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Pagán AF, Huizar YP, Short TR, Gotcher Z, Schmidt AT. Adult Attention-Deficit/Hyperactivity Disorder: a Narrative Review of Biological Mechanisms, Treatments, and Outcomes. Curr Neurol Neurosci Rep 2023:10.1007/s11910-023-01280-4. [PMID: 37335460 DOI: 10.1007/s11910-023-01280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous and complex neurodevelopmental disorder related to disruptions in various neuronal structures and pathways, dopamine (DA) transporter, and receptor genes, resulting in cognitive and regulation deficits. This article reviews recent research on the biological mechanisms and markers, clinical manifestations, treatments, and outcomes of adult ADHD as well as current controversies within the field. RECENT FINDINGS New research identifies white matter disruptions in multiple cortical pathways in adults with ADHD. New treatments for ADHD in adults such as viloxazine ER have shown preliminary effectiveness in addition to research showing transcranial direct current stimulation can be an effective treatment for adults with ADHD. Although questions exist about the effectiveness of current assessments of and treatments for adult ADHD, recent findings represent a step towards improving the quality of life and outcomes for individuals experiencing this life-long, chronic health condition.
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Affiliation(s)
- Antonio F Pagán
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA.
| | - Yazmine P Huizar
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Tucker R Short
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Zoe Gotcher
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Psychological Sciences Building, 2700 18th St, Lubbock, TX, 79410, USA
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Gul A, Gul H. 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. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104557. [PMID: 37327573 DOI: 10.1016/j.ridd.2023.104557] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/14/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Ahmet Gul
- Ufuk University, School of Medicine, Department of Psychiatry, Turkey
| | - Hesna Gul
- Ufuk University, School of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
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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: 35] [Impact Index Per Article: 35.0] [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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Wiggs KK, Froehlich TE, Becker SP. Pharmacologic Management of Cognitive Disengagement Syndrome (CDS) and Implications for Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment: Emerging Treatments and Recommendations for Future Research. CNS Drugs 2023; 37:293-304. [PMID: 37061629 DOI: 10.1007/s40263-023-00999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/17/2023]
Abstract
Although the study of cognitive disengagement syndrome (CDS; previously called sluggish cognitive tempo) first emerged in the 1980s, very little is known about treating CDS or its impact on evidence-based interventions for attention-deficit/hyperactivity disorder (ADHD) with which it frequently co-occurs. The objective of this leading article was to investigate the existing evidence on medication treatment and CDS, including studies that have examined CDS response to medication and CDS as a moderator of ADHD treatment response. A total of seven studies were identified. At present, the limited existing literature suggests that psychostimulants such as methylphenidate and lisdexamfetamine, as well as atomoxetine, may improve CDS symptoms, although replication and research on related medications is needed. However, there are indications that CDS symptoms may predict a reduced response to methylphenidate in children with ADHD. Although untested, research on the neurobiological, neuropsychological, and behavioral correlates of CDS point to a possible benefit of other ADHD medications (e.g., guanfacine), medications that treat narcolepsy (e.g., modafinil), and medications traditionally used to treat depression and anxiety (e.g., viloxazine, bupropion, fluvoxamine), some of which have also recently been used in ADHD management. The article concludes with recommendations for future research on pharmacologic treatment and CDS.
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Affiliation(s)
- Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45206, USA
| | - Tanya E Froehlich
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45206, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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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: 0.5] [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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Gul A, Gul H. 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. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 121:104155. [PMID: 34968870 DOI: 10.1016/j.ridd.2021.104155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Ahmet Gul
- Ufuk University, School of Medicine, Department of Psychiatry, Turkey
| | - Hesna Gul
- Gulhane Research and Training Hospital, Department of Child and Adolescent Psychiatry, Turkey.
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