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Inci Izmir SB, Aktan ZD, Ercan ES. 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. J Atten Disord 2024; 28:1555-1576. [PMID: 39092505 DOI: 10.1177/10870547241267379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
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.
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Miller MC, Shapiro SK, Becker SP. Examining Cognitive Disengagement Syndrome in Relation to Social Problem Solving in Young Adults. J Atten Disord 2024; 28:1289-1298. [PMID: 38616627 DOI: 10.1177/10870547241247176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
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.
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Affiliation(s)
- Melissa C Miller
- Auburn University, AL, USA
- Cincinnati Children's Hospital Medical Center, OH, USA
| | | | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
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Sevincok D, Ozaydin Y, Ozgur BG, Ozbek MM, Aksu H, Sevincok L. The relationship between parental obsessive-compulsive disorder and children's cognitive disengagement syndrome (Sluggish Cognitive Tempo). Clin Child Psychol Psychiatry 2024:13591045241257019. [PMID: 38807463 DOI: 10.1177/13591045241257019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
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.
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Affiliation(s)
- Doga Sevincok
- Department of Child and Adolescent Psychiatry, Balikli Rum Hospital, Turkey
| | - Yigit Ozaydin
- Department of Child and Adolescent Psychiatry, Aydin Adnan Menderes University, Turkey
| | - Borte Gurbuz Ozgur
- Department of Child and Adolescent Psychiatry, Aydin Adnan Menderes University, Turkey
| | | | - Hatice Aksu
- Department of Child and Adolescent Psychiatry, Aydin Adnan Menderes University, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Aydin Adnan Menderes University, Turkey
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Inci Izmir SB, Aktan ZD, Ercan ES. Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-17. [PMID: 38615909 DOI: 10.1080/21622965.2024.2341251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
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.
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Affiliation(s)
| | - Z Deniz Aktan
- Child and Adolescent Clinical Psychology Department, Isik University, Istanbul, Turkey
| | - Eyüp Sabri Ercan
- Child and Adolescent Psychiatry Department, Medical Faculty, Ege University, Izmir, Turkey
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Becker SP, Vaughn AJ, Zoromski AK, Burns GL, Mikami AY, Fredrick JW, Epstein JN, Peugh JL, Tamm L. A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-16. [PMID: 38193746 PMCID: PMC11231062 DOI: 10.1080/15374416.2024.2301771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
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.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Psychology, Washington State University
| | - Aaron J Vaughn
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Allison K Zoromski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | | | | | - Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
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Burns GL, Montaño JJ, Becker SP, Servera M. Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-15. [PMID: 37931059 DOI: 10.1080/15374416.2023.2272944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
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.
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Affiliation(s)
| | - Juan José Montaño
- Department of Psychology, University of the Balearic Islands & Health Research Institute of the Balearic Islands
| | - Stephen P Becker
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine
| | - Mateu Servera
- Department of Psychology, University of the Balearic Islands & Research Institute on Health Sciences
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Russell KMH, Redmond SM, Ash AC. Psycholinguistic profiling of children with sluggish cognitive tempo. CLINICAL LINGUISTICS & PHONETICS 2023; 37:828-844. [PMID: 35748339 PMCID: PMC9789211 DOI: 10.1080/02699206.2022.2092422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Kirsten M Hannig Russell
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, USA
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, USA
| | - Andrea C Ash
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, USA
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Darow EL, Flax MA, Clark OE, Holmbeck GN, Smith ZR. Comparing Cognitive Disengagement Syndrome Growth in Youth With and Without Spina Bifida. J Pediatr Psychol 2023; 48:720-730. [PMID: 37418009 PMCID: PMC10467645 DOI: 10.1093/jpepsy/jsad038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
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.
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Affiliation(s)
- Eva L Darow
- Nationwide Children’s Hospital, USA
- Department of Psychology, Loyola University of Chicago, USA
| | - Marcus A Flax
- Department of Psychology, Loyola University of Chicago, USA
| | - Olivia E Clark
- Department of Psychology, Loyola University of Chicago, USA
| | | | - Zoe R Smith
- Department of Psychology, Loyola University of Chicago, USA
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Becker SP, Willcutt EG, Leopold DR, Fredrick JW, Smith ZR, Jacobson LA, Burns GL, Mayes SD, Waschbusch DA, Froehlich TE, McBurnett K, Servera M, Barkley RA. Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome. J Am Acad Child Adolesc Psychiatry 2023; 62:629-645. [PMID: 36007816 PMCID: PMC9943858 DOI: 10.1016/j.jaac.2022.07.821] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio.
| | | | | | - Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | | | - Lisa A Jacobson
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Susan D Mayes
- Waschbusch are with Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Tanya E Froehlich
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | - Keith McBurnett
- University of California San Francisco, San Francisco, California
| | - Mateu Servera
- IDISBA Institute, University of the Balearic Islands, Palma, Spain
| | - Russell A Barkley
- Virginia Commonwealth University, School of Medicine, Richmond, Virginia
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Gozpinar N, Cakiroglu S, Gormez V. Sluggish Cognitive Tempo Self Report Scale (SCT-SR): Development and Initial Validation Study. J Atten Disord 2023; 27:510-520. [PMID: 36799440 DOI: 10.1177/10870547231153879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Sluggish Cognitive Tempo (SCT) is a psychological construct consisting of daydreaming, confusion, slowness in movements, lethargy, and low motivation. It is important to develop a self-report scale to evaluate SCT symptoms in children and adolescents in order to meet the following needs; (1) Considering the closeness of SCT symptoms with internalized symptoms, it can provide more reliable information, (2) It allows information to be obtained from multiple informants, and (3) The main symptoms of SCT include subjective experiences such as daydreaming and mind wandering that may be difficult to observe from the outside. Therefore, it was aimed to develop a self-report SCT scale. METHOD A total of 467 adolescents and 178 parents participated in the study. Data were collected with scales. RESULTS The scale consists of 20 items and a single factor. Factor loadings were between 0.60 and 0.81. CONCLUSION Sluggish Cognitive Tempo Self-Report Scale is a valid and reliable self-report scale.
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Affiliation(s)
- Nuran Gozpinar
- Department of Child and Adolescent Psychiatry, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Turkey
| | - Suleyman Cakiroglu
- Department of Child and Adolescent Psychiatry, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Turkey
| | - Vahdet Gormez
- Department of Child and Adolescent Psychiatry, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Turkey
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Fredrick JW, Becker SP. Cognitive Disengagement Syndrome (Sluggish Cognitive Tempo) and Social Withdrawal: Advancing a Conceptual Model to Guide Future Research. J Atten Disord 2023; 27:38-45. [PMID: 35927980 DOI: 10.1177/10870547221114602] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Cognitive disengagement syndrome (CDS, previously referred to as "sluggish cognitive tempo") is a set of symptoms defined by excessive mind-wandering, mental confusion, and slowed behaviors separable from ADHD inattention. METHOD Of the studies examining CDS in relation to psychosocial outcomes, one of the most established correlates of CDS is social withdrawal. However, studies have yet to test mechanisms or moderators of the link between CDS and social withdrawal. RESULTS As a parallel body of literature exists in developmental psychopathology on predictors and outcomes of social withdrawal, this review merges these literatures to identify themes and advance a conceptual model on mechanisms (e.g., task-unrelated thought, poorer social skills, social anxiety) and moderators (e.g., behavioral inhibition, sex, parenting) of the CDS and social withdrawal link. CONCLUSION This model provides researchers and clinicians with testable hypotheses to better understand the link between CDS and social withdrawal and to identify treatment targets to improve the social engagement of youth with CDS.
