Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

Objective

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

Method

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

Results

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

Conclusion

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

Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes?

BACKGROUND

Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes.

METHOD

4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments.

RESULTS

Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes.

LIMITATIONS

The data for our LCA were cross-sectional and based primarily on parent ratings.

CONCLUSION

Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.

Hippocampal neuropathology in suicide: Gaps in our knowledge and opportunities for a breakthrough

Suicide is a major global hazard. There is a need for increasing suicide awareness and effective and evidence-based interventions, targeting both suicidal ideation and conduct. However, anti-suicide pharmacological effects are unsatisfactory. The human hippocampus is vulnerable to neuropsychiatric damages and subsequently releases psychobiological signals. Human hippocampal studies of suicide completers have shown mechanistic changes in neurobiology, which, however, could not reflect the neuropathological 'fingerprints' of fatal suicide ideations and suicide attempts. In this review, we provide several leading theories of suicide, including the serotoninergic system, Wnt pathway and brain-derived neurotrophic factor/tropomyosin receptor kinase B signalling, and discuss the evidence for their roles in suicide and treatment. Moreover, the cognitive dysfunctions associated with suicide risk are discussed, as well as the novel evidence on cognitive therapies that decrease suicidal ideation. We highlight the need to apply multi-omics techniques (including single-nucleus RNA sequencing and mass spectrometry histochemistry) on hippocampal samples from donors who died by suicide or legal euthanasia, to clarify the aetiology of suicide and propose novel therapeutic strategies.

Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit

Background

Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions.

Methods

A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children’s unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge.

Results

A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children’s self-harm/suicidality.

Conclusions

Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.

Sluggish Cognitive Tempo and Behavioral Difficulties in Children with ADHD: Associations with Internalizing and Externalizing Symptoms

Sluggish cognitive tempo (SCT) appears to be distinct from attention-deficit/hyperactivity disorder (ADHD) and unique patterns of association between SCT and comorbid symptoms have been reported in the literature. The current study examined the relation between environmental supports and comorbid concerns among children with high SCT. Parents of children (ages 6-12) with a diagnosis of ADHD and clinically elevated SCT (N = 126) completed measures of emotional/behavioral functioning, child routines, and parental adjustment. Regression analyses revealed that after controlling for child age and parental adjustment, Household and Daily Living routines were associated with lower levels of externalizing symptoms while Discipline routines were associated with higher levels of these symptoms, accounting for nearly 20% of the variance in the equation. The findings suggest that for children with ADHD and high SCT routines may play an important role as an environmental support for externalizing symptoms.

Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity during Social and Cognitive Stressor Tasks

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.

Sluggish Cognitive Tempo in Adolescents with and without ADHD: Differentiation from Adolescent-Reported ADHD Inattention and Unique Associations with Internalizing Domains

A growing number of studies support the internal and external validity of youth self-reported sluggish cognitive tempo (SCT) symptoms. However, no study has examined SCT in adolescents without ADHD, examined whether adolescent self-reported SCT is distinct from adolescent self-reported ADHD inattention (ADHD-IN), or evaluated whether links between SCT and internalizing problems differ for adolescents with or without ADHD. The present study is the first to (1) determine the convergent and discriminant validity of self-reported SCT and ADHD-IN symptoms in both adolescents with and without ADHD, (2) test the invariance of SCT and ADHD-IN symptoms across ADHD and comparison groups, (3) examine SCT as uniquely related to a range of internalizing-relevant domains, and (4) evaluate if the association between SCT with internalizing correlates differs for adolescents with or without ADHD. Participants were adolescents (Mage = 13 years) with (n = 162) and without (n = 140) ADHD. Adolescents and parents completed measures of internalizing symptoms and emotion dysregulation; adolescents completed measures of rumination and suicidal ideation. Analyses indicated that 13 of the 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN, and SCT and ADHD-IN demonstrated invariance across the ADHD and comparison groups and across sex. SCT, but not ADHD-IN, was uniquely associated with greater adolescent-reported internalizing symptoms and suicidal ideation. Both SCT and ADHD-IN were uniquely associated with adolescent-reported emotion dysregulation and parent-reported internalizing symptoms. Only ADHD-IN was uniquely associated with parent-reported emotion dysregulation. Findings support the differentiation of adolescent-reported SCT and ADHD-IN and demonstrate associations between SCT and increased internalizing problems in adolescents with and without ADHD.

