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Taylor BJ, Pedersen KA, Mazefsky CA, Lamy MA, Reynolds CF, Strathmann WR, Siegel M. From Alert Child to Sleepy Adolescent: Age Trends in Chronotype, Social Jetlag, and Sleep Problems in Youth with Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06187-0. [PMID: 38017309 DOI: 10.1007/s10803-023-06187-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Developmental changes in sleep in youth with autism spectrum disorder (ASD) are understudied. In non-ASD youth, adolescents exhibit a "night owl chronotype" (i.e., later sleep/wake timing) and social jetlag (i.e., shifts in sleep timing across school nights and weekends), with corresponding sleep problems. The purpose of this study is to evaluate age trends in chronotype, social jetlag, and sleep problems in high-risk youth with ASD. METHODS Youth with ASD (N = 171), ages 5-21 years old, were enrolled at the time of admission to specialized psychiatric units. Caregivers reported children's demographic information, habitual sleep timing, and sleep problems. Multivariate analyses evaluated the effect of age on chronotype, social jetlag, and sleep problems and the effects of chronotype and social jetlag on sleep problems. Covariates and moderators included sex, race, verbal ability, autism symptom severity, supplemental melatonin, and pubertal status. RESULTS Older age was associated with later chronotype, more social jetlag, fewer sleep anxiety/co-sleeping problems, fewer night waking and parasomnia problems, and more daytime alertness problems. The effect of age on chronotype was stronger for youth with greater social affective symptom severity. Mediation analyses showed that later chronotype statistically mediated the association between age and daytime alertness problems. CONCLUSIONS Youth with ASD may exhibit night owl chronotype behavior and social jetlag as they enter adolescence. Shifts toward a later chronotype may be exacerbated by autism severity and may contribute to alertness problems and sleepiness during the day. Chronotype is modifiable and may be leveraged to improve daytime functioning in youth with ASD.
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Affiliation(s)
- Briana J Taylor
- Life Sciences and Medical Research, The Roux Institute at Northeastern University, 100 Fore Street, Portland, ME, 04101, USA.
- Department of Psychology, Northeastern University, Boston, MA, USA.
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA.
| | - Kahsi A Pedersen
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Martine A Lamy
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Charles F Reynolds
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Matthew Siegel
- MaineHealth, Center for Clinical and Translational Science, Portland, ME, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
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Becker SP, Martinez AC, Wiggs KK, Langberg JM, Smith ZR. Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02311-8. [PMID: 37804421 DOI: 10.1007/s00787-023-02311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental fogginess, and slowed behavior/thinking. Studies examining the association between CDS and academic functioning have reported mixed findings and have relied upon limited measures of CDS, broad ratings of academic impairment, and/or focused only on elementary-aged children. The current study examined the relationship between CDS and academic functioning in adolescents using a comprehensive, multi-informant, multi-method design. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD) recruited in the fall of their 8th grade. Above and beyond ADHD inattentive symptoms, CDS symptoms were related to poorer homework performance, lower math fluency, and lower daily academic motivation across multiple informants, and teacher-reported CDS symptoms were related to lower grades. Findings were not moderated by ADHD diagnosis, suggesting that associations between CDS and academic outcomes do not differ for adolescents with and without ADHD. Findings demonstrate that CDS symptoms are uniquely associated with daily academic difficulties as well as global indices of academic performance. These findings have implications for assessing and monitoring CDS symptoms in interventions aiming to improve the academic functioning in adolescents with and without ADHD.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew C Martinez
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Joshua M Langberg
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Despature I, Galiana A. Clinical and Cognitive Features of Attention Deficit Hyperactivity Disorder with Intellectual Giftedness: A Systematic Review. Dev Neuropsychol 2023; 48:347-360. [PMID: 37929569 DOI: 10.1080/87565641.2023.2279117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
A systematic review was carried out on publications from the last 15 years that have studied the effect of intellectual giftedness, defined as IQ > 115, on the clinical and cognitive features of ADHD. Studies indicate that about 15% of people with high IQ meet ADHD criteria. IQ has shown no effect on the pharmacological treatment, and comorbidity does not differ from that of other children with ADHD. High IQ-ADHD, compared to average IQ-ADHD, tends to show less severity in cognitive and behavioral symptoms, as well as a better prognosis; however high IQ may mask ADHD symptoms delaying diagnosis and treatment.
