These days, when increasing distractions and shortened attention spans have led people to conclude “everybody is ADHD,” Bethesda clinical psychologist Carey Heller treats children and adults who have been diagnosed with attention deficit hyperactivity disorder. Heller, 33, grew up in Chevy Chase and attended Charles E. Smith Jewish Day School in Rockville before earning his doctorate in psychology from The George Washington University.
“There’s a lot about ADHD in pop culture,” Heller said, then went beyond the stereotypes of kids bouncing off walls and students who just aren’t trying hard enough in class.
How do you define ADHD and what are some of the behaviors associated with it?
The main criteria are in the categories of inattention or impulsivity, hyperactivity. An easy way to think about it is, it’s a disorder that’s characterized by difficulty focusing, issues of self-regulation and executive functioning. Executive functioning [is] the control center of your mind that helps you get going with tasks, being able to get yourself organized, remember things, follow through and complete things.
With ADHD, a lot of people have a hard time executing things. Some of it is related to difficulties in being able to stay focused. But some of it is underlying difficulties in doing what they need to do, so they give up easily.
Would you say the education system is not made for kids with ADHD?
The system, public or private school, is not designed for each person’s needs. Unless it’s a school where it’s one-on-one teaching. For some kids with ADHD, having a structured environment is really helpful. But if there are not a lot of breaks, especially with kids who can’t sit still, that can make it really hard.
If you have a school where every half hour they get a five-minute movement break, for a lot of kids that can’t sit still, that can go a long way. For some kids, it’s so taxing on them emotionally and physically to have to focus for so long, that even if they get through the school day, sometimes they get irritable when they get home, because it takes so much for them to hold it together during the school day.
I think of executive functioning as the grownup in the room. Is this something that most kids with ADHD grow out of?
A long time ago people said kids sometimes grow out of ADHD. I don’t think they ever really do. The difference is that some people, especially with support, learn to cope very well. So part of it is learning effective tools to manage it better. But the other big thing is choosing your environment. When you’re an adult, you get to choose a job that’s a better fit for your skill set. If someone has a real hard time focusing, a job where they’re sitting in front of a computer all day analyzing numbers might not be the best fit. But maybe a job in sales where they get to go outside and socialize and talk a lot [would be better].
What role do you think Ritilin has or should have?
In my experience, medication can help with helping to regulate impulsivity and being more focused. The problem is, being able to focus doesn’t automatically give you the executive functioning skills of being more organized and having good time management skills. Medicine might making using the tools easier, but it’s not going to give you those tools.
How did this become your specialty?
I initially became interested in being a psychologist in middle school, seeing how horribly kids treated each other when they played. And then I interned in [National Institutes of Mental Health] the end of my senior year [in high school]. I went to Charles E. Smith Jewish Day School and the year that I graduated [2003] the Iraqi war was really bad, so most of the class did not go on the Israel trip. So I needed something to do. So I ended up interning at NIMH for a couple of summers. That experience gave me more insight into mental health disorders.
In graduate school I got very interested in testing. Once you identify ADHD, that’s great. But more importantly, how do you treat it? Now, when I do a testing, I have a feedback session where I talk with the child or teen about different strategies to implement. And it’s very practical. So there might be certain apps they can use, or certain fidgets.
You said that some kids have never opened the calendars on their phone. What are some possible strategies that might be right in front of them?
Anyone who has an iPhone, a reminder app comes with the phone. For some kids that can work well, For some it’s too complicated to set up. I always view it as, you find a problem, you figure out a solution.
Another piece of this is, and I didn’t realize it until later, is that I had trouble in school. I always had a lot of support and tutoring, But what I learned from that is, it’s not just getting the help, it’s getting help that allows you to be independent.
So how to do you encourage them to do more on their own?
One of the things I do to help teens become more independent is to set up a homework plan. The child has a plan of what they’re going to do themselves, and then send it to their parents. If they don’t get it done by a set time, they have a say in how the parent reminds them.
Tell me a little bit about the fidgets and the other things for younger kids.
There’s some research on it. The idea is that if someone’s really bored, they’re not going to be focused. You can trick yourself into thinking you’re more focused than you are by adding sensory motor device, and that’s where the fidget comes in. So instead of someone aimlessly shaking their leg, you take one of the fidget tools and do it in a controlled way. Anytime you use a fidget tool, you have to put your full attention on what’s going on. You don’t have to look directly at the item.
How would you cure meanness in middle school kids?
Part of it is figuring out what is the motivation. So if they’re picking on someone else, what’s behind it? And how do they feel when they’re doing it? Do they feel happy that they’re doing it? Or are they bothered by it and ashamed of themselves? And for the person who’s being picked on, how are they reacting? Kids who are bullies certainly have issues too.
Unfortunately there’s no magic way to fix it. Certainly promoting tolerance and helping kids understand the ramifications of when you are mean.
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