Understanding and Managing Attention-Deficit/Hyperactivity Disorder (ADHD)

Thrive • October 19, 2022

By Thrive Wellness Sacramento Interim Executive Director & Psychiatrist Jaime Avra Ley, M.D.

Almost 10% of children and about 4% of adults in the U.S. struggle with attention-deficit/hyperactivity disorder (ADHD), a condition that diminishes one’s ability to focus, feel at ease, and control impulses. The distressing disorder can interfere greatly with daily life, but a variety of clinical interventions can help make ADHD more manageable.

WHAT IS ADHD?

ADHD is characterized by difficulty regulating a group of important brain processes, called executive function, responsible for:

Attention
Organization
Working memory
Control of emotional and physical behaviors

Executive function prioritizes information by encouraging focus on information deserving attention and allowing less important data to fade to the background. These mental processes also help regulate behaviors by allowing or inhibiting actions, a process called impulse control.

Three types of executive function deficits correspond to three types of ADHD:

ADHD, predominantly inattentive : Difficulty with attention, focus, and organization primarily
ADHD, predominantly hyperactive/impulsive : Difficulty with impulse control and hyperactivity primarily
ADHD, combined type: Having both deficits in attention and impulse control

Symptoms of ADHD are associated with attention, hyperactivity, and impulsivity.

ADHD symptoms associated with attention include:

Difficulty paying close attention to details
Making seemingly careless mistakes often
Trouble listening
Difficulty with organization and prioritization
Feeling reluctant, disliking, or avoiding tasks that require extended focus
Frequently losing important items
Becoming distracted easily
Forgetfulness

ADHD symptoms associated with hyperactivity and impulsivity include:

Often engaging in fidgeting or squirming
Trouble staying in one’s seat
Engaging in physical activity inappropriate for the current environment
Difficulting participating in leisure activities quietly
Frequently feeling “on the go”
Engaging in excessive talking often
Interrupting frequently
Difficulty waiting for one’s turn

Risk factors for ADHD include genetic makeup, premature birth , and exposure to drugs and alcohol in utero.

MISCONCEPTIONS ABOUT ADHD

ADHD is frequently misunderstood. A couple of commonly mistaken beliefs about ADHD include:

Individuals may misperceive those with ADHD as defiant or lazy. In reality, tasks that may seem simple can require much more effort for individuals with ADHD. As a result, those with ADHD may resist undertakings that demand their full concentration.
When individuals with ADHD present symptoms of impulsivity, others may misperceive them as disrespectful, unruly, or disobedient. While there may be defiance involved in their actions, those with ADHD face more of a challenge restraining their impulses and moderating their conduct. Authority figures may rightfully implement consequences for inappropriate behavior. They may also validate the increased difficulty that those with ADHD face which can help reduce any shame stemming from the condition.

THE CONNECTION BETWEEN ADHD AND PERINATAL MENTAL HEALTH

Pregnancy and caring for an infant generally entail biological changes, diminished quantity and quality of sleep , and feelings of overwhelm — all of which can impair executive function and make organization, focus, and emotion regulation tough. If a new parent has ADHD, the perinatal period can aggravate the symptoms of the condition.

THE CONNECTION BETWEEN ADHD AND EATING DISORDERS

ADHD varies in the ways it affects different types of eating disorders , such as:

Binge eating disorder (BED) : Characterized by feeling a lack of control when eating as well as difficulty regulating portions, BED can be worsened by ADHD. Executive function deficits associated with ADHD can make it hard to regulate one’s eating behavior.
Bulimia : Expressed by frequently eating large quantities of food followed by compensatory purging behaviors , bulimia can also be exacerbated by ADHD. ADHD can make controlling the impulse to engage in compensatory actions more challenging.
Anorexia and avoidant restrictive food intake disorder (ARFID) : Individuals who struggle with ADHD and restrictive eating disorders, such as anorexia and ARFID are often able to easily disregard their hunger cues. If ignored long enough, hunger cues can dissipate. During recovery, these individuals may require additional guidance as they learn to be more mindful of returning hunger cues .

