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

Cognitive Disengagement Syndrome in Young Autistic Children, Children with ADHD, and Autistic Children with ADHD

OBJECTIVE

Cognitive Disengagement Syndrome (CDS; previously called Sluggish Cognitive Tempo) refers to a constellation of cognitive and motor behaviors characterized by a predisposition toward mind wandering (cognitive subdomain) and slowed motor behavior (hypoactive). While there are a number of studies linking CDS traits to greater global impairment in children with attention-deficit/hyperactivity disorder (ADHD) and autistic children, there are few studies examining the prevalence and impact of CDS traits in autistic children with co-occurring ADHD (Autistic+ADHD). The current study explored CDS traits in autistic children with and without co-occurring ADHD, children with ADHD, and neurotypical children.

METHODS

Participants were 196 children between 3- and 7-years-of-age comprising four groups: Neurotypical (N = 44), ADHD (N = 51), Autistic (N = 55), and Autistic+ADHD (N = 46). CDS traits, social and communication skills, repetitive behaviors, and sensory processing were all assessed via parent report.

RESULTS

Children diagnosed with ADHD, autistic children, and Autistic+ADHD children exhibited similar levels of overall CDS traits. However, when explored separately, Autistic+ADHD children had higher cognitive CDS trait scores compared to children with ADHD alone. Both overall CDS traits and the cognitive subdomain were associated with greater social difficulties, particularly social withdrawal, higher levels of repetitive behaviors, and more sensory sensitivities, regardless of diagnosis.

CONCLUSIONS

Findings suggest that CDS traits may be an additional factor directly impact functional outcomes in both autistic and ADHD children. As such, clinicians should be assessing CDS traits in addition to other clinical domains associated with ADHD and autism when developing intervention plans for young neurodiverse children.

Predicting adult-age mental health with childhood reading and math disability: do resilience and coping styles matter?

We studied the associations between childhood-identified learning disabilities and adult-age mental health and whether adult-age reading and math skills, coping styles, or resilience influenced the associations. The participants were 159 Finnish adults (60.4% males). Of them, 48 (30%) had a reading disability (RD), 22 (14%) had a math disability (MD), 21 (13%) had RD + MD identified in childhood, and 68 (43%) were population-based controls, matched based on gender, age, and place of residence. At ages 20-40 (Mage = 29), they reported their mental health, coping styles, and resilience, and their reading and math skills were assessed. The hierarchical regression analyses, predicting mental health with RD, MD, and their interaction while controlling for gender and age, indicated that childhood MD predicted the occurrence of more mental health problems in adulthood, but this was not observed in the case of RD. The RDxMD positive interaction effect reflected better mental health in both the RD and the RD + MD groups than in the MD group. Controlling for adult-age reading and math skills had no effect on the association between MD and mental health outcomes while controlling for resilience and coping styles diminished the impact of MD. Strong resilience without the use of an emotion-oriented coping may thus alleviate the association between MD and mental health. As childhood MD can have long-term associations with mental health problems, these issues need to be addressed in school, at work, and in healthcare. Based on our findings, strengthening effective coping and resilience may be one avenue of support.

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

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

Academic functioning in children with and without sluggish cognitive tempo

Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.