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Affiliation(s)
- Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
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12
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Becker SP, Epstein JN, Burns GL, Mossing KW, Schmitt AP, Fershtman CEM, Vaughn AJ, Zoromski AK, Peugh JL, Simon JO, Tamm L. Academic functioning in children with and without sluggish cognitive tempo. J Sch Psychol 2022; 95:105-120. [PMID: 36371121 PMCID: PMC9663971 DOI: 10.1016/j.jsp.2022.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Kandace W Mossing
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Aidan P Schmitt
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Chaya E M Fershtman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron J Vaughn
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allison K Zoromski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John O Simon
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Fredrick JW, Becker SP, Langberg JM. Low School Support Exacerbates the Association between Peer Difficulties and Sluggish Cognitive Tempo in Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:1024-1038. [PMID: 34081553 PMCID: PMC8639839 DOI: 10.1080/15374416.2021.1923021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Joseph W. Fredrick
- Department of Psychology, Miami University, Oxford, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Olsthoorn IM, Holland AA, Hawkins RC, Cornelius AE, Baig MU, Yang G, Holland DC, Zaky W, Stavinoha PL. Sleep Disturbance and Its Association With Sluggish Cognitive Tempo and Attention in Pediatric Brain Tumor Survivors. Front Neurosci 2022; 16:918800. [PMID: 35812214 PMCID: PMC9259867 DOI: 10.3389/fnins.2022.918800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pediatric brain tumor (PBT) survivors are at risk for developing sleep disturbances. While in other pediatric populations sleep disturbance has been associated with worse cognitive functioning, it is unclear to what extent this relationship generalizes to PBT survivors. The aim of the current study was to assess the relationship between sleep disturbance and aspects of cognition, including sluggish cognitive tempo (SCT) as well as attention and working memory. Materials and Methods Eighty-three PBT survivors 6–18 years of age who were at least 3 months post-treatment were included in the present cross-sectional study. Level of sleep disturbance was measured as a composite score reflecting various sleep problems as rated by caregivers. Cognitive measures included caregiver-ratings of sluggish cognitive tempo and attention problems, as well as performance-based cognitive measures assessing attention and executive functioning. Hierarchical regression analysis was used to assess associations between sleep and cognition. Results Of all caregivers, 32.5% reported one or more sleep disturbances as “very/often true” and over 68% of caregivers rated at least one sleep-related item as “somewhat true.” Of all cognitive variables, scores were most frequently impaired for SCT (30%). A higher level of sleep disturbance was associated with worse SCT and parent-rated attention problems. Associations between sleep and performance-based cognitive measures assessing attention and working memory were not statistically significant. Conclusion Findings of the current study highlight the importance of further investigation into the relationship between sleep and cognition in PBT survivors, which may assist efforts to maximize cognitive outcome and health-related quality of life in PBT survivors. The current study additionally suggests further investigation of SCT in this population is warranted, as it may be more sensitive to detecting possible associations with sleep disturbance relative to discrete measures that assess cognitive performance under ideal circumstances.
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Affiliation(s)
- Ineke M. Olsthoorn
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UT Health), Houston, TX, United States
| | - Alice Ann Holland
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
- Department of Psychiatry, Children’s Medical Center of Dallas, Dallas, TX, United States
| | - Raymond C. Hawkins
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Allen E. Cornelius
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Muhammad Usman Baig
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace Yang
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Daniel C. Holland
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Wafik Zaky
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Peter L. Stavinoha
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Peter L. Stavinoha,
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Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization. Res Child Adolesc Psychopathol 2022; 50:809-822. [PMID: 35420391 DOI: 10.1007/s10802-022-00923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
It is unknown whether sluggish cognitive tempo (SCT) is prospectively associated with depression in adolescence, and possible processes linking SCT to depression remain unexamined. Using a longitudinal study with three timepoints over a two-year period, the current study tested the indirect effects of SCT on depression via peer victimization, specifically physical, relational, and verbal victimization. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female participants; 81.8% White; 52% with ADHD). In the fall of 8th grade, adolescents and parents completed measures of adolescents' SCT and ADHD symptoms. Adolescents completed a measure of peer victimization in spring of 8th grade and a measure of depressive symptoms in 10th grade. Models examining indirect effects were conducted with and without control of baseline ADHD and/or depressive symptoms. Across analyses, adolescent and parent ratings of SCT symptoms uniquely predicted greater depressive symptoms two years later when controlling for adolescent sex, study site, and either 8th grade depressive or ADHD symptoms. Further, adolescents' self-reported 8th grade SCT symptoms predicted 10th grade depressive symptoms via verbal victimization when controlling for 8th grade ADHD symptoms, but not in analyses incorporating 8th grade depressive symptoms. Findings underscore the predictive association of SCT on depressive symptoms, the possible role of adverse peer relationships as a mechanism linking SCT to depression, and the importance of considering ADHD and depressive symptoms in research on longitudinal correlates of SCT.
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Becker SP, Fredrick JW, Foster JA, Yeaman KM, Epstein JN, Froehlich TE, Mitchell JT. "My mom calls it Annaland": A Qualitative Study of Phenomenology, Daily Life Impacts, and Treatment Considerations of Sluggish Cognitive Tempo. J Atten Disord 2022; 26:915-931. [PMID: 34623188 DOI: 10.1177/10870547211050946] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To conduct qualitative analysis of interviews to understand phenomenology, daily life impact, and treatment considerations of sluggish cognitive tempo (SCT) behaviors in children and adolescents. Method: Youth with elevated SCT symptoms (N = 15, ages 9-16 years) and their parents completed interviews focused on their perception and daily life impact of SCT behaviors. Parents were also asked about intervention targets. Results: Parents and youth had both negative and positive perceptions of SCT, with SCT fostering creativity/imagination and a break from stressors while also negatively impacting daily functioning. The domains most frequently selected by parents as SCT intervention targets were academics, emotions, mind wandering, morning routines, and self-esteem. Conclusion: Children and their parents share negative and positive views of SCT behaviors, while also detailing specific ways that SCT negatively impacts day-to-day functioning. This study offers insights into possible intervention targets as provided by youth and parents directly impacted by SCT.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | | | - Josalyn A Foster
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | | | - Jeffery N Epstein
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | - Tanya E Froehlich
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
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17
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Multisource Network and Latent Variable Models of Sluggish Cognitive Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children: Equivalent Findings and Recommendations. Res Child Adolesc Psychopathol 2022; 50:881-894. [PMID: 35067811 DOI: 10.1007/s10802-021-00890-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Multisource network and latent variable models were used to examine the construct validity of sluggish cognitive tempo (SCT) symptoms relative to attention-deficit/hyperactivity disorder-inattentive (ADHD-IN) and depressive symptoms. The five objectives were to determine the (1) distinctiveness of SCT, ADHD-IN, and depressive symptom communities, (2) similarity of the three symptom communities across mother, father, and teacher ratings, (3) individual symptoms with the strongest influence on other symptoms, (4) individual symptoms with the strongest relations to academic and social impairment, and (5) similarity between network and latent variable model results. Mothers, fathers, and teachers rated SCT, ADHD-IN, and depressive symptoms for 2,142 Spanish children (49.49% girls, ages 8-13 years, third to sixth grade). Walktrap community analysis resulted in SCT, ADHD-IN, and depressive symptom communities with three SCT symptom communities within the overall SCT symptom community (daydreams, mental confusion, and hypoactive communities). The symptom networks were also similar across mothers, fathers, and teachers, especially mothers and fathers. Finally, for all three sources, the same two SCT and two ADHD-IN symptoms showed unique relations with academic impairment and the same depressive symptom showed unique relations with social impairment. A latent variable model yielded equivalent results. Both models thus supported the validity of SCT symptoms relative to ADHD-IN and depressive symptoms. Complexities are noted in the selection of network and latent variable models to study child and adolescent psychopathology with recommendations for their selection.
