Executive Functions Contribute to the Differences Between ADHD and Sluggish Cognitive Tempo (SCT) in Adults

OBJECTIVES

This paper analyses the relationship between sociodemographic variables, executive dysfunctions, Sluggish Cognitive Tempo (SCT) and the mainly dimensions of ADHD: hyperactivity-impulsivity (ADHD-H/I) and inattention (ADHD-IN) in Brazilian adults.

METHOD

A cross-sectional, exploratory, and comparative design was used. A total of 446 participants (295 women) aging from 18 to 63 years old (M = 3,499 years, SD = 10.7) were recruited on the internet. Correlations, t independent tests and regressions were conducted.

RESULTS

Higher scores in ADHD dimensions were associated to more executive functioning problems and time perception distortions in comparison to those participants without significant ADHD symptoms. However, ADHD-IN dimension as well as SCT were higher associated with these dysfunctions than ADHD-H/I. The regression results showed that ADHD-IN was more related to Self-Management to time while ADHD-H/I to Self-Restraint and SCT to Self-Organization/Problem Solving.

CONCLUSION

This paper contributed to the distinction between SCT and ADHD in adults in important psychological dimensions.

Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors

BACKGROUND

Sluggish cognitive tempo (SCT) has been proposed to be either its own distinct disorder or a transdiagnostic process.

OBJECTIVE

To examine SCT within ADHD (and its specific presentations) and internalizing disorders and its relationship with functional impairment, particularly when considered from a multidimensional perspective.

METHOD

Undergraduate students (N = 2,806) completed self-report scales measuring SCT, ADHD, anxiety, depression, and functional impairment. The SCT scale consisted of three subfactors identified in prior research.

RESULTS

Students with internalizing disorders were equally as likely as those with ADHD to report clinically significant SCT, and having multiple other disorders predicted especially high levels of SCT symptoms. Only sleepy/sluggish symptoms incrementally predicted impairment.

CONCLUSIONS

These findings provide more support for SCT as a transdiagnostic process than as a distinct disorder. All areas of SCT symptoms are associated with ADHD, anxiety, and depression, but the sleepy/sluggish symptoms may be uniquely associated with problems in everyday living.

Cognitive Performance and Psychiatric Self-Reports Across Adult Cognitive Disengagement Syndrome and ADHD Diagnostic Groups

OBJECTIVE

Cognitive disengagement syndrome (CDS) is characterized by inattention, under-arousal, and fatigue and frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD). Although CDS is associated with cognitive complaints, its association with objective cognitive performance is less well understood.

METHOD

This study investigated neuropsychological correlates of CDS symptoms among 169 adults (M_age = 29.4) referred for outpatient neuropsychological evaluation following inattention complaints. We evaluated cognitive and self-report differences across four high/low CDS and positive/negative ADHD groups, and cognitive and self-report correlates of CDS symptomology.

RESULTS

There were no differences in cognitive performance, significant differences in self-reported psychiatric symptoms (greater CDS symptomatology, impulsivity among the high CDS groups; greater inattention among the positive ADHD/high CDS groups; greater hyperactivity among the positive ADHD groups), significant intercorrelations within cognitive and self-report measures, nonsignificant correlations between cognitive measures and self-report measures.

CONCLUSION

Findings support prior work demonstrating weak to null associations between ADHD and CDS symptoms and cognitive performance among adults.

Turkish Adaptation, Validity, and Reliability Study of the Children and Adolescent Behavior Inventory Family Questionnaire

Introduction

This study aimed to conduct the Turkish adaptation, validity, and reliability analyses of the Children and Adolescent Behavior Inventory (CABI) Family Questionnaire.

Method

A total of 1015 parents of children and adolescents aged 6-14 years, with 762 from the community sample and 253 from the clinical sample, participated in the study. After the language adaptation of the scale was completed by experts, its construct validity was determined using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and discriminant validity. The reliability was assessed with Cronbach's alpha internal consistency coefficients, and the test-retest reliability of the scale was tested on 100 participants.

