Sluggish cognitive tempo and exposure to interpersonal trauma in children

Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program

Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.

[Formula: see text] Cognitive disengagement syndrome in pediatric patients with long COVID: associations with mood, anxiety, and functional impairment

Children with long COVID often report symptoms that overlap with cognitive disengagement syndrome (CDS, previously sluggish cognitive tempo (SCT)), a set of behaviors distinct from attention-deficit/hyperactivity disorder (ADHD) including excessive daydreaming, mental fogginess, and slowed behavior and thinking. Those with long COVID also frequently report low mood and anxiety, which are linked to CDS. The relationships between cognitive difficulties, mood, and functional impairment have yet to be explored in pediatric long COVID. Specifically, it is unclear how much cognitive difficulties (CDS, inattention) contribute to functional impairment, when accounting for mood/anxiety symptoms in this population. Retrospective parent-reported data was collected from 34 patients with long COVID (22 females, Mage = 14.06 years, SD = 2.85, range 7-19) referred for neuropsychological consultation through a multidisciplinary Post-COVID-19 clinic. Compared to community and clinically referred samples, on average, long COVID patients showed elevated CDS symptoms, including Sluggish/sleepy (e.g., fatigue) and Low Initiation subscales (e.g., difficulty performing goal directed behaviors). Low Initiation, mood, anxiety, and inattention were associated with functional impairment. In multiple hierarchical regression models, after controlling for mood and anxiety, Low Initiation and inattention were no longer predictive of functional impairment. Instead, anxiety remained the sole predictor of functional impairment. Our results demonstrate that children with long COVID have high levels of CDS symptoms. The association between cognitive difficulties and functional impairment dissipated with the inclusion of mood and anxiety, suggesting behavioral health interventions targeting anxiety may help improve daily functioning and quality of life in pediatric long COVID patients.

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.

The relationship between childhood interpersonal and non-interpersonal trauma and autobiographical memory: a systematic review

Childhood trauma can have negative effects on several domains of mental functioning, including Autobiographical Memory (AM). Conflicting results emerge in the scientific literature regarding the effects of childhood trauma on AM. In this review, we explored the relationship between the childhood trauma and AM, classifying childhood trauma as interpersonal, non-interpersonal and overall (interpersonal and non-interpersonal). We carried out a systematic literature review, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA statement). From searching the PubMed, Scopus, and Web of Science databases, we identified 48 studies conducted from 2014 to 2023, which were included when they: (a) were written in English, (b) investigated the relationship between AM and childhood trauma, (c) included a sample of children, adolescents, or adults who had experienced childhood interpersonal and/or non-interpersonal trauma. Of the 48 eligible studies, 29 referred to trauma of an interpersonal nature, 12 to trauma of a non-interpersonal nature, and 7 to overall trauma. Regarding the relationship between childhood trauma and AM, 24 studies found a negative relationship between childhood interpersonal trauma and AM; among the articles on non-interpersonal trauma, 10 studies found no relevant relationship; in the studies on overall trauma, 4 articles found negative relationship between overall trauma and AM. The literature explored in our systematic review supports the prevalence of a negative relationship between interpersonal childhood trauma and AM. This relationship is present regardless of psychiatric disorders (e.g., Depression, Post Traumatic Stress Disorder, and Personality Disorders), and in the presence of the latter, AM results even more fragmented. Future research should use more accurate methodologies in identifying and classifying childhood trauma in order to more precisely determine its effect on AM.

[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.

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.

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.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder

Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect β = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect β = .15, 95% CI [.11, .18], and aggressive behaviors, total effect β = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Young female offenders and the New Zealand Youth Justice System: the need for a gender-specific response

Young female offenders comprise approximately one fifth of the New Zealand youth offender population; however, they remain an understudied population of offenders. This paper aims to provide a current overview of the key characteristics of this population and recommendations for how the youth justice system could better cater to this population. These recommendations include more training of professionals (specifically judges, youth advocates and justice coordinators) and practitioners (specifically social workers, psychologists and youth workers) in the youth-justice system in matters specific to young female offenders. A gender-responsive and trauma-informed approach to addressing offending behaviour is also necessary. There is a need for new empirical research in the New Zealand context on young female offenders and the best way to address offending by this group. Finally, a focus on the diversity of young female offenders is a priority, given the over-representation of indigenous and ethnic-minority communities in justice jurisdictions worldwide.