I was diagnosed 10 years ago with Inattentive ADHD, and only just recently I discovered that there’s a subtype that more accurately describes me. I’ve read a fair bit about ADHD, however I had never heard of Sluggish Cognitive Tempo (SCT), http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo (http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo) .

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I’m wondering if anyone can share with me what you may know about SCT and how it’s been approached, treatment wise.

It's not been substantiated as a "separate" disorder.

Therefore, ADHD-PI type remains as is.

Also might want to try www.amenclinic.com (http://www.amenclinic.com) : under self tests there is a "brain stem" (or something like that) test.

another site is Http://www.add101.com/types.htm (http://www.add101.com/types.htm)

Granted, please remember these are both only tools to possibly assist your doctor... but there is some interesting information on these sites.

Enjoy

Barkley's transcript from his lecture in San Fran 2000 is interesting. Go to the page 5 subheading entitled, is ADHD inattentive subtype another disorder?
you will have to download the pdf -> http://www.schwablearning.org/Articles.asp?r=54
The topic was hashed out to death on a previous thread. Do a search on here under the heading SCT.
I saw Barkley last year and he said, "the field is wide open". This is a relatively new area of research in ADHD.

A thread where I am going to stick SCT stuff that I find.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811
SCT
-A significant subset are hypoactive and sluggish and have slow response speeds.
-Primary deficit in working memory, especially prominent in auditory processing because of the demands it places on working memory
-Tend to be overely self-conscious
-Social problems because too passive, shy, or withdrawn
More likely to be introverted
-Internalizing disorders, such as anxiety or depression, are somewhat more common in children with ADD than those with ADHD. ADD children tend to be socially isolated or withdrawn. Reading and language deficits and problems with mental mathematical calculations are more commonly comorbid with ADD than with ADHD.
-A significant percentage are not helped by methylphenidate.
Most respond positively to methylphenidate in moderate to high doses. Those who are helped by methylphenidate often do best at low doses. A significant subset are helped by amphetamines rather than methylphenidate. Amphetamines affect both the reuptake and release of catecholamines. A marked deficit in the release of DA and NE might cause sluggishness and underarousal.
-People with ADD are not so much easily distracted as easily bored. Their problem lies more in motivation than in inhibition.
-Individuals with ADD, although typically shy, may engage in risk-taking and thrill-seeking activities as ways to experience a level of engagement they have difficulty sustaining in their daily lives.
-A primary disturbance in prefrontal cortex is implicated.
-The primary neural circuit that is affected may be a frontal–parietal one.
-The 7-repeat allele polymorphism of the DRD4 gene is more strongly linked to ADD than to ADHD. This is consistent with the centrality of prefrontal cortex in ADD because the D4 DA receptor is present in prefrontal cortex but not in the striatum in humans.

and in more detail from the same site....

Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity)

ADELE DIAMOND
Abstract

Most studies of attention-deficit/hyperactivity disorder (ADHD) have focused on the combined type and emphasized a core problem in response inhibition. It is proposed here that the core problem in the truly inattentive type of ADHD (not simply the subthreshold combined type) is in working memory. It is further proposed that laboratory measures, such as complex-span and dual-task dichotic listening tasks, can detect this. Children with the truly inattentive type of ADHD, rather than being distractible, may instead be easily bored, their problem being more in motivation (under-arousal) than in inhibitory control. Much converging evidence points to a primary disturbance in the striatum (a frontal–striatal loop) in the combined type of ADHD. It is proposed here that the primary disturbance in truly inattentive-type ADHD (ADD) is in the cortex (a frontal–parietal loop). Finally, it is posited that these are not two different types of ADHD, but two different disorders with different cognitive and behavioral profiles, different patterns of comorbidities, different responses to medication, and different underlying neurobiologies.

I join the growing chorus of those who argue that attention-deficit/hyperactivity disorder (ADHD) of the “truly” inattentive subtype (what I will call “attention-deficit disorder” [ADD]) is a different disorder from ADHD where hyperactivity is present (e.g., Barkley, 2001; Cantwell, 1983; Carlson, 1986; Carlson & Mann, 2000; Goodyear & Hynd, 1992; Hynd, Lorys, Semrud–Clikeman, Nieves, Huettner, & Lahey, 1991; in particular see the outstanding paper by Milich, Balentine, & Lynam, 2001). Not only is “ADHD without hyperactivity” (ADHD of the predominantly inattentive type) an awkward locution, but it also tries to squeeze ADD into a box in which it does not belong. The term ADHD should be reserved for when hyperactivity is present (as the term implies), regardless of whether inattention is also present.

The points I make in this paper include the following: many individuals currently diagnosed with the inattentive subtype of ADHD appear to be misdiagnosed. ADD appears to be an instance of childhood-onset “dysexecutive syndrome.” ADD and ADHD are characterized by dissociable cognitive and behavioral profiles, different patterns of comorbidities, different responses to medication, and different underlying neurobiological problems. The core cognitive deficit of ADD is in working memory. Contrary to what many have claimed (that laboratory tests cannot capture the core cognitive deficits in ADD), I argue that complex-span and dual-task dichotic listening tasks can indeed capture them. The working memory deficit in many children with ADD is accompanied by markedly slowed reaction times, a characteristic that covaries with poorer working memory in general. Individuals with ADD are not so much distractible as easily bored and underaroused. I hypothesize that the DAT1 gene will be found to be more closely linked to ADHD than to ADD, whereas the DRD4 gene will be found to be more closely linked to ADD than to ADHD, and that the primary neural circuit affected in ADHD is frontal–striatal, whereas the primary neural circuit affected in ADD is frontal–parietal.

The current DSM-IV (American Psychiatric Association [APA], 1994) diagnostic guidelines list three subtypes of ADHD: (a) primarily inattentive, (b) primarily hyperactive and impulsive, or (c) both combined. ADHD conceived in this manner is by far the most commonly diagnosed psychological/behavioral disorder of childhood (e.g., Barkley, DuPaul, & McMurray, 1990; Szatmari, 1992; Weiss & Hechtman, 1979).

Individuals with ADHD of the inattentive subtype tend to be disorganized, easily pulled off course, forgetful, and inattentive (DSM-IV; APA, 1994). They tend to be disorganized mentally and physically. They tend to make careless mistakes, and are not good at paying close attention to detail. They have difficulty organizing their work, setting priorities, planning out a strategy, and remembering to do all required tasks. They have difficulty organizing their things and tend to be sloppy. They have trouble keeping track of their belongings and forget where they have put them, in part because they rarely put things away. If multiple items are needed for an assignment or task, they will typically forget one or more. They have trouble keeping track of multiple things held in mind, which can make arithmetic calculation, reading, or abstract problem solving difficult.

Individuals with ADHD of the inattentive type also tend to have a hard time sustaining focused attention on a task or activity. They are quite poor at following through on something to completion. They tend to get bored with a task fairly quickly and often abandon a task unfinished, bouncing from one partially begun project to another. They may have a hard time keeping their mind on any one thing at a time. When doing homework or reading, they often find their minds wandering. Because focusing deliberate, conscious attention on completing a task is so arduous or aversive for individuals with the inattentive subtype of ADHD, they tend to try to avoid beginning a task, procrastinate, may forget to write an assignment down, forget to bring home the materials needed to complete an assignment, or lose materials needed for an assignment.

In 1986 Baddeley coined the term dysexecutive syndrome to refer to adults who seem to have a deficient “central executive” and who thus appear to be disorganized, easily pulled off course, forgetful, and inattentive. As far as I know, dysexecutive syndrome has always been used with reference to adults. I would like to suggest that children with ADHD of the inattentive subtype provide an instance of the dysexecutive syndrome in children. Dysexecutive syndrome patients may go off on tangents or lose their train of thought. Individual skills, such as encoding an item into memory or retrieving an item from memory, are intact. However, dysexecutive patients “have problems in initiating [a chore], monitoring their performance, and . . using such information to adjust their behavior. As most tests concentrate on the building blocks or component skills and are less concerned with the integration of these skills into real-life tasks, many [dysexecutive] patients … perform adequately on frontal lobe tasks … In contrast, many everyday activities involving executive abilities require patients to organize, or plan their behavior over longer time periods or to set priorities in the face of two or more competing tasks” (Wilson, Evans, Emslie, Alderman, & Burgess, 1998, p. 214). It is on such everyday activities that the dysexecutive deficit is most evident. Dysexecutive patients often start out performing a task well, but quickly become sidetracked. It is hard for them to stay focused on the task at hand, and they commonly must be reminded of what it was they were supposed to be doing.

The DSM-IV cutoffs for the inattentive, hyperactive, and combined subtypes of ADHD were derived largely from research with young males, who are more prone to hyperactivity and impulsivity than are girls or older males or females. Hence, some individuals get miscategorized as inattentive-type ADHD, despite being hyperactive for their gender or age, because they are not significantly more hyperactive or impulsive than young boys (e.g., Carlson & Mann, 2002; deHaas & Young, 1984; Milich et al., 2001; Weiss, Worling, & Wasdell, 2003). Such individuals should be considered the combined type. In this article, I focus on individuals with ADD (those who meet the criteria for inattentive-type ADHD and who are not hyperactive, excluding those with significant hyperactivity even if subthreshold for a combined-type diagnosis according to current DSM criteria). There is considerable overlap between what I am calling “ADD” and what others have called “slow cognitive tempo” (SCT; e.g., Milich et al., 2001), but SCT includes additional features that characterize only a subset of children with ADD. I reserve use of the term ADHD for ADHD that includes prominent hyperactivity (which for all practical purposes means combined-type ADHD because predominantly hyperactive ADHD is so rare after the age of 6).

