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Wiggs KK, Thornton K, Dunn NC, Mitchell JT, Fredrick JW, Smith ZR, Becker SP. Mindful Awareness Practices (MAPs) in Adolescents With ADHD and Cognitive Disengagement Syndrome (CDS): A Pilot Open Trial. J Atten Disord 2025; 29:83-100. [PMID: 39402941 DOI: 10.1177/10870547241290182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2024]
Abstract
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.
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Affiliation(s)
- Kelsey K Wiggs
- Cincinnati Children's Hospital Medical Center, OH, USA
- Indiana University School of Medicine, Indianapolis, USA
| | | | | | | | - Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | | | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
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2
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Fredrick JW, Jacobson LA, Peterson RK, Becker SP. Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research. Child Neuropsychol 2024; 30:783-817. [PMID: 37712631 PMCID: PMC10940202 DOI: 10.1080/09297049.2023.2256052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
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.
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Affiliation(s)
- Joseph W. Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute; Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Rachel K. Peterson
- Department of Neuropsychology, Kennedy Krieger Institute; Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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3
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Becker SP, Martinez AC, Wiggs KK, Langberg JM, Smith ZR. Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning. Eur Child Adolesc Psychiatry 2024; 33:2189-2201. [PMID: 37804421 DOI: 10.1007/s00787-023-02311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
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.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew C Martinez
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Joshua M Langberg
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Luedke JC, Vargas G, Jashar DT, Morrow A, Malone LA, Ng R. Cognitive disengagement syndrome in pediatric patients with long COVID: associations with mood, anxiety, and functional impairment. Child Neuropsychol 2024; 30:652-672. [PMID: 37667487 DOI: 10.1080/09297049.2023.2252967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
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.
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Affiliation(s)
- Jessica C Luedke
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Gray Vargas
- Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Amanda Morrow
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rowena Ng
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Sibley MH, Graziano PA, Coxe SJ, Bickman L, Martin P, Flores S. A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity. Behav Ther 2023; 54:839-851. [PMID: 37597961 PMCID: PMC10440417 DOI: 10.1016/j.beth.2023.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19-.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute.
| | | | | | - Leonard Bickman
- Center for Children & Families, Florida International University
| | | | - Sabrina Flores
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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6
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Darow EL, Flax MA, Clark OE, Holmbeck GN, Smith ZR. Comparing Cognitive Disengagement Syndrome Growth in Youth With and Without Spina Bifida. J Pediatr Psychol 2023; 48:720-730. [PMID: 37418009 PMCID: PMC10467645 DOI: 10.1093/jpepsy/jsad038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
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.
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Affiliation(s)
- Eva L Darow
- Nationwide Children’s Hospital, USA
- Department of Psychology, Loyola University of Chicago, USA
| | - Marcus A Flax
- Department of Psychology, Loyola University of Chicago, USA
| | - Olivia E Clark
- Department of Psychology, Loyola University of Chicago, USA
| | | | - Zoe R Smith
- Department of Psychology, Loyola University of Chicago, USA
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7
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Becker SP, Willcutt EG, Leopold DR, Fredrick JW, Smith ZR, Jacobson LA, Burns GL, Mayes SD, Waschbusch DA, Froehlich TE, McBurnett K, Servera M, Barkley RA. Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome. J Am Acad Child Adolesc Psychiatry 2023; 62:629-645. [PMID: 36007816 PMCID: PMC9943858 DOI: 10.1016/j.jaac.2022.07.821] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio.
| | | | | | - Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | | | - Lisa A Jacobson
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Susan D Mayes
- Waschbusch are with Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Tanya E Froehlich
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | - Keith McBurnett
- University of California San Francisco, San Francisco, California
| | - Mateu Servera
- IDISBA Institute, University of the Balearic Islands, Palma, Spain
| | - Russell A Barkley
- Virginia Commonwealth University, School of Medicine, Richmond, Virginia
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8
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Fredrick JW, Becker SP. Sluggish Cognitive Tempo (Cognitive Disengagement Syndrome) and Academic Functioning: A Systematic Review and Agenda for Future Research. Clin Child Fam Psychol Rev 2023; 26:82-120. [PMID: 36117226 DOI: 10.1007/s10567-022-00411-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 02/01/2023]
Abstract
The past two decades have witnessed substantial interest in sluggish cognitive tempo (SCT), a set of symptoms (e.g., excessive daydreaming, mental confusion, slowed behavior) distinct from attention-deficit/hyperactivity disorder (ADHD) and other psychopathology symptoms. Despite evidence linking SCT to a range of functional outcomes, findings for academic functioning are unclear. The current review summarizes the literature on SCT and academic functioning and offers an agenda for future research. A systematic review was conducted to identify studies assessing SCT and academic outcomes, including academic impairments and performance, in childhood, adolescence, and young adulthood. Sixty studies were retained (53 cross-sectional, 7 longitudinal) from 44 separate samples, with the majority (n = 32, 53%) assessing global ratings of academic impairment and fewer measuring specific academic domains or standardized achievement test scores. Findings were generally consistent in showing SCT to be correlated with global ratings of academic impairment, lower grades, and inconsistently associated with poorer math and reading scores. Findings were more mixed when controlling for ADHD symptoms, intelligence, and/or demographic factors. Overall, SCT is associated with poorer academic functioning, although inconsistencies and key limitations are common across studies. Ten directions for future research are offered to advance understanding of how SCT may be associated with or impact academic functioning.