Results

The results of the EFA showed that the scale had 10 factors. The items associated with the 10th factor, which was different from the original scale, aligned with the subscales of the Sluggish Cognitive Tempo. The results of the CFA indicated that the factor load values were statistically significant, and the fit index values were at moderate, good, and excellent levels. A comparison of the subscale scores of the clinical and population sample groups showed that the scale had a distinctive feature. The Cronbach's alpha value of the total scale score was calculated to be 0.94. No statistically significant difference was found between the mean test-retest scores obtained on the subscales. The test-retest correlation coefficient was found to be within the range of r=0.605-0.853 for the subscales (p<0.01).

Conclusion

This study proved that the CABI Family Questionnaire was a valid and reliable scale and could be administered to the parents of Turkish children and adolescents aged between six and 14 years in population and clinical samples.

[Cognitive impairment in children with organic asthenic disorder]

OBJECTIVE

To study cognitive impairment and neurophysiological characteristics in children with organic asthenia, as well as the effectiveness of the drug Cogitum in the treatment of this pathology.

MATERIAL AND METHODS

The main study group included 40 children aged 8 to 10 years with a diagnosis of «Organic asthenic disorder» (F06.6). The control group consisted of 30 children aged 8 to 10 years without manifestations of asthenia. The following research methods were used in the work: the asthenic state scale (ASS) by L.D. Malkova to assess the severity of asthenic syndrome, the S. Lee «SCT» (sluggish cognitive tempo) scale to assess manifestations of low cognitive tempo, the «Random Access Memory» method to quantify working memory, the TOVA (The Test of Variables of Attention) computer test to quantify assessment of attention disorders and impulsivity level, electroencephalogram (routine and spectral analysis) (p<0.05). For the treatment of patients from the study group, the drug Cogitum was used at a dose of 10 ml of a drinking solution per day for 30 days.

RESULTS

In was shown that children from the study group were characterized by a decrease in working memory (7.8±2.9 vs 14.9±5.4), a statistically significant increase in SCT scores (p<0.05), a significantly greater degree of inattention and impulsivity with a tendency to an increase in the number of errors in the second half of the TOVA test (p<0.05). Comparative analysis of EEG relative power data showed a statistically significant increase in the power of waves in the alpha and theta ranges in the fronto-central leads of both hemispheres in the group of children with organic asthenic disorder (p<0.05). When re-evaluating the condition of children after treatment, a statistically significant decrease in the manifestations of asthenia on the ASS scale was recorded in 77.5% of cases. At the same time, there was a significant improvement in attention, memory, and indicators characterizing a low cognitive pace. The results of an electroencephalographic study after a course of treatment showed a decrease in the relative power of the EEG in the theta and alpha ranges in the anterior sections of the cerebral cortex (p<0.05), which indicates an increase in the level of activation of neocortical structures.

CONCLUSION

Thus, the use of the drug Cogitum for the treatment of organic asthenic disorder leads not only to a decrease in asthenia and cognitive impairment, but also to an improvement in the functional state of the brain.

Cognitive Disengagement Syndrome (Sluggish Cognitive Tempo) and Social Withdrawal: Advancing a Conceptual Model to Guide Future Research

OBJECTIVE

Cognitive disengagement syndrome (CDS, previously referred to as "sluggish cognitive tempo") is a set of symptoms defined by excessive mind-wandering, mental confusion, and slowed behaviors separable from ADHD inattention.

METHOD

Of the studies examining CDS in relation to psychosocial outcomes, one of the most established correlates of CDS is social withdrawal. However, studies have yet to test mechanisms or moderators of the link between CDS and social withdrawal.

RESULTS

As a parallel body of literature exists in developmental psychopathology on predictors and outcomes of social withdrawal, this review merges these literatures to identify themes and advance a conceptual model on mechanisms (e.g., task-unrelated thought, poorer social skills, social anxiety) and moderators (e.g., behavioral inhibition, sex, parenting) of the CDS and social withdrawal link.

CONCLUSION

This model provides researchers and clinicians with testable hypotheses to better understand the link between CDS and social withdrawal and to identify treatment targets to improve the social engagement of youth with CDS.

