Executive Dysfunction and Functional Impairment Associated With Sluggish Cognitive Tempo in Emerging Adulthood

Investigating the Shared and Divergent Neuroanatomical Features of Attentional Deficits in Adolescents

OBJECTIVE

Cognitive disengagement syndrome (CDS), formerly known as sluggish cognitive tempo, is characterized by hypo-activity or slowed behavior, mental fogginess or confusion, excessive sleepiness, and daydreaming. CDS and the predominantly inattentive (IN) presentation of attention-deficit/hyperactivity disorder (ADHD) are frequently co-occurring though separable constructs, each associated with unique constellations of functional impairments. The current study aims to identify their shared and divergent neurobiological correlates.

METHOD

One hundred eighty-one adolescents (Mage=13.9, SDage=2.2) were recruited from the Colorado Learning Disabilities Research Center twin study. Relationships between attentional symptom dimensions - CDS and IN - and brain volume were examined, controlling for age, sex, and average cortical volume. Procedures were repeated in an outside sample of 292 adolescents (Mage=16.8, SDage=1.4) using a 2-item measure of CDS.

RESULTS

Higher levels of CDS symptoms were associated with reduced volume within left ventral parietal, temporo-parietal and temporal regions, regions which fall within the ventral attention network. CDS and IN symptoms were significantly associated with gray matter volume in portions of the dorsal attention and default mode networks in opposite directions. Higher levels of CDS symptoms were associated with reduced volume in the left superior and inferior parietal lobules and left frontal portions of the default mode network, whereas IN symptoms were positively correlated with volume in these areas. Several findings were consistent in the outside sample.

CONCLUSION

Results from the current study provide novel insights into the neurobiological basis of CDS. They suggest that both CDS and IN symptoms are associated with alterations in brain systems that exert top-down attentional control, though likely for differing reasons. The current study enhances understanding of adolescent attentional deficits.

Cognitive disengagement syndrome symptoms in obsessive-compulsive disorder with and without attention deficit hyperactivity disorder

OBJECTIVE

Comorbidity between Obsessive-Compulsive Disorder (OCD) and Attention Deficit/Hyperactivity Disorder (ADHD) appears complex in terms of etiology, phenomenology, and treatment. There is a need to identify possible factors which are related to the co-occurrence of OCD and ADHD in adults. Cognitive Disengagement Syndrome (CDS) may contribute to this comorbidity through its associations with ADHD, emotional dysregulation, cognitive processes, and neuropsychological deficits.

METHODS

In this study, we compared CDS and various sociodemographic and clinical characteristics in OCD patients with (n = 44) and without ADHD (n = 72), and healthy controls (n = 43), using the Yale Brown Obsessive-Compulsive Scale, Wender Utah Rating Scale, Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale, Barkley's Adult Sluggish Cognitive Tempo Rating Scale, Beck Depression Inventory, and Beck Anxiety Inventory.

RESULTS

In addition to contamination obsessions (OR = 7.733, p = 0.002), male gender (OR = 3.732, p = 0.031), high anxiety (OR = 1.053, p = 0.02), and high CDS symptoms (OR = 1.145, p = 0.037) were associated with comorbidity between OCD and ADHD.

CONCLUSION

We suggest that CDS may serve as a valuable construct for understanding the nature of comorbidity between OCD and ADHD.

Symptoms of ADHD and Other Common Mental Disorders Influence Academic Success in South African Undergraduates

OBJECTIVE

ADHD symptoms are highly prevalent among university students. These symptoms, particularly the inattentive cluster, predispose students to poorer academic performance and worse academic adjustment. Moreover, ADHD symptoms are often comorbid with other common mental disorders; this comorbidity also leads to poor outcomes. South African students often have fewer resources to successfully transition to university. Hence, our longitudinal study used data from a sample of South African first-year undergraduate students to investigate (a) associations between ADHD symptoms and academic performance/adjustment, (b) separate influences of the inattentive and hyperactivity-impulsivity clusters on academic performance/adjustment, and (c) the influence of the combination of ADHD and psychiatric comorbidities on academic performance/adjustment.

METHOD

We collected data three times through the first semester of 2023. Predictors within our regression models included sociodemographic variables, psychological variables (self-reported symptoms of ADHD, depression, anxiety, and risky alcohol use), and high school academic performance. Outcomes were first-semester GPA and self-reported academic adjustment (magnitude of change across the semester and overall adjustment at the end of the semester).

RESULTS

Analyses showed that, unlike academic performance (N = 506), magnitude of change in academic adjustment (N = 180) was significantly predicted by ADHD symptoms and the combination of ADHD (p = .02), depression (p < .001), and anxiety symptoms (p = .01). Inattentive ADHD symptoms predicted both academic performance and magnitude of change in academic adjustment.

