Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo

Abstract

Sluggish cognitive tempo (SCT) was originally identified as a construct that characterized the inattention problems of some children with attention deficit disorder (ADD). Research has indicated that using SCT symptoms to identify a subset of youth with attention-deficit/hyperactivity disorder, predominately inattentive type (ADHD-IT) may elucidate distinct patterns of impairment and thereby improve the external validity of ADHD subtypes. The objective of the current study was to investigate whether youth with clinically-assessed ADHD-IT and high levels of SCT exhibit unique social and academic impairments. In a clinic-referred sample of youth (N = 209; 23 % female) aged 6 to 17 years, participants who met criteria for three different groups were identified: ADHD, Combined Type (ADHD-CT; n = 80), ADHD-IT with low SCT symptoms (n = 74), and ADHD-IT with high SCT symptoms (n = 55). These groups were compared on indicators of social and academic functioning while considering the effects of co-occurring internalizing and disruptive behavior disorders. Youth with ADHD-IT high in SCT exhibited uniquely elevated withdrawal, as well as low leadership and low peer-directed relational and overt aggression, which were not accounted for by co-occurring disorders. This high-SCT group was also the only group to have more homework problems than the ADHD-CT group, but only when other disruptive behavior disorders were absent. The distinctiveness of the high-SCT group, which was primarily evident in social as opposed to academic functioning, provides partial support for the external validity and clinical utility of SCT.

Mediating Effect of Psychopathy on the Risk of Social Problems Among Children with ADHD Versus Sluggish Cognitive Tempo Symptoms

“…Perhaps SCT symptoms preclude children from engaging in social interactions and/or from being socially reinforcing to their peers, which would lead them to be neglected, overlooked and/or rejected socially. This is consistent with research revealing that children with SCT have social problems but that they are not necessarily socially impaired [15,38]. The current findings also have important implications for both the assessment and treatment of ADHD.…”

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

“…Although few studies have examined SCT in relation to socioeconomic status (SES) status 16,17,19,42,45,46 , meta-analytic results of extant studies suggest that SCT may be related to less family income and parent education in children (see Table S3A, available online) and adults (see Table S3B, available online).…”

Sluggish Cognitive Tempo and ADHD Inattention as Predictors of Externalizing, Internalizing, and Impairment Domains: A 2-Year Longitudinal Study

“…Both studies included school-aged children and teacher ratings of both SCT and social functioning. Since SCT appears to be associated with peer withdrawal and isolation specifically (Carlson and Mann 2002;Marshall et al 2014;Willcutt et al 2014), more nuanced measures of peer adjustment may be needed to disentangle the impact of SCT vs. ADHD on social functioning in the school context.…”

“…It is also evident that SCT is distinct from internalizing symptoms of anxiety and depression (Becker et al 2014d;Lee et al 2014;Servera et al 2015;Willcutt et al 2014). Moreover, although it remains unclear whether or not SCT is uniquely associated with processing speed (Bauermeister et al 2012;Willcutt et al 2014), it is important to note that SCT is either unassociated with intelligence (Becker and Langberg 2013;Skirbekk et al 2011) or may even be associated with higher levels of intelligence in children with ADHD (Marshall et al 2014). Thus, SCT symptoms are not attributable to low intelligence.…”