The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo: A Meta-Analysis and Critical Review

The relationship between parental obsessive-compulsive disorder and children's cognitive disengagement syndrome (Sluggish Cognitive Tempo)

Although the impact of parental obsessive-compulsive disorder (OCD) on children is well known, there is a still need to investigate additional psychopathological effects that parental OCD may have on children. To our knowledge, the relationship between Cognitive Disengagement Syndrome (CDS), previously referred to as Sluggish Cognitive Tempo CDS in children and parents' OCD has not been investigated to date. In this study, we examined the relationship between parental OCD and children's CDS, while adjusting for parental anxiety, depression, as well as symptoms of internalization, externalization, and Attention Deficit Hyperactivity Disorder (ADHD) in their children. 50 parents with OCD and 45 healthy parents were assessed through Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, and Beck Anxiety Inventory (BAI). The children were applied Child Behavior Checklist, Children ADD/ADHD DSM-IV Based Diagnostic Screening, and Barkley Child Attention Scale (BCAS). BCAS showed significant correlations with BAI (r = 0.280, p = .049), child ADHD-hyperactivity/impulsivity (r = 0.407, p = .003), and ADHD-inattention (r = 0.628, p < .001). The severity of ADHD-inattention (β = 0.618, p = .001) and parental OCD (β = 0.275, p = .016) were significant predictors of CDS severity in the children. Our findings may suggest a significant association between the severity of CDS and ADHD-inattention in children and parental OCD, even after controlling for parental anxiety.

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder

OBJECTIVE

The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD).

METHOD

This study included 842 children aged 8-12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used.

RESULTS

According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children.

CONCLUSION

This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

Emotional Regulation Problems in Cognitive Disengagement Syndrome (formerly Sluggish Cognitive Tempo), Attention Deficit and Hyperactivity Disorder, Anxiety and Depression

Parents have reported emotional regulation problems in cognitive disengagement syndrome (CDS) and attention deficit and hyperactivity disorder (ADHD). The first objective of this research was to explore the differences between the parents' ratings on CDS, ADHD, hyperactivity/impulsivity, inattention, anxiety, depression and emotional dysregulation. The second one was to compare the predictive capacity of CDS and ADHD over anxiety, depression and emotional regulation problems. The third one was to analyze the mediation of emotional dysregulation in CDS, ADHD, hyperactivity/impulsivity, inattention, and anxiety and depression. The sampling used was non-probabilistic. The final sample consisted of 1,070 participants (484 fathers and 586 mothers) who completed the Emotion Regulation Checklist (ERC) and the Child and Adolescent Behavior Inventory (CABI). In relation to the first objective, first, mothers reported more emotional regulation problems in children than in fathers. Second, emotional regulation problems were more strongly correlated with hyperactivity/impulsivity. Significant differences were found in all father scores, except for anxiety and the emotional regulation subscale. Regarding mothers, significant differences were only observed in ADHD scores, hyperactivity/impulsivity, and depression. Both parents reported more problems in older children, except for hyperactivity/impulsivity scores and ADHD rated by mothers. According to the second objective, CDS scores were found to significantly predict anxiety and depression scores, but not those of inattention or emotional regulation problems. Finally, in relation to the third objective, emotional regulation problems mediated the relationships between CDS, ADHD, and anxiety and depression. In conclusion, the data support the importance of emotional regulation problems in understanding CDS and its relationship with ADHD, anxiety, and depression.

The effect of feedback in attention training on Attention Bias to Threat in individuals with Sluggish Cognitive Tempo

BACKGROUND AND OBJECTIVES

This study was conducted to identify the characteristics of attentional bias of individuals with Sluggish Cognitive Tempo (SCT) and how Attention Bias to Threat (ABT) changes when feedback was provided in attention training.

METHODS

First, a dot probe task was conducted to confirm the ABT of the SCT feedback group (N = 27) and SCT no feedback group (N = 25), and healthy control group (N = 30) before intervention. Thereafter, a VR-based attention training was conducted three times with feedback or no feedback. Finally, a dot probe task was executed again.

RESULTS

The SCT groups showed a higher ABT than the healthy control group. A result of the attention training, the reaction time of disengage was significantly reduced when provided feedback. In addition, it was confirmed that the ABT of the SCT group that received feedback, was significantly reduced.

LIMITATIONS

First, the only stimulus used to examine the ABT was the angry face, and the reaction time to other threatening facial expressions was not confirmed. Second, attention training was conducted three times, but further studies are needed on the effect of the duration of training on the magnitude of effect.

CONCLUSIONS

This study identified ABT associated with internalizing symptoms of SCT and suggests that attention training with immediate and continuous feedback is needed to reduce ABT.

ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents

The current study examined attention-deficit/hyperactivity disorder (ADHD) dimensions and cognitive disengagement syndrome (CDS) symptoms in relation to self-injurious thoughts and behaviors (SITBs) in an early adolescent sample. Participants were 341 adolescents ages 10-12 years (52.2% female; 37.8% people of color) recruited from the community. Caregivers reported on CDS and ADHD symptoms. Adolescents completed a rating scale and were administered an interview assessing SITBs. We estimated associations using logistic regression in a stepped fashion: (1) no adjustment, (2) adjustment for sex, race, family income, and psychotropic medication use, and (3) further adjustment for depressive symptoms. In this early adolescent community sample, 22.9% reported a history of suicidal ideation, 8.2% reported a history of a suicide plan, 6.2% reported a history of non-suicidal self-injury (NSSI), and 16.4% met a clinical cutoff for current suicide risk. Across most analyses using rating scale or interview methods, higher mean CDS scores were related to endorsement of suicidal ideation and planning. ADHD inattentive (IN) and hyperactive-impulsive (HI) symptoms were associated with endorsement of NSSI, and ADHD-IN symptoms were associated with thoughts of suicide and/or plan measured via questionnaire, though effects were less robust and not significant, potentially due to low base rates impacting statistical power. This study adds to a growing body of research highlighting the importance of screening for CDS symptoms among individuals with and without ADHD. More research, especially longitudinal work, is needed that examines possible differential pathways to SITBs by ADHD and CDS symptoms to advance SITB prevention, early detection, and intervention.

Psychopathology of cognitive disengagement syndrome (CDS): a network analysis based on CBCL scales in 72,106 Chinese school students

Cognitive Disengagement Syndrome (CDS) is a cluster of behavioral problems that severely affect an individual's functioning. Currently, there is no consensus on the main clinical features of CDS, and further exploration in large samples is needed. Using a cluster-stratified random sampling method, 72,106 children and adolescents were recruited from five provinces in mainland China for this study. Using both the traditional two-factor scoring method and the CBCL DSM-oriented scales, we assessed individual behavioral problems from psychopathological and DSM-oriented perspectives. Network analysis was employed to explore the relationship between CDS and behavioral problems. The various networks were compared by gender and age subgroups. Among 72,106 participants (mean age, 11.49 years; minimum age, 5 years; maximum age, 16 years), there were 36,449 males (50.5%) and 35,657 females (49.5%). From a psychopathological perspective, the motor symptoms node was associated with the sad node and the withdrawn node, while the cognitive symptoms node was linked to the nervous node and the self-conscious node. In terms of gender, males had stronger associations of the motor symptoms node with the sad node and the withdrawn node than females (P = 0.043), and weaker associations of the cognitive symptoms node with the nervous node than females (P = 0.027). In terms of growth stage, the adolescent group had stronger associations of the cognitive symptoms node with the nervous node and the self-conscious node than the child group (P = 0.016, 0.001). From DSM perspective, motor symptoms node were associated with sad node, and cognitive symptoms node were related to can't concentrate node, nervous node, and worthless node. With increasing age, there was an upward trend in the strength of the cognitive and motor symptoms node. CDS is closely linked to psychological and behavioral issues, especially internalizing problems, with differences observed by gender and growth stage. The connection between CDS and the affective, anxiety, and ADH symptoms is particularly pronounced.

