ADHD News & Research

Study: New Parent Behavior Therapy Yields Longer ADHD Symptom Control in Children

ADHD symptom relapse was significantly reduced in children of parents who participated in a new schema-enhanced parent behavior therapy, compared to those whose parents participated in standard PBT.

October 6, 2020

Parent Behavior Therapy (PBT) enhanced with Schema Therapy (ST) significantly reduced the rate of ADHD symptom relapse among children, according to a study published recently in the Journal of Attention Disorders.1 Schema Therapy “is a structured therapeutic approach incorporating elements of cognitive behavioral therapy (CBT), attachment theory, emotion-focused therapy, and psychodynamic thinking.”2 ST identifies schemas, such as self-defeating perceptions, and helps patients replace maladaptive coping styles with adaptive patterns of behavior.

ST has been found to enable significant personality changes that remain stable even after one year. This is notable because symptoms are shown to relapse more quickly after the cessation of traditional PBT, the first-line treatment for ADHD in children younger than six. In children ages 6-12, the Centers for Disease Control and Prevention (C.D.C)  and American Academy of Pediatrics (AAP) recommend ADHD medication paired with PBT; this study suggests that Schema-enhanced Parent Behavior Therapy (SPB) may be an even more effective alternative to standard PBT.

In this study, researchers created a pragmatic controlled trial to evaluate the effectiveness of interventions in real-life routines over three years. Participants were selected from three child and adolescent public mental healthcare clinics (CAMHC) in Israel. An experimental group of 97 parents and 54 children and a control group of 40 parents and 23 children were administered the SPBT and PBT protocols, respectively. Participants were assessed at the beginning of the study, mid-treatment, and at the end of treatment. Standardized questionnaires were given to parents and teachers to assess the severity of ADHD and comorbid symptoms in their children.

The SPBT protocol used in this study comprises a 10-step model delivered in 25 hour-long sessions. Steps 1 to 4 are based on portions of the Barkley protocol3 and are conducted during the first 12 weeks; both the experimental and control groups participated in this portion of the protocol, with differences introduced in Steps 5 to 10. In the experimental SPBT group, the therapist identified relevant parent and child schemas, then created a detailed personal treatment plan for the parent to implement at home. In the control group, parents and children continued with standard PBT treatment through 25 meetings, per the Barkley protocol.

Parents and teachers in both the SPBT and PBT groups reported significant symptom reduction midway through the intervention, which was expected. By the end of treatment, however, ADHD symptoms among children in the control group had returned to clinical status. Among children in the SPBT, ADHD symptom improvements were maintained through the end of the intervention.

Researchers concluded that, though the SPBT program yielded significantly reduced relapse rates at its conclusion, additional research is needed to determine the long-term effects of SPBT for families living with ADHD.


1Solan M, Brunstein Klomek A, Ankori G, Bloch A, Apter A, Plishty S. Impact of a New Parent Behavioral-Schema Training on Children with ADHD: A Pragmatic Control Trial. Journal of Attention Disorders. September 2020. doi:10.1177/1087054720959711

2Young, J. E., Klosko, J. S., Weishaar, M. E. (2006). Schema therapy: A practitioner’s guide. The Guilford Press.

3Barkley, R. A. (2013). Defiant children: A clinician’s manual for assessment and parent training. The Guilford Press.