CONCLUSIONS

Our findings suggest that the presence of ADHD symptoms (both with and without other common mental disorders) is associated with a smaller magnitude of academic adjustment, and that the presence of inattentive symptoms of ADHD is associated with both poorer academic performance and smaller magnitude of academic adjustment. These findings are significant in informing future interventions targeting the academic outcomes of first-year university students.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

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

Neurodevelopmental Impairments in Adult Psychosomatic Patients

Background/Objectives: Neuropsychological, neurodevelopmental, or minimal cerebral dysfunctions (MCD) can be found in many patients with mental disorders. They can be masked by other symptoms, impair the course of the illness, and impair work and social participation. Despite a long history of research, there is still a lack of data on the spectrum, prevalence, and consequences of these dysfunctions in patients with chronic illness. In this study, we compared patients with and without a history of neurocognitive problems in childhood for present neuropsychological dysfunctions. Methods: A convenience sample of 1453 psychosomatic inpatients completed the MCD scale, assessing neurodevelopmental issues in childhood and current neuropsychological dysfunctions. Additional assessments were the Attention Deficit Hyperactivity Self Rating Scale (ADHS-SB) and the Symptom Checklist 90 (SCL-90). Results: Significant early neurodevelopmental problems were reported by 8.87% of the patients. This group also reported a significantly higher rate of MCD symptoms and general psychosomatic symptoms (SCL-90) as compared with other patients. Conclusions: There is a notable prevalence of neuropsychological dysfunctions in psychosomatic patients in general, and especially in those with early neurodevelopmental problems. To adequately address specific potentially participation-relevant impairments, a broader diagnostic approach is necessary, including exploration of MCD history and present neuropsychological dysfunctions.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Neurocognition in children with cognitive disengagement syndrome: accurate but slow

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

Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function

Introduction

Sluggish Cognitive Tempo (SCT) is a syndrome characterized by cognitive hypo-arousal that often appears as daytime sleepiness or drowsiness, mental fogginess, being easily confused, having difficulty with holding and manipulating information in working memory, and being forgetful. Although it frequently co-travels with attention-deficit/hyperactivity disorder (ADHD) or other conditions and confers significantly greater impairment, there are few studies examining SCT among adults with ADHD. Understanding what features SCT confers in association with ADHD, distinct from other conditions associating with ADHD, is critically important to confirm if SCT is a distinct syndrome that requires special assessment methods and special, distinct treatment efforts to reduce its impact. This study describes the clinical and neuropsychological features of SCT in a sample of adults with well-defined ADHD, and examines the relationship of SCT with other measures of ADHD, neurocognition, executive function (EF), and impairment.

Methods

A sample of n = 106 adults with ADHD, ages 18-57 years, was assessed for SCT using the Barkley SCT scale. Adults with (SCT+) and without (SCT-) SCT received a comprehensive clinical assessment battery, and neuropsychological testing. Clinical and neuropsychological variables were examined for their associations with SCT. The variables were treated with Principal Axis Factoring with Promax with Kaiser Normalization to elucidate latent constructs and determine performance profiles associated with SCT among people with ADHD.

Results

EF Deficits and emotional dyscontrol (ED) symptoms significantly differentiated adults with ADHD and SCT whether measured via self or clinician report. Additionally, significantly greater impairment via both clinician and participant report was seen in the SCT + versus SCT - cohorts. SCT was also associated with a significantly distinct profile on the neuropsychological battery, characterized by a pattern of slower latencies and cognitive strategy choices across CANTAB and WAIS subtests, that reveals difficulty with increased cognitive load, which primarily accounted for the higher level of impairment in the SCT group.

Discussion

The convergence of clinical ratings and neurocognitive measures of EF deficits is consistent with the conclusion that SCT represents a distinct subgroup of adults with ADHD.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors

BACKGROUND

Sluggish cognitive tempo (SCT) has been proposed to be either its own distinct disorder or a transdiagnostic process.

OBJECTIVE

To examine SCT within ADHD (and its specific presentations) and internalizing disorders and its relationship with functional impairment, particularly when considered from a multidimensional perspective.

METHOD

Undergraduate students (N = 2,806) completed self-report scales measuring SCT, ADHD, anxiety, depression, and functional impairment. The SCT scale consisted of three subfactors identified in prior research.

RESULTS

Students with internalizing disorders were equally as likely as those with ADHD to report clinically significant SCT, and having multiple other disorders predicted especially high levels of SCT symptoms. Only sleepy/sluggish symptoms incrementally predicted impairment.