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18
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Yung TWK. Sensory Modulation: a Window to Sluggish Cognitive Tempo Symptoms Among Children. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Ekinci O, İpek Baş SA, Ekinci N, Doğan ÖI, Yaşöz C, Adak İ. Sluggish cognitive tempo is associated with autistic traits and anxiety disorder symptoms in children with attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2021; 43:153-159. [PMID: 32876133 PMCID: PMC8023150 DOI: 10.1590/1516-4446-2020-0965] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/16/2020] [Indexed: 12/28/2022]
Abstract
Objective: To investigate the association of sluggish cognitive tempo (SCT) with autistic traits (ATs) and anxiety disorder symptoms among children with attention-deficit/hyperactivity disorder (ADHD). Methods: A total of 195 children with a DSM-5 diagnosis of ADHD were included. The Barkley Sluggish Cognitive Tempo Scale (BSCTS) was used to measure SCT symptoms. Other study measures included the Autism Spectrum Quotient (AQ), Screen for Child Anxiety and Related Disorders (SCARED), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners’ Teacher Rating Scale (CTRS-R). Results: The frequency of SCT was 30.3% (n=59) in the whole group. Those with SCT had higher total AQ and SCARED scores. Significant associations and correlations were also found between SCT and certain subscores of AQ and SCARED. According to the linear regression model, the total score and social skills, attention switching, and imagination scores of AQ, as well as generalized anxiety and panic/somatic scores of SCARED and the total and inattention scores of parent T-DSM-IV, were predictive of SCT total score (p < 0.05). Conclusions: SCT is associated with ATs and anxiety disorders. Children with ADHD and SCT symptoms should be screened for such conditions.
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Affiliation(s)
- Ozalp Ekinci
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Selin A İpek Baş
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Nazan Ekinci
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Özge I Doğan
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - Cemre Yaşöz
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
| | - İbrahim Adak
- Department of Child and Adolescent Psychiatry, Medical Faculty, University of Health Sciences, Istanbul, Turkey
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Yung TWK, Lai CYY, Chan JYC, Ng SSM, Chan CCH. Examining the Role of Attention Deficits in the Social Problems and Withdrawn Behavior of Children With Sluggish Cognitive Tempo Symptoms. Front Psychiatry 2021; 12:585589. [PMID: 34017271 PMCID: PMC8129013 DOI: 10.3389/fpsyt.2021.585589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
Previous studies have found that sluggish cognitive tempo (SCT) symptoms are often associated with social problems and withdrawn behavior. However, the possible neuropsychological mechanism underlying this relationship remains unclear. Some studies have also found that SCT symptoms are related to deficits in sustained attention and selective attention. However, no study has examined whether attention deficits are related to social problems and withdrawn behavior in children with SCT. This study was the first to examine the neuropsychological correlates of social problems and withdrawn behavior among children with SCT symptoms. The results showed that sustained attention measure (omission) predicted the severity of social problems and withdrawn behavior in children with SCT even after controlling for symptoms of attention-deficit hyperactivity disorder. Selective attention measure (response latency mean) was also found to predict the severity of social problems. These results suggest that the social problems commonly exhibited by children with SCT are related to deficits in sustained attention and attentional control. Thus, our results provide an initial support to the link between attention deficits and social problems among children with SCT.
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Affiliation(s)
- Trevor W K Yung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Cynthia Y Y Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jacob Y C Chan
- Department of Counseling Psychology, Social Psychology, and Counseling, Ball State University, Muncie, IN, United States
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chetwyn C H Chan
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.,University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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21
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Smith ZR, Zald DH, Lahey BB. Sluggish Cognitive Tempo and Depressive Symptoms in Children and Adolescents Predict Adulthood Psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1591-1601. [PMID: 32918187 PMCID: PMC10704703 DOI: 10.1007/s10802-020-00692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sluggish cognitive tempo (SCT) is characterized by behavioral symptoms reflecting slowness and lethargy (e.g., sluggishness, appearing sleepy) and inconsistent alertness/mental confusion (e.g., daydreaming, fogginess). SCT is substantially correlated with the inattentive symptoms of attention-deficit/hyperactivity disorder (ADHD) and may be part of that domain, but in cross-sectional data, SCT is also strongly associated with both inattention and depression. To date, no study has examined the prospective associations of SCT symptoms in childhood/adolescence with symptoms of ADHD and internalizing problems in adulthood. Using a sample of 449 twin children and adolescent pairs, prospective multiple regression analyses examined whether self- and parent-reported SCT, depression, and parent-reported symptoms of ADHD predicted symptoms in adulthood 12 years later. SCT and depression at time one were strongly correlated (self-reported SCT and depression r = 0.84; parent-reported SCT and depression r = 0.78). When adult outcomes were separately regressed on each youth symptom dimension, self-reported SCT (β = 0.26, p < 0.0001) and depression (β = 0.13, p < 0.0001) each predicted adult symptoms of depression and self-reported SCT predicted inattention (β = 0.12, p = 0.0026). Parent-reported depression, but not parent-reported SCT, predicted self-reported adult depression symptoms (β = 0.17, p = 0.0003). In contrast, when each adult outcome was regressed simultaneously on youth self-reported SCT and depression, neither predicted adulthood inattention or depression. These findings indicate that SCT in childhood and adolescence is strongly associated concurrently and predictively with both inattention and depression. Theoretical and clinical applications of the construct of SCT must take its robust association with both inattention and depression into account.
