Attention-deficit/hyperactivity disorder and sluggish cognitive tempo throughout childhood: temporal invariance and stability from preschool through ninth grade

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.

The Relationship Between Cognitive Disengagement Syndrome in Children and Cognitive Disengagement Syndrome, Depression, and Anxiety Levels in Their Parents

OBJECTIVE

This study aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) symptoms in children/adolescents and their parents within the Turkish population, examining the association with co-occurring ADHD symptoms, peer/social relationships, and total difficulties.

METHOD

The study included 229 parents aged 18 to 50 with children aged 6 to 18 from the staff of Karabuk Training and Research Hospital. Data collection occurred from April to September 2022. Participants completed various scales, including the Adult Concentration Inventory (ACI), Adult ADHD Self-Report Scale (ASRS), Depression Anxiety Stress Scale-21 (DASS-21), Conners' Parent Rating Scale-Revised Short Form (CPRS-R), Strengths and Difficulties Questionnaire (SDQ), and Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT).

RESULTS

A positive correlation was found between CDS symptoms in children/adolescents and their parents. CDS symptoms in children were also associated with significant comorbidities, such as ADHD, oppositional defiance, peer problems, and internalization problems. In parents, CDS was observed to be associated with levels of depression, anxiety, and stress.

CONCLUSION

The study highlights the strong relationship between CDS symptoms in children and their parents, suggesting potential genetic and environmental factors. CDS is associated with significant mental health comorbidities across all age groups. The findings underscore the need for interventions to support the mental health of both children and parents with CDS. Further research is needed to elucidate the impact and etiology of CDS on family dynamics and mental health.

Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample

OBJECTIVE

The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group).

METHOD

Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures.

RESULTS

First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis.

CONCLUSIONS

The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

A developmental perspective on mind wandering and its relation to goal-directed thought

Mind wandering (i.e., thoughts drifting from one topic to another, with no immediate connection to the perceptual field or the ongoing task) is a widespread cognitive phenomenon. There has been increasing research interest in mind wandering in children and adolescents. However, the developmental origins of this phenomenon remain largely unknown. In the present article, I summarize the purported cognitive mechanisms of mind wandering in adults and review the empirical findings on mind wandering and automatic memory retrieval in children and adolescents. I propose a comprehensive account of the emergence of mind wandering in early and middle childhood, covering the development of its central components identified in the adult literature: motivational and emotional processes, episodic and semantic processes, perceptual decoupling, and meta-awareness. Paying special attention to the roles of developing motivation and executive control, I then address the relationship between mind wandering and goal-directed thought in children.

ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents

The current study examined attention-deficit/hyperactivity disorder (ADHD) dimensions and cognitive disengagement syndrome (CDS) symptoms in relation to self-injurious thoughts and behaviors (SITBs) in an early adolescent sample. Participants were 341 adolescents ages 10-12 years (52.2% female; 37.8% people of color) recruited from the community. Caregivers reported on CDS and ADHD symptoms. Adolescents completed a rating scale and were administered an interview assessing SITBs. We estimated associations using logistic regression in a stepped fashion: (1) no adjustment, (2) adjustment for sex, race, family income, and psychotropic medication use, and (3) further adjustment for depressive symptoms. In this early adolescent community sample, 22.9% reported a history of suicidal ideation, 8.2% reported a history of a suicide plan, 6.2% reported a history of non-suicidal self-injury (NSSI), and 16.4% met a clinical cutoff for current suicide risk. Across most analyses using rating scale or interview methods, higher mean CDS scores were related to endorsement of suicidal ideation and planning. ADHD inattentive (IN) and hyperactive-impulsive (HI) symptoms were associated with endorsement of NSSI, and ADHD-IN symptoms were associated with thoughts of suicide and/or plan measured via questionnaire, though effects were less robust and not significant, potentially due to low base rates impacting statistical power. This study adds to a growing body of research highlighting the importance of screening for CDS symptoms among individuals with and without ADHD. More research, especially longitudinal work, is needed that examines possible differential pathways to SITBs by ADHD and CDS symptoms to advance SITB prevention, early detection, and intervention.

Unveiling cognitive disengagement syndrome: A hidden challenge in children with epilepsy

BACKGROUND

In our study, we aimed to investigate the prevalence of cognitive disengagement syndrome (CDS) and attention deficit hyperactivity disorder (ADHD) in children with epilepsy and to identify the associated factors.

METHOD

The study included 62 patients with epilepsy aged 6-18 and 51 healthy controls. Sociodemographic data, epilepsy characteristics, and medication usage were collected. Psychiatric evaluations used various structured interviews and scales.

RESULTS

The mean ages for patients and controls were 9.7 and 9.9 years, respectively. CDS was present in 76 % of patients with epilepsy compared to 26 % of controls (p < 0.01). Patients with epilepsy scored higher on Barkley Child Attention Scale (BCAS) and Turgay DSM-IV Disruptive Behavior Disorders Symptom Screening Scale (T-DSM-IV-S). CDS prevalence was higher in patients without seizure control and those over age 12. Linear regressions demonstrated that age predicted BCAS-sluggish scores (R2: 0.284, p < 0.001) and T-DSM-IV-S hyperactivity scores (R2: 0.065, p: 0.023). The number of antiseizure medications (R2: 0.065, p: 0.023) and the duration of antiseizure medication usage (R2: 0.079, p: 0.014) predicted T-DSM-IV-S oppositional scores.

CONCLUSION

Our study is the first study in this field. Our study findings highlight the need for further research to understand the pathophysiological mechanisms underlying CDS in epilepsy and to develop targeted interventions.