Children with combined-type ADHD have many of the above symptoms, but they also have great difficulty sitting still (APA, 1994). They are overactive (motor and verbal), restless, and always on the go. They are overly talkative, fidgety, and squirmy. They often do repetitive motions like wiggling their feet or tapping their pencil. They get up when remaining seated is expected. They can talk incessantly and have difficulty playing quietly.

They also tend to be impulsive (APA, 1994) and are inclined to be very disorganized and sloppy, because they are often too impatient to carefully attend to detail or to put things away. They can have trouble waiting their turn, may blurt out an answer before hearing the whole question, and may interrupt others. They may intrude on others' conversation or game, without considering beforehand that it might be inappropriate. Because they tend to act impulsively, they may run into the street without looking or grab a toy from another child.

ADD and ADHD That Includes Hyperactivity Are Dissociable Disorders
Whereas children with ADHD are frenetic and hyperactive, a significant proportion of children with ADD are exactly the opposite. A significant subset of children with ADD are hypoactive, sluggish, and very slow to respond (see Table 1). Children with ADHD are often insufficiently self-conscious; children with ADD tend to be overly self-conscious. Both groups tend to have social problems, but for different reasons. An ADHD child is likely to have social problems because he/she alienates other children by butting in, taking their things, failing to wait his or her turn, and in general, acting without having first considered the feelings of others (e.g., Lahey, Schaughency, Hynd, Carlson, & Niever, 1987). On the other hand, a child with ADD is likely to have social problems because of being too passive, shy, or withdrawn (e.g., Goodyear & Hynd, 1992; Hinshaw, 2002; Maedgen & Carlson, 2000). His or her quietness or slowness to respond may be misinterpreted by others as aloofness, disinterest, or unresponsiveness. Children with ADHD tend to be extroverted; children with ADD do not.

Because of their disruptive behavior, children with ADHD are more likely to be suspended or expelled from school (Weiss et al., 2003). Conduct disorder and aggressivity are far more commonly comorbid with ADHD than with ADD (e.g., Barkley et al., 1990; Barkley, DuPaul, & McMurray, 1991; Faraone, Biederman, Wever, & Russell, 1998; Edelbrock, Costello, & Kessler, 1984; Goodyear & Hynd, 1992; Lahey et al., 1987; Morgan, Hynd, Riccio, & Hall, 1996; Nigg, 2000; Weiss et al., 2003). Conversely, children with ADD are somewhat more prone to internalizing disorders such as anxiety or depression (or at least show a marked absence of externalizing disorders) and tend to be more socially isolated or withdrawn than are children with ADHD (Barkley et al., 1990, 1991; Faraone, Biederman, Wever, & Russell, 1998; Edelbrock, Costello, & Kessler, 1984; Goodyear & Hynd, 1992; Lahey et al., 1987; Morgan, Hynd, Riccio, & Hall, 1996; Nigg, 2000; Weiss et al., 2003). Reading and language deficits are more commonly comorbid with ADD than with ADHD (Faraone et al., 1998; Warner–Rogers, Taylor, Taylor, & Sandberg, 2000; Weiss et al., 2003; Willcutt & Pennington, 2000) as are problems with mental mathematical calculations (Carlson, Lahey, & Neeper, 1986; Hynd et al., 1991; Marshall, Hynd, Handwerk, & Hall, 1997; Morgan et al., 1996).

Most children with ADHD (perhaps as high as 90%; Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003) respond positively to methylphenidate (Ritalin) and over two-thirds of such children respond positively to methylphenidate in moderate to high doses (Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003). In contrast, a significant percentage of children with ADD are not helped by methylphenidate and those who are helped often do best at low doses (Barkley, 2001; Barkley et al., 1991; Milich et al., 2001; Weiss et al., 2003). Many individuals with ADD are helped by amphetamines, such as Adderall. There is considerable overlap in the mechanisms of action of methylphenidate and amphetamines, but there is a significant difference. Although both methylphenidate and amphetamines inhibit reuptake of dopamine and norepinephrine, only amphetamines also promote release of those neurotransmitters. Recent research also suggests that low doses of methylphenidate (the dosages likely to be efficacious in treating ADD) preferentially release norepinephrine in the rat brain (Ishimatsu, Kidani, Tsuda, & Akasu, 2002). Possible problems with the neural release of norepinephrine in ADD are relevant to motivational issues discussed later.

There is also some evidence for differential responsivity to nicotine. There are marked similarities in the neurobiological and psychological effects of nicotine and methylphenidate (e.g., Pomerleau, 1997). It has been hypothesized that individuals with ADHD who are not taking stimulant medication may try to self-medicate by smoking. Certainly, unmedicated adolescents with ADHD smoke far more than do their medicated ADHD peers and their non-ADHD peers (Whalen, Jamner, Henker, Gehricke, & King, 2003). Krause, Dresel, Krause, la Fougere, and Ackenheil (2003) report that individuals with ADHD are far more likely to smoke than are individuals with ADD: “It was striking how many of the 20- to 40-year-old patients in our group, who had shown symptoms of hyperactivity and impulsivity in childhood, were smokers: nine smoked and only three were non-smokers … The opposite was shown in the patients with only inattentive symptoms throughout their whole life: only two smoked, seven were non-smokers” (pp. 610–611; although note that Tercyak, Lerman, & Audrain, 2002, report the opposite).

Filipek, Semrud–Clikeman, Steingard, Renshaw, Kennedy, and Biederman (1997) report that individuals with ADHD who respond favorably to stimulant medication have the smallest caudate nuclei. There is now converging evidence for a primary disturbance in the striatum in children with ADHD. Both structural and functional neuroimaging studies report striatal abnormalities in children with ADHD. Structural magnetic resonance imaging studies consistently find smaller caudate volumes and reversed caudate asymmetry in those with ADHD (Aylward, Reiss, Reader, Singer, Brown, & Denckla, 1996; Castellanos, Elia, Kruesi, Gulotta, Mefford, Potter, Ritchie, & Rapoport, 1994; Castellanos et al., 1996; Filipek et al., 1997; Hynd, Hern, Novey, Eliopulos, Marshall, Gonzalez, & Voeller, 1993; Mataro, Garcia–Sanchez, Junque, Estevez–Gonzalez, & Pujol, 1997; Schrimsher, Billingsley, Jackson, & Moore, 2002), although the laterality of the differences and direction of left–right asymmetry have not always been consistent across studies. Functional neuroimaging studies report less striatal activity in ADHD children while they are performing response–inhibition tasks compared to age-matched controls (Durston, Tottenham, Thomas, Davidson, Eigsti, Yang, Ulug, & Casey, 2003; Lou, Hendriksen, & Bruhn, 1984; Lou, Hendriksen, Bruhn, Borner, & Nielsen, 1989; Teicher, Ito, Glod, & Barber, 1996; Vaidya, Austin, Kirkorian, Ridlehuber, Desmond, Glover, & Gabrieli, 1998; Zametkin, Liebenauer, Fitzgerald, King, Minkunas, Herscovitch, Yamada, & Cohen, 1993). Hyperactivity is more typically found after structural damage to the striatum than after structural damage to frontal cortex. Motor hyperactivity is not a prominent characteristic of frontal patients, although an impulsive, manic type of activity (such as marked verbosity) can sometimes be seen in frontal patients. In contrast, patients with Parkinson disease (where the primary disturbance is in the striatum) can show a kind of motor restlessness (called “akathisia”; Lang & Johnson, 1987).

Dopamine transporter (DAT) is the principal mechanism for reuptake of released dopamine. DAT is abundant in the striatum (Garris & Wightman 1994), where it is widely distributed and strategically located (Sesack, Hawrylak, Matus, Guido, & Levey, 1998). It is far less abundant and less well situated in the prefrontal cortex (Sanchez–Gonzalez & Cavada, 2003; Sesack et al., 1998). Hence, it plays a more important role in striatal function than in prefrontal function. DAT is the product of the DAT1 gene. Several studies report that commonly found polymorphisms in the DAT1 locus are associated with ADHD (Barr, Wigg, Bloom, Schachar, Tannock, Roberts, Malone, & Kennedy, 2000; Cook, Stein, Krasowski, Cox, Olkon, Kieffer, & Leventhal, 1995; Daly, Hawi, Fitzgerald, & Gill, 1999; Gill, Daly, Heron, Hawl, & Fitzgerald, 1997; Swanson et al., 2000; Waldman, Rowe, Abramowitz, Kozel, Mohr, Sherman, Cleveland, Sanders, Gard, & Stever, 1998). In a meta-analysis of 11 family-based studies, Cook (2000) found the association between the DAT1 gene and ADHD to be highly significant (p < .0001). It is important that levels of hyperactive–impulsive symptoms are correlated with the number of DAT1 high-risk alleles but levels of inattentive symptoms are not (Waldman et al., 1998). A role for polymorphisms of the DAT1 gene in ADHD is consistent with the centrality of the striatum in ADHD because DAT plays a particularly important role in the striatum. It is also consistent with the efficacy of methylphenidate in treating ADHD, because methylphenidate acts directly on DAT function (Dresel, Krause, LaFougere, Brinkbaumer, Kung, Hahn, & Tatsch, 2000; Seeman & Madras, 1998; Shenker, 1992; Volkow, Gur, Wang, Fowler, Moberg, Ding, Hitzemann, Smith, & Logan, 1998). Further, there is evidence that nicotine may act directly on DAT in a way similar to that of methylphenidate (Krause et al., 2003; Krause, Dresel, Krause, Kung, & Tatsch, 2000; Krause, Dresel, Krause, Kung, Tatsch, & Ackenheil, 2002). Indeed, DAT binding specifically in the striatum has been found to be related to motor hyperactivity but not to inattentive symptoms (Jucaite, Fernell, Halldin, Forssberg, & Farde, 2005).