Sluggish cognitive tempo: An examination of clinical correlates for adults with autism

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.

Reactive Aggression and Suicidal Behaviors in Children Receiving Outpatient Psychological Services: The Moderating Role of Hyperactivity and Inattention

The current study examines associations between reactive and proactive aggression and suicidal thoughts and behaviors among youth (N = 115, 62% male), ranging from 6 to 12 years, seeking services in an outpatient psychological clinic. Symptoms of hyperactivity/impulsivity and inattention were evaluated as potential moderators of this link. Children and a caregiver completed self- and parent-report questionnaires on aggression, suicidal behaviors, depressive symptoms, and ADHD-related behaviors during intake. Reactive aggression was more strongly linked to suicidal thoughts and behaviors than proactive aggression. Further, hyperactivity/impulsivity, but not inattention, moderated the association between reactive aggression and suicidal thoughts and behaviors, such that reactive aggression was only associated with suicidal behaviors at high levels of hyperactivity/impulsivity. These findings were evident for reactive, not proactive, aggression and when accounting for the variance associated with depressive symptoms, age, and gender. Hyperactivity/impulsivity is discussed as a potentially important target among reactively aggressive youth for prevention of suicidal behaviors.

Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder

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.

Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology

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.

Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD

This study examines how ADHD-related symptoms and impairments interact to predict depression symptoms in young adolescents with ADHD. A sample of 342 adolescents (71% male, mean age = 13 years old) with DSM-IV-TR diagnosed ADHD completed baseline clinical assessments upon entry to a psychosocial treatment study for ADHD. Ratings of ADHD and sluggish cognitive tempo (SCT) symptoms, and social and academic impairment were obtained from parents, while ratings of depressive symptoms and conflict with parents were obtained from youth. Among adolescents with ADHD, elevated depressive symptoms were associated with higher SCT symptom severity, lower hyperactive/impulsive (HI) symptom severity, higher social impairments, higher conflict with parents, and lower academic problems. Interaction effects indicated that clinically significant depressive symptoms were most likely to occur when high levels of parent-youth conflict were present along with high inattentive (IN) symptoms, high SCT, and/or low HI. Among children and adolescents with ADHD, depression prevention efforts might target IN/SCT symptom management, as well as improving interpersonal relationships with parents and peers. Future work is needed to verify these findings longitudinally.

Correlates of Suicidal Ideation and Self-harm in Early Childhood in a Cohort at Risk for Child Abuse and Neglect

OBJECTIVES

This study provides prevalence and persistence rates of suicidal ideation and self-harm, and examines how child maltreatment types, mental health symptoms, and age 4 suicidal ideation and self-harm are associated with each suicidal outcome among 6-year-old children.

METHODS

Participants were 1,090 caregivers assessed when their children were 4 and 6 years old from the Longitudinal Studies of Child Abuse and Neglect. Data were collected from the Child Behavior Checklist, Parent-Child Conflict Tactics Scales, and Child Protective Services.

RESULTS

Persistence rates within each suicidal outcome were high. Failure to provide -a physical neglect subtype- was the only maltreatment type that independently predicted self-harm. Depressive/anxious symptoms and age 4 suicidal ideation were independently associated with age 6 suicidal ideation, whereas attention problems and age 4 self-harm predicted age 6 self-harm.

CONCLUSION

Our findings align with the consensus emerging from adolescent studies that risk factors associate differentially with suicidal ideation and self-harm.