Cognitive disengagement syndrome and attention deficit hyperactivity disorder: An examination of relationships with alexithymia and emotion regulation difficulties

Cognitive disengagement syndrome (CDS) and ADHD are considered distinct but interrelated constructs. This study aimed to investigate the prevalence of elevated CDS symptoms and increased ADHD risk in the general population, and their relationships with emotion regulation difficulty (ERD) and alexithymia. Out of 1166 participants, 142 with known psychiatric conditions were excluded, resulting in 1024 participants. Participants completed various scales including Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5), Barkley Adult Sluggish Cognitive Tempo (SCT) Scale, Difficulties in Emotion Regulation Scale-Short Form (DERS-16), and the Toronto Alexithymia Scale (TAS-20). Four groups were formed based on Barkley and ASRS-5 scores: Group 1) No elevated CDS symptoms and Low risk of ADHD, Group 2) No elevated CDS symptoms and Increased risk of ADHD, Group 3) Elevated CDS symptoms and Low risk of ADHD, Group 4) Elevated CDS symptoms and Increased risk of ADHD. Elevated CDS symptoms was found in 10% of participants, and increased ADHD risk in 9.2%. Among probable ADHD cases, 40% had elevated CDS symptoms, while 60% of elevated CDS symptoms cases had increased ADHD risk. Group 4 (elevated CDS symptoms and increased risk of ADHD) had the highest ERD and alexithymia scores, while Group 1(no elevated CDS symptoms and low risk of ADHD) had the lowest. Regression analyses showed that CDS scores predicted ERD (47%) and alexithymia (32%) better than ADHD scores (ERD: 36%, alexithymia: 23%). CDS and ADHD appear as significant concepts that could be involved in the etiology of ERD and alexithymia.

Examining ADHD and Cognitive Disengagement Syndrome Symptoms in Relation to Food Insecurity in Early Adolescents

Approximately 13.8 million U.S. households face food insecurity, which severely affects child development, with more than half of these households including children. Research links food insecurity to cognitive deficits and mental health challenges, highlighting the need for thorough understanding and intervention. Although existing studies have explored the association between food insecurity and internalizing symptomatology, less research has examined food insecurity in relation to attention-deficit/hyperactivity disorder (ADHD) symptoms. Further, no studies have explored the connection between food insecurity and cognitive disengagement syndrome (CDS) symptoms, closely related to ADHD symptoms. Despite extant research linking CDS to environmental factors, empirical attention to its potential association with food insecurity is notably lacking. Additionally, adolescents, almost twice as likely as younger children to experience household food insecurity, are likely more aware and respond differently to challenges during this developmental period. Accordingly, this study investigated the unique associations of parent-, teacher-, and youth self-reported ADHD dimensions and CDS symptoms in relation to parent-reported food insecurity in early adolescents (N = 136, ages 10-12). Controlling for age, sex, race, and medication use, no informant's ratings of ADHD symptom dimensions were uniquely related to food insecurity. In contrast, higher parent-, teacher-, and youth self-reported CDS symptoms were uniquely associated with greater food insecurity. This finding was robust to additional control of family income for teacher- and youth self-reported CDS symptoms. These findings highlight the complex link between food insecurity and mental health, suggest a connection with CDS symptoms, and stress the need to address food insecurity as a public health priority, especially in early adolescence.

Unified and distinct cognitive control deficits in adolescents with cognitive disengagement syndrome and learning burnout

Introduction

Cognitive disengagement syndrome (CDS) is a psychological disorder characterized by daydreaming, mental fogginess, and slow thinking, while learning burnout (LB) is characterized by a passive and inattentive attitude toward learning. These two disorders are closely related but can be challenging to differentiate from one another. The present study aimed to identify shared and distinct cognitive control deficits between CDS and LB.

Methods

We recruited 136 adolescents (aged 14 to 17 years) from an initial screening of CDS and LB (N = 476) and divided them into four groups: CDS, LB, CDS + LB, and typically developing control. After a second screening, 129 adolescents completed two tasks to assess their attentional networks and cognitive control capacity (CCC).

Results

Adolescents with high CDS symptoms (both CDS group and CDS+LB group) exhibited impaired disengaging effect of attention and lower CCC, indicating deficits in orienting attention and the upper limit of information processing for cognitive control specifically. Furthermore, support vector machine modeling identified CCC as the most significant parameter differentiating the CDS and LB groups.

Discussion

Our findings suggest that while adolescents with high CDS and high LB symptoms have similar outward manifestations in the adolescent's school life, deficits in attention and cognitive control, particularly in the CCC, may distinguish between the two groups.

Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research

Cognitive disengagement syndrome (CDS, previously referred to as sluggish cognitive tempo) is a unique set of symptoms distinct from ADHD inattentive symptoms that appear to be independently associated with neuropsychological and psychosocial outcomes in community and ADHD-specific samples of youth. However, our understanding of CDS in individuals with chronic or complex medical conditions is limited. The current systematic review is the first to summarize the literature on CDS prevalence rates and associations with neurocognitive and functional outcomes in youth with medical conditions, and to discuss areas of future research to guide clinical intervention. We conducted literature searches across four major databases and included studies assessing prevalence estimates, associations with neuropsychological and/or psychosocial functioning, or predictors of CDS in individuals with chronic or complex medical conditions. Twenty-five studies were identified and retained. Fifteen of sixteen studies reported elevations in CDS symptoms, though findings were mixed in studies comparing mean differences to typically developing youth. Seven studies provided inconsistent evidence for CDS being associated with neuropsychological or academic functioning, with six studies demonstrating consistent effects on psychosocial functioning. Finally, nine studies identified biological and sociodemographic factors associated with CDS, though almost all await replication. CDS symptoms are significantly elevated in youth with medical conditions and appear to be particularly linked with psychosocial functioning. Future research is needed to identify prevalence of CDS across a range of medical conditions, examine associations with neuropsychological and psychosocial functioning, and examine whether CDS impacts self-management.

Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning

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.

Cognitive Disengagement Syndrome in Mothers of Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To examine the cognitive disengagement syndrome (CDS) symptoms of mothers of children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

The participants consisted of 223 mothers of children with ADHD, and data were collected using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV), the Stroop Test (ST), the Barkley Adult SCT Scale (CDS), and the Adult ADHD Self-Report Scale (ASRS).

RESULTS

The participants were divided into four groups based on psychopathology: the group without any psychiatric disorder, the group with only ADHD, the group with a psychiatric disorder other than ADHD, and the group with another psychiatric disorder along with ADHD. The group with any psychiatric disorder along with ADHD had the highest CDS scores, while the group without any psychopathology had the lowest CDS scores.