CONCLUSIONS

These findings provide more support for SCT as a transdiagnostic process than as a distinct disorder. All areas of SCT symptoms are associated with ADHD, anxiety, and depression, but the sleepy/sluggish symptoms may be uniquely associated with problems in everyday living.

Cognitive Performance and Psychiatric Self-Reports Across Adult Cognitive Disengagement Syndrome and ADHD Diagnostic Groups

OBJECTIVE

Cognitive disengagement syndrome (CDS) is characterized by inattention, under-arousal, and fatigue and frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD). Although CDS is associated with cognitive complaints, its association with objective cognitive performance is less well understood.

METHOD

This study investigated neuropsychological correlates of CDS symptoms among 169 adults (M_age = 29.4) referred for outpatient neuropsychological evaluation following inattention complaints. We evaluated cognitive and self-report differences across four high/low CDS and positive/negative ADHD groups, and cognitive and self-report correlates of CDS symptomology.

RESULTS

There were no differences in cognitive performance, significant differences in self-reported psychiatric symptoms (greater CDS symptomatology, impulsivity among the high CDS groups; greater inattention among the positive ADHD/high CDS groups; greater hyperactivity among the positive ADHD groups), significant intercorrelations within cognitive and self-report measures, nonsignificant correlations between cognitive measures and self-report measures.

CONCLUSION

Findings support prior work demonstrating weak to null associations between ADHD and CDS symptoms and cognitive performance among adults.

The comparison of sluggish cognitive tempo, processing speed, and executive functions in female children with specific learning disabilities and typically developing female children: A pilot study

This study investigated the association of sluggish cognitive tempo (SCT), processing speed, and executive function (EF) in children with specific learning disabilities (SLD), and the typically developing children (TD) (60 female students aged between 8 and 10). Child and Adolescent Behavior Inventory-Parent Version (CABI), the Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and Wechsler Intelligence Scale for Children-IV (the Processing Speed Index (PSI) were used to assess SCT, processing speed, and EF. The results showed that SCT problems were higher in children with SLD (p < 0.001). In addition, results showed that children with SLD had poorer performance on processing speed (p < 0.001) compared to the TD group. Executive dysfunctioning in self-management to time, self-organization, problem-solving, self-restraint, self-motivation, and self-regulation of emotions were poorer in children with SLD than TD group (p < 0.05). This study provides initial evidence that SCT symptoms are poor in female children with SLD, and associated with executive dysfunction and poor processing speed.

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.

Validation of the executive function strategy awareness and use questionnaire (SAUQ) in a university student population

Objective: The aim of the study is to design and evaluate the Strategy Awareness and Use Questionnaire to estimate students' awareness and use of strategies that optimize control of attention and/or compensate for stress on an executive system due to environmental and/or neurobiological influences. Participants: One hundred and forty-eight undergraduate and graduate students from various disciplines at an urban Canadian university campus participated in the Spring 2019 semester. Methods: An item analysis was conducted that included an assessment of dimensionality and item trimming. Results: Findings from an exploratory factor analysis suggest a seven-factor solution is optimal; Comprehension Monitoring, Planning/Organization, Self-Reward, Self-Regulation, Organization with Mobile Phone Technology, Regulating Technology, and Organization of Materials. Conclusion: This measure is likely to benefit students, as well as counselors and coaches interested in improving EF strategy use among students in a university population.

Psychometric validation of Barkley's Adult Sluggish Cognitive Tempo (SCT) Ratings Scale -Turkish version and distinguishing SCT from attention deficit-hyperactivity disorder (ADHD) among Turkish adults

BACKGROUND & AIMS

SCT is characterized by sluggishness, daydreaming, lethargy/ apathy, slowed behavior/thinking, and mental confusion. For a long time these symptoms were thought to be a part of ADHD but then studies revealed that SCT is a different phenomenon in some cultures. In this study. we aimed to examine the validity and reliability of Barkley's Adult SCT Ratings Scale, and to determine if SCT is an independent factor from ADHD in Turkish adults like in other cultures.

METHODS

274 Medical School students/trainees enrolled the study (Age: 18-35, 70.4 % female). Data was collected via an online survey including SCT and ADHD rating scales.

RESULTS

Exploratory factor analysis demonstrated that the scale consisted of two factors: Daydreaming and Sluggishness.The model demonstrated a good-fit (χ² = 43.642, p = 0.001; χ²/df = 2.425, GFI = 0.962,RMSEA = 0.072). As expected, there were positive and significant associations between SCT total, Daydreaming, Sluggishness, and ADHD-Inattention scores (r = 0.645, 0.664, 0.382; respectively), but all SCT items loaded within SCT factors and distinquished from ADHD factors. Cronbach's alpha values were: 0.87 for SCT-total, 0.87 for Daydreaming; 0.79 for Sluggishness.

