Is adult ADHD real? Carey Heller
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Guest: Carey Heller
Release Date: 7/25/2022
Welcome to Trulyfit the online fitness marketplace connecting pros and clients through unique fitness business software.
Steve Washuta: Welcome to Trulyfit. Welcome to the Trulyfit podcast where we interview experts in fitness and health to expand our wisdom and wealth. I am your host Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101.
In today’s episode, I speak with Carey Heller. Carrie is a psychologist and the founding partner of Heller psych. You can find him at Carey underscore Heller, H E ll er underscore Cy dot d on Instagram. Kerry joins the podcast today to discuss ADHD, and specifically really adult ADHD. And the reason I had carry on is that as fitness professionals. We have the obligation to take in our health history forms. From our clients and our poor queues and look over those.
A lot of times we see things on those health history forms. We may not be that comfortable with diagnoses or medications. One of them that’s that comes up more often, in my experience is ADHD. How do we deal with whether it’s childhood or adult ADHD. When it comes to that intake form that we take from our clients? Kari goes over the clinical definition of ADHD.
What the difference is if any between adult ADHD and childhood ADHD. He walks me through his patient experience during the diagnosing process.Are there any mechanistic testing to show ADHD? Meaning? Do they use an fMRI screening? Or something to look at the prefrontal cortex and see that there’s different brain activity? Or is this just us understanding the subjective nature of ADHD? Assuming ADHD has been diagnosed more now than 30 years ago?
Why is that the case? I’m not sure if it was. But I do propose that question to carry any sort of the interventions. The medications that go on when someone is diagnosed with ADHD. And caregivers really great tips on how to deal with that, whether you’re dealing with someone who has the diagnosis of ADHD or you yourself do as far as organizational perspectives, and, and a host of other really great tidbits.
It was an interesting conversation. And I appreciate Carey’s time. With no further ado, here is psychologist Dr. Carey Heller. Thanks so much for joining the Trulyfit podcast. Why don’t you give the audience and listeners a background bio summary of your credentials. Also what you do in the health industry?
Carey Heller: Sure, absolutely. Thanks for having me today. It’s great to be here. I’m Dr. Carrie Heller. I’m a clinical psychologist at my own practice in Bethesda, Maryland. So I specialize in the evaluation and treatment of ADHD and executive functioning issues. So basically, I help people. To learn to be able to focus better and improve their time management, organization, and efficiency.
And a lot of that, too, is with health. If people have a hard time sticking to a workout routine. Or eating healthy, a lot of that really is related to executive functioning. Which are really mental proxies that are used for carrying out tasks. If you can’t keep organized, it’s hard to stick to a diet or workout routine. So there’s a lot that I do within that realm of helping people. To sort of, you know, essentially be healthier in a lot of ways. Both mentally and physically.
Steve Washuta: I think the general population is confused. Doesn’t really know the difference between a psychiatrist and a psychologist. And sort of what the scope of practice is. Can you describe that?
Carey Heller: Sure, absolutely. Yeah, can definitely be confusing. I mean, so basically, a psychologist usually has either a Ph.D. or Psy D. So either you know, Doctor philosophy, or a doctorate in psychology. Is it a simple way of thinking about it is if someone like, let’s say, medicine. Just wanted to practice, and really had no interest in research, you know, they would do, or some interesting research.
But you know, the primary focus on practice, they would get an MD. If all they wanted was research and no interest in the clinical work, you know, they would do a Ph.D. And so basically, society is essentially more like a practical degree for first psychologists. I mean, people with a Ph.D. can certainly practice by all means. But the society is more focused on the direct, you know, sort of client or patient care, as opposed to sort of research training.
Steve Washuta: Do people come to you directly? Or do you need to be referred by a clinician? And then you were sort of the second step?
Carey Heller: I mean, in most cases, people come directly to me. There are a fair amount of times we get referrals from, you know, like a therapist because their thing to answer their question about the differences are a psychiatrist prescribes medication, psychologists for the exception of a couple of states where they can do it with extra training don’t.
So like a really good distinction is you know, psychiatrists do medication a psychologist does therapy or formal testing. So those are probably the biggest differences. Okay. And there are some psychiatrists that do therapy as well. But really, if you think about medicine versus no medicine is probably simplest way to try to remember the difference. Yeah,
Steve Washuta: yeah, I think that’s, that’s a clean simple way. And obviously, although you don’t prescribe medication. You have to understand the medication, how they work. You know, whether it’s mechanistically, and how The patient takes to those medications. And today specifically, we’re going to be speaking about ADHD. So can you give us either a clinical definition of what ADHD is or your definition? Sure, absolutely.
Carey Heller: So I mean, you know, just to be very technical, technical briefly. So there’s a manual called the Diagnostic and Statistical Manual fifth edition. That’s basically the criteria that psychologists and psychiatrists use for diagnosing ADHD or really any other mental disorder. And so in the DSM five, ADHD is called a neurodevelopmental disorder.