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22
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Becker SP, Marsh NP, Holdaway AS, Tamm L. Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task? Eur Child Adolesc Psychiatry 2020; 29:1371-1384. [PMID: 31776764 PMCID: PMC8010585 DOI: 10.1007/s00787-019-01446-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/19/2019] [Indexed: 01/01/2023]
Abstract
Few studies have examined whether behavioral sluggish cognitive tempo (SCT) symptoms are related to speeded task performance. Mixed findings in existing research could be due to previous studies using a broad conceptualization of processing speed, not including self-report of SCT symptoms, and relying on non-optimal measures of SCT. Using a multi-informant design with both parent- and adolescent-reported SCT symptoms, the present study provides a preliminary test of the hypothesis that SCT symptoms would be associated with slower performance on tasks having greater graphomotor and fine motor demands. Participants were 80 adolescents (ages 13-17 years; 71% male) with attention-deficit/hyperactivity disorder (ADHD). Adolescents and parents completed ratings of SCT. Adolescents were administered the Wechsler Symbol Search and Coding subtests and the Grooved Pegboard Test. When adjusting for age, sex, and ADHD symptom severity, parent-reported SCT symptoms were not significantly associated with Symbol Search or Coding scores but were significantly associated with slower Grooved Pegboard time. Adolescent-reported SCT symptoms were not significantly associated with Symbol Search but were significantly associated with lower Coding scores and slower Grooved Pegboard time. Findings provide preliminary support for the hypothesis that SCT may be more clearly associated with processing speed task performance as motor demands increase and provide a potential explanation for the mixed literature on SCT in relation to processing speed by demonstrating that the presence and magnitude of associations vary by informant and task.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Center for ADHD, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicholas P. Marsh
- Division of Behavioral Medicine and Clinical Psychology, Center for ADHD, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alex S. Holdaway
- Roberts Center for Pediatric Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Center for ADHD, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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23
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Becker SP, McQuade JD. Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity during Social and Cognitive Stressor Tasks. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:923-933. [PMID: 32328864 PMCID: PMC7306431 DOI: 10.1007/s10802-020-00651-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
It is important to establish correlates of sluggish cognitive tempo (SCT) across units of analysis and to better understand how SCT may be conceptualized in models of psychopathology. The current study examined SCT symptoms in relation to automatic nervous system reactivity during social and cognitive stressor tasks. Participants were 61 children ages 8-12 years with a full range of attention-deficit/hyperactivity disorder (ADHD) symptom severity. Parents provided ratings of SCT and parents and teachers completed measures that were used to create composite indices of ADHD symptoms. Children were administered standardized peer rejection and impossible puzzle tasks, during which their respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity were recorded. Regression analyses indicated that SCT symptoms were unassociated with RSA reactivity to either task. Greater SCT symptoms were significantly associated with greater SCL reactivity to peer rejection. Greater SCT symptoms were not significantly associated with SCL reactivity to the impossible puzzle task. The pattern of findings was unchanged in sensitivity analyses that controlled for ADHD symptoms, internalizing symptoms, medication status, or sex. This study provides the first evidence that SCT symptoms are associated with sympathetic nervous system reactivity. These findings suggest that SCT symptoms may be associated with greater behavioral inhibition system activation, and reactivity may be especially pronounced in social challenges.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45241, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Jung SH, Lee S, Burns GL, Becker SP. Internal and External Validity of Self-Report and Parent-Report Measures of Sluggish Cognitive Tempo in South Korean Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09821-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith ZR, Langberg JM. Do sluggish cognitive tempo symptoms improve with school-based ADHD interventions? Outcomes and predictors of change. J Child Psychol Psychiatry 2020; 61:575-583. [PMID: 31667859 DOI: 10.1111/jcpp.13149] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sluggish cognitive tempo (SCT) is a construct that includes symptoms of slowness, excessive daydreaming, and drowsiness. SCT is often comorbid with attention-deficit/hyperactivity disorder (ADHD), and SCT symptoms are associated with significant academic impairment above the influence of ADHD. Despite the overlap between ADHD and SCT and associated impairments, no studies have evaluated how evidence-based psychosocial interventions for adolescents with ADHD impact symptoms of SCT. METHODS This study examined whether SCT symptoms improved in a sample of 274 young adolescents with ADHD who were randomly assigned to an organizational skills intervention, homework completion intervention, or to a waitlist control. SCT intervention response was evaluated broadly in all participants and, specifically, for participants in the clinical range for SCT symptom severity at baseline. Change in ADHD symptoms of inattention, executive functioning, and motivation were examined as potential predictors of improvement in SCT. RESULTS The two intervention groups were collapsed together for analyses because there were no significant differences in change in SCT symptoms. Multilevel modeling results indicate that parent-reported SCT symptoms significantly decreased when comparing the intervention group to waitlist control (d = .410). For adolescents with parent-reported clinical levels of SCT, the decrease in symptoms was more pronounced (d = .517). Self-reported SCT symptoms produced null results, though effect size calculations showed small improvement for the full sample (d = .313) and for the high-SCT group (d = .384). Change in behavior regulation executive functioning (d = .247), metacognitive executive functioning (d = .346), and inattention (d = .230) predicted change in parent-reported SCT symptoms. CONCLUSIONS Although not specifically designed to decrease SCT symptoms, the ADHD interventions evaluated in this study resulted in significant improvements in parent-reported SCT with small to moderate effect sizes. Clinical implications and future directions are discussed, including development of interventions for adolescents with high levels of SCT.
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Affiliation(s)
- Zoe R Smith
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Sevincok D, Ozbay HC, Ozbek MM, Tunagur MT, Aksu H. ADHD symptoms in relation to internalizing and externalizing symptoms in children: the mediating role of sluggish cognitive tempo. Nord J Psychiatry 2020; 74:265-272. [PMID: 31809238 DOI: 10.1080/08039488.2019.1697746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: Although internalizing and externalizing disorders have received considerable attention among young population, the mechanisms that explain the relationships of internalization and externalization symptoms with attention deficit/hyperactivity disorder (ADHD) in children and adolescents are not well understood. Since sluggish cognitive tempo (SCT) symptoms had significant associations with ADHD, and internalization/externalization disorders, we examined whether SCT may mediate between ADHD symptoms and internalizing/externalizing problems during childhood.Methods: We performed a retrospective chart-review of 95 children and adolescents (76 boys and 19 girls, aged 6-16) with ADHD. The severity of ADHD was evaluated by Turgay DSM-IV-Based Disruptive Behavioral Disorders Screening and Rating Scale (T-DSMIV-S) completed by teachers. Measures of SCT, internalisation and externalisation symptoms, social, thought, and attentional problems were based on the Teacher Report Form (TRF) that was completed by subjects' primary teachers.Results: The withdrawn scores were significantly correlated with SCT scores, social problems, and ADHD-inattention. There was an inverse correlation between withdrawn and ADHD-hyperactivity/impulsivity scores. The mediation test using bootstrapping method showed that the indirect coefficient for SCT was significant, after controlling of ADHD-inattention and social problems covariates, consistent with partial mediation.Conclusion: Our results may demonstrate that while externalization symptoms were associated with hyperactivity/impulsivity symptoms of ADHD, the internalization symptoms were significantly related to SCT in youngs with ADHD. Specifically, although social withdrawal was significantly related to ADHD-inattention, this relationship was mediated by the severity of SCT.
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Affiliation(s)
- Doga Sevincok
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Medical School, Aydin, Turkey
| | - Hasan Can Ozbay
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Medical School, Aydin, Turkey
| | - Mutlu Muhammed Ozbek
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Medical School, Aydin, Turkey
| | - Mustafa Tolga Tunagur
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Medical School, Aydin, Turkey
| | - Hatice Aksu
- Department of Child and Adolescent Psychiatry, Adnan Menderes University, Medical School, Aydin, Turkey
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Neuro-physiological correlates of sluggish cognitive tempo (SCT) symptoms in school-aged children. Eur Child Adolesc Psychiatry 2020; 29:315-326. [PMID: 31134350 DOI: 10.1007/s00787-019-01353-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
This study was the first to examine the relationship between neurophysiological abnormalities and symptoms of sluggish cognitive tempo (SCT) in children. Thirty children aged 6-12 years were recruited. Their heart rate variability (HRV) was measured under resting and warning signal conditions. At rest, the children's SCT symptoms were found to be positively associated with their HRV (indicated by the standard deviation of the Poincaré plot along the line of identity in normalized units, SD2 nu). SCT symptoms were also positively associated with a change in SD2 nu between the resting and warning signal conditions. When controlling for symptoms of attention deficit hyperactivity disorder, the children's SCT symptoms were significantly predicted by their resting SD2 nu and by changes in SD2 nu and the percentage of successive RR intervals that differ by more than 50 ms (pNN50) between the resting and warning signal conditions. These findings suggest that the readiness and regulation of the autonomic nervous system may contribute to symptoms of SCT. Specifically, disturbances in the internal neurophysiological system may explain the difficulties experienced by children when exposed to environmental stimulation. These initial data support the hypothesis that SCT results from deficiencies in arousal.