CONCLUSION

CDS seems to be a construct associated with both ADHD and other internalizing disorders. Further studies are needed to shed more light on these relationships.

Examining Cognitive Disengagement Syndrome in Relation to Social Problem Solving in Young Adults

OBJECTIVE

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo (SCT), is characterized by symptoms such as excessive daydreaming, mental confusion, and hypoactivity. CDS symptoms are associated with emotional, social, and daily life impairments. The way in which one solves problems in their daily life is associated with experiences of further problems, such that maladaptive problem-solving can lead to further physical and psychological problems. However, there is limited information on how CDS symptoms are associated with problem solving. The current study examined CDS symptoms in relation to different social problem solving approaches.

METHOD

A total of 280 college students (ages 18-23 years; 77.9% female) completed measures of psychopathology symptoms and social problem solving.

RESULTS

Above and beyond ADHD and internalizing symptoms, CDS symptoms were independently associated with negative problem orientation and avoidance style domains of maladaptive problem solving.

CONCLUSION

Findings indicate that CDS symptoms are related to specific difficulties with social problem solving. CDS symptoms may lead to difficulties attending to problems or working through relevant steps needed to identify solutions for the problem, which may then lead to avoidance and social withdrawal. Longitudinal research is needed to evaluate maladaptive problem solving as a potential mechanism in the association between CDS, social withdrawal, and internalizing symptoms.

Setting a research agenda for examining early risk for elevated cognitive disengagement syndrome symptoms using data from the ABCD cohort

Background

Little research has examined early life risk for symptoms of cognitive disengagement syndrome (CDS) despite a well-established literature regarding co-occurring outcomes (e.g., attention-deficit/hyperactivity disorder). The current study estimated bivariate associations between early life risk factors and CDS in a large and representative sample of U.S. children.

Methods

We conducted secondary analyses of baseline data from the Adolescent Brain Cognitive Development (ABCD) study (N = 8,096 children, 9-10 years old). Birthing parents reported early life risk factors on a developmental history questionnaire, including parental, prenatal, delivery and birth, and developmental milestone information. They also completed the Child Behavior Checklist, which includes a CDS subscale that was dichotomized to estimate the odds of elevated CDS symptoms (i.e., T-score > 70) in children related to risk indices.

Results

We observed significantly elevated odds of CDS related to parental risk factors (i.e., unplanned pregnancy, pregnancy awareness after 6 weeks, teenage parenthood), birthing parent illnesses in pregnancy (i.e., severe nausea, proteinuria, pre-eclampsia/toxemia, severe anemia, urinary tract infection), pregnancy complications (i.e., bleeding), prenatal substance exposures (i.e., prescription medication, tobacco, illicit drugs), delivery and birth risk factors (i.e., child blue at delivery, child not breathing, jaundice, incubation after delivery), and late motor and speech milestones in children.

Conclusions

Several early-life risk factors were associated with elevated odds of CDS at ages 9-10 years; study design prevents the determination of causality. Further investigation is warranted regarding early life origins of CDS with priority given to risk indices that have upstream commonalities (i.e., that restrict fetal growth, nutrients, and oxygen).

The role of cognitive disengagement syndrome in non-suicidal self-injury among adolescents with attention deficit hyperactivity disorder

AIMS

We aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) and non-suicidal self injury (NSSI) in adolescents with attention deficit hyperactivity disorder (ADHD).

METHODS

A semi-structured psychiatric interview and an NSSI screening questionnaire were conducted. Questionnaires assessing CDS (with daydreamer, sleepy, and slow subdimensions), depression, anxiety, self-esteem, emotion regulation, coping strategies, and loneliness were administered.

RESULTS

Among 104 participants (n: 63, 60.6% girls), the combined type of ADHD was the most common (66.3%), and 35 adolescents (27 girls) were in the NSSI+ group. Although only depression and ADHD were found to be predictors of NSSI in ADHD, CDS was associated with many risk factors of NSSI in ADHD: depression, anxiety, emotion dysregulation, low self-esteem, and emotion-oriented coping ways. After controlling for the effects of cognitive problems/inattentiveness, depression, and anxiety, CDS still correlated with low self-esteem and emotion dysregulation. The daydreamer and slow sub-dimensions of CSD differed between NSSI+ and NSSI- groups, while sleepy did not.

CONCLUSIONS

CDS is associated with several relevant factors, indirectly relating it to self-harm in ADHD. CDS increases the vulnerability to mental health changes that could lead to NSSI in adolescence with ADHD.

Personality Traits in Relation to Cognitive Disengagement Syndrome and ADHD Inattention in Two Samples of Children

OBJECTIVE

Cognitive disengagement syndrome (CDS; previously referred to as sluggish cognitive tempo) is a set of behaviors, including excessive mind-wandering, mental fogginess, and hypoactivity, that are separate from ADHD inattentive (ADHD-IN) symptoms and linked to functional outcomes. However, CDS and ADHD-IN symptoms are strongly associated, and our understanding of whether personality correlates are similarly or differentially linked to CDS and ADHD-IN is limited. The objective of the current study was to examine personality correlates of CDS and ADHD-IN symptoms across two independent samples of school-aged youth.

METHOD

Study 1 included 207 school-aged children (ages 7-11; 63% male; 87.9% White) with or without teacher-reported elevations in CDS. Study 2 included 263 school-aged children (ages 8-12; 58% male; 75.3% White) with the full range of CDS symptomatology. Parents and teachers completed ratings of ADHD-IN and CDS, and parents also reported on their child's personality dimensions.

RESULTS

Across two samples and controlling for demographic characteristics as well as ADHD-IN symptoms and other personality traits, higher levels of FFFS-fear/shyness were uniquely associated with higher levels of parent- and teacher-reported CDS symptoms. In most models, lower levels of BAS-drive were also uniquely associated with higher levels of CDS. In contrast, when controlling for demographic characteristics and CDS symptoms, higher levels of BAS-impulsivity/fun-seeking were uniquely associated with higher levels of parent- and teacher-reported ADHD-IN symptoms.

DISCUSSION

The findings provide the clearest evidence to date that personality dimensions are differentially associated with ADHD-IN and CDS symptoms in children, further underscoring CDS as a distinct construct from ADHD-IN.

Bibliometric Trends and Thematic Areas in Research on Cognitive Disengagement Syndrome in Children: A Comprehensive Review

This study aims to explore trends and principal research areas in the literature on Cognitive Disengagement Syndrome (CDS) in children aged 0-17 from a macro perspective. A total of 236 studies, selected based on inclusion and exclusion criteria from the Web of Science and Scopus databases, formed the data source for this research. We conducted a bibliometric analysis to examine the growth of CDS literature and to identify the most productive countries, relevant journals and publications, and trending topics. Additionally, through content analysis, we identified general research themes, sample trends, and methodologies used in these studies. Our findings reveal that the relatively new field of CDS research is expanding. Our thematic analysis shows that the literature on CDS covers a broad spectrum of research topics, addressing various facets of the syndrome and identifying current research themes. The existing studies highlight the complex nature of CDS and its diverse cognitive, psychological, and neurological impacts. Our results also suggest that while research is more prevalent in certain age groups, there is a need to encompass a wider demographic range, considering CDS's potential impact across different life stages. This bibliometric analysis offers a comprehensive review of the current knowledge in the CDS field, providing a valuable resource for researchers. Our analyses and findings can guide future research in this area and suggest approaches for broader study frameworks. It is anticipated that ongoing and future research in the CDS field will incorporate these insights to more effectively address the syndrome's varied aspects and consequences.

Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome

This study aims to investigate the predictive and mediating relationships between emotion dysregulation, internalizing disorders, family functionality, loneliness preference, and executive functions (EF) in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome (ADHD + CDS). This study included 176 children and adolescents (92 boys, 84 girls) who were diagnosed with ADHD + CDS according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist, between ages 8 -12 (M = 10, SD = 1.52) with a convenience sampling method. The solitude scale for children, difficulties in emotion dysregulation scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, Family assessment device, and CNS Vital Signs test were used. The results showed that difficulty in emotion regulation, preference for loneliness, internalizing disorders and CDS symptom severity did not have a mediating effect between family functionality and EF. Still, emotion dysregulation mediates the relationship between EF and internalizing disorders by itself and through loneliness preference. Also, preference for loneliness and emotion dysregulation had a mediating effect between family functionality and internalizing disorders. Finally, it was found that the effect of emotion regulation difficulty, loneliness preference, and internalizing disorders had a mediating role between CDS symptom severity and family functionality. In conclusion, the information obtained from this study on the etiology of CDS may guide future studies.

Preliminary examination of ADHD inattentive and cognitive disengagement syndrome symptoms in relation to probe-caught mind-wandering during a sustained attention to response task

OBJECTIVE

The role of mind-wandering- periods of internally-directed distractibility - among patients with attention-deficit/hyperactivity disorder (ADHD) has recently garnered attention, though few studies have assessed mind-wandering using thought probes during a sustained attention to response task (SART) or examined the possible role of cognitive disengagement syndrome (CDS) symptoms. We examined whether parent- and/or teacher-reported ADHD-inattentive (ADHD-IN) or CDS symptoms were independently associated with probe-caught mind-wandering.

METHODS

Fifty-four children (ages 9-12; 35.2% female) completed a SART with thought probes inquiring about various on- and off-task thoughts, including mind-wandering and distraction. Questionnaires provided information on demographics, medication treatment, and parent- and teacher-reported ADHD-IN and CDS symptoms. Regression models were estimated separately by informant to examine whether ADHD-IN or CDS symptoms were uniquely associated with mind-wandering or distraction frequency during the SART.

RESULTS

Higher teacher-reported CDS ratings, but not ADHD-IN ratings, were uniquely associated with more probe-caught mind-wandering. No significant findings related to parent-reported symptoms or probe-caught distraction were observed.

CONCLUSIONS

These preliminary findings add to an emerging body of work pointing to CDS as more consistently or strongly associated than ADHD-IN with mind-wandering. Theoretical and clinical implications are discussed.

Exploring Subfactors of Adult Cognitive Disengagement Syndrome and Impact on Neuropsychological Performance

OBJECTIVE

This study investigated subfactors of cognitive disengagement syndrome (CDS; previously referred as sluggish cognitive tempo) among adults referred for neuropsychological evaluation of attentiondeficit/hyperactivity disorder (ADHD).

METHOD

Retrospective analyses of data from 164 outpatient neuropsychological evaluations examined associations between CDS subfactors and self-reported psychological symptoms and cognitive performance.

RESULTS

Factor analysis produced two distinct but positively correlated constructs: "Cognitive Complaints'' and "Lethargy." Both correlated positively with symptom reports (rs = 0.26-0.57). Cognitive Complaints correlated negatively with working memory, processing speed, and executive functioning performance (rs = -0.21 to -0.37), whereas Lethargy correlated negatively only with processing speed and executive functioning performance (rs = -0.26 to -0.42). Both predicted depression symptoms, but only Cognitive Complaints predicted inattention symptoms. Both subfactors demonstrated modest to nonsignificant associations with cognitive performance after accounting for estimated premorbid intelligence and inattention.

CONCLUSION

Findings indicate a bidimensional conceptualization of CDS, with differential associations between its constituent subfactors, reported symptoms, and cognitive performance.

Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems

OBJECTIVE

The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey.

METHODS

A total of 274 outpatients (75.9% women; ages 18-64 years; Mage  = 31.06; SDage  = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress.

RESULTS

All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI.

CONCLUSION

This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

The association between cognitive disengagement syndrome and specific learning disorder in children and adolescents with ADHD

This study aimed to examine the associations between Cognitive Disengagement Syndrome (CDS) and Specific Learning Disorder (SLD) in children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). We included sixty "ADHD-only" cases and eighty-two "ADHD + SLD" cases with an IQ score of 80 and above, aged 8-15. We applied both a structured psychiatric interview and a mental status examination. Parents completed the ADHD-Rating Scale IV, Barkley Child Attention Scale, and Specific Learning Disorder-Evaluation Scale. The sample consisted of 94 boys and 48 girls. The mean age of the cases was 10,90 ± 2,32. The "ADHD + SLD" group had a higher proportion of cases with CDS than the "ADHD-only" group (47,6% vs 15%). The "ADHD + SLD" group had significantly higher CDS-total, CDS-sluggish, and CDS-daydreaming scores than the "ADHD-only" group. SLD score was positively associated with CDS-total, CDS-sluggish, and CDS-daydreaming scores. Even when controlled for inattentive symptoms, IQ, drug treatment duration, socioeconomic level, and parental education level, CDS-daydreaming scores but not CDS-sluggish scores were associated with higher SLD scores. The findings indicate a prominent association between CDS and SLD. CDS symptoms -mainly- CDS-daydreaming symptoms are essentially associated with SLD even when controlled for inattentive symptoms, IQ, drug treatment duration, and relevant demographic factors. Therefore, clinicians should pay attention to a possible coexistence of CDS while evaluating cases with SLD.

[Formula: see text] Neurocognition in children with cognitive disengagement syndrome: accurate but slow

Cognitive disengagement syndrome (CDS), previously termed sluggish cognitive tempo (SCT), is characterized by excessive daydreaming, mental confusion, and slowed behavior or thinking. Prior research has found inconsistent relations between CDS and neurocognition, though most studies have used small or ADHD-defined samples, non-optimal measures of CDS, and/or examined limited neurocognitive domains. Accordingly, this study examined the association of parent- and teacher-reported CDS symptoms using a comprehensive neurocognitive battery in a sample of 263 children (aged 8-12) selected with a range of CDS symptomatology. Parents and teachers provided ratings of CDS and ADHD inattentive (ADHD-IN) symptoms. Path analyses were conducted to examine CDS and ADHD-IN as unique predictors of neurocognitive functioning after covarying for age, sex, and family income. CDS symptoms were uniquely associated with slower performance across a range of cognitive domains, including verbal inhibition, rapid naming/reading, planning, divided attention, and set shifting. In contrast, ADHD-IN symptoms were uniquely associated with poorer performance on a Go/NoGo task (inhibition/distractibility), visual scanning and discrimination, and interference control. Findings from the current study, amongst the first to recruit children based on levels of CDS symptomatology, provide the strongest evidence to date that the neurocognitive phenotype of CDS is characterized by slowed cognitive processing, and add to its validity as a separate syndrome from ADHD. If replicated, these findings have implications for assessment, treatment, and school accommodations for CDS. Neuroimaging studies exploring the neurobiological basis of CDS are also needed.