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Affiliation(s)
- Inès Despature
- Faculty of Health Sciences and Education, Department of Psychology of Health. Collado Villalba, Universidad a Distancia de Madrid, Madrid, Spain
| | - Adrián Galiana
- Faculty of Health Sciences and Education, Department of Psychology of Health. Collado Villalba, Universidad a Distancia de Madrid, Madrid, Spain
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Mayes SD, Waschbusch DA, Fernandez-Mendoza J, Calhoun SL. Cognitive Disengagement Syndrome (CDS) (Formerly Sluggish Cognitive Tempo), Autism, and Insomnia Symptoms in Childhood Predict CDS in Adolescence: A Longitudinal Population-Based Study. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01565-2. [PMID: 37391602 DOI: 10.1007/s10578-023-01565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
Our study is the first using multiple variables to compare concurrent with longitudinal predictors of cognitive disengagement syndrome (CDS). The population-based sample comprised 376 youth (mean baseline age 8.7 and follow-up 16.4 years) rated by parents on the Pediatric Behavior Scale. The baseline CDS score was the strongest predictor of follow-up CDS. Baseline autism and insomnia symptoms also predicted follow-up CDS above and beyond baseline CDS. Autism, insomnia, inattention, somatic complaints, and excessive sleep were concurrently related to CDS at baseline and follow-up. Additionally, follow-up depression was associated with follow-up CDS, and baseline hyperactivity/impulsivity was negatively associated with baseline CDS. Oppositional defiant/conduct problems and anxiety were nonsignificant. Age, sex, race, and parent occupation were unrelated to CDS, and correlations between baseline CDS and 15 IQ, achievement, and neuropsychological test scores were nonsignificant. Results indicate childhood CDS is the strongest risk factor for adolescent CDS, followed by autism and insomnia symptoms.
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Affiliation(s)
- Susan D Mayes
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA.
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
| | - Julio Fernandez-Mendoza
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA
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Wang Y, Liu X, Wu T, Zheng D, Chen Q, Chen C. Longitudinal Associations Between Sluggish Cognitive Tempo and Academic Achievement in Adolescents: A Mediated Moderation Model. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01559-0. [PMID: 37386312 DOI: 10.1007/s10578-023-01559-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
Sluggish cognitive tempo (SCT) was initially studied in the context of attention deficit hyperactivity disorder (ADHD), but is now recognized as a distinct disorder. Despite the growing recognition of SCT, its impact on academic achievement among adolescents remains controversial, even when controlling for the level of ADHD. This may be due to the influence of other factors such as learning engagement and emotional distress. To address this gap, we conducted a longitudinal study with a sample of 782 Chinese senior high school students, measuring their SCT, learning engagement, and emotional distress at Grade 10 (Time1, T1) to predict their academic achievement evaluated based on final exams scores five months later (Time2, T2). Results showed that learning engagement mediated the negative relationship between SCT and later academic achievement. Additionally, individuals with high SCT showed less impact by emotional distress on learning engagement. These findings may shed light on the complex interplay between SCT, emotional distress and learning engagement in shaping academic achievement, underscoring the potential adaptive function of SCT as a coping strategy for managing emotional challenges.
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Affiliation(s)
- Yongchun Wang
- School of Psychology, South China Normal University, Guangzhou, 510631, China
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Xiqin Liu
- School of Foreign Languages, South China University of Technology, Guangzhou, 510641, China
| | - Tingting Wu
- Beijing Key Lab of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, 100048, China
| | - Danna Zheng
- School of Psychology, South China Normal University, Guangzhou, 510631, China
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Qishan Chen
- School of Psychology, South China Normal University, Guangzhou, 510631, China
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, 510631, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Caiqi Chen
- School of Psychology, South China Normal University, Guangzhou, 510631, China.
- Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, 510631, China.
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
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Mayes SD, Bangert L, Kallus R, Fosco W, Calhoun SL, Waschbusch DA. Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children. Clin Child Psychol Psychiatry 2023; 28:610-622. [PMID: 35751158 DOI: 10.1177/13591045221110730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on the relationship between sluggish cognitive tempo (SCT) and scores on neuropsychological tests (such as those measuring processing speed and reaction time) is inconclusive, and the association between SCT and motor incoordination and dysgraphia has not been objectively investigated. Mothers of 413 elementary school children (6-12 years of age) rated their children on the Pediatric Behavior Scale (PBS), which yields psychological problem scores, including SCT. Children were administered an extensive battery of neuropsychological tests assessing processing and performance speed, working memory, immediate and delayed recall, sustained attention, response inhibition, cognitive flexibility, fine motor manipulative skill, verbal fluency and retrieval, set shifting, and interference control, as well as intelligence and reading and math achievement. Only three of the 19 correlations between SCT and neuropsychological scores were significant, and all involved graphomotor tests (two timed and one untimed). In regression analysis, the strongest independent predictor of SCT was the maternal PBS incoordination factor score, followed by ratings of autism, inattention, and depression. Neuropsychological test scores did not contribute significantly more to predicting SCT. Among the incoordination PBS factor items, clumsy and draws or writes poorly were significant SCT predictors. Our novel and unexpected findings showed that motor incoordination was a stronger correlate of SCT than other variables assessed in our study, including those previously linked with SCT. Future SCT research needs to include measures of incoordination and dysgraphia in order to replicate and expand upon the current findings. Our results suggest that SCT traits are not reliably measured by currently available neuropsychological tests.