INDIVIDUAL BEHAVIORAL THERAPY FOR ADHD

Individual behavioral therapy allows those with ADHD to strengthen desired behaviors and reduce problematic conduct. Throughout the process, the clinician integrates appropriate goals, incentives, and consequences to help shape the client’s regulation skills.

Therapists can also help with any emotional challenges associated with the disorder. For example, ADHD can contribute to strained relationships as well as diminished work or school performance. Low self-esteem , social skill deficits, anxiety , and depression may result. Therapy can help treat all aspects of the condition, including any co-occurring diagnoses.

FAMILY THERAPY FOR ADHD

For an individual struggling with ADHD, family support can be essential to the successful management of the disorder. A family therapist can guide family members in supporting their loved one with ADHD while also providing them with skills to keep the family dynamic healthy amid the challenge.

ADDITIONAL INTERVENTIONS FOR MANAGING ADHD

A well-rounded approach to treating ADHD is often beneficial.

Some other ADHD management strategies that can complement therapy include:

School support resources: Schools can provide accommodations for students with ADHD to promote their academic success and behavioral modification.
Physical activity in nature: Movement and natural environments can provide a calming, restorative experience which can reduce the stress and anxiety that exacerbate ADHD.
Neurofeedback: A non-invasive procedure, neurofeedback can help a person understand their brain activity and strengthen their brain’s ability to focus, problem-solve, and control impulses.
Medication: Certain medications can help stimulate the parts of the brain needed for focus, attention, and behavior regulation.

TREATMENT FOR ADHD AT THRIVE WELLNESS

Thrive Wellness’ mental and behavioral health experts specialize in treating individuals of all ages struggling with ADHD, including those facing perinatal ADHD and ADHD that co-occurs with eating disorders . By implementing interventions such as individual and family therapy, medication management, and educational advocacy, our clinicians guide individuals in managing ADHD in a way that promotes attention, organization, and impulse control. To learn more about our therapeutic services , reach out .

While all Thrive Wellness locations offer interdisciplinary clinical teams who collaborate to treat eating disorders, perinatal mood and anxiety disorders (PMADs), and additional mental and behavioral health conditions, programs and services may vary by location.

About the Author

Thrive Wellness Sacramento Interim Executive Director & Psychiatrist Jaime Avra Ley, M.D.

Born and raised in Nevada, Dr. Jaime Avra Ley earned her doctorate in medicine at the University of Nevada, Reno Medical School where she also completed a residency in adult psychiatry and a fellowship in child and adolescent psychiatry. As an established and esteemed psychiatrist, Dr. Ley specializes in working with children and adolescents.

Dr. Ley considers comprehensive wellness to be inclusive of the health of one’s relationship with themself and others. She is passionate about addressing mental health barriers that may interfere with one’s ability to live authentically and reach their innate potential. Dr. Ley believes a multidisciplinary approach to care increases the efficacy of treatment for lasting results and is dedicated to supporting the various aspects of an individual’s well-being by providing diagnoses and medication management as appropriate.

At Thrive Wellness Sacramento, Dr. Ley enjoys working alongside a diverse treatment team of compassionate clinical colleagues to help individuals and families on their path to healing.

The post Understanding and Managing Attention-Deficit/Hyperactivity Disorder (ADHD) first appeared on Thrive Wellness.