Cognitive disengagement syndrome in pediatric spina bifida

The primary aim of this study was to characterize Cognitive Disengagement Syndrome (CDS) symptomatology in youth with spina bifida (SB). One hundred and sixty-nine patients aged 5-19 years old were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Parent-reported CDS and inattention were measured using Penny's Sluggish Cognitive Tempo Scale and the Vanderbilt ADHD Rating Scale. Self-reported internalizing symptoms were measured with the 25-item Revised Children's Anxiety and Depression Scale (RCADS-25). We replicated Penny's proposed 3-factor structure of CDS with slow, sleepy, and daydreamer components. The slow component of CDS overlapped heavily with inattention, while the sleepy and daydreamer components were distinct from inattention and internalizing symptoms. Eighteen percent (22 of 122) of the full sample met criteria for elevated CDS, and 39% (9 of 22) of those patients did not meet criteria for elevated inattention. Diagnosis of myelomeningocele and presence of a shunt were associated with greater CDS symptoms. CDS can be measured reliably in youth with SB and can be discriminated from inattention and internalizing symptoms in this population. ADHD rating scale measures fail to identify a substantial portion of the SB population with attention-related challenges. Standard screening for CDS symptoms in SB clinics may be important to help identify clinically impairing symptoms and design targeted treatment plans.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome

OBJECTIVE

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

METHOD

Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

RESULTS

Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

CONCLUSIONS

Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

[Clinical and neurophysiological manifestations of sluggish cognitive tempo in children]

OBJECTIVE

To study the clinical and neurophysiological features of children with low cognitive tempo (NCT), as well as the effectiveness of the drug Pantogam in the treatment of this pathology.

MATERIAL AND METHODS

A total of 90 children aged 8 to 10 years were examined. Of these, the main study group consisted of 30 children with NCT, the comparison group consisted of 30 children with a combined type of attention deficit hyperactivity disorder ADHD (ADHD-K), the control group consisted of 30 children without neuropsychiatric disorders. The study used clinical, neurophysiological (electroencephalography (EEG)) and parametric methods. The CMAS scale of apparent anxiety (The Children's Form of Manifest Anxiety Scale), the SNAP-IY scale (assessment of the degree of inattention, hyperactivity and impulsivity), the TOVA computer test (the Test of Variables of Attention), the scale «SCT» (Sluggish Cognitive Tempo) for assessing manifestations of low cognitive tempo, the «RAM» technique for quantifying working memory. Pantogam was used to treat patients at a dose of 750 mg per day for 8 weeks.

RESULTS

Patients with NCT are characterized by more pronounced attention disorders compared with healthy peers and with children with ADHD-K, and they have a decrease in mainly not selective attention, but the overall level of functional activity. Also, the group of children with NCT has an increased level of anxiety compared to the group of children with ADHD. A comparative analysis of the level of impulsivity showed that children with NCT are less characterized by a deficit in inhibition processes. According to the quantitative analysis of the EEG, specific changes in functional activity in the frontal and central regions of the cerebral cortex were revealed (a statistically significant increase in the ratio of absolute theta rhythm to beta1 rhythm, compared with other groups), reflecting insufficient cortical arousal and less focused neural states. When re-evaluating the condition of children with NCT after a course of therapy with Pantogam, an improvement in the form of a decrease in the degree of inattention, the severity of memory impairment and a decrease in reaction time was recorded in 60% of cases. According to quantitative EEG analysis, there was a significant decrease in the ratio of absolute theta rhythm to beta1 rhythm in the central leads of both hemispheres and in the parietal-temporal leads of the left hemisphere, indicating an increase in the level of overall activation of the cerebral cortex after a course of treatment.

CONCLUSION

Clinical and neurophysiological differences were revealed in patients with NCT and with combined ADHD. It has been shown that the use of Pantogam for the treatment of children with NCT leads not only to a decrease in the main manifestations of this disorder, but also to an improvement in the functional state of the brain.

The Challenges of Distinguishing Cognitive Disengagement Syndrome from Childhood Absence Epilepsy in Clinical Settings

We evaluated clinical parameters distinguishing cognitive disengagement syndrome (CDS) and childhood absence epilepsy (CAE). 40 children with CDS, 27 with CAE, and 41 controls aged 7-12 were compared regarding sleep problems, CDS, and ADHD symptoms. CDS-sluggishness symptoms, but not CDS-daydreaming symptoms, were significantly higher in CDS group than CAE group. CDS scale provided a weak discrimination value between CDS and CAE. Sleep problems and ADHD symptoms were similar between the two clinical entities. These findings highlight that CDS and CAE might have overlapping symptoms. 'Daydreaming' symptoms but not 'sluggishness' symptoms seem to be main overlapping manifestations between CDS and CAE.

Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD

BACKGROUND

Persistent mind-wandering processes are associated with negative emotions; however, mindful states exhibit an anticorrelation with mind-wandering patterns. The aim of this study is to investigate the mediating role of excessive mind wandering (EMW), rumination, and trait mindfulness between attention-deficit hyperactivity disorder (ADHD) symptoms and the severity of anxiety/depression in adults with ADHD.

METHODS

Medication-free 159 adults diagnosed with ADHD completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Hospital Anxiety Depression Scale, Mind Excessively Wandering Scale, Ruminative Response Scale, and Freiburg Mindfulness Inventory after the diagnostic examination according to the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5).

RESULTS

ADHD symptoms exhibited an indirect, but not a direct, association with the severity of anxiety and depression, mediated by increased excessive mind wandering and rumination, as well as decreased trait mindfulness.

LIMITATIONS

This study was carried out within a clinical population using a cross-sectional design. While diagnostic assessments were conducted using SCID-5, psychiatric symptoms were evaluated through self-report measures.

CONCLUSIONS

Coping with EMW and rumination and promoting mindfulness ability may be promising targets in treating comorbid conditions in adults with ADHD. These findings have highlighted the effects of mentation processes on depression and anxiety, which are common comorbidities with ADHD in adults; however, longitudinal studies are needed.

Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample

OBJECTIVE

The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group).

METHOD

Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures.

RESULTS

First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis.

CONCLUSIONS

The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

Cognitive Disengagement Syndrome But Not ADHD Symptoms Increases Risk for Child Body Mass Index: Examination in a Sample of Clinically Referred Youth

Given the substantial increase in pediatric obesity rates in recent decades, its long-term stability, and its pervasive negative outcomes, continuous efforts to identify factors that may place children at increased risk for overweight or obesity (OW/OB) are essential. As such, the primary aim of the present investigation was to examine the extent to which symptoms of Cognitive Disengagement Syndrome (CDS; i.e., Sluggish Cognitive Tempo) relates to child body mass index (BMI) independent of Attention-Deficit/Hyperactivity Disorder (ADHD). The study is the first to examine whether CDS subdomains of slowed thinking, hypoarousal, and daydreamy is associated with BMI. Analyses included data from 72 clinically-referred children (46 males, 26 females) aged 4-12 years old (M = 8.41, SD = 2.48). CDS and ADHD were assessed using standardized parent-report rating scales, and children's BMI was collected at the time of encounter. Bayesian hierarchical regression models revealed no evidence that overall CDS symptoms or ADHD symptoms (overall and subdomain) predicted child BMI. However, models did provide moderate evidence that hypoarousal and daydream subdomains jointly predicted BMI independent of ADHD (BF10 = 19.28-21.87). The present study suggests that CDS is a risk factor for obesity in young children and future research is needed to inform clinical interventions and to provide further understanding of the relatively nuanced association between CDS symptoms and obesity.