The comparison of sluggish cognitive tempo, processing speed, and executive functions in female children with specific learning disabilities and typically developing female children: A pilot study

This study investigated the association of sluggish cognitive tempo (SCT), processing speed, and executive function (EF) in children with specific learning disabilities (SLD), and the typically developing children (TD) (60 female students aged between 8 and 10). Child and Adolescent Behavior Inventory-Parent Version (CABI), the Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and Wechsler Intelligence Scale for Children-IV (the Processing Speed Index (PSI) were used to assess SCT, processing speed, and EF. The results showed that SCT problems were higher in children with SLD (p < 0.001). In addition, results showed that children with SLD had poorer performance on processing speed (p < 0.001) compared to the TD group. Executive dysfunctioning in self-management to time, self-organization, problem-solving, self-restraint, self-motivation, and self-regulation of emotions were poorer in children with SLD than TD group (p < 0.05). This study provides initial evidence that SCT symptoms are poor in female children with SLD, and associated with executive dysfunction and poor processing speed.

An Examination of the Role of Sluggish Cognitive Tempo as a Moderator of the Relationship Between ADHD and Nicotine Use

OBJECTIVE

ADHD is a neurodevelopmental disorder characterized by executive dysfunction and functional impairments including nicotine consumption. Sluggish cognitive tempo (SCT) has been associated with ADHD and posited as an independent construct. The present study hypothesized that SCT would moderate the relationships between ADHD and nicotine-related behaviors.

METHOD

Participants (n = 309) were recruited using Mechanical Turk and completed measures of ADHD symptoms, SCT, and smoking history.

RESULTS

ADHD was associated with age of initiation of smoking and more severe withdrawal symptoms for both combustible and electronic cigarettes. SCT significantly moderated the relationship between ADHD and withdrawal symptom severity (both electronic and combustible cigarettes).

CONCLUSION

The results of the present study suggest that SCT plays an important role in the complex relationship between ADHD and smoking withdrawal. Future research should further explore the construct of SCT to better understand its role in psychopathology and intervention strategies.

A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference

BACKGROUND

The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self- and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD.

METHODS

Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed.

RESULTS

Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent- or parent-reported ADHD symptom dimensions.

CONCLUSIONS

Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.

Low School Support Exacerbates the Association between Peer Difficulties and Sluggish Cognitive Tempo in Adolescents

OBJECTIVE

Although peer difficulties and sluggish cognitive tempo (SCT) are related, studies have yet to examine environmental factors that may advance further understanding of this association. The current study tested whether peer difficulties, specifically social competence and peer victimization, interacted with school support, a component of school climate, in relation to adolescents' SCT symptoms. Further, we explored whether these relations would be differentially associated with SCT in adolescents with and without attention-deficit/hyperactivity disorder (ADHD).

METHOD

Adolescents (N = 288; Mage = 14.08, 45% female, 82.6% White; 52% with ADHD) completed measures of social competence, peer victimization, school climate support, and SCT and ADHD inattentive (IN) symptoms. Parents also reported on adolescents' social competence, SCT, and ADHD-IN symptoms.

RESULTS

Results indicated that adolescent and parent ratings of lower social competence were both associated with higher adolescent-reported SCT symptoms in the context of low, but not high, school support. Relational and nonphysical victimization were associated with higher self-reported SCT symptoms in the context of low school support. Lower adolescent- and parent-reported social competence were also related to higher parent-reported SCT symptoms, with these associations not moderated by school support. These results remained after controlling for demographics and ADHD-IN symptoms and were similar across adolescents with and without ADHD.

CONCLUSIONS

Findings from the current study are the first to provide evidence that peer difficulties and school climate are jointly related to adolescents' self-reported SCT and underscore the importance of continued research investigating social adversity and environmental factors in relation to SCT.

The effect of feedback in virtual attention training on orienting attention in individuals with sluggish cognitive tempo

OBJECTIVE

This study was conducted to assess the effectiveness of feedback in a virtual attention training program to improve the attentional characteristics of sluggish cognitive tempo (SCT).

METHOD

The SCT group (N = 60) and control group (N = 30) were identified, and the attention network test-revised (ANT-R) was performed to measure attention characteristics. Based on this result, a virtual reality (VR) feedback attention training program was developed to improve the efficiency of engagement and disengagement of attention in SCT. Sixty participants with SCT were recruited and grouped into two conditions: VR feedback (n = 30) and no-feedback (n = 30) conditions.

RESULTS

The results show that the VR attention training program with feedback significantly improves the attention-orienting network.