How Consistent Is Sluggish Cognitive Tempo Across Occasions, Sources, and Settings? Evidence From Latent State-Trait Modeling

Research has yet to determine how much of the variance in sluggish cognitive tempo (SCT) symptom ratings is consistent across occasions, sources, and settings versus specific to occasion, source, and setting. Our first objective was to determine the amount of variance in SCT ratings that was consistent ( trait consistency) across three occasions of measurement over 12 months versus specific to the occasion ( occasion-specificity) with ratings by mothers, fathers, primary teachers, and secondary teachers of 811 Spanish children. Our second objective was then to determine the convergent validity for trait consistency and occasion-specificity variance components within and across settings. SCT ratings reflected mostly trait consistency for mothers, fathers, and primary teachers (less so for secondary teachers) with the convergent validity for trait consistency also being strong for mothers with fathers and for primary teachers with secondary teachers. Across home and school, however, convergent validity for trait consistency was low and even lower for occasion-specificity. SCT appears to be more trait-like rather than state-like, with similar levels of trait consistency across occasions and convergent validity within settings as attention-deficit/hyperactivity disorder (ADHD) symptoms in a prior study. However, SCT symptoms had slightly weaker convergent validity for trait consistency across settings relative to ADHD symptoms.

Advancing the Multi-Informant Assessment of Sluggish Cognitive Tempo: Child Self-Report in Relation to Parent and Teacher Ratings of SCT and Impairment

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.

Suicidal Behaviors in College Students: Frequency, Sex Differences, and Mental Health Correlates Including Sluggish Cognitive Tempo

PURPOSE

To (1) describe rates of suicidal behaviors in a sample of college students, (2) evaluate sex differences, and (3) provide a preliminary examination of the unique association of sluggish cognitive tempo (SCT) symptoms and other mental health dimensions in relation to suicidal behaviors in college students.

METHODS

Participants were 1,704 college students from two universities who completed measures assessing mental health symptoms and suicidal behaviors (i.e., past ideation/attempts, past-year ideation, disclosure of intent to commit suicide to another person, and likelihood of a future suicide attempt).

RESULTS

Four percent of participants reported a previous suicide attempt and 2.2% indicated that it was likely they would attempt suicide someday. 7.5% reported thinking about killing themselves often in the past year; 41.4% of these participants reported they had never told someone they might attempt suicide. Approximately one quarter (24%) of participants were classified with suicide risk based on an empirically established cutoff score, though rates differed between women (26.1%) and men (20.4%). Women were also more likely than men to report a previous suicide attempt and to tell someone else about their suicidal ideation. In regression models, depression was the strongest correlate of suicidal behaviors. Attention-deficit/hyperactivity disorder symptoms were unassociated with suicidal behaviors when accounting for internalizing symptoms. SCT remained significantly associated with increased suicidal behaviors beyond other mental health dimensions including depression.

CONCLUSIONS

A substantial minority of college students report suicidal behaviors, with sex differences dependent on the specific behavior examined. This study provides the first evidence linking SCT to suicidal behaviors in young adults.

Sluggish cognitive tempo in adults: Psychometric validation of the Adult Concentration Inventory

[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

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5-15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent-rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT-related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well-Being Assessment, and the Coding subtest of the WISC-III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co-occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.

Can Sluggish Cognitive Tempo Be Distinguished From ADHD Inattention in Very Young Children? Evidence From a Sample of Korean Preschool Children

OBJECTIVE

This study evaluated whether sluggish cognitive tempo (SCT) is separable from ADHD-inattention (IN) and uniquely associated with internalizing dimensions in preschool children in South Korea.

METHOD

Mothers of 172 preschool children (ages 4-6 years; 52% girls) rated children's SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), aggression, emotional reactivity, anxiety/depression, somatic complaints, withdrawal, and sleep problems.

RESULTS

Eight of 10 SCT symptoms showed convergent and discriminant validity with ADHD-IN. ADHD-IN remained significantly positively associated with ADHD-HI, ODD, and aggressive behavior after controlling for SCT, whereas SCT was no longer positively associated with these externalizing behaviors after controlling for ADHD-IN. Both SCT and ADHD-IN were uniquely associated with greater emotionally reactivity, anxiety/depression, and withdrawal. Only SCT was uniquely associated with somatic complaints, and only ADHD-IN was uniquely associated with sleep problems.

CONCLUSION

Findings replicate results with children and adolescents, thus expanding evidence for the validity of SCT in early development.