Mindful Awareness Practices (MAPs) in Adolescents With ADHD and Cognitive Disengagement Syndrome (CDS): A Pilot Open Trial

Objective: Very few studies have investigated intervention approaches that may be efficacious for youth with ADHD and co-occurring cognitive disengagement syndrome (CDS) symptoms. This study examined the feasibility, acceptability, and preliminary efficacy of a mindfulness-based intervention for adolescents with ADHD and co-occurring CDS symptoms. Methods: Fourteen adolescents ages 13 to 17 years (35.71% female; 64.29% White, 7.14% Black, 28.57% Multiracial) with ADHD and elevated CDS symptoms completed the 8-week group-based Mindful Awareness Practices (MAPs) program developed for individuals with ADHD. We collected measures of CDS, ADHD, mind-wandering, mindfulness, and other difficulties and functioning at baseline, 1-month post-intervention, and 3-month post-intervention to examine preliminary efficacy. We measured participant session attendance, session engagement, at-home practice adherence, and satisfaction of adolescents and caregivers at 1-month post-intervention to examine feasibility and acceptability. We also collected qualitative feedback from adolescents and caregivers at 1-month post-intervention. Results: The intervention was overall feasible to administer, and caregivers and adolescents reported satisfaction with the intervention despite some difficulties with attendance and engagement. We observed improvements to both caregiver- and adolescent-reported CDS symptoms and ADHD-inattentive symptoms from pre-intervention to post-intervention time points, though findings across 1- and 3-month follow-up differed based on informant. We also observed improvements to some indices of adolescent-reported mind-wandering, mindfulness, brooding rumination, and academic functioning. For caregiver report, the only other noted improvement was for executive functioning. No improvements were reported by teachers. Conclusions: Findings support the initial feasibility, acceptability, and preliminary efficacy of MAPs for adolescents with ADHD and co-occurring CDS symptoms on a range of outcomes. Larger trials with a randomized design are warranted to further examine mindfulness-based interventions for adolescents with ADHD and co-occurring CDS symptoms.

Attention-deficit hyperactivity disorder symptoms and bullying victimization from childhood to adolescence - A within-person cross-lagged approach

Attention-deficit hyperactivity disorder (ADHD) and subclinical symptoms of hyperactivity-impulsivity and inattentiveness coincide with an increased risk of peer victimization. What remains unclear are the developmental dynamics of these associations. In a sample drawn from two Norwegian birth cohorts (n = 872; 49.94 % girls), assessed biennially from age 6 to age 14, reciprocal relations between ADHD symptoms and victimization were examined while controlling for symptoms of anxiety and depression. ADHD symptoms were assessed through clinical interviews with parents, whereas victimization was reported by teachers using questionnaires. Random-intercept cross-lagged panel modeling revealed a consistent reciprocal within-person effect of increased ADHD symptoms on victimization, and vice versa. Analyses of subdimensions of ADHD projected a consistent cross-lagged bidirectional relationship between victimization and inattentiveness symptoms only, whereas no such reciprocity was found for hyperactivity-impulsivity symptoms. Results did not differ by gender. Findings suggest that the social context may constitute a vulnerability factor in the etiology of the inattentive subtype of ADHD, and at the same time, that inattentiveness symptoms pose a risk for becoming victimized.

Cognitive Disengagement Syndrome-Clinical Interview (CDS-CI): Psychometric support for caregiver and youth versions

Cognitive disengagement syndrome (CDS), formerly termed sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental confusion, and slowed behavior/thinking. CDS is distinct from symptoms of attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies and uniquely associated with functional impairment. However, despite significant progress in developing and evaluating rating scale measures of CDS, no clinical interview of CDS exists with established psychometric properties that can facilitate a multimethod approach assessing CDS. Accordingly, the present study evaluated the psychometric properties of the semistructured Cognitive Disengagement Syndrome-Clinical Interview (CDS-CI). The CDS-CI and the ADHD inattention (ADHD-IN) and hyperactive-impulsivity (ADHD-HI) modules from the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS) were administered to a sample of early adolescents (N = 341, ages 10-12 years) and their caregivers. Adolescents and caregivers also completed rating scale measures of CDS and ADHD symptoms. The CDS-CI demonstrated high internal consistency and interrater reliability. CDS-CI scores showed excellent same-source discriminant validity from K-SADS, ADHD-IN, and ADHD-HI scores and encouraging convergent and discriminant validity with rating scale measures, especially for caregivers. Above and beyond K-SADS, ADHD-IN, and ADHD-HI scores, higher parent and adolescent CDS-CI scores were both significantly associated with greater functional impairment. A threshold of ≥ 6 out of 15 symptoms was selected as an initial threshold for determining clinically elevated CDS using the CDS-CI. Findings provide psychometric support for the CDS-CI as a tool in the multimethod assessment of CDS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Where do neurodevelopmental conditions fit in transdiagnostic psychiatric frameworks? Incorporating a new neurodevelopmental spectrum

Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These "neurodevelopmental conditions" are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses poses significant challenges in both research and clinical settings (e.g., high co-occurrence, arbitrary diagnostic boundaries, high within-disorder heterogeneity). Taking a transdiagnostic dimensional approach provides a useful alternative for addressing these limitations, accounting for shared underpinnings across neurodevelopmental conditions, and characterizing their common co-occurrence and developmental continuity with other psychiatric conditions. Neurodevelopmental features have not been adequately considered in transdiagnostic psychiatric frameworks, although this would have fundamental implications for research and clinical practices. Growing evidence from studies on the structure of neurodevelopmental and other psychiatric conditions indicates that features of neurodevelopmental conditions cluster together, delineating a "neurodevelopmental spectrum" ranging from normative to impairing profiles. Studies on shared genetic underpinnings, overlapping cognitive and neural profiles, and similar developmental course and efficacy of support/treatment strategies indicate the validity of this neurodevelopmental spectrum. Further, characterizing this spectrum alongside other psychiatric dimensions has clinical utility, as it provides a fuller view of an individual's needs and strengths, and greater prognostic utility than diagnostic categories. Based on this compelling body of evidence, we argue that incorporating a new neurodevelopmental spectrum into transdiagnostic frameworks has considerable potential for transforming our understanding, classification, assessment, and clinical practices around neurodevelopmental and other psychiatric conditions.

Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research

Cognitive disengagement syndrome (CDS, previously referred to as sluggish cognitive tempo) is a unique set of symptoms distinct from ADHD inattentive symptoms that appear to be independently associated with neuropsychological and psychosocial outcomes in community and ADHD-specific samples of youth. However, our understanding of CDS in individuals with chronic or complex medical conditions is limited. The current systematic review is the first to summarize the literature on CDS prevalence rates and associations with neurocognitive and functional outcomes in youth with medical conditions, and to discuss areas of future research to guide clinical intervention. We conducted literature searches across four major databases and included studies assessing prevalence estimates, associations with neuropsychological and/or psychosocial functioning, or predictors of CDS in individuals with chronic or complex medical conditions. Twenty-five studies were identified and retained. Fifteen of sixteen studies reported elevations in CDS symptoms, though findings were mixed in studies comparing mean differences to typically developing youth. Seven studies provided inconsistent evidence for CDS being associated with neuropsychological or academic functioning, with six studies demonstrating consistent effects on psychosocial functioning. Finally, nine studies identified biological and sociodemographic factors associated with CDS, though almost all await replication. CDS symptoms are significantly elevated in youth with medical conditions and appear to be particularly linked with psychosocial functioning. Future research is needed to identify prevalence of CDS across a range of medical conditions, examine associations with neuropsychological and psychosocial functioning, and examine whether CDS impacts self-management.

Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental fogginess, and slowed behavior/thinking. Studies examining the association between CDS and academic functioning have reported mixed findings and have relied upon limited measures of CDS, broad ratings of academic impairment, and/or focused only on elementary-aged children. The current study examined the relationship between CDS and academic functioning in adolescents using a comprehensive, multi-informant, multi-method design. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD) recruited in the fall of their 8th grade. Above and beyond ADHD inattentive symptoms, CDS symptoms were related to poorer homework performance, lower math fluency, and lower daily academic motivation across multiple informants, and teacher-reported CDS symptoms were related to lower grades. Findings were not moderated by ADHD diagnosis, suggesting that associations between CDS and academic outcomes do not differ for adolescents with and without ADHD. Findings demonstrate that CDS symptoms are uniquely associated with daily academic difficulties as well as global indices of academic performance. These findings have implications for assessing and monitoring CDS symptoms in interventions aiming to improve the academic functioning in adolescents with and without ADHD.

Trajectory Analysis for Identifying Classes of Attention Deficit Hyperactivity Disorder (ADHD) in Children of the United States

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that affects attention and behavior. People with ADHD frequently encounter challenges in social interactions, facing issues, like social rejection and difficulties in interpersonal relationships, due to their inattention, impulsivity, and hyperactivity.

METHODS

A National Longitudinal Survey of Youth (NLSY) database was employed to identify patterns of ADHD symptoms. The children who were born to women in the NLSY study between 1986 and 2014 were included. A total of 1,847 children in the NLSY 1979 cohort whose hyperactivity/inattention score was calculated when they were four years old were eligible for this study. A trajectory modeling method was used to evaluate the trajectory classes. Sex, baseline antisocial score, baseline anxiety score, and baseline depression score were adjusted to build the trajectory model. We used stepwise multivariate logistic regression models to select the risk factors for the identified trajectories.

RESULTS

The trajectory analysis identified six classes for ADHD, including (1) no sign class, (2) few signs since preschool being persistent class, (3) few signs in preschool but no signs later class, (4) few signs in preschool that magnified in elementary school class, (5) few signs in preschool that diminished later class, and (6) many signs since preschool being persistent class. The sensitivity analysis resulted in a similar trajectory pattern, except for the few signs since preschool that magnified later class. Children's race, breastfeeding status, headstrong score, immature dependent score, peer conflict score, educational level of the mother, baseline antisocial score, baseline anxious/depressed score, and smoking status 12 months prior to the birth of the child were found to be risk factors in the ADHD trajectory classes.

CONCLUSION

The trajectory classes findings obtained in the current study can (a) assist a researcher in evaluating an intervention (or combination of interventions) that best decreases the long-term impact of ADHD symptoms and (b) allow clinicians to better assess as to which class a child with ADHD belongs so that appropriate intervention can be employed.

Cognitive disengagement syndrome in pediatric patients with long COVID: associations with mood, anxiety, and functional impairment

Children with long COVID often report symptoms that overlap with cognitive disengagement syndrome (CDS, previously sluggish cognitive tempo (SCT)), a set of behaviors distinct from attention-deficit/hyperactivity disorder (ADHD) including excessive daydreaming, mental fogginess, and slowed behavior and thinking. Those with long COVID also frequently report low mood and anxiety, which are linked to CDS. The relationships between cognitive difficulties, mood, and functional impairment have yet to be explored in pediatric long COVID. Specifically, it is unclear how much cognitive difficulties (CDS, inattention) contribute to functional impairment, when accounting for mood/anxiety symptoms in this population. Retrospective parent-reported data was collected from 34 patients with long COVID (22 females, Mage = 14.06 years, SD = 2.85, range 7-19) referred for neuropsychological consultation through a multidisciplinary Post-COVID-19 clinic. Compared to community and clinically referred samples, on average, long COVID patients showed elevated CDS symptoms, including Sluggish/sleepy (e.g., fatigue) and Low Initiation subscales (e.g., difficulty performing goal directed behaviors). Low Initiation, mood, anxiety, and inattention were associated with functional impairment. In multiple hierarchical regression models, after controlling for mood and anxiety, Low Initiation and inattention were no longer predictive of functional impairment. Instead, anxiety remained the sole predictor of functional impairment. Our results demonstrate that children with long COVID have high levels of CDS symptoms. The association between cognitive difficulties and functional impairment dissipated with the inclusion of mood and anxiety, suggesting behavioral health interventions targeting anxiety may help improve daily functioning and quality of life in pediatric long COVID patients.

Personality Traits in Relation to Cognitive Disengagement Syndrome and ADHD Inattention in Two Samples of Children

OBJECTIVE

Cognitive disengagement syndrome (CDS; previously referred to as sluggish cognitive tempo) is a set of behaviors, including excessive mind-wandering, mental fogginess, and hypoactivity, that are separate from ADHD inattentive (ADHD-IN) symptoms and linked to functional outcomes. However, CDS and ADHD-IN symptoms are strongly associated, and our understanding of whether personality correlates are similarly or differentially linked to CDS and ADHD-IN is limited. The objective of the current study was to examine personality correlates of CDS and ADHD-IN symptoms across two independent samples of school-aged youth.

METHOD

Study 1 included 207 school-aged children (ages 7-11; 63% male; 87.9% White) with or without teacher-reported elevations in CDS. Study 2 included 263 school-aged children (ages 8-12; 58% male; 75.3% White) with the full range of CDS symptomatology. Parents and teachers completed ratings of ADHD-IN and CDS, and parents also reported on their child's personality dimensions.

RESULTS

Across two samples and controlling for demographic characteristics as well as ADHD-IN symptoms and other personality traits, higher levels of FFFS-fear/shyness were uniquely associated with higher levels of parent- and teacher-reported CDS symptoms. In most models, lower levels of BAS-drive were also uniquely associated with higher levels of CDS. In contrast, when controlling for demographic characteristics and CDS symptoms, higher levels of BAS-impulsivity/fun-seeking were uniquely associated with higher levels of parent- and teacher-reported ADHD-IN symptoms.

DISCUSSION

The findings provide the clearest evidence to date that personality dimensions are differentially associated with ADHD-IN and CDS symptoms in children, further underscoring CDS as a distinct construct from ADHD-IN.