CONCLUSION & IMPLICATIONS

Our study provides a valid and reliable SCT screening tool for Turkish adults and increases our confidence in the transcultural generalizability of SCT.

Executive and Daily Life Functioning Influence the Relationship Between ADHD and Mood Symptoms in University Students

Objectives: Many studies have indicated a close relationship between ADHD and mood symptoms in university students. In the present study, we explore the role of daily functional impairments and executive functioning in the ADHD-mood relationship. Method: A total of 343 adults (126 males) filled out (a) the Conners' Adult ADHD Rating Scale, (b) the Depression Anxiety and Stress Scale, (c) the Weiss Functional Impairment Rating Scale, and (d) the Executive Function Index Scale. Results: The correlation between mood symptoms and ADHD was .48 (moderate correlation) and dropped to .15 (weak correlation) when controlling for functional problems and executive functioning. Hierarchical regression analyses showed that both functional impairments and executive functioning significantly explained 42% to 53% of the variance of mood symptoms. The addition of ADHD symptoms to the model slightly increased the explained mood variance by only 1%. Conclusion: These findings underline the role of experienced difficulties in triggering mood symptoms in ADHD symptomatology.

The relationship between theory of mind and sluggish cognitive tempo in school-age children with attention deficit and hyperactivity disorder

Sluggish cognitive tempo (SCT) is considered as a cognitive-emotional style. Theory of mind (ToM) skills form the basis of human cognition and social behavior. The aim of this study is to contribute to SCT literature by examining the relationship between SCT and cognitive and affective ToM in school-age children with attention deficit and hyperactivity disorder (ADHD). Fifty school-age children with ADHD (43 boys and seven girls) and 40 typically developing children (34 boys and six girls) were assessed using Parent-rated Barkley Child Attention Scale and Child Behavior Checklist/6-18, cognitive (first- and second-order ToM) and affective ToM (Reading Mind in the Eyes Test and Unexpected Outcomes Test (UOT)) tests. Multiple linear regression analysis was performed to determine the variables that may predict SCT levels in children with ADHD. Attention deficit and hyperactivity disorder-inattention (Exp(B) = .334, p = .027), internalization (Exp(B) = .305, p = .006), and UOT scores (Exp(B) = .933, p = .015) significantly predicted SCT severity in children with ADHD. SCT severity was significantly associated with impaired cognitive ToM skills as measured by second-order ToM (Exp(B) = 1.933, p = .045). Our findings may indicate that affective ToM developing with age, and impaired cognitive ToM skills are associated with increasing SCT severity.

Differential Diagnosis of Sluggish Cognitive Tempo Symptoms in College Students

Objective: Sluggish cognitive tempo (SCT) refers to a set of symptoms that prior research has found to be related to several different psychological disorders, especially the predominantly inattentive presentation of ADHD. This study collected evidence relevant to the question of whether SCT is a distinct disorder. Method: College students (N = 910) completed measures of SCT, ADHD, depression, anxiety, sleep quality, and substance misuse. Results: Students reporting clinically high SCT (reporting at least five symptoms often or very often) had significantly higher levels and rates of other types of psychopathology. Moreover, when students reporting clinically significant levels of ADHD, depression, and anxiety symptoms, poor sleep quality, or hazardous levels of alcohol or cannabis use were removed, very few students reporting high SCT remained (only 4.8% of the original high-SCT group). Conclusion: SCT may be best thought of as a symptom set common to many types of psychopathology, and it may be caused by sleep problems or substance misuse as well.

Sluggish Cognitive Tempo Factors in Emerging Adults:Symptomatic and Neuropsychological Correlates

We examined whether there are factors of SCT in nonclinical young adults and whether SCT factors show differential relationships with depression, anxiety, ADHD, and executive functioning as assessed by self-report (EF-SR) or neuropsychological performance (EF-NP). Factor analysis revealed Daydreaming/Bored (D/B), Lethargy (L), and Cognitive Complaints (CC) factors. CC was associated with anxiety and D/B with depression. CC and D/B were associated with inattentive ADHD, while D/B was associated with hyperactive/impulsive ADHD. While all factors were associated with EF-SR, there were few relationships with EF-NP. Higher CC was associated with lower intellect, and higher D/B was related to better working memory.