If the striatum is potentially the primary site for neurobiological dysfunction in ADHD, what is the primary site for dysfunction in ADD? There has been far less research on ADD, especially excluding individuals misdiagnosed as having ADD rather than subthreshold combined-type ADHD. However, the neurobiological, cognitive, and behavioral profile of children with ADD strongly implicates a primary disturbance in prefrontal cortex. Whereas polymorphisms in the DAT1 gene are hypothesized to be more strongly linked to ADHD than ADD, the 7-repeat allele polymorphism of the DRD4 gene is more strongly linked to ADD then to ADHD (Rowe, Stever, Giedinghagen, Gard, Cleveland, Terris, Mohr, Sherman, Abramowitz, & Waldman, 1998). The dopamine receptor subtype, DRD4, is present in prefrontal cortex in humans, but not in the striatum (Meador–Woodruff, Damask, Wang, Haroutunian, Davis, & Watson, 1996). Hence, a link with the DRD4 gene implicates prefrontal, rather than striatal, involvement. In the human prefrontal cortex, mRNAs for the dopamine receptor subtypes (DRD1 and DRD4) are the most abundant, although the other dopamine receptor subtypes are present. In the human striatum, in contrast, receptors are abundant for, and limited to, D1, D2, and D3 (Meador–Woodruff et al., 1996). Similarly, in the rhesus monkey, DRD4 is densely localized to prefrontal cortex and the hippocampus, with significantly lower levels in the striatum (De La Garza & Madras, 2000). Although DRD4 and DRD5 expression is noticeably higher in the cortex than the striatum of the rhesus brain, levels of DRD1 and DRD2 mRNAs are noticeably higher in the striatum than in the cortex. Consistent with an association between DRD4 polymorphism and ADD is Auerbach, Benjamin, Faroy, Geller, and Ebstein's finding (2001) of a significant relation between individual differences in sustained attention and working memory on the one hand and polymorphism of the DRD4 gene on the other hand in normal infants (those with the 7-repeat allele performing worse). Also consistent with this is that DAT1 gene expression has been found to preferentially affect caudate volume, whereas DRD4 gene expression preferentially affects prefrontal gray matter volume (Durston et al., 2005). However, the finding that ADHD children with the DRD4 7-repeat allele required higher doses of methylphenidate is inconsistent with this (Hamarman, Fossella, Ulger, Brimacombe, & Dermody, 2004).

No brain region functions in isolation. The striatum has close links with prefrontal cortex and there is considerable evidence that a disturbance in frontal–striatal circuitry is found in ADHD (e.g., Casey et al., 1997; Castellanos, 1997; Hale, Hariri, & McCracken, 2000; Heilman, Voeller, & Nadeau, 1991). Brain regions participate in more than one circuit. The patterns of deficits often seen in ADD (such as problems with math calculation, language, and working memory, and lethargy (not due to depression) implicate a frontal–parietal circuit (e.g., Chochon, Cohen, van de Moortele, & Dehaene, 1999; Peers, Ludwig, Rorden, Cusack, Bonfiglioli, Bundesen, Driver, Antoun, & Duncan, 2005; Ravizza, Delgado, Chein, Becker, & Fiez, 2004; Rivera, Reiss, Eckert & Menon, 2005; Simon, Mangin, Cohen, Le Bihan, & Dehaene, 2002; van Honk, Schutter, Putman, de Haan, & d'Alfonso, 2003).

Several groups have noted deficits in executive functions in children with ADHD (Bayliss & Roodenrys, 2000; Pennington & Ozonoff, 1996; Powell & Voeller, 2004); but, because so many of the children studied were hyperactive, many previous studies and theorists have emphasized deficits in inhibitory control, especially in motor inhibition (Barkley, 2000; Nigg, Blaskey, Huang–Pollock, & Rappley, 2002). I propose that the core executive function deficit in ADD is in working memory, as it is in patients with frontal cortex damage who suffer from a dysexecutive syndrome. If I am correct about the underlying neurobiological bases for ADD and ADHD it would hardly be surprising that executive functions would be compromised in both disorders, despite their being distinct disorders, given that ADHD a frontal–striatal circuit is disrupted and in ADD a frontal–parietal circuit is hypothesized to be most affected.

Children With ADD, Like Adult Dysexecutive Syndrome Patients, Have a Primary Deficit in Working Memory
The term working memory has been defined in a number of different ways. Goldman–Rakic (1987) used it to refer to holding information in mind. Baddeley (1992; Baddeley & Hitch, 1994) defined working memory as holding information in mind while simultaneously manipulating or transforming that information (maintenance + manipulation, or temporary storage + processing). Many have adopted that seminal model of working memory, including D'Esposito, Detre, Alsop, Shin, Atlas, and Grossman (1995), Miyake and Shah (1999), Petrides (1995), and Smith and Jonides (1999). Another prominent model of working memory is that of Engle, who defines working memory as the ability to (a) maintain selected information in an active, easily retrievable form while (b) blocking or inhibiting other information from entering that active state (i.e., maintenance + inhibition; Conway & Engle, 1994; Kane & Engle, 2000, 2002). This shares much in common with the influential thinking of Hasher and Zacks (1988) who have emphasized the inhibitory requirements of gating out irrelevant information from the mental workspace of working memory and deleting no longer relevant information from that limited-capacity workspace.

The perspectives of Baddeley and Engle share in common with my own (e.g., Diamond, 1990, 2002) that simply holding information in mind is not that taxing (unless the number of items becomes very large) and does not generally require involvement of dorsolateral prefrontal cortex (Brodmann's Areas 46 and 9). It is when holding information in mind must be combined with another operation, such as manipulation (which Baddeley emphasized) or inhibition (which Engle and I have emphasized), that cognitive capacity is truly taxed and the dorsolateral prefrontal cortex is required. I have argued that inhibition and holding information in mind are dissociable in that they can be independently varied, although it is their conjunction that requires dorsolateral prefrontal cortex involvement. There is general agreement that the dorsolateral prefrontal cortex is needed when one must both maintain information in mind and perform another operation (such as working with that information or inhibiting a strong response tendency; for reviews, see D'Esposito, Postle, & Rypma, 2000; Owen, 1997; Petrides, 1996; Smith, Jonides, Marshuetz, & Koeppe, 1998;).

Activation of the dorsolateral prefrontal cortex is more likely to be increased if you are asked to add numbers or repeat them backward (backward digit span) than if you are asked to simply repeat them (forward digit span). Simply repeating back digits in the order in which you have heard them does not require working with the information held in mind; it does not require working memory. Patients with prefrontal damage often show no impairment on forward digit span, although they perform worse than controls on backward digit span (Stuss & Benson, 1986). Mixed groups of children with ADHD and/or ADD also perform worse than controls on backward, but not forward, digit span (Mariani & Barkley, 1997; McInnes, Humphries, Hogg–Johnson, & Tannock, 2003; Milich & Loney, 1979; Shue & Douglas, 1992) and backward, but not forward, spatial span (McInnes et al., 2003).

Similarly, frontal patients and children with ADD have problems when they have to add or manipulate numbers in their head (Barkley et al., 1990; Benedetto–Nasho & Tannock, 1999; Hynd et al., 1991; Welsh & Pennington, 1988; Zentall & Smith, 1993) or when they have to compute two-step problems in their heads, although they can solve each step individually (Barbizet, 1970; Barkley, 1997; Luria, 1973). They can remember an item as well as anyone. Their deficit becomes evident as the number of items increases and as the demands on manipulating those items increase.

Frontal patients and children with ADD perform well on many assessment measures, leading some to argue that tests cannot capture their executive dysfunction (e.g., Barkley et al., 1991). It is easy to see why people would come to that conclusion. The tests used often measure short- or long-term memory rather than working memory. The tests people have used often focus on discrete skills (rather than the conjunction of holding information in mind plus manipulating it or exercising inhibition). Further, tests are often given in situations where there are minimal distractions and the examiner provides the executive functioning, such as repeatedly bringing the test taker back to the task at hand. Finally, frontal patients and children with ADD can have periods of excellent executive functioning; they just cannot perform reliably at that level. A single “snapshot” testing might catch a patient at an unrepresentatively high level of executive functioning. Better accuracy and reliability can be achieved if more than a single testing is administered.