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Affiliation(s)
- Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Becker SP, Epstein JN, Burns GL, Mossing KW, Schmitt AP, Fershtman CEM, Vaughn AJ, Zoromski AK, Peugh JL, Simon JO, Tamm L. Academic functioning in children with and without sluggish cognitive tempo. J Sch Psychol 2022; 95:105-120. [PMID: 36371121 PMCID: PMC9663971 DOI: 10.1016/j.jsp.2022.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Kandace W Mossing
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Aidan P Schmitt
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Chaya E M Fershtman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron J Vaughn
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allison K Zoromski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John O Simon
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Hossain B, Bent S, Parenteau C, Widjaja F, Davis M, Hendren RL. The Associations Between Sluggish Cognitive Tempo, Internalizing Symptoms, and Academic Performance in Children With Reading Disorder: A Longitudinal Cohort Study. J Atten Disord 2022; 26:1576-1590. [PMID: 35373641 PMCID: PMC9373189 DOI: 10.1177/10870547221085493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether sluggish cognitive tempo (SCT) was associated with anxiety, depression, and academic performance (AP) in children with reading disorder (RD), and whether ADHD-Inattention (ADHD-IN) moderated these relationships. METHOD Parents and teachers of children with RD (N = 147, ages 6-18) completed evaluations of SCT, ADHD, anxiety, depression, and AP, every 3 months for 18 months. Baseline and longitudinal associations between SCT and outcomes, and effect moderation of ADHD-IN, were assessed. RESULTS Teacher-rated SCT was positively associated with teacher-rated anxiety (p < .001) and negatively associated with AP (p < .001) cross-sectionally and longitudinally, with significant effect modification by ADHD-IN for both outcomes. SCT was not associated with depression in adjusted cross-sectional and longitudinal analyses. There were no significant findings for any parent-reported measures. CONCLUSION SCT has negative effects on anxiety and AP in children with RD among individuals with low ADHD-IN according to teacher report. Targeted treatment of SCT may provide substantial benefits.
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Affiliation(s)
- Bushra Hossain
- University of California, San
Francisco, CA, USA,Bushra Hossain, Department of Psychiatry,
University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Stephen Bent
- University of California, San
Francisco, CA, USA
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11
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Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization. Res Child Adolesc Psychopathol 2022; 50:809-822. [PMID: 35420391 DOI: 10.1007/s10802-022-00923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
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 (Mage = 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.
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12
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Becker SP, Fredrick JW, Foster JA, Yeaman KM, Epstein JN, Froehlich TE, Mitchell JT. "My mom calls it Annaland": A Qualitative Study of Phenomenology, Daily Life Impacts, and Treatment Considerations of Sluggish Cognitive Tempo. J Atten Disord 2022; 26:915-931. [PMID: 34623188 DOI: 10.1177/10870547211050946] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To conduct qualitative analysis of interviews to understand phenomenology, daily life impact, and treatment considerations of sluggish cognitive tempo (SCT) behaviors in children and adolescents. Method: Youth with elevated SCT symptoms (N = 15, ages 9-16 years) and their parents completed interviews focused on their perception and daily life impact of SCT behaviors. Parents were also asked about intervention targets. Results: Parents and youth had both negative and positive perceptions of SCT, with SCT fostering creativity/imagination and a break from stressors while also negatively impacting daily functioning. The domains most frequently selected by parents as SCT intervention targets were academics, emotions, mind wandering, morning routines, and self-esteem. Conclusion: Children and their parents share negative and positive views of SCT behaviors, while also detailing specific ways that SCT negatively impacts day-to-day functioning. This study offers insights into possible intervention targets as provided by youth and parents directly impacted by SCT.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | | | - Josalyn A Foster
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | | | - Jeffery N Epstein
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
| | - Tanya E Froehlich
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Medicine, OH, USA
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Smith ZR, Del Castillo A, Clark OE, Holmbeck GN. Working memory and cognitive flexibility predict growth trajectories of sluggish cognitive tempo in youth with spina bifida. Child Neuropsychol 2022; 28:1052-1071. [PMID: 35196965 DOI: 10.1080/09297049.2022.2042503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As sluggish cognitive tempo (SCT) shows similar inattention and neuropsychological dysfunction as youth with spina bifida (SB), it is important to examine whether neuropsychological functioning may affect the development of SCT in this population. Participants were 140 youth with SB and their parents who participated in five waves of a longitudinal study across eight years (ages 8-15 years at Time 1). At Time 1, teacher-, mother-, and father-report of SCT showed 9%, 8.3%, and 5.3% impairment in SCT respectively compared to other youth in the sample. Growth curves were used to examine changes over time in mother-, father-, and teacher-reported SCT. Four neurocognitive variables were included (attention, working memory, cognitive flexibility, plan/organize) as predictor variables of SCT growth and intercepts. Mother, father, and teacher-report of SCT were included in separate models. Age and shunt status were included as covariates in the growth models. Inattentive symptoms were also included as a covariate in working memory, shift, and plan/organize models. Worse working memory at Time 1 predicted an increase in mother-reported SCT symptoms over eight years (β = -.28) and poorer cognitive shifting skills predicted higher rates of teacher-reported SCT over time (β = -.61). All other neurocognitive variables predicted the intercept, but not the slope of SCT symptoms. Results indicate that worse neurocognitive functioning is associated with higher levels of SCT symptoms and that worse working memory and cognitive flexibility at baseline predicted an increase in SCT symptoms as youth with SB age. It may be important for clinicians to monitor and assess levels of SCT in youth with SB.