So it’s essentially a disorder that impacts self-regulation, which is associated with attention, hyperactivity, and impulsivity. One of the biggest sorts of confusion around ADHD is people ask what happens if I have trouble with attention. I’m not hyperactive.
So since 1994, the way it’s still called ADHD, even if you don’t have hyperactivity. The way that its differentiated is you’d have ADHD predominantly inattentive presentation. Which means that the inattentive issues are primary. And you might still have some fidgeting, but not enough of the hyperactive-impulsive behaviors to warrant. What’s called a combined presentation diagnosis.
We have clinically significant issues with attention as well as hyperactivity and impulsivity. And then this one’s I don’t see that often, anecdotally. But there is also an ADHD predominantly hyperactive-impulsive presentation. Where those symptoms are prominent, and then two, inattention is far less.
Steve Washuta: Okay, that explains a lot. You know, for the purposes of this podcast, again, my goal here on the social podcast. As always, is to help fitness professionals and health professionals. But specifically, fitness professionals, better assist our clients and grow their business. And most of our clients are adults. So I want to sort of flip here to adult ADHD. What is the difference between adult ADHD and childhood ADHD if there, isn’t it?
Carey Heller: Sure, it’s a good question. So I mean, while they’ve definitely died, adults that get diagnosed for the first time with EEG as an adult. Typically, the symptoms or criteria are supposed to have been there prior to age 12. So a lot of times, even if someone first gets diagnosed in adulthood, the symptoms are always there.
But a lot of times they change as you get older. So for example, one of the probably the biggest differences is hyperactivity. So you know, probably the stereotype of a baby. She’s often you know, childlike, can’t sit still, it’s bouncing off the walls and things like that. When you get more into adolescence into adulthood.
A lot of times, you know, there may still be fidgeting. But it sometimes gets more channeled into a sort of inner restlessness. And so you miss, but I think it’s the trouble of attention. The, you know, impulsivity sometimes is there in adulthood and problematic. It’s oftentimes it’s the trouble getting stuff done, that it’s, you know, the person who is always late for stuff who, you know, can’t follow a routine, if they want to work out, or, you know, they have a diet plan, but they just can’t seem to follow it. And they, you know, forget to do it or, you know, just can’t sort of follow step-by-step directions.
Steve Washuta: Well, with that being said Can you walk me through your patient experience? Let’s say somebody comes to you and says, Hey, I think I probably have ADHD, I was never diagnosed formally. Are there particular steps that you take to then diagnose? Or are you getting a diagnosis from someone else? And then working with them?
Carey Heller: Sure. So it really depends on the circumstances. I definitely do it both ways, quite a bit because part of my practice is formal assessment. So in that case, basically, in with adults. It’s a little different than with kids. Because, like, if someone’s done with school, and they don’t need an evaluation for documentation purposes, so kids oftentimes need a formal report for purposes of getting Congress in school with adults.
If it’s clear and cut enough. Like if there’s, it seems like there’s a lot of anxiety, depression, other things that were like a mimic. Then there’s often more of a benefit of doing formal testing. But you know, sometimes with adults, if it’s pretty clear cut. You can, you know, the clinical interview questionnaires. To you know, sort of assessing symptoms, And maybe a few informal tests kind of get a fairly clear picture. It just depends on circumstances.
But so the idea would be either formal testing or an informal, you know, corner meeting and clinical group discussion, you know, gain that information, and then ultimately arriving at the diagnosis, but like, the way that I approach it, generally is whether someone has a diagnosis he or not, I forgot, what are the actual issues. So whether someone comes in with a diagnosis, or we’re not quite sure, if they’re having trouble getting stuff done, they can’t focus, we’re still that’s what the senators are targeting anyway.
Steve Washuta: So it seems like a lot of this is not in a bad way at all, but as your specialty and your expertise using kind of subjective things to look at what is going on with the person are there any like objective mechanistic things that go on maybe in like, with another profession that interviews with yours, where they’re looking at their brain to say, Okay, this person’s brain is actually firing differently than someone who doesn’t have ADHD? Um, it’s a good question.
Carey Heller: I mean, so a lot of the psychological neuropsychological tests, you can sort of indirectly assess certain aspects of brain functioning. I mean, you know, one of the questions people often ask about is, you know, could you just, you know, so for example, if someone has strep throat, you know, there’s a pretty standard test you take and you can determine if someone has it or not, or I guess the current situation COVID.
