADHD as “not working up to their potential.”
Symptoms are not better accounted for by another disorder
-There are a number of conditions, for which attention and impulsivity/hyperactivity may manifest (e.g., sleep disorder, anxiety, learning disability). These disorders should be ruled out before making a diagnosis of ADHD.

14. How Common is ADHD?
ADHD is the most commonly diagnosed childhood psychiatric disorder.
Prevalence rates are rising. I don’t want to get into a debate about why this may be other than to say it may have to due with
(1) More screening by pediatricians and other primary care providers
(2) more awareness of the disorder by parents
(3) Decreased stigma around the disorder
(4) increase in medication-pushing from the drug companies (more children are also now prescribed stimulant medication than before)
(5) Exposure to environmental toxins
(6) Overdiagnosis (diagnosing even the mildest of cases)
Regardless of reasons, the rates are increasing.
Results from parent survey administered by the CDC:
-The percentage of children (4-17) diagnosed with ADHD has risen from 7.8% in 2003, 9.5% in 2007, to 11% in 2011
This increase is similar in both girls and boys…

15. ADHD: Boys vs. Girls Is ADHD different in boys vs girls?
Boys are more likely to be diagnosed with ADHD compared to girls (2:1). This may be due to the difference in the way the symptoms manifest in boys vs. girls…

16. ADHD: Boys vs. Girls Compared to boys, girls:
Rated lower on scales in hyperactivity and impulsivity
Display fewer behavioral problems
Have more internalizing problems (e.g., depression, anxiety)
Clinical presentation in girls:
Inattention –spacey, daydreamers, may appear shy
Hyperactivity –extremely talkative
ADHD is often more easily recognized in boys than girls due to the difference in the way boys and girls manifest symptoms.
Girls with ADHD tend to draw less attention to themselves than boys, and the “squeaky wheel get the grease.” So, it may be that girls are under-diagnosed.
-girls tend to be rated lower on scales of hyperactivity and impulsivity and display fewer behavior problems
-girls tend to internalize symptoms and we may focus on treating those symptoms instead
For girls,
-they may present as more inattentive –quiet, off in “la-la” land
-hyperactivity may manifest as excessive talking/”chatty Cathy”

17. Can ADHD be Diagnosed in Gifted Children?
Yes, ADHD and GT can co-exist.
Like most children with ADHD, gifted children with ADHD:
may display problems with sustained attention and hyperactivity in less stimulating or motivating environments
may display academic inconsistencies and/or underachievement
May exhibit a wider gap between intellectual functioning and social/emotional functioning
Children who are intellectually gifted can also have ADHD
Like most children with ADHD, gifted children with ADHD:
May display problems with sustained attention/hyperactivity in less stimulating or motivating environments
-A common myth for why gifted children can’t be diagnosed with ADHD is due to the fact that they may hyperfocus on activities. Yes, and so do non-gifted children with the ADHD. It’s how they attend to tasks that require increased or sustained cognitive effort or are less interesting. Another consideration may be how well a child is able to shift their attention from a preferred to a less-preferred activity.
May display academic inconsistencies and/or underachievement
May exhibit a wide gap between intellectual functioning and social/emotional functioning
Another myth is that strong academic performance suggests no impairment in functioning and thus, they can’t have ADHD.
-this may be true. If the child exhibits symptoms of inattention that don’t interfere with his or her functioning, then they don’t have ADHD. But,
-gifted children often have more intellectual resources and are thus able to compensate for some of their difficulties. Thus, they tend to slip under the radar more than other children
-regardless of intellectual ability, it’s important to look at how the child achieved his/her “success.” It may have taken considerable effort or discipline on the part of the child to focus or frequent redirection and structure by the parent for the child to be successful.