Bibliometric Trends and Thematic Areas in Research on Cognitive Disengagement Syndrome in Children: A Comprehensive Review

This study aims to explore trends and principal research areas in the literature on Cognitive Disengagement Syndrome (CDS) in children aged 0-17 from a macro perspective. A total of 236 studies, selected based on inclusion and exclusion criteria from the Web of Science and Scopus databases, formed the data source for this research. We conducted a bibliometric analysis to examine the growth of CDS literature and to identify the most productive countries, relevant journals and publications, and trending topics. Additionally, through content analysis, we identified general research themes, sample trends, and methodologies used in these studies. Our findings reveal that the relatively new field of CDS research is expanding. Our thematic analysis shows that the literature on CDS covers a broad spectrum of research topics, addressing various facets of the syndrome and identifying current research themes. The existing studies highlight the complex nature of CDS and its diverse cognitive, psychological, and neurological impacts. Our results also suggest that while research is more prevalent in certain age groups, there is a need to encompass a wider demographic range, considering CDS's potential impact across different life stages. This bibliometric analysis offers a comprehensive review of the current knowledge in the CDS field, providing a valuable resource for researchers. Our analyses and findings can guide future research in this area and suggest approaches for broader study frameworks. It is anticipated that ongoing and future research in the CDS field will incorporate these insights to more effectively address the syndrome's varied aspects and consequences.

Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome

This study aims to investigate the predictive and mediating relationships between emotion dysregulation, internalizing disorders, family functionality, loneliness preference, and executive functions (EF) in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome (ADHD + CDS). This study included 176 children and adolescents (92 boys, 84 girls) who were diagnosed with ADHD + CDS according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist, between ages 8 -12 (M = 10, SD = 1.52) with a convenience sampling method. The solitude scale for children, difficulties in emotion dysregulation scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, Family assessment device, and CNS Vital Signs test were used. The results showed that difficulty in emotion regulation, preference for loneliness, internalizing disorders and CDS symptom severity did not have a mediating effect between family functionality and EF. Still, emotion dysregulation mediates the relationship between EF and internalizing disorders by itself and through loneliness preference. Also, preference for loneliness and emotion dysregulation had a mediating effect between family functionality and internalizing disorders. Finally, it was found that the effect of emotion regulation difficulty, loneliness preference, and internalizing disorders had a mediating role between CDS symptom severity and family functionality. In conclusion, the information obtained from this study on the etiology of CDS may guide future studies.

Cognitive disengagement syndrome in pediatric spina bifida

The primary aim of this study was to characterize Cognitive Disengagement Syndrome (CDS) symptomatology in youth with spina bifida (SB). One hundred and sixty-nine patients aged 5-19 years old were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Parent-reported CDS and inattention were measured using Penny's Sluggish Cognitive Tempo Scale and the Vanderbilt ADHD Rating Scale. Self-reported internalizing symptoms were measured with the 25-item Revised Children's Anxiety and Depression Scale (RCADS-25). We replicated Penny's proposed 3-factor structure of CDS with slow, sleepy, and daydreamer components. The slow component of CDS overlapped heavily with inattention, while the sleepy and daydreamer components were distinct from inattention and internalizing symptoms. Eighteen percent (22 of 122) of the full sample met criteria for elevated CDS, and 39% (9 of 22) of those patients did not meet criteria for elevated inattention. Diagnosis of myelomeningocele and presence of a shunt were associated with greater CDS symptoms. CDS can be measured reliably in youth with SB and can be discriminated from inattention and internalizing symptoms in this population. ADHD rating scale measures fail to identify a substantial portion of the SB population with attention-related challenges. Standard screening for CDS symptoms in SB clinics may be important to help identify clinically impairing symptoms and design targeted treatment plans.

Quantifying Potential Bias Resulting From Child Age on Screening for Hyperactive/Impulsive Presentations of ADHD

OBJECTIVE

This study aims to quantify the potential age bias in screening of hyperactive/impulsive presentations of ADHD in children ages 5 to 12 through comparison of age-based and overall percentiles in screening.

METHOD

A referred clinical sample of 307 children ages 5 to 12 with behavioral concerns completed the Vanderbilt Attention Deficit-Hyperactivity Disorder Diagnostic Parent Rating Scale (VADPRS) and were formally evaluated for ADHD with a diagnostic interview. Analysis utilizing logistic regression and receiver operating characteristic (ROC) curves was performed to compare the screening performance of agebased and overall percentiles.

RESULTS

The age-based percentiles demonstrated no improvement in the analyzed models compared to overall percentiles in hyperactive presentation ADHD screening. This finding was present in the overall sample and in the sub analysis of the 5 to 6 year old children.

CONCLUSIONS

This study identifies no improvement in modeling of hyperactive/impulsive ADHD screening when considering a child's age using age-based percentiles.

Psychometric Properties of the Turkish version of the Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT) in Children and Adolescents

Sluggish cognitive tempo (SCT) (cognitive disengagement syndrome) (CDS) describes a cluster of symptoms including slowness, lethargy, and daydreaming. This study aims to evaluate the psychometric properties of the Turkish version of the Child and Adolescent Behavior Inventory (CABI-SCT) scale and its relationship to other psychological difficulties. A total of 328 children and adolescents aged between 6-18 years were included in the study. CABI-SCT, Revised Child Anxiety and Depression Scale (RCADS), Barkley Child Attention Scale (BCAS), ADHD Rating Scale-IV, and Strengths and Challenges Questionnaire (SDQ) were administered to parents of participants. Reliability analysis demonstrated good internal consistency and reliability. Confirmatory factor analysis indicated that the one-factor model of the Turkish version of CABI-SCT is an acceptable construct. This study supports the validity and reliability of the Turkish version of CABI-SCT for use in children and adolescents providing initial data concerning the psychometric properties and difficulties associated with the Turkish version of the CABI-SCT.