But with ADHD, even if you were to do brain imaging, because people’s brains look slightly different, and you can sometimes have people that have more activation in certain areas than others, it doesn’t always mean it’s typically due to one thing or another. So it’s not even that doesn’t sort of super objective. I mean, maybe one day may get to that point, where, you know, could be obsessed, you know, it’s sort of brain imaging, but it’s the science is really not there yet, by any means to be. Yeah, besides the practicality of that,
Steve Washuta: is ADHD diagnosed more today than it was, let’s say, 1520 30 years ago? If so, is it because we have better medical systems in place to diagnose that? Or is it because we’re being more, I guess, liberal with the diagnosis?
Carey Heller: Um, I tried to say for sure, I think it’s sort of a mixture of things. So on the one hand, I think there’s less stigma with it, and people are more aware of it. So I think that in some ways people are getting diagnosed more because they realize there’s an issue. And, you know, I would say probably ADHD is probably among the least stigmatized diagnoses. You know, in terms of mental health issues.
You know, so I think there’s that part of it, I think there again, there’s greater awareness. I think other things contribute to it are, if you think about the demands placed on people that you have, especially with adults with a job, that even if your job is really, you know, something you’re really good at.
You know, a lot of times, especially with increases in technology, there’s more of an expectation of doing things yourself. And there’s often oftentimes less like admin support, depending on your job. And so, you know, if you look at like generationally, there may be people in a prior generation, where they had a secretary and office assistant that did a lot of stuff that sort of got by, even if they couldn’t stay focused and organized with, you know, the aspects of checking email answering phone calls.
But a lot of times, there’s less of that in jobs these days. And so I think people tend to be struggling more. So it’s sometimes it’s, you know, even if it was there more in the past, they, it comes out more because of the way society is set up right now, in a lot of ways.
Steve Washuta: As you know, put, you can put yourself in the personal trainer role here, if I am working with a client, we typically have like an intake form, like a health history form, and a poor cue, physical activity readiness questionnaire, health history, they write down all of the medications, they’re taking on that form, too, so that we understand if we have a client who’s an adult, and they come back and let us know, they have ADHD, and they’re on set medication, some form of Adderall, I assume, what should we be potentially concerned with from a health perspective? Um,
Carey Heller: I mean, I think practical things would be, you know, looking at what side effects if any, they have from it? So do they not eat as much when they’re on it? Does that impact, you know, functioning in terms of whether it’s, you know when they’re working out or after, rather, in terms of, you know, not feeling hungry? So they’re not going to refuel after looking at, you know, do they get more dehydrated, or they drink enough water?
So like, from a physical standpoint, looking at those things? I think otherwise, not so much the medication itself, he in general, looking at? How easy is it for them to follow through on stuff on their own? So it’s one thing if they’re working directly with you, but if you said workout routine with them, and they’re supposed to do it on their own? How good?
Are they executing it themselves? You know, is it that they know what they have to do but just can’t get themselves to do it? Do they maybe do a quarter of it? Do they sort of skip around? Like how consistent are they? Yeah, like, I think that would be something and to also work through for them?
The idea of how do you increase that? So you know, to ask them, you know, honestly, you know, how are they doing whatever you’ve set up, and if they’re not following through looking at ways to increase the follow through, so whether it’s helping them to, you know, set up a sort of time of day to work out, setting, you know, various reminders in their phone, whatever it is, yeah, I think just maybe a little extra sort of assistance in the planning piece to help them to execute the working out, or also thinking through, i
f maybe, you know, a typical workout just is not as fun for them. It’s hard. And that’s harder looking at, you know, could you figure out a way to help them to sort of find something they enjoy doing this sort of gets at the same sort of skill sets you’re trying to build up?
Steve Washuta: Yeah, that’s all fantastic information. And really good points there. I you know, I, I’ve had clients before who either forget appointments, or they have so much going on, let’s say they work a nine to five, that they cancel very often, right? They have adult ADHD, and they have so much going on, they go home, and they go, You know what, I don’t have milk in my fridge, and I have to answer this mail.
I have to call this person back. So what I do is make sure that, let’s say they’re 20 minutes away from the gym. If they get off at five, our appointment is at 530. So that they don’t have time to go home and then come back to the gym. Otherwise, they may never get back to the gym, they have to go straight to the gym so that they’re prioritizing their health and fitness, and then we can avoid some of those issues.
Carey Heller: So I think that’s a really great idea.
Steve Washuta: And, you know, I just I also want to, you know, kind of piggyback off of some of the things you said and talk about the health issues potentially behind taking some of these medications is it can be an appetite suppressant, or it is an appetite suppressant. And some people I’m sure everyone’s bodies are different, deal with that differently than others.
But we have to know that, you know, if our client is potentially on these medications, we have to ask them when they last ate or did they eat because they may not be hungry and they may not have eaten prior to the session, which changes how we work with our clients. Right? So if my plan for the day was to Do a very intense workout, I hit the workout with a lot of legs and a lot of jumping and plyometrics.