18. Do Children Grow out of ADHD?
No, most children do not “grow out” of ADHD
In general, ADHD increases the risk for academic and occupational underachievement, substance abuse, delinquent behavior, relationship problems, trouble managing stress, etc.
However, many children learn various coping strategies for managing their difficulties.
Risks are particularly high for un-treated ADHD
Children’s don’t necessarily grow out of ADHD. Rather they symptoms manifest differently based on (a) maturity and (b) environmental demands

19. ADHD Across the Lifespan
Preschool
Poor sustained attention, easily distracted
Elevated gross motor activity
School Age
Poor sustained attention, distractibility
Inconsistent academic progress
Restless, fidgety
Adolescence/Adulthood
Problems with sustained effort and concentration
Executive functioning weaknesses
Internal feelings of restlessness
Participation in risky activities
Academic / occupational underachievement
How the symptoms of ADHD manifest may change as the individual ages. So,
In young children, you might see…
-trouble sustaining attention and distractibility
-elevated gross motor activity
--children have trouble sitting in circle time, might touch other children or grab other children’s belongings, have trouble focusing on lessons or classroom activities
School aged children…
-continue to have difficulty focusing and remaining on task
-they may have better controlled behavior and appear fidgety or having trouble sitting still
-you may start to see variability in their academic performance (e.g., variable grades, variable effort –reduced effort on less interesting tasks)
Adolescents
-Symptoms of inattention remain largely consistent in adolescence in adulthood
-Symptoms of hyperactivity may shift from an outward presentation to internal feelings of restlessness
-Due to impulsivity, adolescents may engage in more risky activities (driving fast, drugs use, take dares)
-Trouble with EF skills due to the greater demands on these skills in later years of school in combination with parents and teachers being less hands-on
-Not working up to their potential in school or academic underachievement

20. Comorbidity: Rule Not the Exception
Tourette/Tics
10%
Learning Disability
46%
ADHD
Conduct Disorder
27%
Speech Problems
12%
ADHD is often seen in the context of other medical, psychiatric, and behavioral disorders.
ADHD is isolation is less common.
From this slide, you can see that there are many different disorders that tend to co-exist with ADHD.
-Children with ADHD may also experience difficulties with learning, in particular reading.
-They may also have mood or anxiety disorders (particularly girls, as we have talked about)
-and, other disorders
-Brain pathology in ADHD may be similar in other disorders
-Symptoms of ADHD interfere with other aspects of cognitive functioning or impact emotional/self-esteem
Autism Spectrum Disorder
25%
Anxiety
18%
Depression
14%

21. What Causes ADHD: Neurodevelopment
Differences in brain maturation, structure, and function
Prefrontal cortex
Basal ganglia
Cerebellum
There is likely no single cause for ADHD, but rather a combination of biological and environmental factors.
We most commonly think about the frontal regions of the brain as regulating attention and executive skills. But, the posterior and interior regions of the brain also play a significant role. With ADHD, there is likely some dysfunction in these brain regions which result in the behavioral presentation that we see.
When research has examined the brains in individuals with ADHD and those without, they have found differences in brain maturation, structure, and function in these different regions.

22. What Causes ADHD: Genes and the Environment
Familial and significantly heritable
30-35% of first-degree relatives of children with ADHD also have the disorder
Environmental Risk Factors
Premature birth and birth complications
Maternal smoking and substance use
Lead exposure/toxicity
Traumatic brain injury

23. What Doesn’t Cause ADHD?
Bad parenting
Sugar
Diet
Too much television
Videogames
These theories have been tested and have not been found to have much merit.
Food additives –the debate is still out.

24. How is ADHD Diagnosed?
What kind of psychological work-up should be done to make a diagnosis?
Is there a specific test used to diagnose ADHD?
Where should I go to get a diagnostic evaluation?

25. Diagnosing ADHD Diagnostic requirements:
At least 6 symptoms of inattention and/or 6 symptoms of hyperactivity/impulsivity
Symptoms must:
have been present before age 12
have persisted for at least six months
be present across two different settings
be present to a degree that causes problems and is inconsistent with developmental level
Symptoms are not better accounted for by another disorder
Children mature at different rates and have different personalities, temperaments, and energy levels.
Most children get distracted, act impulsivity, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD.
Symptoms can be difficult to sort out in terms of what’s normal or typical for age or may be a reaction to a particular acute stressor or specific environment
ADHD can be difficult to diagnosis since a number of factors needs to be carefully considered.