I predict that complex-span tasks will prove exquisitely sensitive to ADD and will capture the essence of the cognitive problem of individuals with ADD. Complex-span tasks require transforming information held in mind under high-interference conditions (Dempster, 1981, 1985). When people discuss individual differences, or age-related differences, in working memory, they are often referring to differences in precisely these tasks.

One such complex-span task is the counting-span task (Case, Kurland, & Goldberg, 1982). On each trial, the participant is asked to count the number of blue dots, which appear embedded in a field of yellow dots, touching each blue dot and enumerating it. Immediately thereafter, the participant is to give the total number of blue dots for that display and the total number of blue dots for all preceding displays in correct serial order. This requires holding information in mind while executing another mental operation (Counting), selectively attending to the blue dots while inhibiting attention to the yellow ones, updating the information held in mind on each trial, and keeping track of the order of the totals computed across trials (temporal order memory).

In the spatial-span task (Case, 1992a, 1992b), the participant inspects a 4 × 4 matrix on each trial, noting which cell is shaded. A filler pattern is then shown, and then an empty 4 × 4 grid. The participant is to point to the cell that had been shaded on that trial. Over several blocks of trials, the number of shaded cells gradually increases. Interference from prior trials and from the filler pattern is high.

The pattern-span task is similar to the spatial-span task. Several cells are shaded. The participant gets a quick look at the pattern. At test, one of the cells that had been shaded is now unshaded and the participant must point to that cell. The number of shaded cells increases until the participant's accuracy falls below criterion. Performance on the pattern-span task, as on the counting and spatial-span tasks, improves greatly between 5 and 11 years of age, when it starts to be asymptotic (Miles, Morgan, Milne, & Morris, 1996; Wilson, Scott, & Power, 1987).

In the compound stimulus visual information task (Pascual–Leone, 1970), the participant is taught a different novel response (e.g., raise your hand, clap your hands) for each of several different visual cues (e.g., a square shape or red color). After learning these to criterion, compound stimuli (e.g., a red square) are presented, each for 5 s, and the participant is to “decode the message” by producing every response called for by the stimuli. As on the above complex-span tasks, the number of correct responses increases until about 11 years of age (Case, 1972, 1995).

Two language-related complex-span tasks have been developed by Daneman and Carpenter (1980). The listening-span task (Daneman & Carpenter, 1980) requires processing auditorially presented sentences (sometimes being asked to verify the truthfulness of the sentence just read) while retaining, in correct temporal order, the final words of each preceding sentence. Performance on that improves from 6 years until at least 15 years and probably until the early 20s (Siegel, 1994). The reading-span task (Daneman & Carpenter, 1980) is similar, but participants read the sentences aloud themselves, rather than hearing someone else read them.

Performance across these complex-span tasks is remarkably consistent and shows exceptionally consistent developmental change. The counting and spatial-span tasks have been normed on large numbers of children over a wide age range. A meta-analysis by Case (1992a, 1992b) of 12 cross-sectional studies shows developmental progressions for these two measures that could not be more comparable (see Figure 1). In typically developing children, continuous and marked improvements are seen from 4.5 to 8 years of age, then continued, more gradual improvement until 10–11 years of age, with much more gradual improvement thereafter. The compound stimulus visual information task has also been administered to large numbers of children and is highly correlated with performance on Case's counting and spatial-span tasks. A mirror image of the close relation between improvements on complex-span tasks during early development is the remarkably similar developmental degradation during aging across letter, reading, spatial, and computation-span tasks (Park & Payer, 2005).

There is no research of which I am aware that looks at complex-span test performance in children with ADD, and almost none looking at this in children with broadly defined ADHD. One of the few studies examining the latter is the outstanding work of Westerberg, Hirvikoski, Forssberg, and Klingberg (2004). They administered a spatial-span task and found a striking difference between children with ADHD broadly defined and controls. The size of the group difference increased markedly with age due to floor effects at the youngest ages (see Figure 2). I predict that mathematical and linguistic complex-span tasks would show similarly striking group differences, that the differences would be even more dramatic if only children with ADD were included, and that marked differences at the youngest ages tested here, and at still younger ages, can be found with complex-span measures more appropriate for younger children.

Verbal presentation of material places a particularly high demand on working memory. Hence, it is proposed that verbal presentation of material is not the best instructional format for children with ADD. Findings of central auditory processing problems in many children with ADD (e.g., Gascon, Johnson, & Burd, 1986; Riccio, Hynd, Cohen, & Hall, 1994) may be largely due to working memory demands. Listening comprehension is highly correlated with both spatial and verbal working memory (e.g., Daneman & Carpenter, 1980; Just & Carpenter, 1992; McInnes et al., 2003). Indeed, a good part of the co-occurrence of language impairment with ADD may be due to the working memory demands of much linguistic processing. Children with ADHD broadly defined have no difficulty recalling discrete facts from verbally presented stories (that requires no working memory; Lorch, Milich, Sanchez, van den Broek, Baer, Hooks, Hartung, & Welsh, 2000; Pugzles Lorch, Milich, & Sanchez, 1998; Sanchez, Lorch, Milich, & Welsh, 1999; see also Aaron, Joshi, & Phipps, 2004; Ghelani, Sidhu, Jain, & Tannock, 2004). They show deficits, however, in comprehending complex causal relationships from those same stories (Aaron, Joshi, & Phipps, 2004; Ghelani, Sidhu, Jain, & Tannock, 2004; Lorch, Milich, Sanchez, van den Broek, Baer, Hooks, Hartung, & Welsh, 2000; Pugzles Lorch, Milich, & Sanchez, 1998; Sanchez, Lorch, Milich, & Welsh, 1999). Dichotic listening tasks, especially those that require multitasking (reporting what is heard in both ears; Lipschutz et al., 2001), I predict, should be as sensitive to detecting differences in performance between children with ADD and comparison groups as complex-span tasks. Higher working memory span and better performance on dichotic listening are highly correlated (Conway, Cowan, & Bunting, 2001). Indeed, tasks in the auditory domain, whether complex-span or dual-task dichotic listening, should be particularly sensitive to the problems of children with ADD for the reasons discussed above.

In my experience, there is often a trade-off between linguistic and spatial skills. Individuals with ADD are often superior in spatial reasoning and/or artistic drawing. The verbal component of schooling is enormous. Were spatial skills more emphasized in school, and verbal skills less so, children with ADD would show themselves to be far better students.

The name ADD implies a primary deficit in attention. It may seem odd, then, that I am proposing a primary deficit in working memory. It is perhaps a bit less odd when the close, intimate relation between memory and attention is appreciated. Focusing on information held in mind for several seconds might as easily be called focused or sustained attention as working memory. Behavioral (Awh & Jonides, 2001; Barnes, Nelson, & Reuter–Lorenz, 2001; de Fockert, Rees, Frith, & Lavie, 2001) and neuroimaging (Awh, Anllo–Vento, & Hillyard, 2000; Casey, Forman, Franzen, Berkowitz, Braver, Nystrom, Thomas, & Noll, 2001; LaBar, Gitelman, Parrish, & Mesulam, 1999) studies converge on the conclusion that the same neural system that is important for working memory is important for selective attention. Individual differences in working memory correspond to individual differences in selective attention (Conway, Tuholski, Shisler, & Engle, 1999; Kane, Bleckley, Conway, & Engle, 2001). The same prefrontal system that helps us selectively attend to stimuli in our environment (tuning out irrelevant stimuli) is the same system that helps us selectively keep our mind focused on the information we want to hold in mind in working memory.

Children With ADD, Like Adult Dysexecutive Syndrome Patients, Often Have Slow Processing Speeds
Another primary characteristic of a large subset of children with ADD is very slow reaction time and speed of processing (e.g., Barkley, Grodzinsky, & DuPaul, 1992; Holdnack, Moberg, Arnold, & Gur, 1995; Weiler, Holmes–Bernstein, Bellinger, & Waber, 2000; Westerberg et al., 2004). Many ADD children, although not all, appear sluggish, drowsy, spacey, lethargic, and markedly hypoactive (Barkley et al., 1990; Hynd, Nieves, Connor, Stone, Town, & Becker, 1989; Lahey & Carlson, 1991; Stanford & Hynd, 1994). They fit the criteria for having a sluggish cognitive tempo (SCT; Carlson & Mann, 2000, 2002; Frick et al., 1994; Goodyear & Hynd, 1992; Hartman, Willcutt, Rhee, & Pennington, 2004; Milich et al., 2001). The SCT classification, especially its features of daydreaming and drowsiness (not due to medication), which can be separate from slow speed, limits its applicability to only a subset of ADD children (Carlson & Mann, 2002).