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Brewe AM, Simmons GL, Capriola-Hall NN, White SW. Sluggish cognitive tempo: An examination of clinical correlates for adults with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1373-1383. [PMID: 32028780 DOI: 10.1177/1362361319900422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
LAY ABSTRACT Adults with autism spectrum disorder often experience a range of co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as difficulties with executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder, and limited research has suggested that individuals with autism spectrum disorder may experience sluggish cognitive tempo. We examined co-occurring mental health problems and executive function in 57 young adults with autism spectrum disorder, aged 16-25 years to better understand sluggish cognitive tempo in autism spectrum disorder. Parents of the young adults answered questions about their children's sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms, and the young adults completed tests of their executive function. Results demonstrated that nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were related, our findings suggest they are not the same constructs. Increased sluggish cognitive tempo is related to more difficulties with executive function and increased depression, but not anxiety symptoms. Results demonstrate that sluggish cognitive tempo may pose heightened difficulties for adults with autism spectrum disorder, making it an important construct to continue studying. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.
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Rondon AT, Hilton DC, Jarrett MA, Ollendick TH. Sleep, Internalizing Problems, and Social Withdrawal: Unique Associations in Clinic-Referred Youth With Elevated Sluggish Cognitive Tempo Symptoms. J Atten Disord 2020; 24:524-534. [PMID: 29415601 DOI: 10.1177/1087054718756197] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We compared clinic-referred youth with ADHD + sluggish cognitive tempo (SCT; n = 34), ADHD Only (n = 108), and SCT Only (n = 22) on demographics, co-occurring symptomatology, comorbid diagnoses, and social functioning. Method: In total, 164 youth (age = 6-17 years, M = 9.97) and their parent(s) presented to an outpatient clinic for a psychoeducational assessment. Between-group analyses and regressions were used to examine study variables. Results: SCT groups were older and exhibited more parent-reported internalizing problems, externalizing problems, sleep problems, and social withdrawal on the Child Behavior Checklist. No significant differences emerged between groups on the Teacher Report Form. Regression analyses involving multiple covariates revealed that SCT symptoms were uniquely related to social withdrawal but not general social problems. Conclusion: Based on parent report, SCT symptoms have a unique relationship with internalizing problems, sleep problems, and social withdrawal. Future research should explore correlates of SCT in youth using multiple informants.
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Sáez B, Servera M, Becker SP, Burns GL. Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2019; 48:825-839. [PMID: 29452000 PMCID: PMC6599489 DOI: 10.1080/15374416.2017.1416619] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity, oppositional defiant disorder, limited prosocial emotions, anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study-consistent across mother, father, and teacher ratings-appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.
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Affiliation(s)
- Belén Sáez
- Department of Psychology and Research Institute on Health Sciences, University of the Balearic Islands
| | - Mateu Servera
- Department of Psychology and Research Institute on Health Sciences, University of the Balearic Islands
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine
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Kofler MJ, Irwin LN, Sarver DE, Fosco WD, Miller CE, Spiegel JA, Becker SP. What cognitive processes are "sluggish" in sluggish cognitive tempo? J Consult Clin Psychol 2019; 87:1030-1042. [PMID: 31613137 PMCID: PMC6814302 DOI: 10.1037/ccp0000446] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Sluggish cognitive tempo refers to a constellation of symptoms that include slowed behavior/thinking, reduced alertness, and getting lost in one's thoughts. Despite the moniker "sluggish cognitive tempo," the evidence is mixed regarding the extent to which it is associated globally with slowed (sluggish) mental (cognitive) information processing speed (tempo). METHOD A well-characterized clinical sample of 132 children ages 8-13 years (M = 10.34, SD = 1.51; 47 girls; 67% White/non-Hispanic) were administered multiple, counterbalanced neurocognitive tests and assessed for sluggish cognitive tempo symptoms via multiple-informant reports. RESULTS Bayesian linear regressions revealed significant evidence against associations between sluggish cognitive tempo and computationally modeled processing speed (BF01 > 3.70), and significant evidence for associations with slower working memory manipulation speed. These findings were consistent across parent and teacher models, with and without control for attention-deficit/hyperactivity disorder inattentive symptoms and IQ. There was also significant evidence linking faster inhibition speed with higher parent-reported sluggish cognitive tempo symptoms. CONCLUSIONS These findings provide strong evidence against characterizing children with sluggish cognitive tempo symptoms as possessing a globally sluggish cognitive tempo. Instead, these symptoms appear to be related, to a significant extent, to executive dysfunction characterized by working memory systems that are too slow and inhibition systems that are too fast. Behaviorally, these findings suggest that requiring extra time to rearrange the active contents of working memory delays responding, whereas an overactive inhibition system likely terminates thoughts too quickly and therefore prevents intended behaviors from starting or completing, thereby giving the appearance that children are absent-minded or failing to act when expected. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Dustin E. Sarver
- Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, 2500 North State Street, Jackson MS 39216, USA
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson MS 39216, USA
| | - Whitney D. Fosco
- Center for Children and Families, Florida International University, Miami, FL 33199, USA
| | | | | | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA
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Burns GL, Becker SP. Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 50:267-280. [PMID: 31671271 DOI: 10.1080/15374416.2019.1678165] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A nationally representative sample of U.S. children was used to determine the empirical and clinical differentiation of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptoms using both categorical and dimensional approaches. Mothers of children (N = 2,056, M± SDage = 8.49 ± 2.15 years, 49.3% girls) completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, sleep difficulties, daily life executive functioning, conflicted shyness, friendship difficulties, and social and academic impairment. Scores greater than the top 5% on SCT and ADHD measures were used to create SCT-only (n = 53, 2.58%), ADHD-only (n = 93, 4.52%), SCT+ADHD (n = 49, 2.38%), and comparison (n = 1,861, 90.52%) groups. Fifty-two percent of the SCT group did not qualify for the ADHD group, whereas 65% of the ADHD group did not qualify for the SCT group. The SCT-only group had higher levels of anxiety, depression, conflicted shyness, and sleep difficulties than the ADHD-only group. In contrast, the ADHD-only group had greater executive functioning deficits and higher ODD than the SCT-only group. SCT-only and ADHD-only groups showed similar levels of friendship, social, and academic impairment. Similar findings emerged when using structural regression analyses to determine the unique clinical correlates of SCT and ADHD dimensions. This is only the second study to examine the distinction of clinically-elevated SCT from ADHD in a national sample of children and extends previous findings to a broader array of functional outcomes. Normative information on the SCT scale also provides a validated rating scale to advance research and clinical care.