CONCLUSION

This suggests that it is necessary to provide immediate feedback for effective attention training for SCT and continuous intervention may be possible when feedback is provided together.

The Associations Between Sluggish Cognitive Tempo, Internalizing Symptoms, and Academic Performance in Children With Reading Disorder: A Longitudinal Cohort Study

OBJECTIVE

To investigate whether sluggish cognitive tempo (SCT) was associated with anxiety, depression, and academic performance (AP) in children with reading disorder (RD), and whether ADHD-Inattention (ADHD-IN) moderated these relationships.

METHOD

Parents and teachers of children with RD (N = 147, ages 6-18) completed evaluations of SCT, ADHD, anxiety, depression, and AP, every 3 months for 18 months. Baseline and longitudinal associations between SCT and outcomes, and effect moderation of ADHD-IN, were assessed.

RESULTS

Teacher-rated SCT was positively associated with teacher-rated anxiety (p < .001) and negatively associated with AP (p < .001) cross-sectionally and longitudinally, with significant effect modification by ADHD-IN for both outcomes. SCT was not associated with depression in adjusted cross-sectional and longitudinal analyses. There were no significant findings for any parent-reported measures.

CONCLUSION

SCT has negative effects on anxiety and AP in children with RD among individuals with low ADHD-IN according to teacher report. Targeted treatment of SCT may provide substantial benefits.

Neuropsychological characteristics of children with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

OBJECTIVE

The present study aims to explore the neuropsychological features of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sluggish Cognitive Tempo (SCT).

METHODS

Fifty-eight children with ADHD+SCT, 480 children with ADHD-SCT, and 105 healthy controls (HC) were recruited. Neuropsychological tests and the Behavior Rating Inventory of Executive Function (BRIEF) were used.

RESULTS

The ADHD+SCT group performed worse than the HC in processing speed (p = .005), set-shifting (p = .0003), interference control (p = .00014), and visual memory (p = .007), while the ADHD-SCT group performed worse than the HC in sustained attention measurements (all p < .0001). The ADHD+SCT group scored higher than the ADHD-SCT group in the following factors from BRIEF: plan/organize (p = .00083), working memory (p < .001), and shift (p = .0054).

CONCLUSION

Our results indicated that SCT symptoms are associated with worse executive function in children with ADHD except for sustained attention.

Sluggish Cognitive Tempo as a Transdiagnostic Link Between Adult ADHD and Internalizing Symptoms

Objective

Although absent from traditional diagnostic nosologies, Sluggish Cognitive Tempo (SCT) may have transdiagnostic utility given its robust associations with ADHD and internalizing symptoms as well as with cognitive impairments common to these conditions. Within-person variation in SCT symptoms may also serve to link ADHD, cognitive deficits, and internalizing psychopathology, however, few studies have utilized intensive longitudinal designs to probe within-person variation in SCT and its links to cognitive deficits and psychopathology.

Method

Ecological Momentary Assessment was used to measure between and within-person variance in SCT 4 times per day across 7 days (28 time-points) in 158 college students (approximately 51% with elevated ADHD and/or internalizing symptoms). Participants also completed ratings of current and childhood ADHD symptoms, cognitive function and internalizing psychopathology. Parameters derived from longitudinal multilevel models indexing between and within person variation in SCT were examined as mediators of the associations between (1) ADHD and internalizing symptoms and (2) self-reported cognitive functioning and internalizing symptoms.

Results

Results indicated that between-person differences in SCT, but not within-person variability, linked current and childhood ADHD and internalizing symptoms. Similarly, problems in time-management and organization influenced internalizing psychopathology via between-person differences in SCT.

Conclusion

Results found that SCT may be a transdiagnostic link bridging mental health comorbidities, cognitive dysfunction, and internalizing psychopathology.

Networks of ADHD and SCT Symptoms in Emerging Adulthood

OBJECTIVE

Emerging adulthood (18-25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one another during this period, if there are differences based on biological sex, or how closely results will align with adulthood.

METHODS

We used network analysis techniques to explore the structure of ADHD and SCT symptoms within emerging adulthood, with additional comparisons between sexes as well as between emerging adulthood and adulthood. Using an online platform, 8,506 adults reported on their symptoms of ADHD and SCT.