Fast speed of processing is not an executive function, yet slow response rates are typical of patients with the dysexecutive syndrome. For reasons not yet fully understood, (a) frontal patients have slowed reaction times and can sometimes perform well on tasks on which they are typically impaired if given more time, (b) there is a strong, well-replicated relation between speed of processing and performance on executive function measures (Duncan, Burgess, & Emslie, 1995; Fry & Hale, 1996; Kail & Salthouse, 1994; Salthouse, 1992), (c) age-related improvements in speed of processing during childhood and adolescence are highly correlated with developmental improvements on complex-span tasks (Case et al., 1982; Hitch, Towse, & Hutton, 2001; Kail, 1992), and (d) age-related decline in the speed of processing from early through late adulthood is highly correlated with age-related decline in performance on complex-span tasks and related measures of executive function (Salthouse, 1992, 1993; Salthouse & Meinz, 1995).

Children's performance on the countingspan task is linearly related to the speed with which they can count the presented dots (Case et al., 1982). Similarly, the faster people can repeat back the word they have just heard, the more words they can hold in mind. As the speed of word repetition improves so too does word-span memory. When the speed at which adults and 6-year-olds can repeat back words is equated (by presenting adults with unfamiliar words), children and adults show equivalent word-span memory (Case et al., 1982). Similarly, when the speed at which adults and children can count is equated (by requiring adults to count in a foreign language), equivalent countingspan memory is found in adults and 6-year-olds.

The empirical relation between performance on complex-span tasks and generalized speed of processing might be due to any number of factors. Faster processing would mean that items do not need to be held in mind as long, reducing the demand on working memory. Faster processing and improved executive function performance may covary because they both reflect more efficient neural processing and improved signal/noise ratios, either because of systemwide improvements in the nervous system or because a better functioning prefrontal cortex improves signal/noise ratios for diverse neural regions, permitting faster and more efficient cognitive processing.

Whereas impaired working memory appears to be ubiquitous in ADD, slower speed of processing is not, although it is quite common. Similarly, although a great deal of the variance in performance on complex-span tasks can be accounted for by processing speed, controlling for speed does not eliminate all age-related differences in complex-span performance (Hitch et al., 2001). Speed and complex-span performance are correlated, but not perfectly so. Indeed, in a study of ADHD broadly defined, poor working memory, poor attentional inhibition, and disorganization were found to load a separate factor from sluggish cognitive tempo (Carlson & Mann, 2002).

Simple choice reaction-time tests would seem a reasonable way to obtain a quick and easy indication of whether a child's response speed is slowed or not. Westerberg et al. (2004) report that choice reaction-time performance differentiated children with ADHD broadly defined almost as well as did complex-span performance, and far better than performance on either a continuous performance task or a go/no-go measure. If one finds that a child with ADD has a slowed reaction rate, it does not necessarily follow, however, that a better instructional format for the child is to present material at a consistently slow rate if that might lead to boredom. Studies have shown that children with ADHD broadly perform poorly when material is presented at a constant slow rate (e.g., Sykes, Douglas, Weiss, & Minde, 1971), as do frontal patients (Rueckert & Grafman, 1998). However, if rates of presentation are intermixed, children with ADHD broadly defined are able to benefit from the greater processing time available for the more slowly presented items without that being counteracted by their attention wandering because the task is too easy and boring (Conte, Kinsbourne, Swanson, Zirk, & Samuels, 1986).

A Motivational Component to ADD
Although the literature and diagnostic manuals refer to children with ADD as easily distracted, I would like to propose that a more accurate description is that they are easily bored. Their problem lies more in motivation than it does in inhibition. Having lost interest in a project after only a short time, their attention drifts as they look for something else to engage their interest. Bored with the initial task, they abandon it before completion, moving on to the next project. It is not so much that external distraction derails them, as that they go looking for external (or internal) distraction because their interest in what they are supposed to be doing, or had started, has dwindled. (Sergeant, Oosterlaan, and colleagues have proposed a cognitive-energetic model of ADHD, which shares some features in common with what is being discussed here, but they have focused especially on aberrant reactions to reinforcement, which is different from the focus here, e.g., Luman, Oosterlaan, & Sergeant, 2005; Sergeant, Geurts, Huijbregts, Scheres, & Oosterlaan, 2003.)....

The conclusion

....Challenge or risk, something to literally get their adrenaline pumping, can be key to keeping their attention and to eliciting optimum performance from persons with ADD. In line with this, adults with ADD sometimes say they can focus better when driving if they speed than if they drive slowly. Children with ADHD broadly defined often perform normally on the continuous performance task when challenged by a fast presentation rate (Chee, Logan, Schachar, Lindsay, & Wachsmuth, 1989; van der Meere, Wekking, & Sergeant, 1991). Individuals with ADD, although typically shy, may engage in risk-taking and thrill-seeking activities, such as bungee jumping or riding roller coasters, as ways to experience a level of engagement they have difficulty sustaining in their daily lives. Computer and video games (which children with ADD can play for hours and hours) are fast paced, often with imminent danger keeping arousal high. Such games often rely on the execution of well-practiced associations between button presses and game features or well-practiced sequences of button presses, which children with ADD have no difficulty retrieving from their intact long-term memory and procedural memory. Executive function is taxed when conscious, top-down control is needed. The execution of any well-practiced skill, such a playing a computer game, is impaired by attempts to exert top-down control and is optimized by allowing older, subcortical systems to guide performance (e.g., Herrigel & Suzuki, 1953; Miller, Verstynen, Raye, Mitchell, Johnson, & D'Esposito, 2003).

Another way of looking at this is that if the neural systems of individuals with ADD have poorer signal/noise ratios, as would be consistent with slower speed of processing, then sustaining focused concentration on all the things that must be remembered and integrated for a task might well be more demanding for individuals with ADD. Hence, they would “burn out” on a task earlier than other folk and would need a greater infusion of adrenaline to fuel the system. Under the right circumstances, when sufficiently motivated, children with ADD (like patients with frontal cortex damage) can perform well, but it is hard for them to sustain that level of performance (frontal patients: Fuster, 1989; Stuss & Benson, 1986; children with ADHD broadly defined: Corkum & Siegel, 1993; Douglas & Peters, 1978; van der Meere & Sergeant, 1988).

Referenced in the above article.

http://www.blackwell-synergy.com/doi/abs/10.1093/clipsy.8.4.463

ADHD Combined Type and ADHD Predominantly Inattentive Type Are Distinct and Unrelated Disorders
Richard Milich, Amy C. Balentine and Donald R. Lynam

We comprehensively reviewed research assessing differences in attention-deficit hyperactivity disorder (ADHD) subtypes to examine the possibility that ADHD/ combined type (ADHD/Q and ADHD/predominantly inattentive type (ADHD/I) are distinct and unrelated disorders. Differences among subtypes were examined along dimensions identified as being important in documenting the distinctiveness of two disorders. These include essential and associated features, demographics, measures of cognitive and neuropsychological functioning, family history, treatment response, and prognosis. Important differences among subtypes were found in several areas of study, supporting the conclusion that ADHD/C and ADHD/I may best be characterized as distinct disorders. We identify major limitations of the available research and present future directions for research.

Quotation from abstract cited by Scuro

One such complex-span task is the counting-span task (Case, Kurland, & Goldberg, 1982). On each trial, the participant is asked to count the number of blue dots, which appear embedded in a field of yellow dots, touching each blue dot and enumerating it. Immediately thereafter, the participant is to give the total number of blue dots for that display and the total number of blue dots for all preceding displays in correct serial order. This requires holding information in mind while executing another mental operation (Counting), selectively attending to the blue dots while inhibiting attention to the yellow ones, updating the information held in mind on each trial, and keeping track of the order of the totals computed across trials (temporal order memory).

In the spatial-span task (Case, 1992a, 1992b), the participant inspects a 4 × 4 matrix on each trial, noting which cell is shaded. A filler pattern is then shown, and then an empty 4 × 4 grid. The participant is to point to the cell that had been shaded on that trial. Over several blocks of trials, the number of shaded cells gradually increases. Interference from prior trials and from the filler pattern is high.

This reminds me of one of the aptitude tests we had to take when I was in 8th grade (I believe this was actually done under the aegis of the DOD to determine what we should be trained in when we were drafted to fight the Communist Menace -- this was many many years ago) I could no more perform these tasks than I could turn lead into gold. There was another test which had one look at a shape and determine what it would look like if it were rotated 79 degrees(or words to that effect).

I am sure that somewhere in the recesses of the Pentagon there is a file with my name on it which is stamped "Never let this one have anything to do with fighting the Communist Menace." A wise decision, given that I'm a pacifist and all.

Seriously, this abstract helps me understand my diagnosis more clearly. Thanks.

so for them stimulants would work best, correct? If Adderall wasn't working, what else should they try?

Hm, that's interesting. I read a description of "SCT" here before, but it was probably not as well-developed a description, because it had too many discrepancies from my own case to make it sound applicable. Now however, this theory of being ADD as something separate from ADHD sounds quite reasonable. Individuals with ADD, although typically shy, may engage in risk-taking and thrill-seeking activities, such as bungee jumping or riding roller coasters, as ways to experience a level of engagement they have difficulty sustaining in their daily lives.That's one of those contradictory things about me that I've always hoped to understand.

I do hope these studies really get somewhere, because my feelings of not really belonging anywhere tend to even apply to being among many ADHD people.

-A significant subset are hypoactive and sluggish and have slow response speeds. More time to process both input and output.