Profiles of Diagnosed and Undiagnosed College Students Meeting ADHD Symptom Criteria

Objective: This study compared the psychological profiles of college students who self-reported an ADHD diagnosis in contrast to students without a diagnosis who reported above-threshold ADHD symptoms. Method: A large sample of college students yielded four subgroups: students with a self-reported diagnosis who met symptom criteria (Diagnosed, n = 40), students with a self-reported diagnosis who did not meet symptom criteria (Low Symptoms, n = 47), students who had no diagnosis and did not meet symptom criteria (Controls, n = 87), and students who had no diagnosis yet met symptom criteria (Undiagnosed, n = 38). All participants completed a battery of self-report rating scales assessing a variety of symptom and impairment domains. Results: The Diagnosed and Undiagnosed groups differed significantly from Controls on all domains, while the Low Symptom group did not differ significantly from Controls in any domain. Conclusion: Implications for engaging with reported diagnosis of ADHD in the college population are discussed.

Sluggish Cognitive Tempo in Adults Referred for an ADHD Evaluation: A Psychometric Analysis of Self- and Collateral Report

Objective: Sluggish cognitive tempo (SCT) symptoms uniquely contribute to psychiatric and functional outcomes in child samples; however, the psychometric properties of SCT measures among adult outpatients are unknown. Method: Adults (n = 124) presenting for an ADHD evaluation provided self- and collateral report of SCT symptoms. Results: The SCT scale had good internal consistency and yielded three factors across raters: Slow/Daydreamy, Sleepy/Sluggish, and Low Initiation/Persistence. SCT scores exhibited convergent validity with ADHD symptoms across raters. Individuals with ADHD received higher SCT ratings than those without ADHD via collateral report, a pattern that was similar when comorbidity was considered. SCT was associated with poorer functioning after accounting for ADHD symptoms with some differential effects based on reporting source. Conclusion: Findings support the internal consistency and validity of a three-factor SCT scale among adult outpatients. Differential results between self- and collateral report demonstrate the importance of multiple reporters of SCT in clinical settings.

Sluggish cognitive tempo (SCT) in an adult outpatient sample seeking an attention-deficit/hyperactivity disorder assessment: Age of onset and assessment method impact on SCT rates

BACKGROUND

Sluggish cognitive tempo (SCT) is associated with-but distinct from-attention-deficit/hyperactivity disorder (ADHD). This study examined SCT rates in adult outpatients seeking an ADHD assessment, differences in rates based on ADHD status, impact of assessment method (i.e., reporting source, symptom count, and functional impairment), and age of SCT symptom onset.

METHODS

Outpatients (n = 124) completed an SCT measure (n = 120 other-reporters). SCT was based on reporting source (i.e., self-report, other-report, either reporting source ["or" rule], and both reporting sources ["and" rule]), symptom count (i.e., age-based norms at or near the 93rd percentile, and a higher symptom count threshold of five), and functional impairment (i.e., 0, 1, and ≥2 domains).

RESULTS

SCT rates varied based on assessment method for the full sample (26%-82%) and among those with (32%-91%) and without (16%-66%) ADHD. Rates decreased with stricter functional impairment and symptom count criteria. SCT was higher in the ADHD group than the non-ADHD group based on other-reporters and the "or" rule, but not the "and" rule. Functional impairment and symptom count criteria did not impact these comparisons. For self-reported SCT rates, ADHD/non-ADHD group comparisons did not differ based on age-based symptom count threshold, but did with a symptom count threshold of five. Self-reported SCT symptom onset was 13.36 years-old and was significantly younger for the ADHD group (11.69 years) than the non-ADHD group (16.36 years).

CONCLUSIONS

Elevated SCT symptoms and related impairment are common among adults seeking an ADHD evaluation. These rates and ADHD/non-ADHD group differences vary substantially based on diagnostic methods.

Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo

Although fears of negative and positive social evaluation are hallmark cognitive features of social anxiety, attentional difficulties may exacerbate the relation between fears of social evaluation and social anxiety. Thus, the goal of the current study was to test whether two different types of self-reported attentional difficulties, specifically sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) inattention symptoms, moderate the relation between fears of social evaluation and social anxiety. Participants (N = 4756; Mage = 19.28 years; 72.7% female) enrolled in five universities across the United States completed self-report measures of fears of negative and positive evaluation and psychopathology symptoms. Results indicated a significant two-way interaction of fear of negative evaluation and SCT in relation to social anxiety symptoms, as well as a significant two-way interaction of fear of positive evaluation and SCT in relation to social anxiety symptoms. In both instances, the associations between fears of negative and positive evaluation in relation to social anxiety became increasingly stronger at higher levels of SCT. Conversely, the interactions between fears of negative and positive evaluation with ADHD inattentive symptoms were non-significant. These results are the first to report that self-reported SCT, but not ADHD inattentive symptoms, exacerbate the relation between fears of social evaluation and social anxiety, and suggest that attentional difficulties characteristic of SCT may prolong engagement in fears.