Comparison of Possible Changes in Oxidative Stress, DNA Damage, and Inflammatory Markers in Children/Adolescents Diagnosed with Sluggish Cognitive Tempo and Children/Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder

Background: There has been a debate on whether sluggish cognitive tempo (SCT) differs from attention-deficit/hyperactivity disorder (ADHD). Although there have been many studies on metabolic parameters in relation to ADHD, no similar studies have been conducted on patients with SCT. We investigated whether there are differences between SCT and ADHD in terms of these factors. Subjects and Methods: Sixty-two participants with ages ranging from 11 to 18 who have diagnosis of ADHD (33 subjects) and SCT (29 subjects) were included in this study. The parents of all participants completed the 48-item Conners' Parent Rating Scale (CPRS) and the Barkley Child Attention Scale (BCAS) forms, and all participants' blood was taken to compare metabolic, oxidative stress, and antioxidant status of the SCT and ADHD groups. A child and adolescent psychiatrist interviewed the parents and children to assess the diagnosis of SCT and ADHD using standard diagnostic procedures. Results: In the comparison between the SCT and ADHD groups in terms of metabolic parameters, statistically significant differences were found in terms of total oxidant status, total antioxidant status, Oxidative Stress Index, total thiol, native thiol, disulfide, interleukin (IL)-1β, IL-6, and DNA damage (p < 0.05), but not in terms of tumor necrosis factor-α (p > 0.05). Conclusions: Our data showed that these two disorders may be different, but we believe that the data that indicate their differences remain inconclusive overall, but this study may be a potential pathway for future research.

Comparing Cognitive Disengagement Syndrome Growth in Youth With and Without Spina Bifida

OBJECTIVE

Cognitive disengagement syndrome (CDS; formally known as sluggish cognitive tempo), difficulties with social engagement, and lower levels of autonomy have been identified as maladaptive comorbidities in youth with spina bifida (SB). This study compared growth curves of CDS for youth with and without SB and examined whether these trajectories were associated with later functioning.

METHODS

Longitudinal data spanning 8 years included youth with SB (n = 68, Mage = 8.34) and a demographically matched sample of typically developing (TD) peers (n = 68, Mage = 8.49). Adolescents, along with their caregivers and teachers, reported on youth social skills, behavioral functioning, and CDS. Growth curve models were examined by comparing CDS trajectories by SB status.

RESULTS

Growth curves indicated that youth with SB had higher levels of teacher-reported CDS at ages 8 and 9, but growth curves were relatively stable for both groups. When predicting social skills, higher levels of teacher-reported (but not mother-reported) CDS at baseline predicted worse social functioning for both youth with and without SB in adolescence. For the slope findings, higher rates of mother-reported CDS over time predicted worse social skills (β = -0.43) and lower levels of youth decision-making (β = -0.43) for the SB group, while higher rates of teacher-reported CDS predicted worse social skills for the TD group.

CONCLUSION

Next steps include understanding the impact that impaired social functioning and restricted autonomy have on youth with and without SB due to CDS to inform interventions. Additionally, advocacy for increased awareness of CDS-related impairment is needed, particularly for youth with chronic health conditions.

An Evaluation of the Structure of Attention in Adolescence

This study evaluated the factor structure of attention, considering internal and external attention, and juxtaposed alongside processing speed (PS) and working memory (WM). We expected the hypothesized model to fit better than unitary or method factors. We included 27 measures with 212 Hispanic middle schoolers from Spanish-speaking backgrounds, where a substantial proportion were at risk for learning difficulties. Confirmatory factor analytic models separated factors of PS and WM, but the final model did not align with theoretical predictions; rather only measurement factors emerged. Findings extend and refine our understanding of the structure of attention in adolescents.

Sluggish cognitive tempo (Cognitive Disengagement Syndrome) symptoms are more associated with a higher risk of internet addiction and internet gaming disorder than ADHD symptoms: A study with medical students and resident doctors

BACKGROUND & AIMS

The purpose of this study was to examine the relationships between Attention Deficit Hyperactivity Disorder (ADHD), Sluggish Cognitive Tempo (SCT), demographic factors, and Internet Addiction (IA) and internet gaming disorder (IGD) among medical students and resident doctors.

METHODS

The study included 274 medical students and resident doctors. (Ages:18-35, 70.4% female). Fisher exact test, Contingency Table analyses, Mann Whithey-U Test and structural equation model-path analysis were used for analysis. The Sociodemographic Information Form, ASRS Scale, Barkley SCT Scale, Young Internet Addiction Test-Short Form and The Digital Game Addiction Scale were utilized to collect data.

RESULTS

In the sample, 48 participants (17.51%, 22 female, 26 male) were classified as having a high-risk internet gaming disorder (IGD+), while 53 participants (19.3%, 37 female, 16 male) were classified as having a high-risk internet addiction (IA+). SCT Scale Daydreaming and Sluggishness scores, as well as ASRS Scale Inattention and Hyperactivity/Impulsivity ratings, were all substantially higher in high-risk groups (for all, p < 0.05). Instead of age, there was no difference between high and low-risk groups, but men had a significantly greater rate of high risk- IGD (%32.1 vs. 11.4; p = 0.001). Path analysis revealed that while older age has a substantial negative effect (β = -0.37, p = 0.001) on increased risk of IA, Inattention (β = 0.19, p = 0.028), Daydreaming (β = 0.62, p0.001), and Sluggishness ( β = 1.12, p0.001) had significant positive effects. On the other hand, results revealed that male gender (β = 5.08, p0.001), IA scores (β = 0.21, p0.001), and only Sluggishness ( = 0.52, p = 0.002), but not Inattention, Hyperactivity/impulsivity, or Daydreaming, have positive effects on greater risk of internet gaming disorder (IGD).

CONCLUSION & IMPLICATIONS

Our study is the first to show that SCT symptoms increase the risk of Internet addiction and Internet Gaming Disorder even when ADHD symptoms are controlled. To date, many research have highlighted the necessity of ADHD treatment when evaluating IA and IGD. However, SCT symptoms have a greater impact on people who are predisposed to these behavioral addictions, and despite high comorbidity rates, various treatment approaches for ADHD and SCT are effective. SCT should be kept in mind when assessing treatment-resistant individuals with IA and IGD.

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.

Data-Driven Methods for Predicting ADHD Diagnosis and Related Impairment: The Potential of a Machine Learning Approach

Current diagnostic criteria for ADHD include several symptoms that highly overlap in conceptual meaning and interpretation. Additionally, inadequate sensitivity and specificity of current screening tools have hampered clinicians' ability to identify those at risk for related outcomes. Using machine learning techniques, the current study aimed to propose a novel algorithm incorporating key ADHD symptoms to predict concurrent and future (i.e., five years later) ADHD diagnosis and related impairment levels. Participants were 399 children with and without ADHD; multiple informant measures of ADHD symptoms, global impairment, academic performance, and social skills were included as part of an accelerated longitudinal design. Results suggested eight symptoms as most important in predicting impairment outcomes five years later: (1) Has difficulty sustaining attention in tasks or play activities, (2) Does not follow through on instructions and fails to finish work, (3) Has difficulty organizing tasks and activities, (4) Avoids tasks (e.g., schoolwork, homework) that require sustained mental effort, (5) Is often easily distracted, (6) Is often forgetful in daily activities, (7) Fidgets with hands or feet or squirms in seat, and (8) Interrupts/intrudes on others. The algorithm comprising this abbreviated list of symptoms performed just as well as or significantly better than one comprising all 18 symptoms in predicting future global impairment and academic performance, but not social skills. It also predicted concurrent and future ADHD diagnosis with 81-93% accuracy. Continued development of screening tools will be key to ensuring access to clinical services for youth at risk for ADHD.