And it was at 530. And they hadn’t eaten since 8:30 am. Because they just weren’t hungry, well, then I may have to change that plan and workout, because they’re not going to have necessarily the energy to do that sort of workout when we get to it. Like you mentioned dehydration. I’ll also add one more factor. And you can correct me if I’m wrong here.
But I imagine for some people, depending upon the type of medication, whether it is your some people take a lesser of a long-lasting medication, and some people are taking doses throughout the day that sleep could be affected by this potentially. So if you’re working with a client in the morning, and they didn’t sleep properly, because maybe they took a dose late at night, that would have to be factored in.
Carey Heller: Right, exactly. And I think but even whether medication or not, is consuming them to you’re not sleeping? Well. I mean, you definitely obviously, if it’s true, no one will look at the sleep. Because we think about one of the other issues a lot of times with ADHD and self-regulation is getting yourself to bed, whether you’re tired or not.
It’s there’s often a tendency to, oh, let me just get this, you know, get a couple more things done, and then get to bed that I think like I always use sleep as think about as an appointment, you have to attend during certain hours. And then you fit everything else around because I think a lot of people do it, where let me get anything done.
And I’ll fit into sleep around whatever time I have. But I think taking that other approach of focusing on it as if it’s an appointment to attend can often be helpful.
Steve Washuta: Is the first intervention for somebody who potentially has ADHD, let’s say you go through your assessments, and you’re and you’re, you’re pretty sure that this is what they have, is the first intervention medication or Are there exercises and activities and work that you’re doing one on one, and to try to push maybe potentially medication out of the equation altogether?
Carey Heller: Sure. I mean, it depends who you ask in terms of like some, like, you know, who might say is it a first line sort of treatment, or the other things, either way, I mean, so medication is going to help with the direct focus and to some degree with the task initiation. Yourself started to do things, it’s not going to magically give you executive function skills to be organized, and on top of stuff.
Either way, you need that extra support. I mean, my approach oftentimes is to say, you know, unless there’s some, like, for example, someone who’s extremely impulsive, and you know, it’s causing really serious issues here, then maybe look at medication first may make sense, if there’s stuff that’s a lot harder control behaviorally, but otherwise,
I think, in general, either doing behavioral sufferer, seeing how they get how far that gets you and then looking medication to sort of supplement things, or doing both at the same time with the idea that, you know, maybe you could potentially cut back on medication over time, once the skills are there more, you know, or, you know, sort of figure out, you know, happy balance.
But I think that either way, you’re not going to get as much contrary to I think some people believe it’s not a magic pill, in most cases, you’re not able to, to suddenly have reason to be perfect. Just because you take medication like I think for a lot of people can help a lot. But really especially like I think in some ways, it’s with you know, older kids and with adults, I think in some ways you miss far more by not looking at behavioral interventions like coaching or therapy to sort of help with the practical skills.
Steve Washuta: This may seem like sort of a sidebar question. But we talk a lot in this podcast about networking, how important it is to network with other professionals to help your clients. Who do you network with? And how does that work? As far as your industry? Are you? Are you working with other medical doctors or OTS or things of this nature? How does it work?
Carey Heller: Sure. So I mean, I actually work with a lot of different types of questions. It’s actually really cool because there are all sorts of pressures I never even knew existed. But like so for example, you know, one of the ones that’s probably a little lesser known or thought of, they actually interact with a fair amount our developmental optometrist. And they do actually contrary to what you might think, given the term, they do actually work with adults, because a lot of times, like when you’re testing, sometimes people have vision issues that what, and it’s not so much like the, you know, can they see the eye chart, but it’s how the eyes work together.
Sometimes that can mimic issues with attention or be a contributing factor with ADHD just in that if someone is slow to read because their eyes aren’t working together very well, that can cause excessive fatigue and product concentration. And so that’s one area that, you know, you just want to look at, everything’s, you know, obviously, physical therapists, certainly, depending on like, if someone’s having a health issue, you know, and kind of rehabbing for different things.
Then if they’re having to hold on to their exercises, you know, then there can be cooperation with that. Certainly, other mental health professionals, because a lot of times, there are people that will already have a therapist, you know, maybe they’re working on just lifestyle stuff, anxiety, depression, and then I’ll work them justice, etc, or executive function issues, because they’re not that many people that will you know, exactly what I do in terms of this.
So I think that it’s, you know, the average therapist. Yeah, they probably know what he is, but I don’t think they’re oftentimes not equipped to, like do like the practical matters, sort of skill stuff that I would often do with people.
Steve Washuta: How do the initial conversation and you can talk from an anecdotal perspective happen between someone, let’s say, a family member, and someone who potentially has ADHD to, again, sort of awaken that conversation? If it could be potentially awkward.