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.

Sluggish cognitive tempo and positive valence systems: Unique relations with greater reward valuation but less willingness to work

BACKGROUND

Research has started conceptualizing sluggish cognitive tempo (SCT) within the Research Domain Criteria (RDoC), but no study has tested SCT symptomatology in relation to the positive valence systems.

METHODS

Participants (N = 4,679; 18-29 years; M = 19.08, SD = 1.36; 69% female; 80.9% White) enrolled in six universities in the United States completed self-reported measures of positive valence systems, SCT, and psychopathology dimensions.

RESULTS

SCT symptoms were uniquely associated with greater reward valuation and expectancy of reward, but less willingness to work for reward. SCT symptoms were not uniquely related to initial and sustained response to reward. Conversely, depressive symptoms remained uniquely associated with greater reward valuation but less expectancy, willingness to work, initial, and sustained response to reward.

LIMITATIONS

The present study included a relatively homogenous sample of college-age students, solely relied on self-report measures of the positive valence systems, and analyses were conducted cross-sectionally.

CONCLUSIONS

Findings demonstrated that SCT has unique relations with various components of the positive valence system while controlling for commonly co-occurring psychopathology dimensions. Future research should continue investigating relations between SCT and positive valence systems to understand whether these domains may be targets for prevention and intervention.

Executive Functioning and Impairment in Emerging Adult College Students With ADHD Symptoms

Objective: To better understand current issues with adult ADHD assessment contributing to adult ADHD being under recognized and undertreated. Method: This study examined the relationship between symptoms, impairment, and executive functioning (EF) in a college sample. Results: Among individuals screening negative for ADHD, those higher in EF experienced significantly less impairment than those lower in EF. Executive functioning was shown to have a negative relationship with impairment while ADHD symptomology was shown to have a positive relationship with impairment. In addition, impairment was significantly predicted by ADHD symptom level and EF, and there was a significant interaction between EF and ADHD symptom level in predicting impairment. However, high EF did not significantly protect against impairment in individuals reporting a significant level of ADHD symptoms. Conclusion: Further research is needed to clarify the relationships between these variables in emerging adult college students.

ADHD and SCT Symptomatology in Relation to College Students' Use of Self-Regulated Learning Strategies

Objective: The present study examined the relation between self-regulated learning (SRL) strategies and ADHD and sluggish cognitive tempo (SCT) symptomatology. Method: Participants were 303 college students, aged 18 to 25 (M = 20.04, SD = 1.45), from a Midwestern university who completed the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), and a shortened, generalized version of the Motivated Strategies for Learning Questionnaire (MSLQ). Results: Among college students, inattention symptomatology was consistently predictive of deficits in use of value, expectancy, and self-regulation strategies, while SCT symptomatology was only predictive of deficits in the use of self-regulation strategies. Conclusion: This study is the first to examine the relation between SCT symptomatology and SRL strategy use in college students. The findings revealed that SRL strategy use differs between college students exhibiting ADHD or SCT symptomatology. Remediation focusing on these deficits would likely increase academic achievement. Clinical implications, limitations, and suggestions for future research are discussed.

Psychometric properties of a sluggish cognitive tempo scale in Japanese adults with and without ADHD

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.

Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression

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 ± SD_age  = 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.

Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model

We evaluated sluggish cognitive tempo (SCT) symptoms in relation to personality as assessed via both the Reinforcement Sensitivity Theory (BIS/BAS) and Five Factor (Big 5) Model of personality. 3,172 students from five universities completed psychopathology, BIS/BAS, and Big 5 measures. Correlations and path models with SCT, attention-deficit/hyperactivity disorder (ADHD) dimensions, and anxiety/depression in relation to personality were examined. SCT evidenced a different pattern of relations to adult personality than ADHD and anxiety/depression. SCT was significantly uniquely associated with higher BIS and Neuroticism, as well as higher BAS Fun-Seeking. SCT was uniquely associated with lower Extraversion and Conscientiousness. This study provides the first evidence linking SCT to adult personality and underscores the importance of differentiating SCT from both ADHD and anxiety/depression.

