Relationship between sluggish cognitive tempo and sleep, psychological, somatic, and cognitive problems and impairment in children with autism and children with ADHD

Abstract

Sluggish cognitive tempo (SCT) is a topic of renewed interest. Much remains to be learned about its association with symptoms and diagnoses that have received little research attention, particularly sleep disturbance, somatic complaints, and autism. Our study is the first to explore the relationship between SCT and sleep, internalizing, externalizing, somatic, and cognitive problems, impairment, and demographics in large samples of children with autism, ADHD-Combined, and ADHD-Inattentive. Mothers rated 1,436 children with autism and 1,056 with ADHD without autism, 2 to 17 years, on the Pediatric Behavior Scale (PBS). Factor analysis yielded a 6-item SCT factor (sluggish/slow moving/low energy, stares/preoccupied/in own world, tires easily, in a fog/confused, drowsy/sleepy/not alert, and apathetic) plus 10 additional factors. SCT was distinct from but related to several factors and was associated with social and academic impairment. The strongest independent predictors of SCT were depression, sleeping more than normal, cognitive problems, autism, and somatic complaints. Scores on the remaining factors (sleep disturbance, attention deficit, impulsivity, hyperactivity, oppositional defiant disorder, conduct disorder, and anxiety) increased explained variance by less than 2%. Findings suggest that SCT is not simply sluggish cognitive tempo, as the name implies, and is a complex construct with behavioral, affective, emotional, cognitive, and somatic components and associations. Given that 49% of children with autism had SCT, SCT symptoms should be considered in all children being evaluated for autism, as well as for ADHD-C and ADHD-I (with SCT percentages of 31% and 40%). Assessing and treating SCT is especially important because of its association with impairment.

Sleep Disturbance and Its Association With Sluggish Cognitive Tempo and Attention in Pediatric Brain Tumor Survivors

“…The relatively high endorsement of SCT in the current study adds to mounting evidence that SCT is common in the PBT population in a manner that is distinct from other neurocognitive deficits (Kahalley et al, 2011;Willard et al, 2013;Peterson et al, 2021). Our findings suggest that the relationship between SCT and sleep disturbance observed in pediatric populations with neurodevelopmental conditions such as ADHD and autism (e.g., Mayes et al, 2021;Fredrick et al, 2022) appears applicable to PBT survivors as well, and this has implications for screening and assessment. Recognition of this association underscores the importance of differential assessment of SCT and sleep to improve identification of core difficulties experienced by PBT survivors with the goal of maximizing HRQOL.…”

“…Our findings suggest that the relationship between SCT and sleep disturbance observed in pediatric populations with neurodevelopmental conditions such as ADHD and autism (e.g., Mayes et al, 2021 ; Fredrick et al, 2022 ) appears applicable to PBT survivors as well, and this has implications for screening and assessment. Recognition of this association underscores the importance of differential assessment of SCT and sleep to improve identification of core difficulties experienced by PBT survivors with the goal of maximizing HRQOL.…”

“…One construct that has been associated with sleep disturbances in both healthy adolescents as well as children and adolescents with neurodevelopmental conditions (such as ADHD) is sluggish cognitive tempo (SCT; e.g., Mayes et al, 2021 ; Fredrick et al, 2022 ), which refers to a set of symptoms that includes mental fogginess and confusion, slowed behavior/thinking, daydreaming, feelings of confusion, and low motivation ( Becker et al, 2016 ). However, SCT does not merely reflect a cluster of individually measurable cognitive functions ( Becker, 2021 ), and its empirical differentiation from constructs such as internalizing emotional disorders (e.g., anxiety, depression) and ADHD-related symptoms (e.g., inattention and hyperactivity) suggests it should be seen as a distinct entity ( Smith et al, 2019 ).…”

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta‐analysis

“…Co-occurring anxiety and mood disorders are also common among autistic individuals and may have a bidirectional relationship with sleep disturbance. Studies indicate that children with anxiety and sensory sensitivities are more predisposed to sleep problems (Mazurek & Petroski, 2015), and that sleeping more than normal is associated with higher levels of depressive symptoms in autistic children (Mayes et al, 2020). The finding that sleep problems are most strongly associated with internalizing and externalizing symptoms suggests that sleep interventions should be prioritized when treating internalizing and externalizing symptoms in ASD.…”

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

“…In addition to ADHD and community samples, SCT has recently been investigated in children and adolescents with autism spectrum disorder (Brewe et al, 2020; Duncan et al, 2019; Mayes et al, 2021), trauma (Musicaro et al, 2020), and sleep disorders (Becker et al, 2016), which points toward SCT being a construct of transdiagnostic significance. However, SCT has rarely been examined in the context of reading disorder (RD), which includes dyslexia.…”