RESULTS

Symptoms grouped together within their respective domains during emerging adulthood with no significant differences in overall network structure between sexes. Similarly, network structure appeared to be robust across emerging adulthood and adulthood.

CONCLUSION

Such consistency supports a conceptualization of ADHD in emerging adulthood as similar to adulthood.

"My mom calls it Annaland": A Qualitative Study of Phenomenology, Daily Life Impacts, and Treatment Considerations of Sluggish Cognitive Tempo

Objective: To conduct qualitative analysis of interviews to understand phenomenology, daily life impact, and treatment considerations of sluggish cognitive tempo (SCT) behaviors in children and adolescents. Method: Youth with elevated SCT symptoms (N = 15, ages 9-16 years) and their parents completed interviews focused on their perception and daily life impact of SCT behaviors. Parents were also asked about intervention targets. Results: Parents and youth had both negative and positive perceptions of SCT, with SCT fostering creativity/imagination and a break from stressors while also negatively impacting daily functioning. The domains most frequently selected by parents as SCT intervention targets were academics, emotions, mind wandering, morning routines, and self-esteem. Conclusion: Children and their parents share negative and positive views of SCT behaviors, while also detailing specific ways that SCT negatively impacts day-to-day functioning. This study offers insights into possible intervention targets as provided by youth and parents directly impacted by SCT.

Working memory and cognitive flexibility predict growth trajectories of sluggish cognitive tempo in youth with spina bifida

As sluggish cognitive tempo (SCT) shows similar inattention and neuropsychological dysfunction as youth with spina bifida (SB), it is important to examine whether neuropsychological functioning may affect the development of SCT in this population. Participants were 140 youth with SB and their parents who participated in five waves of a longitudinal study across eight years (ages 8-15 years at Time 1). At Time 1, teacher-, mother-, and father-report of SCT showed 9%, 8.3%, and 5.3% impairment in SCT respectively compared to other youth in the sample. Growth curves were used to examine changes over time in mother-, father-, and teacher-reported SCT. Four neurocognitive variables were included (attention, working memory, cognitive flexibility, plan/organize) as predictor variables of SCT growth and intercepts. Mother, father, and teacher-report of SCT were included in separate models. Age and shunt status were included as covariates in the growth models. Inattentive symptoms were also included as a covariate in working memory, shift, and plan/organize models. Worse working memory at Time 1 predicted an increase in mother-reported SCT symptoms over eight years (β = -.28) and poorer cognitive shifting skills predicted higher rates of teacher-reported SCT over time (β = -.61). All other neurocognitive variables predicted the intercept, but not the slope of SCT symptoms. Results indicate that worse neurocognitive functioning is associated with higher levels of SCT symptoms and that worse working memory and cognitive flexibility at baseline predicted an increase in SCT symptoms as youth with SB age. It may be important for clinicians to monitor and assess levels of SCT in youth with SB.

Psychometric Properties of the Sluggish Cognitive Tempo Scale in a Turkish Sample of Children and Adolescents

Sluggish Cognitive Tempo (SCT) has been proposed as a serious problem of attention, however there no validated psychometric measures for its evaluation in Turkish in a community sample. The present study aimed to examine the psychometric characteristics of the first SCT scale in Turkish in children and adolescents. A total of 418 children and adolescents between the ages of 6-18 years (9.83±2.8) were recruited. The data was obtained from parents using Sluggish Cognitive Tempo Scale and Strengths and Difficulties Questionnaire. The SCT scale-Turkish form demonstrated very good internal homogeneity (Cronbach's α = .90), good test-retest reliability (r = .98), good concurrent validity (r range = .35- .65) and good construct validity. Goodness of fit indices were found to be acceptable and statistically significant associations were found between SDQ and SCT scales. The SCT scale is a valid and reliable instrument in Turkish children and adolescents.

Eveningness Diurnal Preference: Putting the "Sluggish" in Sluggish Cognitive Tempo

OBJECTIVE

Eveningness diurnal preference is common in psychiatric conditions, including attention-deficit/hyperactivity disorder (ADHD) and internalizing disorders. Little is known about how diurnal preference relates to sluggish cognitive tempo (SCT)-a distinct clinical construct associated with functional impairment-in clinical samples.