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Affiliation(s)
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine
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Becker SP, Burns GL, Schmitt AP, Epstein JN, Tamm L. Toward Establishing a Standard Symptom Set for Assessing Sluggish Cognitive Tempo in Children: Evidence From Teacher Ratings in a Community Sample. Assessment 2019; 26:1128-1141. [PMID: 28649849 PMCID: PMC6309721 DOI: 10.1177/1073191117715732] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite increasing interest in sluggish cognitive tempo (SCT) in children, the field is stymied by the lack of a standard symptom set that can be used across studies. Without a standard symptom set, it is difficult to determine if differences across studies are due to methodological or sample differences, or simply the way SCT was measured. To move the field toward a standard symptom set, this study evaluates a teacher-report rating scale of SCT revised based on recent meta-analytic findings that identified optimal items for distinguishing SCT from attention-deficit/hyperactivity disorder inattention (ADHD-IN). Participants were 1,349 students (50.7% male) from grades 2 to 5. Teachers provided ratings of SCT, ADHD-IN, academic impairment, and social impairment. Exploratory structural equation modeling found 15 of the 16 SCT items to demonstrate excellent convergent validity and discriminant validity with ADHD-IN. The measurement properties of the SCT construct were also invariant across sex. SCT was uniquely associated with both academic and social impairment above and beyond ADHD-IN and sex. Although replication and extension is needed, the current study provides the strongest evidence to date of a possible standard symptom set that can be used across studies examining SCT in children.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, Washington, USA
| | - Aidan P. Schmitt
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Duncan A, Tamm L, Birnschein AM, Becker SP. Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1354-1362. [PMID: 30426763 PMCID: PMC6517090 DOI: 10.1177/1362361318811329] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents with autism spectrum disorder frequently experience social communication difficulties, executive functioning deficits, and anxiety and depressive symptoms, which are similar to the symptoms and correlates of sluggish cognitive tempo. Although sluggish cognitive tempo is related to, but distinct from, the inattentive and hyperactive-impulsive symptoms of attention-deficit/hyperactivity disorder that commonly co-occur with autism spectrum disorder, few studies have examined sluggish cognitive tempo in autism spectrum disorder. We examined whether sluggish cognitive tempo and attention-deficit/hyperactivity disorder were differentially associated with autism symptomatology, daily life executive functioning, and internalizing and externalizing symptoms in 51 adolescents (ages 13-18 years) with autism spectrum disorder without intellectual disability. Regression analyses controlling for age and IQ showed that sluggish cognitive tempo symptoms, but not attention-deficit/hyperactivity disorder symptoms, were associated with increased autism symptomatology and internalizing symptoms. Attention-deficit/hyperactivity disorder symptoms, but not sluggish cognitive tempo symptoms, were associated with increased externalizing behaviors and behavior regulation deficits. Both sluggish cognitive tempo and attention-deficit/hyperactivity disorder were independently associated with increased metacognitive deficits. This study provides preliminary evidence that sluggish cognitive tempo symptoms are elevated in autism spectrum disorder and associated with key clinical correlates, with implications for the assessment and treatment in adolescents with autism spectrum disorder.
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Affiliation(s)
- Amie Duncan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039
| | - Leanne Tamm
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039
| | - Allison M. Birnschein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039
| | - Stephen P. Becker
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, Ohio 45229-3039
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Becker SP, Webb KL, Dvorsky MR. Initial Examination of the Bidirectional Associations between Sluggish Cognitive Tempo and Internalizing Symptoms in Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 50:258-266. [PMID: 31251086 DOI: 10.1080/15374416.2019.1630836] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Few studies have examined the longitudinal association between sluggish cognitive tempo (SCT) symptoms and internalizing symptoms, and no study has examined the potentially bidirectional associations between SCT and internalizing symptoms. The present study used a short-term longitudinal design to examine the directionality of the associations between SCT, depressive, and anxious symptoms in children. Teachers of 188 children in 1st to 6th grades (6-13 years of age; 47% boys) provided ratings of children's SCT, anxiety, and depressive symptoms in the fall school semester (T1) and again 6 months later (T2). Children in 3rd to 6th grades (n = 133) provided ratings of anxiety and depressive symptoms at both time points. Cross-lagged panel models examining the longitudinal associations between SCT, anxiety, and depressive symptoms were conducted controlling for sex and grade, with separate models for teacher- and child-reported internalizing symptoms. SCT symptoms at Time 1 (T1) predicted increased depressive symptoms at T2, with findings consistent across teacher-rated depression and child-rated depression. Depression at T1 did not predict SCT at T2. SCT symptoms at T1 also predicted increased teacher-rated anxiety at T2 but not child-rated anxiety. Finally, child-rated anxiety at T1 predicted increased SCT at T2. Findings from this study provide the first evidence that SCT symptoms predict subsequent depressive symptoms and not the reverse. Associations between SCT and anxiety are more nuanced, with results differing based on the informant. Additional studies are needed to replicate and extend these findings across longer developmental periods with more time points and to examine mechanisms of the associations between SCT and internalizing symptoms in children.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Kandace L Webb
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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Becker SP, Willcutt EG. Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. Eur Child Adolesc Psychiatry 2019; 28:603-613. [PMID: 29524018 PMCID: PMC6131087 DOI: 10.1007/s00787-018-1136-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/23/2018] [Indexed: 02/06/2023]
Abstract
Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies, and growing evidence demonstrates SCT to be associated with impairment in both children and adults. However, it remains unclear how SCT should optimally be conceptualized. In this article, we argue that multiple models of psychopathology should be leveraged to make substantive advances to our understanding of SCT. Both categorical and dimensional approaches should be used, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) nosology, the Research Domain Criteria (RDoC) initiative, and hierarchical models of psychopathology. Studies are needed to determine whether individuals categorized with SCT can be reliably identified and differentiated from individuals without SCT in pathophysiological, neuropsychological, behavioral, and daily life functioning. Studies are also needed to evaluate the validity and utility of SCT as a transdiagnostic and dimensional construct. In considering SCT as a dimensional and potentially transdiagnostic construct, we describe ways in which SCT might be examined within the RDoC framework, including negative valence systems, cognitive systems, and arousal/regulatory systems, as well as within hierarchical models of psychopathology. Conceptualizing SCT within both categorical and dimensional models of psychopathology will help to better understand the causes, developmental pathways, and clinical implications of SCT, both as a construct in its own right and also in relation to other psychopathologies.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45229, USA.
| | - Erik G Willcutt
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA
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Psychometric properties of a sluggish cognitive tempo scale in Japanese adults with and without ADHD. ACTA ACUST UNITED AC 2019; 11:353-362. [PMID: 30911898 DOI: 10.1007/s12402-019-00300-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
This study examined the psychometric properties, convergent validity, and divergent validity of a Japanese translation of Barkley (The Barkley adult ADHD rating scale-IV, Guilford Press, New York, 2011) rating scale for assessing sluggish cognitive tempo (SCT) in adults. In total, 429 Japanese adults participated across three samples: 26 diagnosed with attention-deficit/hyperactivity disorder (ADHD; ages 19-50), 81 adults without ADHD (ages 22-65), and 322 university students (ages 18-27). All participants completed rating scales of SCT, ADHD, anxiety, and depressive symptoms. A subset of participants completed the SCT measure at two time points two weeks apart. The SCT measure (5 items) showed acceptable levels of internal consistency and test-retest reliability. This scale also demonstrated convergent and discriminant validity, as evidenced by factor analyses between SCT and ADHD inattention (ADHD-IN) symptoms as well as adequate fit of a four-factor model involving SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (ADHD-HI), and internalizing symptoms. Additionally, SCT and ADHD-IN dimensions were differentially associated with ADHD-HI and internalizing factors. The ADHD group scored higher on SCT ratings compared to the student and adult non-ADHD groups even after controlling for the severity of ADHD and internalizing symptoms. The 5-item SCT measure appears reliable and demonstrates preliminary evidence of validity in Japanese adults, providing initial support for the transcultural validity of the SCT construct. Additional studies are needed to further evaluate the SCT items that did not meet criteria for convergent and discriminant validity in the current study, and to examine functional outcomes of individuals recruited based on clinically elevated SCT symptoms.
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Ferretti NM, King SL, Hilton DC, Rondon AT, Jarrett MA. Social Functioning in Youth with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2019; 92:29-35. [PMID: 30923471 PMCID: PMC6430168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The current review summarizes the research to date on social functioning for youth with attention-deficit/hyperactivity disorder (ADHD) with a focus on three key domains: peer rejection, friendship, and social information processing. The review extends past reviews by examining the research to date on how the presence of sluggish cognitive tempo (SCT) symptoms, a common correlate of ADHD, affects the social presentation of youth with ADHD. Overall, youth with ADHD show significant difficulty with peer rejection, forming and maintaining friendships, and abnormalities in how they process and respond to social information. Further, the presence of SCT symptoms results in great social withdrawal and isolation. Future studies are needed to better understand the social difficulties of youth with ADHD, particularly using experimental approaches that can manipulate and isolate mechanisms within the social information processing model. In addition, novel intervention approaches are needed to more effectively ameliorate the social difficulties of youth with ADHD and those with co-occurring SCT symptoms.