Sluggish cognitive tempo, eating habits, and daytime sleepiness in obese adolescents

OBJECTIVE

Rates of obesity have risen steeply in the western world in all age groups. Sluggish Cognitive Tempo (SCT) is characterized by a cluster of symptoms. Daytime sleepiness, commonly seen in obesity, may share a similar origin with sleepiness and daydreaming symptoms of SCT. This study aims to investigate the relationship between obesity, SCT, daytime sleepiness, and eating habits.

METHOD

Adolescents, aged between 10-17 years, with a BMI >95^th centile, were recruited to the study. Clinical interviews were supplemented with standardized questionnaires.

RESULTS

Of the 35 adolescents, more than one quarter (N = 10, 28.6%) had SCT. Emotional overeating and food enjoyment subscale scores showed moderate correlations with the SCT scores, though these associations were not significant when controlling for ADHD symptoms. Daytime sleepiness score in adolescents with SCT was found to be significantly higher than those without.

CONCLUSION

Sluggish Cognitive Tempo is frequently present in adolescents with obesity and associated with higher levels of emotional overeating, food enjoyment, and daytime sleepiness. Targeting aspects of SCT might offer additional avenues to assist in weight management programs for youth.

Gestational organophosphate ester exposure and preschool attention-deficit/hyperactivity disorder in the Norwegian Mother, Father, and Child cohort study

BACKGROUND

Attention-deficit/hyperactivity-disorder (ADHD) is a leading neurodevelopmental disorder in children worldwide; however, few modifiable risk factors have been identified. Organophosphate esters (OPEs) are ubiquitous chemical compounds that are increasingly prevalent as a replacement for other regulated chemicals. Current research has linked OPEs to neurodevelopmental deficits. The purpose of this study was to assess gestational OPE exposure on clinically-assessed ADHD in children at age 3 years.

METHODS

In this nested case-control study within the Norwegian Mother, Father, and Child Cohort study, we evaluated the impact of OPE exposure at 17 weeks' gestation on preschool-age ADHD. Between 2007 and 2011, 260 ADHD cases were identified using the Preschool Age Psychiatric Assessment and compared to a birth-year-stratified control group of 549 children. We categorized bis(2-butoxyethyl) phosphate (BBOEP) and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) as values < limit of detection (LOD) (BBOEP N = 386, BDCIPP N = 632), ≥LOD but < limit of quantification (LOQ) (BBOEP N = 413; BDCIPP N = 75), or above LOQ (BBOEP N = 70; BDCIPP N = 102). Diphenyl phosphate (DPhP) and di-n-butyl phosphate (DnBP) were categorized as quartiles and also modeled with a log10 linear term. We estimated multivariable adjusted odds ratios (ORs) using logistic regression and examined modification by sex using an augmented product term approach.

RESULTS

Mothers in the 3rd DnBP quartile had 1.71 times the odds of having a child with ADHD compared to the 1st quartile (95%CI: 1.13, 2.58); a similar trend was observed for log10 DnBP and ADHD. Mothers with BDCIPP ≥ LOD but < LOQ had 1.39 times the odds of having a child with ADHD compared to those with BDCIPP < LOD (95%CI: 0.83, 2.31). Girls had lower odds of ADHD with increasing BBOEP exposure (log10 OR: 0.55 (95%CI: 0.37, 0.93), however boys had a weakly increased odds (log10 OR: 1.25 (95%CI: 0.74, 2.11) p-interaction = 0.01].

CONCLUSIONS

We found modest increased odds of preschool ADHD with higher DnBP and BDCIPP exposure.

A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference

BACKGROUND

The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self- and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD.

METHODS

Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed.

RESULTS

Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent- or parent-reported ADHD symptom dimensions.

CONCLUSIONS

Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.

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.

Investigating the Measurement Invariance and Method-Trait Effects of Parent and Teacher SNAP-IV Ratings of Preschool Children

The Swanson, Nolan, and Pelham scale version IV (SNAP-IV) is widely used to assess symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children and adolescents. Nevertheless, there is insufficient data to support its use in preschool children. The study had three goals: First, to test the factorial validity of the three correlated-factors model of ADHD and ODD items of the SNAP-IV. Second, to investigate the measurement invariance of the items over time (6-month longitudinal interval) and by sex. Third, to investigate the convergent validity and method-specific influences on ADHD/ODD assessments with respect to multiple raters (parents/teachers) of children's symptoms. Participants were 618 preschool children (3.5-6 years) at baseline and 6-month follow-up. For model testing, we used confirmatory factor analysis for categorical observed variables. Method and trait effects were examined using the CT-C(M-1) model. The analyses showed partial measurement invariance over time and according to sex. Moreover, strong rater-specific effects were detected. The implication of the results for construct validation of the instrument and clinical assessment of ADHD and ODD traits are discussed.

Networks of ADHD and SCT Symptoms in Emerging Adulthood

OBJECTIVE

Emerging adulthood (18-25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one another during this period, if there are differences based on biological sex, or how closely results will align with adulthood.

METHODS

We used network analysis techniques to explore the structure of ADHD and SCT symptoms within emerging adulthood, with additional comparisons between sexes as well as between emerging adulthood and adulthood. Using an online platform, 8,506 adults reported on their symptoms of ADHD and SCT.

RESULTS

Symptoms grouped together within their respective domains during emerging adulthood with no significant differences in overall network structure between sexes. Similarly, network structure appeared to be robust across emerging adulthood and adulthood.

CONCLUSION

Such consistency supports a conceptualization of ADHD in emerging adulthood as similar to adulthood.

Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization

It is unknown whether sluggish cognitive tempo (SCT) is prospectively associated with depression in adolescence, and possible processes linking SCT to depression remain unexamined. Using a longitudinal study with three timepoints over a two-year period, the current study tested the indirect effects of SCT on depression via peer victimization, specifically physical, relational, and verbal victimization. Participants were 302 adolescents (M_age = 13.17 years; 44.7% female participants; 81.8% White; 52% with ADHD). In the fall of 8th grade, adolescents and parents completed measures of adolescents' SCT and ADHD symptoms. Adolescents completed a measure of peer victimization in spring of 8th grade and a measure of depressive symptoms in 10th grade. Models examining indirect effects were conducted with and without control of baseline ADHD and/or depressive symptoms. Across analyses, adolescent and parent ratings of SCT symptoms uniquely predicted greater depressive symptoms two years later when controlling for adolescent sex, study site, and either 8th grade depressive or ADHD symptoms. Further, adolescents' self-reported 8th grade SCT symptoms predicted 10th grade depressive symptoms via verbal victimization when controlling for 8th grade ADHD symptoms, but not in analyses incorporating 8th grade depressive symptoms. Findings underscore the predictive association of SCT on depressive symptoms, the possible role of adverse peer relationships as a mechanism linking SCT to depression, and the importance of considering ADHD and depressive symptoms in research on longitudinal correlates of SCT.

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.

National Norms for the Vanderbilt ADHD Diagnostic Parent Rating Scale in Children

OBJECTIVE

To provide national norms and percentiles for both research and clinical scoring modalities of the Vanderbilt Attention Deficit/Hyperactivity Disorder (ADHD) Diagnostic Parent Rating Scale (VADPRS) for a representative sample of children ages 5-12 in the United States.

METHOD

The five clinical subscales of the VADPRS were completed by 1,570 caregivers of children ages 5-12 in the United States, with children representative of the national population on key demographic variables including race, sex, ethnicity, family income, and family educational level. Descriptive statistics and measures of internal consistency of both dimensional and symptom count scoring were provided for each of the five clinical subscales of the inventory, as well as percentiles and group comparisons for select dimensional scoring subscales based on age and child sex.

RESULTS

Measures of internal consistency for each subscale using both scoring modalities of the VADPRS ranged from high to acceptable. There were statistically significant differences among the different subscales for both age (ADHD hyperactivity, anxiety/depression) and sex [both presentations of ADHD, oppositional defiant disorder (ODD)] for the total sample. These differences, however, were modest in magnitude and unlikely to be clinically meaningful.

CONCLUSIONS

This study enhances the research and clinical utility of the VADPRS by providing national norms and percentiles for each of its subscales. Differences between age and sex across the sample were statistically significant for two of the subscales (Hyperactivity and Anxiety/Depression) with additional subscales significant for sex alone (Inattentive and ODD), but these differences were not substantial enough to indicate a need for separate cut-offs for screening purposes.

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.

Greek Validation of the Factor Structure and Longitudinal Measurement Invariance of the Strengths and Difficulties Questionnaire-Self Report (SDQ-SR): Exploratory Structural Equation Modelling

The study examined the factor structure and longitudinal measurement invariance over three time points (1-year apart) of the Strengths and Difficulties Questionnaire-Self Report (SDQ-SR) for ratings provided by adolescents in Greece. It used exploratory structural equation modelling (ESEM) to achieve these two goals. At time point one, a total of 968 adolescents (males = 508, and females = 460) between 12 and 17.9 years completed the SDQ-SR. In relation to factor structure, ESEM tested the fit of one- to five-factor models. The findings were interpreted as indicating most support for the ESEM model with three factors (the factors being dysregulation, peer problems, and prosocial behaviour). This model showed support for configural invariance and full metric invariance across the three time points. Except for two thresholds, all other thresholds were also invariant across the three time points. Thus, there was good support for longitudinal measurement invariance. The implications of the findings for use of the SDQ-SR are discussed.

Relationship between sluggish cognitive tempo, IQ and academic achievement test scores, and academic impairment in autism, ADHD, and elementary school samples

Sluggish cognitive tempo (SCT) is of renewed interest. The relationship between SCT, IQ and achievement scores, and academic impairment ratings was investigated in 218 students with autism and 676 with ADHD (6-16 years) and 549 elementary school students (IQ ≥ 80). Mothers rated their children on the Pediatric Behavior Scale. Children in the autism/ADHD sample were also rated by teachers. Correlations between SCT and IQ and achievement scores (Verbal Comprehension, Perceptual Reasoning, Working Memory, Processing Speed, reading, math, and written expression) were all negative and were nonsignificant in the total autism/ADHD and elementary school samples, except for small correlations with Processing Speed and a timed math test. In contrast, mother and teacher SCT ratings were significantly related to mother and teacher academic and cognitive impairment ratings. SCT was not a significant predictor of achievement scores or academic impairment ratings in regression analysis. The strongest predictor of achievement test scores was IQ, and the strongest predictors of academic impairment were mother and teacher cognitive impairment ratings. Teacher inattention ratings predicted teacher academic impairment ratings in autism/ADHD and mother inattention ratings predicted mother academic impairment ratings in elementary school children. Therefore, inattention was more predictive of academic functioning than was SCT. Research shows a weak link between SCT and processing speed (contrary to what is implied by the term sluggish cognitive tempo), and other neuropsychological test scores are not consistently associated with SCT. It remains to be determined if neuropsychological tests can be developed to measure and further our understanding of SCT.

Sluggish Cognitive Tempo Symptoms, But Not ADHD or Internalizing Symptoms, Are Uniquely Related to Self-Reported Mind-Wandering in Adolescents With ADHD

Objective: The purpose of this study was to test the relation between sluggish cognitive tempo (SCT) symptoms and self-reported mind-wandering in a sample of adolescents with ADHD. Method: Adolescents (N = 79; aged 13-17 years; 70% male) diagnosed with ADHD completed measures of SCT, ADHD, anxiety, and depression symptoms, in addition to mind-wandering. Parents also provided ratings of adolescents' ADHD symptoms. Results: All adolescent-reported psychopathology dimensions, including ADHD, internalizing, and SCT, were significantly bivariately correlated with greater mind-wandering. However, in regression analysis that considered psychopathologies simultaneously, SCT was the only dimension uniquely associated with greater mind-wandering. This finding was unchanged when parent-reported ADHD symptoms were included in the model. Conclusion: These findings are the first to show that SCT symptoms are uniquely related with self-reported mind-wandering in adolescents with ADHD and underscore the importance of considering co-occurring SCT symptoms when testing the interrelations between ADHD and mind-wandering. Replication is needed in larger samples and with other measures of mind-wandering.