26. Assessing Symptoms of ADHD
There is NO test for ADHD
Diagnosis is made based on information gathered about presenting concerns/symptoms through:
Review of development and clinical history
Historical review of concerning behaviors
Behavioral observation
Diagnosing a child with ADHD is a complex task. It requires one to consider all possible explanations for why a child is experiencing a particular symptom. They may have:
1: ADHD
2. ADHD and another disorder,
3: Another disorder that manifests as inattention and/or hyperactivity
4: Or, they may just have difficulties with some aspects of attention that do not rise to the level of clinical significant for an attention disorder.
There is NO test for ADHD! You have to rely on information from the patient and/or caregivers and other sources.
So, it’s very important to gather information about the child’s developmental history as well as familial history:
-did the mother have any complications with her pregnancy, labor, or delivery?
-did the mother smoke or take any medications or drugs while pregnant with the child?
-was the child born premature?
-has the child been diagnosed and/or treated with a genetic or other medical condition?
-does someone else in the family have an attention disorder or is the child like anybody else in the family?
It’s important to understand more about the presenting symptoms?
-when did the parents first notice or become concerned with attention or activity level?
-what have the teachers or others involved in the child’s care (coaches, tutors) said about the child?
-when and where do the symptoms manifest? (e.g., only in the morning or afternoon, only in school, only at home)
Behavioral Observations are important, both mine and others (parents, teachers)

27. Standardized Assessment of ADHD
Standardized assessment may include:
Questionnaires/rating scales completed by parents and teachers
Cognitive testing
Assessment should be individualized to an individual child’s specific problems.
Considerations:
Children may do well on standardized tests
Performance may be variable on measures
There is NO test for ADHD. Psychologists/Neuropsychologists have a lot of tools that assess different aspects of attention, but none of those tests diagnose ADHD. The diagnosis is based on history, clinical presentation, behavioral observation, and judgment from the clinician. For example, a child who bombs the CPT may have ADHD, but maybe they didn’t eat a good breakfast, were falling asleep, talking on the telephone during the task, etc.
Not uncommon to see children with ADHD do well on standardized testing, particularly older and brighter children. You may also see variability across the test data. Testing conditions are very different from the real-world, so it is very important to gather information from those who see the child day-to-day in different settings.
Diagnosis is not as important as a good assessment of the problems the child is having (strengths and weaknesses) and what can be done to improve the problems
Assessment should be tailored to the child’s specific problems. It is not necessary to put a child through an assessment mill where everyone gets the same test. Depending on the child’s problems, some things may need to examined more intensely, while other things may not merit much scrutiny at all.

28. Symptoms of ADHD are not better accounted for by another disorder
Medical
Hearing/vision problems
Intellectual disability
Learning disability
Language disorder
Sleep apnea
Seizure disorder
Metabolic disorder
Substance abuse
Psychological
Depression or Anxiety
Behavioral problems
Stress or changes and sudden changes in life
Environmental
Family dynamics
Academic environment
While considering the presenting concerns, one has to be mindful of other things may be contributing to the child’s current behavior. Thus, it is important to rule out other factors for the symptoms.
-Does the child have an ear infection that is causing hearing problems or need glasses?
-Has the child had any medical problems that affect thinking and behavior?
-Does the child have a learning disability?
-Is the child experiencing undetected seizures?
-Is the adolescent/adult using substances or experiencing side effects of a particular medication?
-Has anxiety, depression, or other psychiatric problems that might cause ADHD-like symptoms been considered?
-are the symptoms that a child exhibits caused by factors such as divorce, death of a parents or caregiver, or a change in school and living situation

29. Specialists who diagnose ADHD
Pediatrician/Developmental Pediatrician
Psychiatrist
Behavioral Neurologist
Psychologist/Neuropsychologist
The person conducting the evaluation should be a professional trained in assessing children’s development, emotions, and behavior and in differential diagnosis

30. Neuropsychological Evaluation
Assess learning and behavior in relation to an individual’s brain processes.
Intellectual functioning
Academic achievement
Language
Visual processing
Attention and concentration
Executive functioning
Learning and memory
Sensory and motor functioning
Affective, behavioral, and social functioning

31. Neuropsychological assessment is helpful when…
There is suspicion of low cognitive abilities
There is low academic achievement
In order to differentiate among coexisting disorders
In order to describe an individual’s strengths and weaknesses and to tailor recommendations and help with treatment and educational planning
In order to increase validity of diagnostic impressions
There are coexisting medical conditions (e.g., epilepsy)