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Affiliation(s)
| | | | | | - Ana T. Rondon
- University of Alabama, Department of Psychology, Tuscaloosa, AL
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Sáez B, Servera M, Burns GL, Becker SP. Advancing the Multi-Informant Assessment of Sluggish Cognitive Tempo: Child Self-Report in Relation to Parent and Teacher Ratings of SCT and Impairment. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:35-46. [PMID: 29700714 PMCID: PMC6204116 DOI: 10.1007/s10802-018-0436-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite increasing interest in sluggish cognitive tempo (SCT) in children and advancements in its measurement, little research has examined child self-reported SCT. Child self-report of SCT is important for the multi-informant assessment of SCT. The current study used a large, school-based sample of children and a multi-informant design to examine child self-reported SCT using the Child Concentration Inventory - Version 2 (CCI-2) which was recently revised based on meta-analytic findings and parallels the item content of validated parent and teacher rating scales. The study involved 2142 unique children (ages 8-13 years, 50.51% males). Children (n = 1980) completed measures of SCT, loneliness, and preference for solitude. Mothers (n = 1648), fathers (n = 1358), and teachers (n = 1773) completed measures of SCT, attention-deficit/hyperactivity disorder-IN (ADHD-IN), academic impairment, social impairment, and conflicted shyness. Children's self-reported SCT demonstrated good reliability with the 15 SCT symptoms showing moderate to strong loadings on the SCT factor. The child self-report SCT factor also showed moderate convergent validity with mother, father, and teacher ratings of children's SCT. In addition, higher child-reported SCT predicted greater mother, father, and teacher ratings of children's academic impairment even after controlling for mother, father, and teacher ratings of children's SCT and ADHD-IN. Higher child-rated SCT also predicted greater mother ratings of children's social impairment after controlling for mother ratings of children's SCT and ADHD-IN. The present study provides initial empirical support for the reliability and validity of child-reported SCT as part of the multi-informant assessment of SCT. A key direction for future research includes evaluating the unique contributions of different informants and their utility within specific contexts to guide evidence-based recommendations for assessing SCT.
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Affiliation(s)
- Belén Sáez
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - Mateu Servera
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Servera M, Sáez B, Burns GL, Becker SP. Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:818-829. [PMID: 30265014 PMCID: PMC6237634 DOI: 10.1037/abn0000375] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study (a) determined whether clinical elevations of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptom distributions in a large community sample of children would allow for identifying SCT-only, ADHD-only, and SCT + ADHD clinical groups; (b) examined co-occurrence of clinically elevated SCT and ADHD; (c) evaluated whether these clinical groups differed in their gender distribution, co-occurring mental health symptoms, or impairment in academic and social functioning; and (d) explored patterns of independence and overlap when clinically elevated depressive symptoms were considered in tandem with SCT and ADHD. Participants were mothers, fathers, and teachers of 2,142 children (50.51% boys, ages 8-13 years) from 32 schools in Spain. All three groups of informants completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, shyness, social impairment, and academic impairment. Cut-off scores for the top 5% of the sample were used to create SCT-only, ADHD-only, SCT + ADHD, and comparison groups. Across informants, 4.97%-5.53% met criteria for clinically elevated ADHD-only, and 2.30%-2.80% met criteria for clinically elevated SCT-only; 27%-35% of the ADHD group also met the criteria for the SCT group, whereas 44%-54% of the SCT group met the criteria for the ADHD group (primarily based on inattentive symptoms). The ADHD-only group had higher ODD scores than the SCT-only group, whereas the SCT-only group generally had higher shyness and internalizing scores (particularly depression) than the ADHD-only group. Additional analyses that also included clinically elevated depression revealed that 28-46% of the children with elevated SCT had elevations in neither ADHD nor depression. This study moves the field toward examining both the empirical and clinical differentiation of SCT and ADHD. Findings are discussed regarding how SCT may fit in diagnostic nosologies and models of psychopathology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Mateu Servera
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - Belén Sáez
- Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Fredrick JW, Luebbe AM, Mancini KJ, Burns GL, Epstein JN, Garner AA, Jarrett MA, Becker SP. Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression. J Clin Psychol 2018; 75:221-237. [PMID: 30368829 DOI: 10.1002/jclp.22703] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/24/2018] [Accepted: 08/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The current study investigated whether a maladaptive family environment would moderate the strength of the relations of sluggish cognitive tempo (SCT) to attention-deficit/hyperactivity disorder inattention (ADHD-IN) and to depressive symptoms in a large sample of college students. METHODS Participants (n = 3,172), between the ages of 18-29 (M ± SDage = 19.24 ± 1.52; 69.8% women; 80.4% White) and enrolled in five universities in the United States completed self-report measures of symptomatology, interparental conflict, and family expressiveness of emotions. RESULTS A negative emotional climate strengthened relations of SCT with ADHD-IN and depressive symptoms. Moreover, the lack of a positive emotional climate strengthened the co-occurrence of SCT with depressive symptoms, though not with ADHD-IN. CONCLUSIONS The current study is the first to demonstrate that the family environment moderates the association between SCT and co-occurring symptomatology in young adults.
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Affiliation(s)
| | | | | | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Annie A Garner
- Department of Psychology, Saint Louis University, Saint Louis, MO
| | | | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Becker SP, Burns GL, Leopold DR, Olson RK, Willcutt EG. Differential impact of trait sluggish cognitive tempo and ADHD inattention in early childhood on adolescent functioning. J Child Psychol Psychiatry 2018; 59:1094-1104. [PMID: 29957822 PMCID: PMC6158103 DOI: 10.1111/jcpp.12946] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sluggish cognitive tempo (SCT) is distinct from attention-deficit/hyperactivity disorder inattention (ADHD-IN) and concurrently associated with a range of impairment domains. However, few longitudinal studies have examined SCT as a longitudinal predictor of adjustment. Studies to date have all used a relatively short longitudinal time span (6 months to 2 years) and only rating scale measures of adjustment. Using a prospective, multi-method design, this study examined whether SCT and ADHD-IN were differentially associated with functioning over a 10-year period between preschool and the end of ninth grade. METHODS Latent state-trait modeling determined the trait variance (i.e. consistency across occasions) of SCT and ADHD-IN across four measurement points (preschool and the end of kindergarten, first grade, and second grade) in a large population-based longitudinal sample (N = 976). Regression analyses were used to examine trait SCT and ADHD-IN factors in early childhood as predictors of functioning at the end of ninth grade (i.e. parent ratings of psychopathology and social/academic functioning, reading and mathematics academic achievement scores, processing speed and working memory). RESULTS Both SCT and ADHD-IN contained more trait variance (Ms = 65% and 61%, respectively) than occasion-specific variance (Ms = 35% and 39%) in early childhood, with trait variance increasing as children progressed from preschool through early elementary school. In regression analyses: (a) SCT significantly predicted greater withdrawal and anxiety/depression whereas ADHD-IN did not uniquely predict these internalizing domains; (b) ADHD-IN uniquely predicted more externalizing behaviors whereas SCT uniquely predicted fewer externalizing behaviors; (c) SCT uniquely predicted shyness whereas both SCT and ADHD-IN uniquely predicted global social difficulties; and (d) ADHD-IN uniquely predicted poorer math achievement and slower processing speed whereas SCT more consistently predicted poorer reading achievement. CONCLUSIONS Findings of this study - from the longest prospective sample to date - provide the clearest evidence yet that SCT and ADHD-IN often differ when it comes to the functional outcomes they predict.