Relationship Between Sluggish Cognitive Tempo and Age and IQ in Preschool and School-Age Children and Adolescents with Autism and with ADHD

Relationships between sluggish cognitive tempo (SCT) and age and IQ were investigated in children with autism and/or ADHD covering broader age and IQ ranges than in previous studies. Mothers rated 1436 children with autism and 1,056 with ADHD (2-17 years, IQs 9-149) on Pediatric Behavior Scale SCT items. Increasing age correlated with SCT in the autism, ADHD-Combined, and ADHD-Inattentive samples. SCT prevalence rates were 22% preschool, 29% early childhood, 41% late childhood, and 50% adolescence. Correlations between IQ and SCT were small and negative. SCT was lowest in children with above average intelligence. Children referred for autism and ADHD should be assessed for SCT, irrespective of IQ and age, given SCT's high prevalence and association with social and academic impairment.

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.

A Longitudinal and Gender Invariance Analysis of the Strengths and Difficulties Questionnaire Across Ages 3, 5, 7, 11, 14, and 17 in a Large U.K.-Representative Sample

Developmental invariance is important for making valid inferences about child development from longitudinal data; however, it is rarely tested. We evaluated developmental and gender invariance for one of the most widely used measures of child mental health: the parent-reported Strengths and Difficulties Questionnaire (SDQ). Using data from the large U.K. population-representative Millennium Cohort Study (N = 10,207; with data at ages 3, 5, 7, 11, 14, and 17 years), we tested configural, metric, scalar, and residual invariance in emotional problems, conduct problems, hyperactivity/inattention, prosociality, and peer problems. We found that the SDQ showed poor fit at age 3 in both males and females and at age 17 in males; however, it fit reasonably well and its scores were measurement invariant up to the residual level across gender at ages 5, 7, 11, and 14 years. Scores were also longitudinally measurement invariant across this age range up to the partial residual level. Results suggest that the parent-reported SDQ can be used to estimate developmental trajectories of emotional problems, conduct problems, hyperactivity/inattention, prosociality, and peer problems and their gender differences across the age range 5 to 14 years using a latent model. Developmental differences outside of this range may; however, partly reflect measurement differences.

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

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.

Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions

In this review, we consider issues relating to the pharmacological treatment of young children with attention deficit hyperactivity disorder (ADHD). ADHD in preschool-age children has a profound impact on psychosocial function and developmental trajectory. Clinical studies on pharmacotherapies for ADHD in young children have expanded rapidly in the past 2 decades, providing some evidence of efficacy for both psychostimulant and non-psychostimulant medications. However, preschool children may be more susceptible to adverse effects of medications, including growth reduction and cardiovascular side effects. Many questions remain regarding the long-term safety and effectiveness of these interventions; thus more research is needed to help clinicians evaluate the risk-benefit ratio for preschoolers with ADHD. As this body of knowledge grows, providers should consider the level of impairment caused by current symptoms in the risk-benefit analysis. Families should be educated not just about potential effects of medication but known complications of untreated ADHD; parents will likely not fully appreciate the long-term psychological effects of chronic behavioral problems and underachievement on a young child. A blanket "wait and see" approach should be avoided, in order to prevent a permanent loss of self-esteem and motivation that may affect some children throughout their lifespan.

Validity of Sluggish Cognitive Tempo in Turkish Children and Adolescents

The internal and external validity of sluggish cognitive tempo (SCT) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with Turkish children and adolescents. Parents completed the SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), callous-unemotional (CU), anxiety, depression, social impairment, and academic impairment scales of the Child and Adolescent Behavior Inventory (CABI) on 1015 Turkish children and adolescents (56% girls; ages 6-15 years; M_age = 10.05, SD_age = 2.32), including 762 recruited from the community and 253 recruited from outpatient psychiatric clinics. SCT symptoms demonstrated excellent internal validity with the ADHD-IN symptoms. SCT symptoms also showed invariance across boys and girls as well as across community and clinical samples. SCT showed stronger first-order and unique associations than ADHD-IN with anxiety and depression whereas ADHD-IN showed stronger first-order and unique associations than SCT with ADHD-HI, ODD, and academic impairment. SCT and ADHD-IN showed equal associations with CU behaviors and social impairment. The current study is the first to support the validity of CABI SCT scores with Turkish children and adolescents and also replicates the findings from similar studies with children from South Korea, Spain, and United States. These findings thus further strengthen the transcultural validity of CABI SCT scale scores.

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

Previous studies have demonstrated that sluggish cognitive tempo (SCT) behaviors are empirically distinct from inattentive (IN) behaviors that are used to define attention-deficit/hyperactivity disorder. However, most studies used cross-sectional designs during middle childhood. Using parent and teacher ratings from the Family Life Project (N = 1,173), we investigated the factor structure, longitudinal measurement invariance, developmental trajectories, and predictors of developmental change in SCT and IN from age 3 years through Grade 5. SCT and IN were dissociable but correlated constructs that exhibited longitudinal invariance for both informants. Mean levels of SCT increased modestly with age, becoming more prominent between age 5 years and first grade, while IN was more stable. Lower parental education was associated with higher parent- and teacher-reported SCT, male sex was associated with higher teacher-reported IN, and African American race was associated with higher teacher-reported IN but lower teacher-reported SCT. These findings support the validity of SCT starting in early childhood.

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 and processing speed in adolescents with ADHD: do findings vary based on informant and task?

Few studies have examined whether behavioral sluggish cognitive tempo (SCT) symptoms are related to speeded task performance. Mixed findings in existing research could be due to previous studies using a broad conceptualization of processing speed, not including self-report of SCT symptoms, and relying on non-optimal measures of SCT. Using a multi-informant design with both parent- and adolescent-reported SCT symptoms, the present study provides a preliminary test of the hypothesis that SCT symptoms would be associated with slower performance on tasks having greater graphomotor and fine motor demands. Participants were 80 adolescents (ages 13-17 years; 71% male) with attention-deficit/hyperactivity disorder (ADHD). Adolescents and parents completed ratings of SCT. Adolescents were administered the Wechsler Symbol Search and Coding subtests and the Grooved Pegboard Test. When adjusting for age, sex, and ADHD symptom severity, parent-reported SCT symptoms were not significantly associated with Symbol Search or Coding scores but were significantly associated with slower Grooved Pegboard time. Adolescent-reported SCT symptoms were not significantly associated with Symbol Search but were significantly associated with lower Coding scores and slower Grooved Pegboard time. Findings provide preliminary support for the hypothesis that SCT may be more clearly associated with processing speed task performance as motor demands increase and provide a potential explanation for the mixed literature on SCT in relation to processing speed by demonstrating that the presence and magnitude of associations vary by informant and task.