When a child grows up with untreated mental illness, there's a good chance that'll affect their

identity. We'll look at how to work with that in the psychotherapy of ADHD.

Welcome to the Carlite Psychiatry Podcast, keeping psychiatry honest since 2003.

And this is a throwback Thursday episode, where we're going to podcast, keeping psychiatry honest since 2003.

And this is a throwback Thursday episode, where we're going to update this 2019 classic with new research and CME credits at the end.

Today we'll continue our talk with psychiatrist Scott Shapiro about the therapy of adult ADHD. Dr. Shapiro

practices schema-focused therapy, which is a branch of cognitive behavior therapy that was

developed in the mid-1980s by Dr. Jeffrey Young. Dr. Young had become dissatisfied with the effects

of traditional CBT on patients with chronic problems

like personality disorders. He hypothesized that these patients had deep-seated beliefs about themselves.

He called these schemas, which he defined as a life trap or pattern of negative behavior

that a person repeats over and over again throughout their life.

Drawing from attachment theory, he theorized that these schemas developed at an early age

when basic childhood needs failed to be met by early caregivers.

Schema-focused therapy is best studied in borderline personality disorder, but it's now being

applied to ADHD and other chronic mental health conditions as well.

Some of the schemas or enduring beliefs that are common in ADHD include failure, the belief

that one will fail in virtually all endeavors,

defectiveness and shame, the idea that one is unwanted or insignificant to others,

and unrelenting standards, the idea that one must meet unreachable goals in order to avoid criticism from others.

Outcomes in ADHD are much better when treatment is started early, particularly before puberty.

So it seems to me that this schema-focused therapy would be most useful in people whose ADHD was not recognized and treated until adulthood because of

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