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Affiliation(s)
- Zoe R Smith
- The Psychology Department, Loyola University Chicago, Chicago, IL, USA
| | | | - Olivia E Clark
- The Psychology Department, Loyola University Chicago, Chicago, IL, USA
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O'Hare K, White N, Harding R, Galland B, Sellbom M, Shine B, Schaughency E. Sluggish Cognitive Tempo and Daytime Sleepiness Mediate Relationships Between Sleep and Academic Performance. J Dev Behav Pediatr 2021; 42:637-647. [PMID: 34074917 DOI: 10.1097/dbp.0000000000000948] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep difficulties, daytime sleepiness, and sluggish cognitive tempo (SCT) are associated with impairments in academic performance. SCT refers to symptoms of sluggishness, tiredness/lethargy, and slowed thinking/processing, but despite symptom overlap with sleepiness, research examining interrelations of SCT with sleep and daytime sleepiness is limited. The aims of this study were to evaluate the relationship between SCT and daytime sleepiness and to examine pathways between sleep, daytime sleepiness, SCT, and academic performance. METHOD Participants were a community sample of 1628 parents/caregivers of children aged between 6 and 10 years who completed questionnaires about their child's behavior, sleep, and academic performance. Confirmatory factor analysis was used to examine whether SCT was distinct from daytime sleepiness. Then, structural equation modeling was used to examine direct and indirect pathways between sleep (sleep-disordered breathing [SDB] symptoms, sleep duration, and latency), daytime sleepiness, SCT, and academic performance in reading, writing, and math. RESULTS SCT and daytime sleepiness were distinct but moderately correlated (r = 0.33, p ≤ 0.001). Sleep, in particular SDB symptoms, predicted increased SCT and daytime sleepiness. SCT was directly and negatively associated with all domains of academic performance, daytime sleepiness was associated with poorer reading performance, and longer sleep duration was directly associated with poorer math performance. SCT and, to a lesser extent, daytime sleepiness mediated effects of sleep on academic performance. CONCLUSION SCT symptoms are important for understanding how sleep difficulties affect academic performance in children. Sleep, daytime sleepiness, and SCT are interrelated but distinct factors that affect children's academic performance.
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Affiliation(s)
- Kirstie O'Hare
- Departments of Psychology
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Naomi White
- Departments of Psychology
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Rebecca Harding
- Departments of Psychology
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara Galland
- Women's and Children's Health, University of Otago, Dunedin, New Zealand
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15
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Peterson RK, Jones K, Jacobson LA. The contribution of sluggish cognitive tempo to processing speed in survivors of pediatric brain tumors. Child Neuropsychol 2021; 27:960-972. [PMID: 33866922 PMCID: PMC8574989 DOI: 10.1080/09297049.2021.1917529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
Sluggish Cognitive Tempo (SCT) describes a pattern of under-activity, poor initiation, and slowness. It was first reported within the Attention Deficit Hyperactivity Disorder (ADHD) literature and found to be positively associated with the inattentive symptoms of ADHD and negatively or not significantly associated with the hyperactivity/impulsivity symptoms of ADHD. SCT has since been considered applicable to the pediatric oncology population given the emergence of inattentive, sluggish symptoms secondary to cancer treatment. The present study examined the unique contribution of SCT to various processing speed skills in a clinical sample of pediatric brain tumor (BT) survivors in order to determine the degree to which SCT explained timed "cognitive" processing components. Measures included speeded naming, graphomotor speed, and speeded inhibition. Hierarchical linear regression analyses were used to predict performance-based measures of processing speed. After controlling for verbal ability and inattention, SCT, particularly Daydreamy SCT (β = -0.698, p = 0.023), explained 28% of variance in speeded inhibition. SCT did not add significantly to the prediction of speeded naming or graphomotor speed. Findings suggest that the "daydreamy" aspect of SCT, rather than "sluggishness" per se, may be related to more complex, cognitively-demanding tasks with greater executive functioning burdens in BT survivors. Implications for intervention for oncology survivors as well as future research directions are discussed.