How do you start that conversation or how does it come about with your clients, are you finding that your clients come to you? And they report back to you that their teachers or the people they work with their colleagues or their family told them? Or did they notice themselves? There were issues?
Carey Heller: I think it depends. I mean, there are a lot of people that notice it themselves to some degree, but it’s usually some sort of push, either, you know, they’re really struggling to work and risk of getting fired. Or the student, you know, there’s had it with them, because, you know, they’re, you know, forgetting to do stuff like picking their kids up from school. I mean, that’s probably a little more extreme, but I’ve certainly seen that happen.
Yeah, so it’s, I think, or it’s just, you know, never getting not getting stuff done on time. And, you know, sort of being very stressed. And the similar other just feeling like, Oh, I’ve asked you a million times to do this, you still haven’t gotten it done. So I think that there’s a lot of you know, so when there’s an external issue going on that’s created creating problems. I think that’s where I think people start to sort of recognize, oh, I need to take action and do something.
Steven Washuta: Do you find that people taking sort of agency over their health and fitness helps them with their ADHD to that it may be sort of, I don’t know, again, if this was sort of a mechanistic thing where the hormones in the body are different, and there’s more serotonin, or they’re just more relaxed that that exercise helps us?
Carey Heller: Yeah, I mean, in jet, I mean, obviously, exercise is healthy for pretty much everyone. Sure. But I think with ADHD, I think that the ways that I find are often extremely helpful, are especially people that really hyperactive, like, you know, I often recommend getting exercise and throughout the day, like in terms of movement breaks, and things like that. And you know, as well as like a, you know, an actual workout.
But for a lot of people doing it first thing in the morning can help kind of carry them throughout the day. The other thing it also is so for a lot of people that fidget, what I often recommend is I like to call it 80 of harnessing fidgeting to improve focus. If someone’s like shaking their leg or you know, fidgeting with stuff, basically what you can do is sort of taking it in a controlled way. One of the things I often recommend are things like using a desk, bike, or elliptical under your desk.
You’re sitting all day working, if you’re pedaling throughout the day, you’re getting a lot, at least you’re getting physical activity and throughout the day so that in turn can help harness the fidgeting. And so you can be more focused, you know, teltik is getting movement in, through, you know, hand fidget using, like a free weight or like one of the, I forget what they’re Squeezy things, I have one somewhere in my desk, but um, you know, those types of things, you know, can be really helpful, because then you’re getting a little bit physical activity in, and you’re also able to continue working,
I mean, it’s so hard to stand up and take breaks and, you know, go for walks, and do everything can like physically not at your desk, but you know, if you’re gonna be happier, as long periods of time, at least doing something physical, you know, can be really helpful. You know, and the same thing with, you know, sitting, I guess, if you can see behind me, you know, I’d like a yoga ball shooting chair, you know, behind my yoga balls, well, just the like, I think basically, the idea also is having stuff that’s basically like, easily accessible can be really helpful.
So if you have five minutes, you know, pull out a mat, and, you know, do some stretching, and things like that. So I do a lot of that. I mean, you know, in my physical office, I have, you know, a yoga mat, I have a yoga ball, we love to walk in my office and, and ask if I sort of also do, you know, like, if people come in to do workouts, I mean, I do actually have some people that will use the elliptical in the office while we’re doing sessions.
But, you know, I think the point is that having all this easily accessible makes it far easier to follow through on, you know, doing various workouts throughout the day, you know, in addition to the sort of like the main workout.
Steve Washuta: Yeah. I mean, preparation, it, it helps in for everybody’s life, but especially I’m assuming if you, if you have ADHD, being able to like a journal, I would imagine and write things down and make sure you are recording, either things that you should be doing, or things that you have done to look at those things that help him in everyone’s life, but I’m sure having ADHD, that’s it’s just as if not more important.
Carey Heller: Right, exactly. And what’s hard though, is because of the nature of ADHD, and the heart, the trouble of follow through, it’s often hard for people to take the time to like, remember to do it, or, you know, just because it’s in a phone and with an alert doesn’t mean someone’s gonna follow through on it.
So for each person, it’s important to figure out what works best for them in terms of like, you know, structuring time getting their attention with an alert as sort of a way to help remember To do something but also working on the following through. There’s also a lot of times people need to get very overwhelmed easily with stuff.
Also thinking through, I mean, if you have 30 reminders coming through once, that’s, I mean, that’d be a lot for anyone. But the idea of thinking through, like, how do you also help them to slow down because sometimes it’s the, you know, the rush of all this to do or that to do can make it really hard. So then something gets pushed off.
For example, working out, you know, after recommended people, you know, have like a block of time that’s in your calendar that says, like, this is the workout time and again, like treat it whether you know, even if you’re not getting what they want, and you’re doing yourself to treat that as your workout period.