32. How is ADHD Treated? There is no cure
The focus of treatment should be on reducing the symptoms of ADHD and improving functioning
Common treatment methods include:
Medication
Behavioral/Cognitive Behavioral Therapy
Combination of Treatment
Medication > Medication + Behavioral Intervention > No Treatment
There is no cure. ADHD is a life-long process.
The focus of treatment should be on reducing the symptoms of ADHD and improving functioning.
A multi-modal treatment study of children with ADHD was conduced in 1999 (a bit outdated, but it’s the largest, best-controlled study to date assessing the efficacy of medication and behavior therapy).
A 3-year study whereby they randomly assigned children to one of three treatment groups –medication only, medication plus therapy, and no treatment. They found that medication had the most effect followed by medication plus behavioral intervention, plus no treatment.
Most individuals recommend a combination of medication and therapy since therapy has been shown to improve the outcome in some non-symptom areas like social skills, reduction of disruptive behavior, executive functioning skills if that’s an area of weakness

33. Medication Medications Types: Side Effects:
Psychostimulants (e.g., Ritalin, Adderall, Concerta)
Non-stimulants (e.g., Strattera, Tenex, Intuniv)
Short vs. Long Acting
Pill/capsule, Liquid, Skin patch
Side Effects:
Decreased appetite, sleep problems, anxiety, irritability
Not a one-size-fits-all approach –finding the right medication requires careful and continuous fine-tuning
Disclosure –not a prescribing physician. This is not my area of expertise.
For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn.
There is no one-size-fits-all approach. What works for one child may not work for the next. One child might have side effects with a certain medication while another child may not. Sometimes several different medications and dosages must be tried before finding one that works for a particular child. Any child taking medication must be monitored closely and carefully by doctors and caregivers.
Importantly, medications do not cure ADHD. Rather, they help control the symptoms for as long as they are taken. Typically, medication is used to improve behavioral and attention regulation. It is not clear whether they directly help children improve their academic skills, which is where therapy or “coaching” comes in.

34. Behavior / Cognitive Behavior Therapy
Behavioral Parent /Teacher Training
Focuses on teaching the child more socially acceptable behavior by training caregivers and teachers in contingency management strategies.
Academic Interventions
Environmental modifications, curriculum changes, testing accommodations, assistive technology
Peer-related Interventions
Addresses difficulties that children have with initiating and maintaining appropriate peer relationships
Medication are effective at reducing the core symptoms, but don’t address co-occurring social skills deficits or poor parent-child and peer-peer relationships.
Behavioral Parent/Teacher Training
-teaching the parents various strategies to manage behavior (rewards, consequences, consistent discipline, establishing structure, etc.)
Academic Interventions
-preferential seating
-repeating instructions
-relaxed time limits or reducing task length
-more hands-on approach to learning
-help with organization
-ways to bolster child’s self-esteem
-behavioral system that includes rewards for positive behavior and consequences for unacceptable behavior
Peer-related Intervention
-social skills training

35. Alternative and Complementary Treatments
Treatments that have not been scientifically validated to improve symptoms of ADHD
Dietary changes
Herbal supplements
Chiropractic adjustments
Interactive metronome training

36. Resources Books for Parents
Taking Charge of ADHD: The Complete Authoritative Guide for Parents by Russell Barkley
Parenting Children with ADHD: 10 Lessons that Medicine Can Not Teach by Vincent Monastra
How to Reach and Teach ADD/ADHD Children by Sandra Reif
Living with ADHD: A Practical Guide to Coping with ADHD by Rebecca Kajander
Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare
Smart but Scattered: A Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential by Peg Dawson and Richard Guare

37. Resources Cont. Books for Kids Organizations
Clayton’s Path by Brett Bishop
Joey Pigza Swallowed the Key by Jack Gantos
Help Is on the Way: A Child’s Book about ADD by Marc Nemiroff, Margaret Scott, and Jane Annunziata
Organizations
CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder)

38. Questions

39. Jillian C. Schneider, Ph. D
Jillian C. Schneider, Ph.D. Fairfax Neonatal Associates 2720-D Prosperity Avenue Fairfax, Virginia (703)