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Affiliation(s)
- Rachel K. Peterson
- Kennedy Krieger Institute Neuropsychology Department
- Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Kelly Jones
- Kennedy Krieger Institute Neuropsychology Department
| | - Lisa A. Jacobson
- Kennedy Krieger Institute Neuropsychology Department
- Johns Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences
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16
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Relationship Between Sluggish Cognitive Tempo and Age and IQ in Preschool and School-Age Children and Adolescents with Autism and with ADHD. J Autism Dev Disord 2021; 52:3746-3754. [PMID: 34347230 DOI: 10.1007/s10803-021-05222-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
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.
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17
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Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade. J Am Acad Child Adolesc Psychiatry 2021; 60:690-709. [PMID: 33166623 PMCID: PMC8099929 DOI: 10.1016/j.jaac.2020.10.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the measures designed to assess sluggish cognitive tempo (SCT) since the first SCT scale using careful test-construction procedures was published in 2009. METHOD MEDLINE (PubMed), Embase, PsychINFO, and Web of Science databases were searched from September 2009 through December 2019. Articles reporting on reliability (internal consistency, test-retest, and interrater reliability), structural validity (an aspect of construct validity focused on items' convergent and discriminant validity), concurrent and longitudinal external validity, invariance, or intervention/experimental findings were included. RESULTS Full criteria for data extraction and inclusion were met by 76 studies. Nine measures for assessing SCT were identified (7 assessing parent report, teacher report, and/or self-report in children and 2 assessing self-report and/or collateral informant report in adults). Each measure demonstrated acceptable to excellent reliability. All or at least the majority of SCT items on each measure also had structural validity (high loadings on an SCT factor and low loadings on an attention-deficit/hyperactivity disorder [ADHD] inattention factor). Studies have supported the invariance of SCT across sex and time, and there is initial evidence of invariance across informants, youths with ADHD and youths without ADHD, and ADHD presentations. The Child and Adolescent Behavior Inventory (CABI), Child Concentration Inventory, Second Edition (CCI-2), and Barkley Adult ADHD Rating Scale-IV (BAARS-IV) have particularly strong support for assessing parent/teacher-reported, youth self-reported, and adult self-reported SCT, respectively. CONCLUSION The SCT measures included in this review share numerous positive properties, have promising psychometric support, and have proven useful for examining the external correlates of SCT across the life span. Although substantial progress has been made over the last decade, work remains to be done to further improve the assessment of SCT and key directions for future research are provided.
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Becker SP, Dvorsky MR, Tamm L, Willoughby MT. Preschool Neuropsychological Predictors of School-aged Sluggish Cognitive Tempo and Inattentive Behaviors. Res Child Adolesc Psychopathol 2021; 49:197-210. [PMID: 33369703 PMCID: PMC7855990 DOI: 10.1007/s10802-020-00728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
Sluggish cognitive tempo (SCT) is characterized by excessive daydreaming, slowed thinking, and mental confusion and 'fogginess'. A growing body of research supports the empirical differentiation of sluggish cognitive tempo (SCT) from the inattentive (IN) behaviors that characterize attention-deficit/hyperactivity disorder (ADHD). Further SCT and IN are uniquely associated with clinical correlates across academic, social, and emotional domains; however, there is limited understanding of how neuropsychological functioning contributes to SCT and/or IN behaviors. The two broad domains of neuropsychological functioning that have been most frequently examined in relation to SCT behaviors are processing speed and executive functions (EF). The present study tested whether EF and processing speed measured when children were on average age five years were predictive of teacher-rated IN and SCT behaviors in 1st - 3rd grades. Participants included 1,022 children from the Family Life Project, an ongoing prospective longitudinal study of child development in low-income, non-metropolitan communities. EF and processing speed uniquely made independent contributions to the prediction of IN and SCT. In secondary analyses that focused on specific facets of EF and processing speed, inhibitory control and working memory abilities predicted lower IN but not SCT behaviors, whereas slower processing speed significantly predicted both greater SCT and IN behaviors. These results are discussed as they inform developmental models of SCT and IN.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Melissa R Dvorsky
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael T Willoughby
- Education and Workforce Development, RTI International, Research Triangle Park, NC, USA.
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