METHOD

Adult outpatients (n = 65; 43 with ADHD, 22 with internalizing/adjustment disorders) self-reported on SCT symptoms (total symptoms; slow/daydreamy, sleepy/sluggish, and low initiation/persistence factors) and diurnal preference.

RESULTS

Greater eveningness was associated with overall SCT severity and sleepy/sluggish symptoms in the full sample. Relationships between eveningness and overall SCT severity and slow/daydreamy symptoms were stronger for those with internalizing/adjustment disorders compared to ADHD. The relationship between eveningness and sleepy/sluggish symptoms was uniform across groups.

CONCLUSION

Findings suggest a potential role of eveningness preference in adult SCT presentation. Future studies should investigate underlying mechanisms linking these two constructs and the efficacy of circadian interventions in the treatment of SCT among adult outpatients.

The relationship between theory of mind and sluggish cognitive tempo in school-age children with attention deficit and hyperactivity disorder

Sluggish cognitive tempo (SCT) is considered as a cognitive-emotional style. Theory of mind (ToM) skills form the basis of human cognition and social behavior. The aim of this study is to contribute to SCT literature by examining the relationship between SCT and cognitive and affective ToM in school-age children with attention deficit and hyperactivity disorder (ADHD). Fifty school-age children with ADHD (43 boys and seven girls) and 40 typically developing children (34 boys and six girls) were assessed using Parent-rated Barkley Child Attention Scale and Child Behavior Checklist/6-18, cognitive (first- and second-order ToM) and affective ToM (Reading Mind in the Eyes Test and Unexpected Outcomes Test (UOT)) tests. Multiple linear regression analysis was performed to determine the variables that may predict SCT levels in children with ADHD. Attention deficit and hyperactivity disorder-inattention (Exp(B) = .334, p = .027), internalization (Exp(B) = .305, p = .006), and UOT scores (Exp(B) = .933, p = .015) significantly predicted SCT severity in children with ADHD. SCT severity was significantly associated with impaired cognitive ToM skills as measured by second-order ToM (Exp(B) = 1.933, p = .045). Our findings may indicate that affective ToM developing with age, and impaired cognitive ToM skills are associated with increasing SCT severity.

Sluggish Cognitive Tempo Symptoms, But Not ADHD or Internalizing Symptoms, Are Uniquely Related to Self-Reported Mind-Wandering in Adolescents With ADHD

Objective: The purpose of this study was to test the relation between sluggish cognitive tempo (SCT) symptoms and self-reported mind-wandering in a sample of adolescents with ADHD. Method: Adolescents (N = 79; aged 13-17 years; 70% male) diagnosed with ADHD completed measures of SCT, ADHD, anxiety, and depression symptoms, in addition to mind-wandering. Parents also provided ratings of adolescents' ADHD symptoms. Results: All adolescent-reported psychopathology dimensions, including ADHD, internalizing, and SCT, were significantly bivariately correlated with greater mind-wandering. However, in regression analysis that considered psychopathologies simultaneously, SCT was the only dimension uniquely associated with greater mind-wandering. This finding was unchanged when parent-reported ADHD symptoms were included in the model. Conclusion: These findings are the first to show that SCT symptoms are uniquely related with self-reported mind-wandering in adolescents with ADHD and underscore the importance of considering co-occurring SCT symptoms when testing the interrelations between ADHD and mind-wandering. Replication is needed in larger samples and with other measures of mind-wandering.

Examining the Structural and External Validity of the Adult Concentration Inventory for Assessing Sluggish Cognitive Tempo in Adults

The Adult Concentration Inventory (ACI) is an adult self-report measure of sluggish cognitive tempo (SCT) developed following a meta-analysis identifying items distinguishing SCT from attention-deficit/hyperactivity disorder (ADHD) inattention. To date, only one study conducted in college students has examined the structural and external validity of the ACI. The current study evaluated the convergent and discriminative validity of the ACI in a community sample of adults, in addition to testing unique associations with internalizing symptoms, daily life executive functions, and sleep. Adults (N = 286; M_age = 44.45; 83.6% female) completed ratings of SCT, ADHD symptom dimensions, and external correlates. An a priori two-factor model with cross-loadings found 10 of the 16 SCT items to have high loadings on the SCT factor and low loadings on the ADHD inattention factor. SCT was uniquely associated with higher internalizing symptoms, time management and self-organization difficulties, poorer sleep quality, shorter sleep duration, lower sleep efficiency, and more daytime sleepiness. These findings replicate and extend support for the ACI in assessing SCT in adults.