The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors

Although sluggish cognitive tempo (SCT) symptoms are often observed in children with attention deficit hyperactivity disorder (ADHD), an increasing number of studies have highlighted its uniqueness. Nevertheless, no national survey on SCT among children and adolescents has been conducted in China. Hence, this research aims to study SCT in China and to evaluate the differences between SCT and ADHD symptoms by comparing their risk factors in terms of life events (LE) and parental rearing behaviors (PRB). This cross-sectional study used data from a survey on 71,929 children and adolescents in 5 province-level regions in China to study the incidence and demographic information of SCT in the Chinese population. Subsequently, the study investigated the comorbidity of ADHD and SCT, and conducted three logistic regressions on the LE and PRB scores to predict whether participants develop symptoms of ADHD or SCT, or neither symptom. 6658 participants were allocated into the SCT group, and the weighted point prevalence of SCT was 9.78%. 36.34% of participants with ADHD (n = 676) were found to demonstrate SCT symptoms, whereas no statistically significant difference was observed in its comorbidity to the three ADHD subtypes (χ2 = 1.668, p > 0.05, Δ = 2). The regression results on the presence or absence of ADHD revealed paternal excessive-interference and rejection, and maternal favoring were associated with ADHD diagnosis, whereas paternal punishment and favoring and maternal emotional warmth was related to the absence of ADHD symptoms. Academic stress and maternal excessive-interference were associated with SCT symptoms, and maternal emotional warmth associated with SCT absence. Concerning the presence of ADHD-only or SCT-only symptoms, LE adaptation was found to relate to SCT-only symptoms, while PRB paternal rejection and maternal favoring were associated with ADHD-only symptoms. While evidencing the high prevalence of SCT in China, our findings supported that although ADHD and SCT were highly comorbid, they may be considered two independent disorders with different risk factors. Specifically, participants with SCT symptoms are more vulnerable to stress from LE and tend to face more maladjustment than ADHD and normally-developing participants, and maternal rearing behaviours are the key factors to SCT symptoms. SCT brings global challenges in its diagnosis and treatment, and the challenge is more severe in a mentally stressful environment. Therefore, stress management and SCT etiology studies are recommended.

Psychometric Properties of the Turkish version of the Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT) in Children and Adolescents

Sluggish cognitive tempo (SCT) (cognitive disengagement syndrome) (CDS) describes a cluster of symptoms including slowness, lethargy, and daydreaming. This study aims to evaluate the psychometric properties of the Turkish version of the Child and Adolescent Behavior Inventory (CABI-SCT) scale and its relationship to other psychological difficulties. A total of 328 children and adolescents aged between 6-18 years were included in the study. CABI-SCT, Revised Child Anxiety and Depression Scale (RCADS), Barkley Child Attention Scale (BCAS), ADHD Rating Scale-IV, and Strengths and Challenges Questionnaire (SDQ) were administered to parents of participants. Reliability analysis demonstrated good internal consistency and reliability. Confirmatory factor analysis indicated that the one-factor model of the Turkish version of CABI-SCT is an acceptable construct. This study supports the validity and reliability of the Turkish version of CABI-SCT for use in children and adolescents providing initial data concerning the psychometric properties and difficulties associated with the Turkish version of the CABI-SCT.

Is the deficit in attention-deficit/hyperactivity disorder a concentration deficit?

Attention-deficit/hyperactivity disorder (ADHD) is comprised of two behavioral clusters of symptoms, inattention and hyperactivity/impulsivity. Numerous studies have attempted to address the underlying neuropsychological mechanism of ADHD. However, there is still no uniform mechanism that can fully explain both inattention and hyperactivity/impulsivity symptoms. This review describes the research findings that have shifted the focus from cognitive selective attention to executive function deficits and notes that the prominence of the attention deficit remains unclear. As ADHD is not consistently explained by cognitive selective attention but rather with cognitive sustained attention/vigilance and executive function deficits, this review suggests that concentration deficit is likely the cause of inattention symptoms. Indeed, considering concentration deficit as the cause of inattention symptoms may better describe the underlying difficulties of maintaining and controlling attention in ADHD. In addition, as concentration, impulsivity, and hyperactivity may share a common cognitive deficit, this shift in focus may help in identifying a single mechanism for all ADHD symptoms.

Evaluation of cognitive disengagement syndrome in children with obsessive-compulsive disorder: Clinical implications

Cognitive disengagement syndrome (CDS) has been found to be associated with internalizing symptoms. Yet, no study thus far has focused on whether there is an association between obsessive-compulsive disorder (OCD) and CDS. The purpose of this study is to examine the symptom frequency and clinical implications of CDS in children with OCD. The study included sixty-one children with OCD and sixty-six typically developing children. Children were evaluated by a semi-constructed diagnosis interview, Obsessive-Compulsive Inventory, Barkley Child Attention Scale, and Stroop test. The frequency of elevated symptoms of CDS, and total time, total error, and total correction scores of the Stroop test were significantly higher in the OCD group compared to the controls. Elevated CDS symptoms were significantly associated with higher OCD symptom prevalence and poorer performance on the Stroop Test. Moreover, poor insight, hoarding symptoms, mental compulsions, and ADHD comorbidity were significantly higher in those with elevated CDS symptoms than in those without CDS in the OCD group. The findings of this study provide clinical implications that CDS symptoms may contribute to deficits in attentional orientation, conceptual flexibility, and cognitive processing speed in OCD.

Cognitive and behavioral predictors of procrastination behavior in adolescents at a mental health clinic in Turkey

OBJECTIVE

Procrastination behavior (PB) negatively impacts individuals' daily lives. Based on existing evidence that states executive function (EF) problems and internalizing symptoms (IS) are related to PB, this study examined IS, EF problems, and sluggish cognitive tempo (SCT) symptoms in adolescents, and their relationships with PB and gender.

METHODS

The sample consisted of 78 adolescents (56.4% female) aged 12-18 years. Participants and their families completed the Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED), Barkley Sluggish Cognitive Tempo Scale-Children and Adolescent (BSCTS-CA), General and Academic Procrastination Scales, Behavior Rating Inventory of Executive Function (BRIEF), and Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The scores for academic PB were significantly positively associated with the CDI, SCARED, subscales comprising the metacognitive index of the BRIEF, and all four subscales of the SDQ but not with SCT. General and academic PB yielded similar results except for the conduct problems. Academic PB and EF problems were more prevalent in males. Lack of organizational skills, a part of EF; IS; and attention problems were associated with academic and general PB in girls and boys.

CONCLUSION

Adolescents who have difficulty organizing their work and attention problems may have higher PB.