-Primary deficit in working memory, especially prominent in auditory processing because of the demands it places on working memorySometimes I'm just not sure what I heard. It takes me longer to get it. I may have to look at it or hear it several times.



-Tend to be overely self-conscious
First time I have heard this related to ADHD but it is very true.



-Social problems because too passive, shy, or withdrawn
More likely to be introverted
-Internalizing disorders, such as anxiety or depression, are somewhat more common in children with ADD than those with ADHD. ADD children tend to be socially isolated or withdrawn.There is something else here...an immaturity that I had as a kid. I'd be playing with younger kids but still had impulse control problems especially as I got older. Quietly pleasant pre-school, but was an emotionally charged teeenager. I don't think that was all enviornment.



Reading and language deficits and problems with mental mathematical calculations are more commonly comorbid with ADD than with ADHD.
I see that in myself and others.



-A significant percentage are not helped by methylphenidate.
Most respond positively to methylphenidate in moderate to high doses. Those who are helped by methylphenidate often do best at low doses. A significant subset are helped by amphetamines rather than methylphenidate. Amphetamines affect both the reuptake and release of catecholamines. A marked deficit in the release of DA and NE might cause sluggishness and underarousal.I would very much like to have this explained to me.



-People with ADD are not so much easily distracted as easily bored. Their problem lies more in motivation than in inhibition.
I use the computer as a way to perk up my interest/ motivation level in the morning and afternoon.



-Individuals with ADD, although typically shy, may engage in risk-taking and thrill-seeking activities as ways to experience a level of engagement they have difficulty sustaining in their daily lives.
-A primary disturbance in prefrontal cortex is implicated.
-The primary neural circuit that is affected may be a frontal–parietal one.
I would like to hear this explained.



-The 7-repeat allele polymorphism of the DRD4 gene is more strongly linked to ADD than to ADHD. This is consistent with the centrality of prefrontal cortex in ADD because the D4 DA receptor is present in prefrontal cortex but not in the striatum in humans.This also.



One thing not mentioned here is erratic retrival of long term memory. I have seen my mom stumble..grasping for words or ideas. I do this all the time, even with spelling. The word is not there...I can't even sometimes think of the first two letters...and then pop...the whole word is there.

Scuro....I feel as though that was written by me. It fits me to a T!
Addy hasn't helped...guess I should try a higher dosage.

Maybe a higher dosage... The studies suggest we don't have the same success rate with meds. Try a different stim or even lower your dose. :eek: Research would back up both approaches.
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I've been thinking some more about those points.
Tend to be overely self-conscious - does not equate with this -> Social problems because too passive, shy, or withdrawn.

I am often self conscious in one on one discussions. My eyes only feel confomfortable in holding a gaze with children or people that I generally love. It's not an issue of shyness because this can happen with people that I am familiar with. And it comes on like a wave...sometimes things are okay and then I feel very akward.

...and why the problem with long term memory? Does that really have anything to do with Active Working memory?

It's VERY important to remember that SCT is in a theorectical and research phase. It's not the officially accepted standard at this point. Maybe someday, but if you go to your doctor and try to talk about SCT you likely won't get very far.

Even if it does become officially recognized, it isn't like if you are ADHD/Pi today, you will automatically be relabled SCT. Some Pi would become SCT and some would be relabled combined.

If you are interested in the newest research, then look at SCT, but if you come here trying to learn how to cope with and treat your condition, the SCT path is probably not going to be much use to you at this point, just ignore it for now.

Glad to see you again unleashed...I hadn't seen you post in a while. I missed your thoughtful posts.
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Yes, SCT is not listed in the DSM4 which was published in 1994. The next edition is planned for 2011. Is it important that we not talk about these kids until this category is possibly listed in 2011 or beyond?

I don't think the diagnostic labeling is the major issue. For instance, Andrew's mom doesn't really care what her child is labeled with as long as he gets the best service and treatment possible.

What is important, is providing best practices for these children. At school where I work these kids, this group is a clear and distinct from other ADHDers. Do I write SCT on these kids IEP's? No, but I know that generally, these "foggy" kids have a unique set of problems not related to classic ADHD. Typically they have true processing difficulties and memory retrieval difficulties. I see this everyday. Am I simply to ignore this and not provide special accommodations for these kids because these issues are not typically an ADHD problem? That would be a little backwards.

My philosophy is to provide the best service possible based on current info and best practices suggested by current research. Slap my wrists if you must but what matters is to do the best job possible.

I have no issue with doing the best job possible. I'm just concerned about confusing labels.

I came here newly diagnoses as ADHD-pi, I started reading SCT posts. So I thought I was SCT. The dose of my medication wasn't right at first, and I was reading how the meds aren't always effective against SCT. So I started to get discouraged because I thought I'd finally be able to deal with my problem, and here I was reading information saying I didn't have what I thought I had, and since the meds weren't working well, I was problably out of luck.

Then I read what Barkley actually wrote, his idea of 'combined type' was different than the DSM definition. If you had any impulsive/hyperactive symptoms at all, Barkley would consider you combined, whereas you need 6 under the DSM. So then I realized I was ADHD after all, not SCT. After that I regained hope and started making progress with the meds.

So that's the reason I'm picky about posts that suggest that ADHD-pi is a separate disorder, because it's not so cut and dried.

....because it's not so cut and dried.
Nope...it's tricky and complicated. Do not attempt to do this at home.

Then again, if you go to a Doctor, they may have no idea what you are talking about anyways. I wish I could say that you just need to find a professional who has expertise in this area, but that is not always possible.

<p>Just came across the info on Sluggish Cognitive Tempo this week, and am quite sure if I could find a time machine and drag my 7 year old self in to see Dr. Barkley he'd be using that child of many years ago as his poster boy.</p>
<p>However, as I am now an adult, without access to such time machine, and more than a little frustrated with the lack of info on what works for Adults with ADHD, I am wondering if any one here has any links to effective strategies, tactics, compensations, approaches or treatments, other than medication, specific to Adults with SCT. Nothing against meds, I'm on a stimulant and it helps, but not enough for me to be functional and stable. </p>
<p>Am looking through the other topics on treatment, but every thing I've found so far has been very generalized, or honestly reads more like a sales pitch for a coach, rather than a treatment module. I'm trying to find a framework of what works and why. Thanks for any pointers or info any one may share.</p>

Wow. Thank you for that post.

To follow up to my own question on what treatment modules/strategies are helpful for those with ADD-SCT, a chance conversation brought me to look at the symptoms and problems those coming off crystal meth addiction often experience. While the symptoms are not fully congruent, there are enough parallels (easily bored, low energy, low motivation, difficulty concentrating, difficulty with multi-variable problem solving, increase in anxiety) to make me wonder if some of the treatment methodology used might be of benefit for those with this sub-form of ADHD/ADD. Does any one know if there is any research or information on Motivational Interviewing, Motivational Enhancement Therapy (MET), and/or Rewards/Contingency Management for treatment of ADHD/ADD? Anything specific on Problem Oriented Cognitive Behavorial Therapy? Again, I find very vague and general statements, but little in the way of "how to do it" or "why it works". Please post if you come across anything. Thanks.

Holy Crap!!! When I read the Wikipedia explination of SCT, it was a big relief. There may not be much known about it, but at least I have an explaination of why my brain isn't working as fast as I want it to.

I am going to the doctor tomarrow and see what he thinks about this.

I've run out of meds waiting for my controlled substance to make its way through bureaucratic mess of state laws and insurance rules, and to reassure myself that I am really not a criminal for using amphetamine salts, decided to check up on the status of add/adhd in the public opinion. Came across SCT at Wikipedia, and now my whole life makes sense! I'd like to share my treatment experiences:

Adderall: Generic adderal is my treatment of choice. For me it takes care of the Slugishness and the lack of motivation. It does not help the working memory, or mixed up logic, but, but it motivates me to concentrate on whatever work I'm doing for long enough to work through the memory problems.

Strattera and Caffeine (I mean each individually, not together) take care of the sluggishness, but do nothing for motivation, and tend to leave me in a very uncomfortable restless state.

ajterreault: Methamphetamines being similar to the dextroamphetamines and amphetamines which make up adderall, I often feel I am no better than a meth addict, only I get my drugs legally. I have to believe that a good number of meth addicts have some sort of add or something like it only dont have the resources to diagnose is, thus self medicate with meth. In that case the those symptoms may have been there before the addict even started using meth.... i could be wrong.

So when is "Sluggish Cognitive Tempo" going to have its own subforum on here? This is exactly me.

I have no motivation,sluggish and always tired. I am quite, introvert, shy and suffer from social anxiety. I am terrible with mathmatics once I get to multiplication.

Those symptoms are me 100%. That is the answer I have been trying to find for the past 24yrs.

I am the complete opposite of your normal ADHDer. I brought all the paperwork on this to my therapist today and he is going to send the recommendation to my family doctor to let me try adderall.

Hey guys! I started a topic about this awhile back in the Scientific forum:

http://www.addforums.com/forums/showthread.php?t=41839

The general consensus (as of now) seems to be that while SCT is probably an accurate sub-group, the treatment for it is pretty much = ADHD-PI (i.e. stimulants) so there's really no reason to split them apart.