Steve Washuta: Now, a lot of this is working with it, what about working against it, and let me sort of unpacking that meaning? So if I’m a personal trainer, and one of my clients has ADHD, and I feel like Oh, it’s great with want to do circuit training, and they do 30 seconds in this exercise and 30 seconds here, and I have them going around, and they always sort of, you know, captivated by these exercises. But what about things that sort of slow the mind down to help them like meditation or yoga or things where we’re actually trying to help them just kind of decompress?
Carey Heller: No, I think those I mean can definitely be very helpful and are important. And I think it’s also kind of like weaving in a workout time throughout the day. Weaving in time to do meditation or mindfulness can be useful. You know, oftentimes, like I recommend First thing in the morning can be really good.
Sometimes like in like mid to late afternoon can be good. It’s just sort of a way to kind of decompress from everything so far today, but also to prepare ahead for the rest of the day. And then usually, like around bedtime can often be good. And I think for a lot of people that thought it some may think, oh, you know, if I have a hard time focusing, the last thing I could do was sit and listen to this long thing.
I mean, I definitely recommend people to start off with like, really short. I mean, their apps like the mindfulness app, for example, have a time session, that’s three minutes. So like something about that’s really good as a starting point because it’s not that long. And you can sort of build up if you wanted to do more, you know, or calm is a really good app that people use a lot of the apps what’s great too, is they also you can set reminders or minds or whatever time you pick to meditate each day.
Steve Washuta: Yeah, I, yeah, I’ve used those apps before. And they’re, they’re wonderful. I mean, I don’t have ADHD, but I imagine they help anybody. And they certainly helped me, like you said, kind of really shape a morning routine, and just inserting one thing into your day, and then be able to base all of your other kind of appointments off of that keeps you accountable and keeps you organized.
Carey Heller: Right, exactly, because then it also becomes about this idea of structuring your time throughout the day. And you know, this is just another thing I’m moving in the same way, if you have a very rigid eating plan. Yeah, even though these are times I have to be free to eat, or there’s a time to be free to work out. And then this way, it’s just, it’s just sort of putting all the pieces of the puzzle together to be able to sort of, you know, function successfully.
Steve Washuta: Is ADHD tied to any other medical diagnoses? Meaning, are you more likely to have a, b? Or C if you’re diagnosed with ADHD? Or does it just sort of stand-alone?
Carey Heller: Um, I mean, there’s often high comorbidity so like a high, you know, if you have this you like, with anxiety and depression, and I think a lot of it is, you know, if you have trouble focusing, you’re not on top of stuff. Yeah, you, you know, it can be acting socially, which is having a hard time like falling through it making plans or keeping plans do obviously those things weigh on people after a while.
And so it can often create anxiety, but oh, how am I gonna get this done, I know I have trouble doing this. Or sometimes feeling bad about yourself over time. For me all this trouble getting stuff done, or you know, other things that can pop through. So I think anxiety and depression are often quite common with ADHD. There’s a decent, there’s the pretty high comorbidity with learning disorders as well.
I mean, that’s what’s interesting, too, is there are times where it’s something I’ve never seen someone’s ever been bullied as a child, there are times I see where people, you know, have had learning disabilities all along, they just never knew. And then you know, do tasks in adulthood, realize it, and depending on their job, it can be helpful then to figure out, you know, for example, if they have a reading disorder, you’re looking at strategies to help them with it. But if they have no idea, then that’s an issue, that it’s harder to sort of figuring out how to do even know to try to work on it make changes,
Steve Washuta: we talked a little bit about, from a vague perspective, your assessments, can you dive into that a bit? Can you tell us a few things that you would do in the assessment? Sure.
Carey Heller: So I do formal testing, it consists of a clinical interview, which is about an hour and a half appointment. And basically, you know, asking questions, getting a lot background information released, and then getting a dialogue going. Because I really want to understand someone in terms of like, what’s their history? So, you know, how did they do in school when they were younger?
Yeah, how are they doing now with work? You know, how do they organize themselves? So did they use a task list? Do they have a ton of unread emails? I mean, that’s always a fair question to ask is how many unread emails do you have? And you know, and obviously, that’s not though, not the only sort of factor looking for any means. But it’s just it’s an interesting thing to look at.
Because people also have different mindsets and how they do things, some people feel, oh, I’ll just look at whatever emails I need to it doesn’t matter if I have 200, or 2000, unread emails, as long as I know, you know, sort of what I need to do. There are people that want to be organized but they can’t be.
And so just, you know, getting that kind of image is also really useful for me, because part of it is after we do testing and testing consists of about, you know, about to like four and a half, five-hour sessions. And essentially, I mean, I’m not telling people the entire time during this what exactly I’m looking at, but basically, that consists of doing a lot of standardized measures that looked at cognitive functioning.