Comparison of Possible Changes in Oxidative Stress, DNA Damage, and Inflammatory Markers in Children/Adolescents Diagnosed with Sluggish Cognitive Tempo and Children/Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder

Background: There has been a debate on whether sluggish cognitive tempo (SCT) differs from attention-deficit/hyperactivity disorder (ADHD). Although there have been many studies on metabolic parameters in relation to ADHD, no similar studies have been conducted on patients with SCT. We investigated whether there are differences between SCT and ADHD in terms of these factors. Subjects and Methods: Sixty-two participants with ages ranging from 11 to 18 who have diagnosis of ADHD (33 subjects) and SCT (29 subjects) were included in this study. The parents of all participants completed the 48-item Conners' Parent Rating Scale (CPRS) and the Barkley Child Attention Scale (BCAS) forms, and all participants' blood was taken to compare metabolic, oxidative stress, and antioxidant status of the SCT and ADHD groups. A child and adolescent psychiatrist interviewed the parents and children to assess the diagnosis of SCT and ADHD using standard diagnostic procedures. Results: In the comparison between the SCT and ADHD groups in terms of metabolic parameters, statistically significant differences were found in terms of total oxidant status, total antioxidant status, Oxidative Stress Index, total thiol, native thiol, disulfide, interleukin (IL)-1β, IL-6, and DNA damage (p < 0.05), but not in terms of tumor necrosis factor-α (p > 0.05). Conclusions: Our data showed that these two disorders may be different, but we believe that the data that indicate their differences remain inconclusive overall, but this study may be a potential pathway for future research.

Psycholinguistic profiling of children with sluggish cognitive tempo

Language disorders are frequently comorbid with attention deficit/hyperactivity disorder (ADHD). Sluggish cognitive tempo (SCT), a second attention disorder, may potentially explain some of the links between language disorders and ADHD. In this study we examined the psycholinguistic abilities of 207 children (mean age 7;10) with and without clinically significant levels of SCT symptoms to determine the degree to which symptoms of language disorder co-occur in cases of SCT. Analyses of children's tense-marking, nonword repetition, and sentence recall indicated that deficits in these areas were not associated with SCT. Instead, SCT appears to be more closely aligned with features of social (pragmatic) communication disorder.

Physical and Extracurricular Activity in Adolescents With and Without ADHD: Examining Group Differences and the Role of Cognitive Disengagement Syndrome Symptoms

OBJECTIVE

This study examined extracurricular and physical activity related to ADHD (diagnosis and symptoms) and cognitive disengagement syndrome (CDS) symptoms.

METHODS

Participants were 302 adolescents (ages 12-14) with and without ADHD and primary caregivers. ADHD diagnosis was determined with parent interview. Questionnaires provided information on parent-reported demographic characteristics, ADHD symptoms, and extracurricular activity involvement; and adolescent-reported ADHD and CDS symptoms and indices of physical activity.

RESULTS

Although ADHD diagnosis and symptom dimensions were correlated with less extracurricular and physical activity involvement, CDS symptoms were most often independently associated with these outcomes. Females and adolescents from lower income homes also often had less involvement in extracurricular and physical activity.

CONCLUSIONS

Findings point to the need for more research in this area, careful assessment of risk factors (i.e., CDS symptoms, economic burden), and interventions that address inactivity in adolescents with ADHD, including those that address inequity related to income and sex.

Comparing Cognitive Disengagement Syndrome Growth in Youth With and Without Spina Bifida

OBJECTIVE

Cognitive disengagement syndrome (CDS; formally known as sluggish cognitive tempo), difficulties with social engagement, and lower levels of autonomy have been identified as maladaptive comorbidities in youth with spina bifida (SB). This study compared growth curves of CDS for youth with and without SB and examined whether these trajectories were associated with later functioning.

METHODS

Longitudinal data spanning 8 years included youth with SB (n = 68, Mage = 8.34) and a demographically matched sample of typically developing (TD) peers (n = 68, Mage = 8.49). Adolescents, along with their caregivers and teachers, reported on youth social skills, behavioral functioning, and CDS. Growth curve models were examined by comparing CDS trajectories by SB status.

RESULTS

Growth curves indicated that youth with SB had higher levels of teacher-reported CDS at ages 8 and 9, but growth curves were relatively stable for both groups. When predicting social skills, higher levels of teacher-reported (but not mother-reported) CDS at baseline predicted worse social functioning for both youth with and without SB in adolescence. For the slope findings, higher rates of mother-reported CDS over time predicted worse social skills (β = -0.43) and lower levels of youth decision-making (β = -0.43) for the SB group, while higher rates of teacher-reported CDS predicted worse social skills for the TD group.

CONCLUSION

Next steps include understanding the impact that impaired social functioning and restricted autonomy have on youth with and without SB due to CDS to inform interventions. Additionally, advocacy for increased awareness of CDS-related impairment is needed, particularly for youth with chronic health conditions.

Cognitive Disengagement Syndrome and Child Sleep Problems in ADHD, Anxiety and Depression

The main objective of this study was to analyse the relationship and differential contribution of Cognitive Disengagement Syndrome (CDS) and sleep problems in children in different psychopathological measures. A total of 1133 participants (612 fathers/mothers and 521 children aged 7-13 years in Years 3-6 of Primary Education) completed the scales on CDS, sleep problems, depression (DEP), anxiety (ANX) and attention deficit and hyperactivity disorder (ADHD). Similar and significant correlations were identified in the measures of CDS and sleep problems between fathers and mothers, obtaining a high coefficient between the two parents. However, weak correlations were found between fathers/mothers and children. The scores of CDS and the sleep disturbance scale for children (SDSC) significantly predicted the internalising measures and ADHD, especially between SDSC and DEP. It was confirmed that sleep problems had a greater presence in the group of children with the highest ADHD scores, and especially in CDS and ADHD jointly. To conclude, the data indicate the importance of sleep problems in understanding CDS and its relationship with other psychopathological measures, especially ADHD, although to a greater extent with internalising symptoms, especially DEP.

Validation of the Farsi Version of the Adult Concentration Inventory for Assessing Cognitive Disengagement Syndrome

The internal and external validity of cognitive disengagement syndrome (CDS) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated herein with Farsi-speaking adults. A total of 837 Iranian adults assessed throughout the whole country (54.72% women, Mage = 23.85; SD = 7.05; age range = 18 to 58 years; 75% between 18 and 24 years old; reporting higher educational training) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), depression, anxiety, and stress. Seven of the fifteen CDS symptoms showed a good convergent (high loadings on the CDS factor) and discriminant (higher loadings on the CDS factor than the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations with depression than ADHD-IN, whereas ADHD-IN showed stronger first-order and unique associations with ADHD-HI and anxiety than CDS. The first-order and unique associations of CDS and ADHD-IN did not differ in relation to stress. This study is the first to support the validity of the self-report of assessing CDS symptoms with the Adult Concentration Inventory with Farsi-speaking individuals residing in Iran, thus further strengthening the transcultural validity of the CDS, and paving the way for further transcultural research in the field of CDS among adults.

A Twin Study of the Relationships between Cognitive Disengagement Syndrome and Anxiety Phenotypes in Childhood and Adolescence

Data on the etiological factors underlying the co-occurrence of Cognitive Disengagement Syndrome (CDS) with anxiety symptoms are very limited. The present study investigated the nature of latent shared etiological elements in 400 Italian twin pairs aged 8-18, explaining the covariation between CDS and anxiety symptoms. Preliminary analysis demonstrated significant correlations between Child Behaviour Checklist/6-18 Sluggish Cognitive Tempo Scale and two (Somatic Anxiety, Generalized Anxiety) out of five Screen for Child Anxiety Related Disorders anxiety subscales. Results from causal analysis seem to exclude the hypothesis that co-occurrence between CDS and Anxiety Symptoms could be due to a direct phenotypic effect of one trait upon the other. Model fitting-analysis indicated that the aforementioned associations were partially explained by shared genetic and environmental factors influencing a common liability factor. A latent variable capturing the covariation between CDS and anxiety problems can be considered as a unifying (patho)physiological mechanism/system common to these constructs. Our results support the adoption of a broader view of the relationships between CDS and anxiety phenotypes in childhood and adolescence for both clinicians and educators.