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Eating Disorders in Adolescents: What Providers Need to Know for Early Intervention

September 22, 2025

Eating disorders are one of the most serious mental health concerns facing today’s adolescents. They can affect every aspect of a young person’s life, including their physical health, school performance, relationships, self-esteem, and more. According to the National Institute of Mental Health, about 2.7% of adolescents in the U.S. will experience an eating disorder in their lifetime, and many more engage in disordered eating behaviors that may not meet full diagnostic criteria. The good news is that providers are in an influential position to notice early warning signs, open conversations, and connect families to support before these patterns of behavior become too engrained. Why Early Intervention Matters The earlier an eating disorder is identified and treated, the better the treatment outcomes. Research shows that getting support quickly after the disorder’s onset is linked to faster recovery, lower relapse rates, and healthier long-term development (Treasure & Russell, 2011). Waiting too long to seek help can mean medical complications, deeply ingrained behaviors, and a more difficult path to healing. For many adolescents, a caring provider who notices the signs and advocates for treatment can make all the difference in recovery and can even save lives. Recognizing Early Warning Signs Adolescents may not always disclose their struggles directly, so providers should keep an eye out for a range of indicators: Physical signs: noticeable weight changes, menstrual irregularities, digestive issues, dizziness, or fatigue. Behavioral patterns: skipping meals, restrictive eating, excessive exercise, frequent dieting, eating in secret, or leaving for the bathroom after meals. Emotional and cognitive signs: preoccupation with weight or body shape, food rituals, heightened anxiety around eating, or perfectionistic tendencies. It’s important to remember that eating disorders don’t always “look” a certain way. Teens can be distressed about food and body image even if their weight appears to be within a “normal” range. Screening Tools and Assessments Using free screening tools available online can be an effective way to gauge a patient’s needs and gain further insight on treatment options for a possible eating disorder. Here are 4 free screening resources we recommend you use before making a referral for a higher level of care. EDE-Q (Eating Disorder Examination Questionnaire) : helps assess eating attitudes and behaviors. Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS) : helps to assess the signs of ARFID in children. Eat 26 Screening Tool : a screening measure to help you determine attitudes towards food and eating. BEDS-7 (Binge Eating Disorder Screener) : for situations where binge eating is suspected. When possible, gathering input from parents, teachers, or coaches can also help, as teens may minimize their experiences out of fear or shame. The Role of Primary Care and Pediatric Providers Routine checkups are often where eating disorders first come to light. Providers treating children, teen, and adolescents can: Incorporate simple questions about eating habits and body image into wellness visits. Track growth charts and weight trends while pairing them with questions about mood, anxiety, and behavior. Foster trust by creating a safe, nonjudgmental space where adolescents feel comfortable sharing sensitive information and know there will be no weight stigma. Coordinating Multidisciplinary Care Supporting a young person with an eating disorder works best when care is collaborative . In order to treat the whole person, there are usually multiple members of a treatment team needed, including: Medical support: monitoring vital signs, lab work, and physical health. Therapeutic care: evidence-based approaches such as family-based therapy (FBT) and cognitive-behavioral therapy (CBT) help address thoughts and behaviors. Nutritional guidance: dietitians provide education, meal support, and reassurance. Family involvement: engaging caregivers empowers them to support recovery in everyday life. Addressing Barriers and Stigma Many families face challenges in seeking help, whether due to stigma, lack of awareness, or limited access to specialists. To help, providers can: Normalize conversations about body image and mental health as part of overall well-being. Use culturally sensitive approaches that honor diverse experiences with food, body, and health. Connect families to community organizations, online resources, or telehealth when in-person specialty care is limited. Eating disorders in adolescents are serious, but with early recognition and timely support, recovery is possible. Providers are often the first to notice changes and can play a vital role in opening doors to crucial support. By blending professional expertise with empathy and collaboration, providers can guide adolescents and their families toward lasting recovery and a healthier future. References National Institute of Mental Health. (2023). Eating Disorders . Treasure, J., & Russell, G. (2011). The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. The British journal of psychiatry : the journal of mental science, 199(1) , 5–7.