So essentially an IQ test, looking at academic function because even for adults, it’s often helpful to figure out if, because sometimes, if someone’s having a hard time focusing, it may, you know, could be related to, you know, some sort of processing issue with reading or, you know, writing depending on what’s going on or an underlying language issue. So, you know, it’s important to at least do some academic testing, usually. And then I look at attention in depth, I do use some computerized measures.
I look at differences between someone’s ability to pay attention. If listening to stuff versus seeing things that response control abilities. Executive functioning and depth, then I look at emotional functioning. Because even if, you know there’s no, no one set person. And say, Oh, I’m not anxious at all, I’m not depressed, you still want to look at stuff because people that’s impactful differently. Some people were very aware of the symptoms, but sometimes it can create physical symptoms.
So, someone, you know, someone’s really anxious. They may not realize they’re anxious, but they may get stomach aches or their muscles may really be tense. And so just you want to kind of look at everything. So that you don’t miss something when you’re trying to see what’s going on. And then after all the testing sessions, we have a feedback session where go over everything.
But basically, you know, they have like very detailed recommendations. But it’s important really to have a dialogue about what I’m seeing and then go over the recommendations. Because if I just gave someone a list of recommendations, it’d be hard for them to implement them. And you know, so it’s important really to help them to process their feelings on whatever. I found, and then identify, which are the most important recommendations to take action on now.
Steve Washuta: Yeah, and we have to do that as personal trainers every day. And that’s, that’s a big crossover there. Where we’re recommending things for our clients, but we can’t go zero to 60. Right? If a client comes in and they’re obese. They have really bad lifestyle habits. And hey haven’t done anything to really help themselves in the health realm.
We can’t say, Okay, now you have to go on keto, do short running marathons, get nine hours of sleep, and cut out alcohol, because they’re going to fail, right? We have to implement one thing at a time, slowly. Let them conquer that and then move on to the next thing. And that’s how people develop, you know, good long-term lifestyle and habits.
Carey Heller: Exactly. And I think one thing I’ve found over the years is that there’s so much overlap between what I do and so many other people, it because there’s, you know, a lot of the principles are the same in terms of having them kind of meet people where they are, help them with it with execution, but also problem solve when it’s not going in the way that sort of they want it to be, or you want it to be.
Steve Washuta: Yeah, that’s That’s exactly right. And I think it seems like you don’t have this blanket, big box approach that you have, like, let’s say, maybe pillars or structures and what you believe in, but you’re still assessing each individual client, amongst their own problems in their own lifestyles and their own lives, and then developing a plan around that.
That’s what I really preach here, to the young personal trainers is you can’t just lay out a blanket program, everyone’s lives, there are so many different variables, and we have to make sure that we’re manipulating their workouts, and they’re based on their goals and their lives.
Carey Heller: Right, exactly. I think, yeah, I think for most things, and imaging approaches are often best because he missed so much if you try to, you know, because one size does not fit all, for most things.
Steve Washuta: Is OCD, if there was a spectrum, a horizontal line and ADHD was here is is OCD on the other end of the spectrum, or is there actually a kind of crossover between the two? Um,
Carey Heller: I mean, they’re not really, it’s sort of hard to compare them. Okay. Because they’re not they’re, they’re different. I mean, OCD, you know, it’s sort of often involved, you know, obsessions or compulsions, and, you know, sort of, you know, sensory-related to, oftentimes anxiety about if you can’t do those things. I mean, there are definitely people that have both ADHD and OCD. But I think it’s hard.
They’re not really I wouldn’t view those as really like on a continuum or anything. Like, I think that they’re, they’re fairly separate. I mean, there’s certainly a need for connection. Because there times where someone has a hard time if they sort of tried to do stuff, and they almost, you know, avoid sort of being too structured? Because then it can sort of exacerbating OCD symptoms in some cases.
So there’s, I mean, there’s an interaction in that regard. But like, if you look at the two disorders themselves, it’s I don’t I at least I wouldn’t consider them necessary on like a continuum with each other.
Steven Washuta: Interesting. Yeah, I think that’s just good to know, as far as you know, how we view ADHD, it’s not just the opposite of OCD, it’s not just instead of being extremely careful and worried about all the things you’re doing than just being sort of like impartial to everything that you’re doing. That’s not the case, you’re saying it’s more, it’s more of a concentration thing than just being impartial.
Carey Heller: Right. And it’s also it’s like, a lot of times people, like, you know, the probably one thing I hate the most, when people say it to someone, he is, oh, you’re just lazy. You know, it’s a sort of, from my viewpoint, a terrible thing to sort of, to say to someone. And because I think What’s hard is that a lot of times, you will have like, on some level, have the motivation, they want to do this, but they just can’t, it’s hard to like get themselves to sit down and do what they need to do.