Sluggish Cognitive Tempo Symptoms Contribute to Heterogeneity in Adult Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in over 50% of cases, although its associated symptom profiles, comorbid problems, and neuropsychological deficits change substantially across development. Sluggish cognitive tempo (SCT) symptoms may contribute to associations between ADHD and comorbid problems and may partially explain the substantial heterogeneity observed in its correlates. 349 adults aged 18-38 years (M = 23.2, SD = 4.5, 54.7% male, 61.03% with ADHD) completed a multi-informant diagnostic procedure and a comprehensive neuropsychological battery. Adults with ADHD (n = 213) were retained for analyses. Latent class analyses (LCA) revealed three profiles of SCT symptoms among those with ADHD, which we classified as minimal, moderate, or severe SCT. Multiple analysis of covariance (MANCOVA) revealed significant differences among these profiles, which remained when controlling for persistence of ADHD symptoms and sex. In general, adults with ADHD combined with SCT symptoms (moderate and severe) had significantly more symptoms of anxiety, depression, and persistent inattention, and had more severe professional and relational impairment compared to ADHD adults without SCT. Compared to those with moderate or minimal SCT symptoms, the severe SCT group had the most symptoms of depression and internalizing disorders, and the most impairment in the domain of daily responsibility. No significant differences based on externalizing symptoms emerged when controlling for sex and persistence of inattention symptoms, suggesting the moderate and severe SCT groups do not simply reflect more symptoms. Moreover, follow-up mediation analyses revealed that SCT might at least partially explain the heterogeneity in ADHD. Findings have implications for refinement of etiological conceptualization, assessment methods, and intervention strategies.

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

Are sluggish cognitive tempo symptoms associated with executive functioning in preschoolers?

The aim of this study is to investigate whether sluggish cognitive tempo (SCT) symptoms are associated with neurocognitive task performance and ratings of real-world executive functioning (EF) in preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD). The associations between parent- and teacher-rated SCT symptoms and neuropsychological task performance and ratings of EF in 61 4-year-old preschool children (51 boys, 10 girls) with self-regulation difficulties were examined, with regression analyses controlling for the effects of ADHD inattention symptoms. In the study sample, higher teacher-rated SCT symptoms are significantly associated with poorer performance on tasks of visual-perceptual abilities, auditory and visual attention, sustained and selective attention, inhibitory control, pre-numerical/numerical concepts, and slower processing speed, but SCT symptoms are not significantly associated with working memory, attention shifting or cognitive flexibility when controlling for ADHD inattention. Higher parent-rated SCT symptoms are significantly associated with visual-perceptual abilities. ADHD inattention symptoms are more strongly associated than SCT with daily life EF ratings; neither parent- nor teacher-rated SCT symptoms are significantly associated with daily life ratings of inhibition, working memory, or planning/organization after controlling for ADHD inattention. This study suggests that SCT symptoms contribute to EF deficits at least on neurocognitive tasks assessing visual-perceptual/spatial abilities, attention to detail and processing speed, as observed in this sample of young children at risk for ADHD, and may be an important intervention target.

Sluggish Cognitive Tempo, Internalizing Symptoms, and Executive Function in Adults With ADHD

OBJECTIVE

We sought to characterize relationships between sluggish cognitive tempo (SCT) and both internalizing symptoms and executive functioning in adults with ADHD.

METHOD

A total of 102 adults with ADHD completed clinical interviews and clinical rating scales. Hierarchical regression analyses were conducted to ascertain the independent predictive power of SCT symptoms for deficits in executive function (EF) after considering severity of ADHD inattentive and hyperactive-impulsive symptoms and internalizing symptoms.

RESULTS

SCT correlated with ADHD inattentive symptoms and dimensional measures of depression and anxiety but not with clinical diagnosis of depression or anxiety. SCT predicted EF deficits over and above the effects of internalizing and ADHD symptoms. This relationship between SCT and EF was limited to the subset of participants ( n = 48) receiving stimulant treatment.

CONCLUSION

SCT in adults with ADHD is associated with internalizing symptoms, ADHD inattentive symptoms, and, independently, with EF deficits. Further research is needed to ascertain why this relationship occurred primarily in adults concurrently receiving stimulants.

"For Some Reason I Find it Hard to Work Quickly": Introduction to the Special Issue on Sluggish Cognitive Tempo

The body of research investigating the sluggish cognitive tempo (SCT) construct continues to accumulate at a rapid pace. This article provides an introduction to the Special Issue on SCT, which includes 10 empirical studies that collectively make a major contribution to the SCT knowledge base. Notably, the studies in this Special Issue include participants spanning in age from 4 to 64 years and from four continents, helping to move the field toward a life span, transcultural understanding of SCT. Together, these studies demonstrate that SCT symptoms can be distinguished from ADHD symptoms as early as preschool and that SCT does not fall under the overarching umbrella of ADHD. These studies also show SCT to be associated with a range of external correlates including internalizing symptoms, learning difficulties, functional impairment, and daily life executive functioning (but not performance-based measures of executive functions). Preliminary findings of SCT in relation to thyroid functioning and tobacco exposure are reported. In addition to providing a summary of the key themes across studies included in the Special Issue, this article highlights key ways in which future research can build from these studies. There is a particular need for research utilizing longitudinal, multi-method, and multi-informant designs that can shed light on the etiologies and developmental psychopathology of SCT across the life span.