An Open-Label Trial of Methylphenidate Treating Sluggish Cognitive Tempo, Inattention, and Hyperactivity/Impulsivity Symptoms Among 6- to 12-Year-Old ADHD Children: What Are the Predictors of Treatment Response at Home and School?

Objective: This study investigated the effects of sluggish cognitive tempo (SCT), other psychiatric symptoms, age, dose, and pretreatment ADHD severity on methylphenidate (MPH) treatment response among ADHD children in both home and school. In addition, the predictors of the MPH-SCT treatment response were examined. Methods: One hundred eighty-five (6-12 years old) ADHD children who were treated with MPH included in the study. Results: MPH improved SCT total and SCT-Daydreaming scores both at home and school while improved SCT-Sluggish scores in only school. Higher pretreatment Daydreaming score predicted lower treatment response for inattention (B = .301, p = .002), and higher Daydreaming-Sluggish scores predicted lower treatment response for total ADHD symptoms at school (B = .456, p = .006; B = .888, p = .04, respectively). Also higher oppositional defiant disorder symptoms have negative effects on MPH treatment response in ADHD. Older age positively affected the MPH-SCT treatment response in paternal and teacher ratings. Conclusion: SCT symptoms have negative effects on MPH treatment response at school.

Differential Diagnosis of Sluggish Cognitive Tempo Symptoms in College Students

Objective: Sluggish cognitive tempo (SCT) refers to a set of symptoms that prior research has found to be related to several different psychological disorders, especially the predominantly inattentive presentation of ADHD. This study collected evidence relevant to the question of whether SCT is a distinct disorder. Method: College students (N = 910) completed measures of SCT, ADHD, depression, anxiety, sleep quality, and substance misuse. Results: Students reporting clinically high SCT (reporting at least five symptoms often or very often) had significantly higher levels and rates of other types of psychopathology. Moreover, when students reporting clinically significant levels of ADHD, depression, and anxiety symptoms, poor sleep quality, or hazardous levels of alcohol or cannabis use were removed, very few students reporting high SCT remained (only 4.8% of the original high-SCT group). Conclusion: SCT may be best thought of as a symptom set common to many types of psychopathology, and it may be caused by sleep problems or substance misuse as well.

Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade

OBJECTIVE

To conduct a systematic review of the measures designed to assess sluggish cognitive tempo (SCT) since the first SCT scale using careful test-construction procedures was published in 2009.

METHOD

MEDLINE (PubMed), Embase, PsychINFO, and Web of Science databases were searched from September 2009 through December 2019. Articles reporting on reliability (internal consistency, test-retest, and interrater reliability), structural validity (an aspect of construct validity focused on items' convergent and discriminant validity), concurrent and longitudinal external validity, invariance, or intervention/experimental findings were included.

RESULTS

Full criteria for data extraction and inclusion were met by 76 studies. Nine measures for assessing SCT were identified (7 assessing parent report, teacher report, and/or self-report in children and 2 assessing self-report and/or collateral informant report in adults). Each measure demonstrated acceptable to excellent reliability. All or at least the majority of SCT items on each measure also had structural validity (high loadings on an SCT factor and low loadings on an attention-deficit/hyperactivity disorder [ADHD] inattention factor). Studies have supported the invariance of SCT across sex and time, and there is initial evidence of invariance across informants, youths with ADHD and youths without ADHD, and ADHD presentations. The Child and Adolescent Behavior Inventory (CABI), Child Concentration Inventory, Second Edition (CCI-2), and Barkley Adult ADHD Rating Scale-IV (BAARS-IV) have particularly strong support for assessing parent/teacher-reported, youth self-reported, and adult self-reported SCT, respectively.

CONCLUSION

The SCT measures included in this review share numerous positive properties, have promising psychometric support, and have proven useful for examining the external correlates of SCT across the life span. Although substantial progress has been made over the last decade, work remains to be done to further improve the assessment of SCT and key directions for future research are provided.