Or it’s they know what they have to do, but they can’t get themselves to do it. And so it’s often this, like, sort of this idea of sometimes being like understimulated, because, you know, with ADHD, if there’s something that you’re really interested in doing, most people can get themselves to do it within reason.
So it becomes more about the things that you’re not as interested in doing that are far harder. I mean, I realize everyone, it’s probably easier to do stuff you want to do.
Steve Washuta: If there’s a personal trainer, again, we have that intake form the health history form. And we see that our client has ADHD. Do you think it’s worthwhile reaching out to somebody like you who works with that client is kind of like, interconnect and make sure that we’re on the same page?
Carey Heller: I mean, I think it I guess, every situation is different. But I think a lot of cases. Especially if you want to make sure that whatever plan you’re setting up is something that they can follow. Or also have have the therapist or a professional, help them on some of the follow through in a different way than you you will be able to or make sense to, I think that would be helpful, because then you get that collaboration.
Whereas if you’re working on you know, the plan in isolation, you don’t know what the therapist thinks or, you know, their perception on maybe how tweaking things can be helpful, then you’re missing a lot. And then but I also think helping. You know if he can give directly may that make it easier for the person. To you know, or for the clinician to work with the client and their sessions and, you know, help navigate things. So it’s sort of on both ends, things can kind of go better
Steve Washuta: Yeah, yeah, I couldn’t agree more. It’s important to make sure that we’re working with all of the health professionals that surround our clients. Number one, obviously, this is your wheelhouse, you know a lot more than we do. And you can give us recommendations as to how we can tweak things accordingly to make it better for our client.
But number two, maybe they had a lapse, maybe they were doing great and something happened. And they had a huge lapse. We don’t really know what’s going on, provided that’s not sort of patient doctor confidentiality. You could relay that information to us so that we’re not so concerned if they come into the session, and we think that there’s something wrong and that we know that there was sort of maybe a setback, and then we can we can work with that.
Carey Heller: Right, exactly. Yeah. I mean, I think yeah, and most, as long as you know that the client signs a release for him. Then yeah, and that’s you should be able to share information back and forth. So yeah, so I think that kind of stuff is helpful. Because also, with ADHD, a lot of times, even if someone gets into really good routine. If something throws off, if they have, I don’t know, a break of some kind. You know, some of the throws off, it’s sometimes harder to get back on track with with teens. Then, you know, the average person a lot of cases.
But also the one of the other big things is the awareness. Figuring out, like what you can do to help things sort of it’s such a pain in someone’s face. Enough to like it like. So for example, with drinking enough water, like one things that can be helpful, and, you know, work with us on clients is, you know, thinking about like, I mean, I use a water bottle, where it’s me, you see, basically like numbers.
And so you know, based on the time of day, how much water to drink. So something like that is a very visual thing for someone. Where you just say, you know, drink X amount of ounces of water a day. They’re probably not going to be alive when they have trouble doing it anyway. But like thinking like, how do you break down? Like, How Much Water Should I have drinking by 10am to 12pm. And so like helping people based on like, what their schedule is like, it can be really helpful.
Steve Washuta: Yeah, and then keep continuing to tweak those things. If it doesn’t work, you can’t just try one thing. So for your water example. I tried to buy a really expensive bottle of water, excuse me, like a, something to hold water in. I thought like, if I spent a lot of money on this. That I’m going to make sure that I always have it around and use it.
That didn’t work for me, for whatever reason. Having a jug of water or buying $1.10 cent jug of water around makes me carried around. And that’s just what helps me. So that’s what I have to do. And if, if you’re trying to help your client. Think of three or four or five different ways to do these things. And if one doesn’t work, you’re ready and prepared with the next one. Until something does click because we all respond to different things.
Carey Heller: Exactly. And it is. And because everyone’s different. It’s important to sort of, you know, it’s unfortunate trial and error to some degree. But it’s the act of continuing to keep trying that is going to bring about those changes long term. Whereas if you sort of give up, you’re not going to make any changes. Yeah.
Steve Washuta: This was great information. Where can the audience find more about you and the information that you give. Or even reach out to you directly if they have questions? Sure.
Carey Heller: Absolutely. So I’m based in Bethesda, Maryland. With telehealth, I can you know, in terms of you know, if you want to work with me, I can see clients in DC, Maryland, Virginia, and about 23 other states.
So, if you go to my website is Heller psychology group.com. Facebook Heller, psychology, Twitter at Carey Heller, Psy D. And you can also email me at APBT at the Heller, psychology group.com. If you have questions.
Steve Washuta: My guest today is Carey Heller, thank you so much for joining us for the podcast.
Carey Heller: Thanks for having us. This is fun.
Steven Washuta: Thanks for joining us on The Trulyfit podcast. Please subscribe rate and review on your listening platform. And feel free to email us we’d love to hear from firstname.lastname@example.org. Thanks again