I think the main thing reason why they need to be split is the hyperactivity symptom; generally ADHD is in the public mind as the disorder where you're hyper and can't sit still.

For those of us with SCT/ADHD-PI, it's hard to tell somebody that you have ADHD and they say "Wait...but you're not hyperactive? You're just making up excuses for your laziness."

I can't recall how many times I've heard that over and over and over. I think if SCT is made/labeled 'separate' it would be mainly to distinguish those of us with "ADD" instead of saying we have "ADHD". I think it was good for them to lump them all together initially when the disorder was still be discussed and researched - but now that it's pretty established I think they need to really delve into the different types of the disorder.

I mean, just like diabetes - they all have issues with insulin, but that doesn't mean you lump them together - the have type 1, type 2, etc. And for us it should be the same thing - we all have issues with attention defecit, but some of us are hyperactive (ADHD), some of us grow out it (Adult ADHD), and some us were never hyper to begin with (ADD/ADHD-PI/SCT).

I hope the adderall works for you! If you search the Adderall board specifically, you will see that it helped a lot of people in the way you are looking for it to help you.

SCT seems to describe me fairly well also, but a lot of what it describes also goes along with some auto-immune disorders I have that cause severe fatigue and other things that then lead to the shyness, lack of motivation, et cetera. So it's complicated and I'm trying to figure out where I really fit.

As I said in your other post, though, the Adderall didn't help me with energy, and I am assuming it's becuase it's not only trying to work against the ADD but also the other causes of fatigue, and I just need something conjunction to create a one-two punch that might actually help.

Children with combined-type ADHD have many of the above symptoms, but they also have great difficulty sitting still (APA, 1994).I am not "the complete opposite" of anybody with ADHD. The study isn't even suggesting "complete opposite", its suggesting "differences". I agree, there are differences, otherwise there would be no need to make any differentiations at all.

-A significant percentage are not helped by methylphenidate.
Most respond positively to methylphenidate in moderate to high doses. Those who are helped by methylphenidate often do best at low doses. A significant subset are helped by amphetamines rather than methylphenidate.
I can take methylphenidate, or I can take the amphetamine class medication dexedrine...and ONLY dexedrine. I know plenty of combined and hyperactives who cannot take methylphenidates either, who also respond only to amphetamines of one type or another. This is definitely nothing that could be considered a cut-and-dried issue.

I tend to think that at the present time, the following type of thing also carries a lot of weight and bearing on the issue:

It's not been substantiated as a "separate" disorder.

Therefore, ADHD-PI type remains as is.
Research isn't personal; it's either valid & reliable over the long haul or it isn't.
22 yrs of concentrated study,including the week I spent with Russ Barkley, have shaped my opinion.

I'm a Licensed Psychologist in Minnesota with a Master's Degree...

Methamphetamines being similar to the dextroamphetamines and amphetamines which make up adderall, I often feel I am no better than a meth addict, only I get my drugs legally. I have to believe that a good number of meth addicts have some sort of add or something like it only dont have the resources to diagnose is, thus self medicate with meth. In that case the those symptoms may have been there before the addict even started using meth.... i could be wrong. Gilly, from what I have read, long term crystal meth use has been associated with lesions and other physical damage to the brain, mostly in the frontal lobes, and sometimes permanent damage to the parts of the brain associated with the production of dopamine. As the frontal lobe and neurotransmitter issues are associated with ADHD/ADD, I am not surprised this would lead to similar symptoms, just as traumatic brain injury can. Indeed, I've found a few articles that indicate they are experimenting with using Adderall as part of treatment for this particular addiction, reinforcing the relationship. Whether or not some one had undiagnosed ADHD/ADD prior to the addiction really is irrelevant. What matters is simply - do these things cross-over and help us?

Frankly, I am at the point where I really don't care what causes ADHD/ADD, whether it be neurotransmitters, mis-wired frontal lobes, hemorrhoids, Chinese toothpaste, or special radio signals beamed by satellites launched by the New World Order (tongue-planted-firmly-in-cheek). All I really care about is what can I do about it. Pills help some, but they don't solve everything. Hence, my questions, what have people tried, and what has worked? What you and others have said about Adderall I found signifigant and helpful, and am looking forward to talking that drug over with my doctor very soon. Found some interesting articles today on Modafinil, which I want to look into further. The few blurbs I've found on Social Skills Training (SST) being helpful for those with ADD-SCT point toward another avenue, and I'll continue to look for anything else that might help, though I'll want several peer-reviewed double-blind studies as evidence showing aluminum foil head covers really work before adding that to my wardrobe.


Like many here, I am extremely frustrated with the problems that come with ADHD/ADD and how they have impacted on my life. I am even more frustrated with how little there is on what you can do about them. At least with message boards such as this, we can share what we know. Not much, but is something.

Well as someone who has ADHD-PI/SCT and has been on adderall for over a week. I can say I have noticed a slight difference in myself.

I am still on a low dosage as I tiltrate up, but here is what I have noticed so far.

Pros
- Eyes no longer feel heavy throughout the day.
- Increased motivation, although due to my low dosage, I start slacking by the time afternoon comes around.
- Increased Energy.
- A little more in the mood to talk to people. I think this has to do with the increased energy
- Social skills are still suffering. I still get bad anxiety. I am thinking I will probably have to do some Social Skills training to teach myself all the skills I failed to take in as I grew up.
- Increased Focus.
- I am finally waking up early in the mornings (7am-8am) with no problems at all, this is a big change coming from someone who used to sleep in atleast till 10:30 every morning. Now I get out of bed no problem.
- Decreased Appetite. This has really helped me with my over eating problem. I used to eat atleast 2 huge plates of spagetti at dinner time. Now its only 1 plate and there might be a little I have to dump in the garbage. So I am still able to eat, it has just helped me to not over eat. Hence I am starting to loose the pounds fast. :)

Cons
- Elevated blood pressure.
- Increased Anxiety.
- I had my first pannick attack the other day. (I'm pretty sure the increased blood pressure had something to do with this.)
- A few muscle twitches.

So how have I managed these symptoms? The doc prescribed me Guanfacine and it has eliminated all the bad symptoms caused from the adderall. My only issue now is I need my adderall dose increased because the guanfacine tends to overpower it and I can feel tired sometimes throughout the day.

I recognise myself totally in the SCT / ADHD-PI characteristics. There is one thing that I wonder about .. process information more slowly .. how does that work if your IQ is in the gifted range .. say > 130? Generally, a high IQ is associated with a proficiency in analytic manipulations .. isn't that the opposite of processing slowly?
I am trying to put into words how that works with me. Kinda hard. I find I am quite good at holding complex abstract ideas in my head. I can grasp those almost intuitively. But, at the same time, I have great difficulty to follow reasoning, like in math class. This last thing has seriously impaired my academic performance, especially after grade 8, and made it impossible to follow lectures. I dropped out of university after one semester .. despite being tested higly gifted and trying really hard.

I am curious how this works. In what sense is the ability to hold these ideas in your head differ from processing information? Does the working memory deficit that is mentioned play a role? (it feels like that might be the case)

And how is it with the fact that ADD people are said to have "many, fast thought, jumping all over the place" .. compared to this slow processing? I certainly feel like my brain is like a sped-up pinball machine, but somehow, *something* is slow and sluggish at the same time. I am physically sluggish/slow too.

@Jeremynd .. how's it going with the adderall?

love & light :)

I have no idea what it means. Ive read the DSM and various neuropsychology and LD textbooks thru [more than a few times], and truly have no idea what this SCT thing is.

I tend to think "SCT" is a made up term.

It might be something translated from another language, meaning: "slow processing speed" ?

QueensU, I do not quite understand your post. Are you questioning if "Sluggish Cognative Tempo" actually exists? ADD-SCT is currently a provisional diagnosis that is under debate and review for the next edition of the DSM. However, a quick search on Google brings up over twenty thousand hits, most pointing to articles published in medical journals on the subject. For a quick summary, you can see the Wikipedia article on Sluggish Cognative Tempo at http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo with another excellant summary found at this location http://findarticles.com/p/articles/mi_m0902/is_5_32/ai_n6234463<http: findarticles.com="" p="" articles="" mi_m0902="" is_5_32="" ai_n6234463=""></http:> (http://%3Ca%20href=%22http://findarticles.com/p/articles/mi_m0902/is_5_32/ai_n6234463%22%3ELookSmart%27s%20FindArticles%20-%20The%20relation%20between%20sluggish%20cognitive %20tempo%20and%20DSM-IV%20ADHD%3C/a%3E%3Cbr%3E)
If you are need of a book, Dr. Russell Barkely's "Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment" (http://www.russellbarkley.org/attention-deficit-hyperactivity-disorder-handbook.htm) includes some information on this sub-type.

Regarding my own experience, I've recently switched to Adderall from Concerta, and am at a dosage comparable to what I was at with Concerta. I find that Adderall seems to take slightly longer to kick in, but so far provides a similar level of benefit, as far as not feeling sleepy through out the day, less forgetful, more able to stay on task, and more cognizant of time. However, I do not feel that I am getting the maximum benefit I could, and still struggle with intiating tasks, dealing with boredom, and motivation. At the suggestion of my psychiatrist, I am also taking Nordic Natural's Ultimate Omega-3 suppliment at three 1000mg capsules in the morning with breakfast, which I believe has offered some additional help with the depressive-like symptoms associated with ADD-SCT. However, while I am cautiously encouraged by this, I still am of the belief that some practical interventions and skill building are needed.