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When Mealtimes Become Battlegrounds: How ARFID Impacts Families

August 21, 2025

When Emma was 8, her parents noticed her food choices shrinking. At first, they assumed it was just picky eating — “She’ll outgrow it,” friends said. But by 10, Emma would only eat crackers, cheese, and chicken nuggets. Family dinners became nightly struggles, her growth slowed, and she skipped birthday parties to avoid “strange food.” Her parents felt powerless, her brother grew frustrated, and outings dwindled. What began as food avoidance soon reshaped the rhythm of the entire household. When children avoid food, most parents expect it’s a passing stage. But when restriction deepens, shrinks to only a few “safe foods,” and begins affecting growth or health, families suddenly find themselves in unfamiliar territory. This is often where Avoidant/Restrictive Food Intake Disorder (ARFID) emerges — with effects that extend far beyond the plate. As providers, we need to be attuned to these patterns. It’s tempting to dismiss them as “no big deal,” yet for many families, they are life-altering. Sadly, Emma’s story is not unusual. Mealtimes as Battlegrounds Families living with ARFID often describe mealtimes as emotionally charged, exhausting, and unpredictable. What should be a chance to connect around the table can feel more like a negotiation or even a standoff. Parents wrestle with whether to push their child to try a new food or give in to the same “safe foods” again and again to avoid tears, gagging, or complete meltdowns. This ongoing tension can make mealtimes dreaded rather than cherished. Siblings, too, are affected. Some may feel resentful when family meals are limited to what only one child will tolerate. Others may act out in response to the constant attention the child with ARFID receives. Over time, the dinner table shifts from a place of nourishment and bonding into a stage for conflict, anxiety, and guilt — a pattern that can erode family cohesion and resilience. Social Isolation and Missed Experiences ARFID impacts more than what happens at home; it influences how families engage with the world around them. Everyday events — birthday parties, school lunches, vacations, even extended family dinners — become sources of stress. Parents may pack special foods to avoid confrontation or, in many cases, decline invitations altogether to protect their child from embarrassment or overwhelm. This avoidance can lead to an unintended consequence: isolation. Families miss out on milestones, friendships, and traditions because of the unpredictability surrounding food. The child may feel left out or ashamed, while parents grieve the loss of “normal” family experiences. This social withdrawal can compound the anxiety already present in ARFID and deepen its impact across generations. Emotional Toll on Parents The emotional strain on parents navigating ARFID is significant. Many describe living in a constant state of worry — Will my child get enough nutrients? Will they ever grow out of this? Am I doing something wrong? This worry often spirals into guilt and self-blame, particularly when outside voices dismiss the disorder as mere “picky eating.” In addition, the pressure to “fix” mealtimes can strain marital relationships, creating disagreements over discipline, feeding strategies, or medical decisions. Parents may also feel emotionally depleted, pouring all their energy into managing one child’s needs while inadvertently neglecting themselves or their other children. Without support, this chronic stress can lead to burnout, depression, and disconnection within the family system. The Role of Providers For clinicians, ARFID must be viewed not only as an individual diagnosis but as a family-wide challenge. Effective care requires attention to both the clinical symptoms and the family dynamics that shape recovery. Parent Support: Educating caregivers that ARFID is not their fault, offering psychoeducation, and helping them reframe mealtime struggles as part of the disorder — not a parenting failure. Family-Based Interventions: Coaching families in structured meal support, communication strategies, and gradual exposure work so parents don’t feel powerless. Holistic Care: Involving therapists, dietitians, occupational therapists, and medical providers ensures that the family does not shoulder the weight of treatment alone. When families are validated, supported, and given practical tools, the entire household can begin to heal. Treatment is not only about expanding a child’s food repertoire but also about restoring peace, resilience, and connection at home. Moving Forward ARFID may begin with one individual, but its ripple effects are felt across the entire family system. By addressing both the psychological and relational dimensions, providers can help transform mealtimes from a source of conflict into an opportunity for healing and connection. For those who want to go deeper, we invite you to join our upcoming training on ARFID , where we will explore practical strategies for supporting both clients and their families.