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

BACKGROUND

Although identified as a significant public health concern, few studies have examined correlates of suicide risk in school-aged children. Recent studies show a relation between sluggish cognitive tempo (SCT) symptoms and a range of adverse outcomes linked to suicidal ideation, including depression, emotion dysregulation, lowered self-esteem, and peer problems/social withdrawal, yet no study to date has examined SCT in relation to suicide risk.

METHODS

We tested the hypothesis that SCT would be associated with suicide risk in a sample of 95 psychiatrically hospitalized children (74% male; 62% black) between the ages of 8 and 12 (M = 10.01, SD = 1.50). Parents completed measures of their child's psychiatric symptoms, including SCT and depression, as well as a measure of their own psychopathology. Children completed measures assessing loneliness and depression. Both parents and children completed measures of suicide risk.

RESULTS

White children reported greater suicide risk than nonwhite children. After controlling for demographic characteristics, loneliness, parental psychopathology, and correlated psychiatric symptoms, including both parent- and child self-reported depressive symptoms, SCT remained uniquely associated with children's suicide risk. Results were consistent across both parent and child measures of suicide risk.

CONCLUSIONS

This multi-informant study provides strong preliminary support for an association between SCT symptoms and suicide risk in psychiatrically hospitalized children, above and beyond loneliness, depression, and demographic characteristics. Findings are discussed in the context of the interpersonal theory of suicide. Additional studies are needed to replicate and extend these findings, with a particular need for studies that examine the cognitive processes and daydreaming content of individuals displaying elevated SCT symptomatology.

Sluggish Cognitive Tempo is Associated With Poorer Study Skills, More Executive Functioning Deficits, and Greater Impairment in College Students

OBJECTIVES

Few studies have examined sluggish cognitive tempo (SCT) in college students even though extant research suggests a higher prevalence rate of SCT symptoms in this population compared to general adult or youth samples. The current study examined SCT symptoms in relation to two domains related to college student's academic success, study skills and daily life executive functioning (EF), as well as specific domains of functional impairment.

METHOD

158 undergraduate students (M_age = 19.05 years; 64% female) completed measures of psychopathology symptoms, study skills, daily life EF, and functional impairment.

RESULTS

After controlling for demographics and symptoms of attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression, SCT remained significantly associated with poorer study skills, greater daily life EF deficits, and global impairment and with greater functional impairment in the specific domains of educational activities, work, money/finances, managing chores and household tasks, community activities, and social situations with strangers and friends. In many instances, ADHD inattentive symptoms were no longer significantly associated with study skills or impairment after SCT symptoms were added to the model.

CONCLUSION

SCT is associated with poorer college student functioning. Findings highlight the need for increased specificity in studies examining the relation between SCT and adjustment.

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

OBJECTIVE

To conduct the first meta-analysis evaluating the internal and external validity of the sluggish cognitive tempo (SCT) construct as related to or distinct from attention-deficit/hyperactivity disorder (ADHD) and as associated with functional impairment and neuropsychological functioning.

METHOD

Electronic databases were searched through September 2015 for studies examining the factor structure and/or correlates of SCT in children or adults. The search procedures identified 73 papers. The core SCT behaviors included across studies, as well as factor loadings and reliability estimates, were reviewed to evaluate internal validity. Pooled correlation effect sizes using random effects models were used to evaluate SCT in relation to external validity domains (i.e., demographics, other psychopathologies, functional impairment, and neuropsychological functioning).

RESULTS

Strong support was found for the internal validity of the SCT construct. Specifically, across factor analytic studies including more than 19,000 individuals, 13 SCT items loaded consistently on an SCT factor as opposed to an ADHD factor. Findings also support the reliability (i.e., internal consistency, test-retest reliability, interrater reliability) of SCT. In terms of external validity, there is some indication that SCT may increase with age (r = 0.11) and be associated with lower socioeconomic status (r = 0.10). Modest (potentially negligible) support was found for SCT symptoms being higher in males than females in children (r = 0.05) but not in adults. SCT is more strongly associated with ADHD inattention (r = 0.63 in children, r = 0.72 in adults) than with ADHD hyperactivity-impulsivity (r = 0.32 in children, r = 0.46 in adults), and it likewise appears that SCT is more strongly associated with internalizing symptoms than with externalizing symptoms. SCT is associated with significant global, social, and academic impairment (r = 0.38-0.44). Effects for neuropsychological functioning are mixed, although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits.

CONCLUSION

This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is currently not enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research.