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Affiliation(s)
- Susan D Mayes
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Lauren Bangert
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Rachel Kallus
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Whitney Fosco
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, 12310Penn State College of Medicine, Hershey, PA, USA
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Fredrick JW, Becker SP. Sluggish Cognitive Tempo (Cognitive Disengagement Syndrome) and Academic Functioning: A Systematic Review and Agenda for Future Research. Clin Child Fam Psychol Rev 2023; 26:82-120. [PMID: 36117226 DOI: 10.1007/s10567-022-00411-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 02/01/2023]
Abstract
The past two decades have witnessed substantial interest in sluggish cognitive tempo (SCT), a set of symptoms (e.g., excessive daydreaming, mental confusion, slowed behavior) distinct from attention-deficit/hyperactivity disorder (ADHD) and other psychopathology symptoms. Despite evidence linking SCT to a range of functional outcomes, findings for academic functioning are unclear. The current review summarizes the literature on SCT and academic functioning and offers an agenda for future research. A systematic review was conducted to identify studies assessing SCT and academic outcomes, including academic impairments and performance, in childhood, adolescence, and young adulthood. Sixty studies were retained (53 cross-sectional, 7 longitudinal) from 44 separate samples, with the majority (n = 32, 53%) assessing global ratings of academic impairment and fewer measuring specific academic domains or standardized achievement test scores. Findings were generally consistent in showing SCT to be correlated with global ratings of academic impairment, lower grades, and inconsistently associated with poorer math and reading scores. Findings were more mixed when controlling for ADHD symptoms, intelligence, and/or demographic factors. Overall, SCT is associated with poorer academic functioning, although inconsistencies and key limitations are common across studies. Ten directions for future research are offered to advance understanding of how SCT may be associated with or impact academic functioning.
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Affiliation(s)
- Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Comparison of the Cognitive Disengagement and Hypoactivity Components of Sluggish Cognitive Tempo in Autism, ADHD, and Population-Based Samples of Children. Res Child Adolesc Psychopathol 2023; 51:47-54. [PMID: 36048375 DOI: 10.1007/s10802-022-00969-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
An international Sluggish Cognitive Tempo (SCT) Work Group proposed a new term for SCT, "cognitive disengagement syndrome," that more accurately describes the syndrome than does SCT. According to the Work Group, symptoms of SCT represent a cognitive dimension (cognitive disengagement) and a motor dimension (hypoactivity). Our study determined (1) if distinct factors representing cognitive disengagement and hypoactivity emerged when SCT items were factor analyzed and (2) the degree of differences in cognitive disengagement and hypoactivity within diagnostic groups. Mothers rated 1,177 children with autism, 725 with ADHD-Combined, and 307 with ADHD-Inattentive (4-17 years) and 665 elementary school children (6-12 years) on the Pediatric Behavior Scale (PBS). SCT prevalence rates were autism 32%, ADHD-Inattentive 27%, ADHD-Combined 18%, and elementary school students 7%. Factor analysis of the SCT items yielded two factors reflecting cognitive disengagement (in a fog/confused and stares/preoccupied/in own world) and hypoactivity (sluggish/slow moving/low energy, drowsy/sleepy/not alert, and tires easily) in all diagnostic groups. Cognitive disengagement prevalence rates and scores were significantly higher than hypoactivity in the autism and ADHD-C groups and in the autism and ADHD-C subgroups of children with SCT (but not in the ADHD-I and elementary school total groups and SCT subgroups). Our findings factor analyzing five SCT items support two SCT subfactors: cognitive disengagement and hypoactivity.
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Mayes SD, Waschbusch DA, Mattison RE, Kallus R, Baweja R, Fernandez-Mendoza J, Calhoun SL. Stability of Sluggish Cognitive Tempo Compared to Externalizing and Internalizing Parent Symptom Ratings from Age 9 to 8-Years Follow-up in a Population-Based Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09977-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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