Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children.

Abstract

This study (1) determined if clinical elevations of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptom distributions in a large community sample of children would allow for identifying separate SCT only, ADHD only, and SCT+ADHD clinical groups, (2) examined co-occurrence of clinically elevated SCT and ADHD, (3) evaluated whether these clinical groups differed in their gender distribution, co-occurring mental health symptoms, and impairment in academic and social functioning, and (4) explored patterns of independence and overlap when clinically elevated depressive symptoms were considered in tandem with SCT and ADHD. Participants were mothers, fathers, and teachers of 2,142 children (50.51% boys; ages 8–13 years) from 32 schools in Spain. All three informants completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, shyness, social impairment, and academic impairment. Cut-scores for the top 5% of the sample were used to create SCT only, ADHD only, SCT+ADHD, and comparison groups. Across informants, 4.97–5.53% met criteria for clinically elevated ADHD only, and 2.30–2.80% met criteria for clinically elevated SCT only. 27–35% of the ADHD group also met the criteria for the SCT group whereas 44–54% of the SCT group met the criteria for the ADHD group (primarily based on inattentive symptoms). The ADHD only group had higher ODD scores than the SCT only group, whereas the SCT only group generally had higher shyness and internalizing scores (particularly depression) than the ADHD only group. Additional analyses that also included clinically elevated depression found that 28–46% of the children with elevated SCT had elevations in neither ADHD nor depression. This study moves the field toward examining both the empirical and clinical differentiation of SCT and ADHD. Findings are discussed regarding how SCT may fit in diagnostic nosologies and models of psychopathology.

Testing the Longitudinal Structure and Change in Sluggish Cognitive Tempo and Inattentive Behaviors From Early Through Middle Childhood

“…However, in contrast to our hypotheses, male sex was not associated with SCT. The failure to find sex differences in SCT is consistent with multiple studies that do not report sex differences for SCT (Barkley, 2012; Becker & Langberg, 2013; Carlson & Mann, 2002; Jarrett, Rapport, Rondon, & Becker, 2014; Marshall et al, 2014; Servera et al, 2018). Notably, participants in these studies were all drawn from community or school-based samples with two exceptions (Marshall et al, 2014).…”

“…However, SCT does not appear to indicate a subtype of ADHD (Barkley, 2012, 2013; Becker, Marshall, McBurnett, 2014; Becker et al, 2016; Willcutt et al, 2012). Instead, researchers have increasingly examined SCT as a separate construct in community and clinical samples (Becker, Luebbe, Fite, Stoppelbein, & Greening, 2014; Becker, Burns, Schmitt, Epstein, & Tamm, 2019; Leopold et al, 2016; Servera, Sáez, Burns, & Becker, 2018). These efforts have suggested that SCT may be a construct of transdiagnostic importance (Becker & Willcutt, 2019) or its own mental disorder (Barkley, 2013, 2014).…”

Shortened Sleep Duration Causes Sleepiness, Inattention, and Oppositionality in Adolescents With Attention-Deficit/Hyperactivity Disorder: Findings From a Crossover Sleep Restriction/Extension Study

“…Further, in contrast to ADHD inattention, there is emerging evidence that youth can provide valid self-reports of their own SCT symptoms 36,40 and we found sleep restriction to worsen SCT across both parent and adolescent ratings. These multi-informant effects are important since it is estimated that 25-40% of youth with ADHD also have elevated SCT symptoms 41,42 and SCT symptoms are themselves linked to a range of functional impairments such as social withdrawal and internalizing psychopathology. 18 Consistent with other studies, 8,15,16 parents did not report greater hyperactivity-impulsivity during sleep restriction compared to sleep extension.…”

Sluggish cognitive tempo and personality: Links to BIS/BAS sensitivity and the five factor model

“…That is, SCT and ADHD-IN are strongly correlated empirically (Becker et al, 2016) and also overlap clinically (Barkley, 2012). The picture grows even more complex when also considering the clinical overlap of SCT and ADHD with internalizing symptoms such as depression (Servera et al, 2018). It is thus somewhat difficult to know what the nature of SCT is when both ADHD and internalizing symptoms are partialled out.…”