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Daniel R. Leopold
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Richard K. Olson
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Erik G. Willcutt
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
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Dikkat Eksikliği Hiperaktivite Bozukluğu’na Eşlik Eden Yavaş Bilişsel Tempo'nun Klinik Özellikleri. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.458361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lau AS, Gonzalez JC, Barnett ML, Kim JJ, Saifan D, Brookman-Frazee L. Community Therapist Reports of Client Engagement Challenges During the Implementation of Multiple EBPs in Children's Mental Health. ACTA ACUST UNITED AC 2018; 3:197-212. [PMID: 31263771 DOI: 10.1080/23794925.2018.1455545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study investigated therapist reports of client engagement challenges in delivering evidence-based practices (EBPs), within the context of a large-scale implementation of multiple practices in children's mental health services. Data were drawn from an online survey of 668 therapists (88% female, 35.0% Non-Hispanic White). The majority of therapists (75.4%) endorsed at least one client engagement challenge during their implementation of an EBP with an identified client over the previous two months. Two types of EBP client engagement challenges with distinct correlates but similar overall frequencies could be readily differentiated - Expressed Client Concerns and Limited Client Engagement in therapy activities. Limited Client Engagement were more commonly reported for clients with externalizing problems and by therapists with higher emotional exhaustion and negative perceptions of the specific EBP being delivered, whereas Hispanic/Latino therapists were less likely to report Limited Client Engagement. In contrast, Expressed Client Concerns were more commonly reported by therapists with positive general attitudes towards EBPs, and among therapists delivering a parent training EBP. Limited Client Engagement but not Expressed Concerns were linked with therapists' self-reported ability to carry out the EBP with the target client. Findings suggest that client engagement challenges are frequent during the delivery of EBPs, but may impact implementation differently based on whether they relate to challenges in engaging clients in therapy activities versus addressing concerns raised by clients.
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Affiliation(s)
- Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Miya L Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Joanna J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego, San Diego, CA, USA
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Holdaway AS, Becker SP. Sluggish cognitive tempo and student-teacher relationship quality: Short-term longitudinal and concurrent associations. ACTA ACUST UNITED AC 2018. [PMID: 29543471 DOI: 10.1037/spq0000245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although sluggish cognitive tempo (SCT) is associated with poorer peer functioning, no study has examined SCT in relation to student-teacher relationship quality. The current study examined whether SCT, as rated by both teachers and children, was uniquely associated with poorer student-teacher relationship quality above and beyond child demographics and other mental health symptoms (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder/conduct disorder [ODD/CD], anxiety/depression). Gender was examined as a possible moderator of the association between SCT and student-teacher relationship quality. Participants were 176 children in 1st-6th grades and their teachers. Teachers rated children's SCT and other mental health symptoms in the fall semester (T1) and the student-teacher relationship (conflict and closeness) 6 months later (T2). Children provided self-ratings of SCT at T2. Above and beyond age, gender, and other mental health symptoms, teacher-rated SCT at T1 was associated with greater student-teacher conflict at T2. This association was qualified by a SCT × Gender interaction, with SCT associated with greater conflict for girls but not boys. Further, child-rated SCT was also associated with greater teacher-rated conflict, above and beyond covariates. In addition, teacher-rated SCT at T1 was the only mental health dimension to be significantly associated with less student-teacher closeness at T2. Findings extend the social difficulties associated with SCT to the student-teacher relationship, an important relationship associated with children's academic and socioemotional outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Alex S Holdaway
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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Becker SP, Burns GL, Garner AA, Jarrett MA, Luebbe AM, Epstein JN, Willcutt EG. Sluggish cognitive tempo in adults: Psychometric validation of the Adult Concentration Inventory. Psychol Assess 2018; 30:296-310. [PMID: 28383930 PMCID: PMC5630483 DOI: 10.1037/pas0000476] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 30(3) of Psychological Assessment (see record 2017-30273-001). In the article, the Table 1 item content was incorrectly ordered. The table, as well as text referencing Table 1 in the Results and Discussion, have been corrected in all versions of this article.] As interest in sluggish cognitive tempo (SCT) increases, a primary limitation for the field is the lack of a unified set of symptoms for assessing SCT. No existing SCT measure includes all items identified in a recent meta-analysis as optimal for distinguishing between SCT and attention-deficit/hyperactivity disorder (ADHD) inattention. This study evaluates a new self-report measure for assessing SCT in adulthood, the Adult Concentration Inventory (ACI), which was developed in response to the meta-analytic findings for assessing SCT. Using a large, multiuniversity sample (N = 3,172), we evaluated the convergent and discriminant validity and reliability of the ACI. We also evaluated the ACI measure of SCT in relation to self-reported demographic characteristics, daily life executive functioning, socioemotional adjustment (i.e., anxiety/depression, loneliness, emotion dysregulation, self-esteem), and functional impairment. Exploratory confirmatory factor analyses resulted in 10 ACI items demonstrating strong convergent and discriminant validity from both anxiety/depressive and ADHD inattentive symptom dimensions. SCT was moderately to-strongly correlated with daily life EF deficits, poorer socioemotional adjustment, and greater global functional impairment. Moreover, SCT remained uniquely associated in structural regression analyses with most of these external criterion domains above and beyond ADHD. Finally, when internalizing symptoms were also covaried, SCT, but not ADHD inattention, remained significantly associated with poorer socioemotional adjustment. These findings support the use of the ACI in future studies examining SCT in adulthood and make a major contribution in moving the field toward a unified set of SCT items that can be used across studies. (PsycINFO Database Record
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Affiliation(s)
- Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, Washington, USA
| | - Annie A. Garner
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Matthew A. Jarrett
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Aaron M. Luebbe
- Department of Psychology, Miami University, Oxford, Ohio, USA
| | - Jeffery N. Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Erik G. Willcutt
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Bry LJ, Chou T, Miguel E, Comer JS. Consumer Smartphone Apps Marketed for Child and Adolescent Anxiety: A Systematic Review and Content Analysis. Behav Ther 2018. [PMID: 29530263 PMCID: PMC6082393 DOI: 10.1016/j.beth.2017.07.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anxiety disorders are collectively the most prevalent mental health problems affecting youth. To increase the reach of mental health care, recent years have seen increasing enthusiasm surrounding mobile platforms for expanding treatment delivery options. Apps developed in academia and supported in clinical trials are slow to reach the consumer marketplace. Meanwhile, proliferation of industry-developed apps on consumer marketplaces has been high. The present study analyzed content within mobile products prominently marketed toward consumers for anxiety in youth. Systematic inventory of the Google Play Store and Apple Store using keyword searches for child and adolescent anxiety yielded 121 apps, which were evaluated on the basis of their descriptive characteristics, mobile functionalities, and adherence to evidence-based treatment principles. Findings revealed that evidence-based treatment content within the sample is scant and few comprehensive anxiety self-management apps were identified. Advanced features that leverage the broader functionalities of smartphone capabilities (e.g., sensors, ecological momentary assessments) were rarely present. Findings underscore the need to increase the prominence and accessibility of quality child anxiety intervention products for consumers. Strategies for improving marketing of supported apps to better penetrate consumer markets are discussed.
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Affiliation(s)
- Laura Jane Bry
- Mental Health Interventions and Technology (MINT) Program, Florida International University
| | - Tommy Chou
- Mental Health Interventions and Technology (MINT) Program, Florida International University
| | - Elizabeth Miguel
- Mental Health Interventions and Technology (MINT) Program, Florida International University
| | - Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Florida International University
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