Psychopathology and mind wandering in young university students

Mind wandering has often been studied in relation to psychopathology. However, debates remain as to whether sluggish cognitive tempo, recently termed cognitive disengagement syndrome (CDS), and ADHD symptoms could be unique predictors of mind wandering. Therefore, this study was aimed at documenting the associations between CDS, ADHD symptoms and mind wandering while controlling for age, sex, internalized symptoms, and sleep. A sample consisting of university students (N = 60; aged between 17 and 32 years; 65% female) completed measures of CDS, ADHD symptoms, internalized functioning and insomnia. Mind wandering was also assessed using the 5-item Mind Wandering Questionnaire (MWQ) and thought sampling during a reading task. Multiple regression analyses show that while younger age and inattention were significant predictors of greater levels of self-reported mind wandering on the MWQ, sex, CDS, hyperactivity/impulsivity, internalized symptoms, and sleep were not. In addition, no variables were able to significantly predict spontaneous and deliberate mind wandering as assessed by thought sampling. These findings raise important questions regarding the equivalence between measures of state-level and trait-level mind wandering. The associations between ADHD, CDS and mind wandering in young adults are still unclear, but our findings highlight critical methodological considerations for future studies that might further our understanding of the relationship between task-unrelated thought and psychopathology.

Cognitive Disengagement Syndrome (CDS) (Formerly Sluggish Cognitive Tempo), Autism, and Insomnia Symptoms in Childhood Predict CDS in Adolescence: A Longitudinal Population-Based Study

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.

Longitudinal Associations Between Sluggish Cognitive Tempo and Academic Achievement in Adolescents: A Mediated Moderation Model

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.

Sluggish cognitive tempo (Cognitive Disengagement Syndrome) symptoms are more associated with a higher risk of internet addiction and internet gaming disorder than ADHD symptoms: A study with medical students and resident doctors

BACKGROUND & AIMS

The purpose of this study was to examine the relationships between Attention Deficit Hyperactivity Disorder (ADHD), Sluggish Cognitive Tempo (SCT), demographic factors, and Internet Addiction (IA) and internet gaming disorder (IGD) among medical students and resident doctors.

METHODS

The study included 274 medical students and resident doctors. (Ages:18-35, 70.4% female). Fisher exact test, Contingency Table analyses, Mann Whithey-U Test and structural equation model-path analysis were used for analysis. The Sociodemographic Information Form, ASRS Scale, Barkley SCT Scale, Young Internet Addiction Test-Short Form and The Digital Game Addiction Scale were utilized to collect data.

RESULTS

In the sample, 48 participants (17.51%, 22 female, 26 male) were classified as having a high-risk internet gaming disorder (IGD+), while 53 participants (19.3%, 37 female, 16 male) were classified as having a high-risk internet addiction (IA+). SCT Scale Daydreaming and Sluggishness scores, as well as ASRS Scale Inattention and Hyperactivity/Impulsivity ratings, were all substantially higher in high-risk groups (for all, p < 0.05). Instead of age, there was no difference between high and low-risk groups, but men had a significantly greater rate of high risk- IGD (%32.1 vs. 11.4; p = 0.001). Path analysis revealed that while older age has a substantial negative effect (β = -0.37, p = 0.001) on increased risk of IA, Inattention (β = 0.19, p = 0.028), Daydreaming (β = 0.62, p0.001), and Sluggishness ( β = 1.12, p0.001) had significant positive effects. On the other hand, results revealed that male gender (β = 5.08, p0.001), IA scores (β = 0.21, p0.001), and only Sluggishness ( = 0.52, p = 0.002), but not Inattention, Hyperactivity/impulsivity, or Daydreaming, have positive effects on greater risk of internet gaming disorder (IGD).

CONCLUSION & IMPLICATIONS

Our study is the first to show that SCT symptoms increase the risk of Internet addiction and Internet Gaming Disorder even when ADHD symptoms are controlled. To date, many research have highlighted the necessity of ADHD treatment when evaluating IA and IGD. However, SCT symptoms have a greater impact on people who are predisposed to these behavioral addictions, and despite high comorbidity rates, various treatment approaches for ADHD and SCT are effective. SCT should be kept in mind when assessing treatment-resistant individuals with IA and IGD.

Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome

OBJECTIVE

The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.

METHOD

An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.

RESULTS

Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected "cognitive disengagement syndrome" (CDS) to replace "SCT" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.

CONCLUSION

It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.

Pharmacologic Management of Cognitive Disengagement Syndrome (CDS) and Implications for Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment: Emerging Treatments and Recommendations for Future Research

Although the study of cognitive disengagement syndrome (CDS; previously called sluggish cognitive tempo) first emerged in the 1980s, very little is known about treating CDS or its impact on evidence-based interventions for attention-deficit/hyperactivity disorder (ADHD) with which it frequently co-occurs. The objective of this leading article was to investigate the existing evidence on medication treatment and CDS, including studies that have examined CDS response to medication and CDS as a moderator of ADHD treatment response. A total of seven studies were identified. At present, the limited existing literature suggests that psychostimulants such as methylphenidate and lisdexamfetamine, as well as atomoxetine, may improve CDS symptoms, although replication and research on related medications is needed. However, there are indications that CDS symptoms may predict a reduced response to methylphenidate in children with ADHD. Although untested, research on the neurobiological, neuropsychological, and behavioral correlates of CDS point to a possible benefit of other ADHD medications (e.g., guanfacine), medications that treat narcolepsy (e.g., modafinil), and medications traditionally used to treat depression and anxiety (e.g., viloxazine, bupropion, fluvoxamine), some of which have also recently been used in ADHD management. The article concludes with recommendations for future research on pharmacologic treatment and CDS.

Sluggish cognitive tempo, eating habits, and daytime sleepiness in obese adolescents

OBJECTIVE

Rates of obesity have risen steeply in the western world in all age groups. Sluggish Cognitive Tempo (SCT) is characterized by a cluster of symptoms. Daytime sleepiness, commonly seen in obesity, may share a similar origin with sleepiness and daydreaming symptoms of SCT. This study aims to investigate the relationship between obesity, SCT, daytime sleepiness, and eating habits.

METHOD

Adolescents, aged between 10-17 years, with a BMI >95^th centile, were recruited to the study. Clinical interviews were supplemented with standardized questionnaires.

RESULTS

Of the 35 adolescents, more than one quarter (N = 10, 28.6%) had SCT. Emotional overeating and food enjoyment subscale scores showed moderate correlations with the SCT scores, though these associations were not significant when controlling for ADHD symptoms. Daytime sleepiness score in adolescents with SCT was found to be significantly higher than those without.

CONCLUSION

Sluggish Cognitive Tempo is frequently present in adolescents with obesity and associated with higher levels of emotional overeating, food enjoyment, and daytime sleepiness. Targeting aspects of SCT might offer additional avenues to assist in weight management programs for youth.

Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children

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.