I found Luthien's experience to be very similar to mine, as far as the ability to deal with abstract concepts and be considered quick in some respects, yet have the difficulty with math and slowness. I think this may be a cultural bias in that was tend to equate speed of thought with intelligence, while forgetting that many who were known in the past as very intelligent, were not always the fastest. Einstein is the example that many will point to, with the exceptionally long time it took him to speak, and his own struggles (including being labeled "slow") in his elemenatry-education years, yet his creativity and brilliance with abstract concepts was exceptional.

My own experience has me wonder if perhaps those in this SCT subtype while intellectually as capable as those with out this issue, find it harder to evaluate some information as quickly, and develop from it appropriate expectations. The fact that SCT is seen as a developmental issue, i.e., it takes these people more time, but they do get there, seems to go hand in hand with this.

I personally would not ever rely on Wiki as any kind of definitive "expert source"...the contributions are made by whomever wishes to contribute.

Difficulties with mathematics, and processing the written word can often be expplained by LDs. Nothing about the ADHD DX, no matter what type or whatever you wish to call it, rules out a LD. Certainly muddies up this particular puddle of water, IMHO of course.

This is somewhat off topic but this seriously has me perplexed. Perhaps it is my "slow processing speed" but I find the responses regarding Wikipedia confusing. While I do agree with the idea that relying on Wikipedia for "authorative content" would be a fallacy considering how it operates, refering to it in a discussion board as providing a helpful summary seems to me to be an appropriate use. If Wikipedia cannot be used for such a purpose, then what value does it have at all?

ADHD/ADD is not something you self-diagnose. What information can be found online, in books and magazines and in other media is information a patient can discuss with their doctor, and hopefully helps provide avenues of effective treatment. Science and Medicine are not disiplines that are static and unchanging. New ideas, infomation and tools are constantly being developed and researched. Any educated consumer is served by gathering what information can be found and critically examining that information. More than once, a patient has become aware of some new treatment or new procedure their doctor was not aware of. Most practioners I know of, welcome having these things brought to their attention, and discussing if what was found would be helpful to the patient.

Regarding those who have never heard of Sluggish Cognative Tempo. Obviously, you now have. Perhaps I'm being over-literal, but are you trying to imply that if you haven't heard of it before it must not exist? Therefore every possible illness or disorder that Medicine will address has already been discovered and defined? If Sluggish Cognative Tempo does not seem to apply to you, okay, good for you. Do you lose out if those of us it does seem to apply to discuss it?

I am seriously baffled by how the idea that there may be a distinctive subtype of ADHD-I seems to arrouse a religous passion over whether it is or is not a proper diagnosis.

This is a support forum, and everyone is encouraged to be mindful of the guidelines when responding to threads.

While I do agree with the idea that relying on Wikipedia for "authorative content" would be a fallacy considering how it operates, refering to it in a discussion board as providing a helpful summary seems to me to be an appropriate use. If Wikipedia cannot be used for such a purpose, then what value does it have at all?


I think that there may be a difference in perception here.

I believe the reference to Wikipedia was used by echo5tango as a source to explain what SCT is for those who do not know - however the response from CF that Wikipedia was not a authoritative resource in psychiatric conditions was made so that readers would see the Wikipedia in the proper light {informative perhaps but not authoritative}.

I do know even in debate communities using Wikipedia is considered a poor source to back up ones presentation because of the nature of the contributions.


OKay next point is:

My questions tp the seperate condition supporters are if inattenve ADD is really a seperate condition:


1)Why would hyperactive ADD traits be replaced by inattentive traits as a person ages

2)Why would the same medication and treatments used for hyperactive and combined ADDers also work for inattentive ADDers as well.

3)Why don't the medication non-responders fall exclusive into the inattentive sub-type as opposed to following the population trend - meaning that most medication non-responder are combined simply because most ADDers are combined - inattentive some time do not respond but the number correlate with the percentage of the ADD population the represent

4)To what benefit is changing the name from ADD-PI to SCT-> Really does it make a difference seeing the conditions respond to the same treatments. :confused:






I am seriously baffled by how the idea that there may be a distinctive subtype of ADHD-I seems to arouse a religious passion over whether it is or is not a proper diagnosis.


First of all religion is a banned topic so I can't touch it {this is meant to be funny}

Second of all SCT isn't a proper diagnosis as of this writing { this isn't}

answer your question as to why this SCT idea arouses such a passionate response - seriously there are several possibilities

First reason the SCT raises such passions in those who are not inattentive - because you are basically saying to the rest of us who are not inattentive " We are different from you so you can't be part of our little group, because only "people with purple eyes" belong to this group"

Second reason - reality I see the entire SCT issue as adding confusion to a subject that is murky enough as it is - personally I am looking to simplify not create more confusion.

The third reason will be addressing why some of the respondents are inattentive themselves.

If you will step back for a moment with me in the objective realm - using only the English language as a reference point what are you really saying when you say "SCT is a separate condition" You are saying " we aren't ADD at all"

Some with the inattentive ADD diagnosis do not wish to be separated from the ADD community they now call home - they finally found a place where they belong and frankly those who purpose that inattentive become a separate condition are threating to yank that away from them - which btw would engender strong emotions in those who have searched a life time for a place to belong thus the reason behind the "religious passions"

{so the reasons are really very obvious on many levels okay they are for me - well so much for hyperactive ADDers being unable to have insight -shrug}

I do hope my post helps answer as many question as it generates- :)

From what I understood with the articles I read they seemed to suggest that Sluggish Cognitive Tempo was ADHD-I, but I really don't read everything and I am most likely repeating meadd823's post but I figured I would constructively add something since I thought I did already, even though I had to google it because I had never heard of it.

<!-- ================================================== ===== --><!-- Created by AbiWord, a free, Open Source wordprocessor. --><!-- For more information visit http://www.abisource.com. --><!-- ================================================== ===== --> An interesting response meadd823...

The way you frame the Wikipedia usage does make sense and serves to make the thrust of Crazy~Feet's response much clearer to me. Perhaps it makes even more sense as I had not viewed this as a "debate" forum, but a "support" forum.


I have little interest in arguing if ADHD or ADD exists, nor the respective validity of the subtypes and differentiations (I believe Dr. Amen argues there are six different types of ADHD/ADD). My interest lies solely on what works in helping those with ADD-SCT, a framework that I have found fits for me, and my practitioner agrees with. However, to answer the explicit and implied questions...

Regarding whether or not ADD-SCT is a "separate" condition. First, let me quote some one well known on this forum and who has an acknowledged level of expertise.

Not again!


This keeps coming up. There is a common misperception that all ADHD Inattentive people have this Sluggish Cognitive Tempo or SCT.


The truth is, only some inattentives fall into this SCT group (maybe 30%-50%) and it may or may not be a separate disorder (depending on which research papers you read)


Also, the way to distinguish SCT from plain ADHD inattentive isn't well defined yet.

In other words, as currently defined, some one with ADD-SCT fits under the ADHD-I subtype, but not every one that has ADHD-I would be ADD-SCT. The research that I have found since Unleashed made the statement above back in 2005 has gone farther to hone and define the symptomatology of ADD-SCT, but over all, the thrust that SCT is subset of ADHD-I and does not fit all of those with ADHD-I remains constant.

So are we then are we "ADD at all?"

Well, I guess that comes down too how wide is the umbrella? My understanding is that one of Russell Barkley's more controversial assertions is that ADHD and ADD are in-fact subtypes of what have been labeled "Executive Function Disorders" and which may include Aspergers, Autism, Bipolar, and OCD. All of which have overlaps and similarities in symptomatology and impact. So, if what label is on your medical chart is important to you, then perhaps this opens up for the choice to either see this as an expanded family, with variations and differing aspects, but still under one big tent, or you (and this is a general you, not any one in specific) can look for what makes you different from others and try to fit in with an exclusive little tribe that requires everyone to conform to one specific title.

I would find it troubling if we have made ADHD/ADD into an identity, where we only want to talk to those who have it, or only allow them to be part of the group. ADHD/ADD is a diagnosis, that is, a definition of difficulties and problems that need to be addressed. It is not a group nor a person. It confers no special status, nor does it bestow some exclusivity to any of us. I have seen people on this forum refer to "us Hyperactives" as if we all shared that in common. Those with SCT to battle would probably find that phrasing exclusionary, as they are hypoactive and could only wish for the energy those who experience hyperactivity try to focus, control and contain. To pound the point home, while we may share some characteristics, and have some things in common, there are many differences. We take different meds, we use different compensations, and adjust as individuals to how this disorder affects us as individuals. There is not one drug that works for all, there is not one intervention or compensation that works for all. We are all not the same.


Acknowledging ADD-SCT may fit some does not diminish the ADHD community, but does allow for the differences that individuals experience to be accepted and acknowledged. We all do not have to be the same in order to get along, share, and support one another, accept and understand that what applies and works for one, may not apply and work for all. To be blunt, if the ADHD community is so insecure that it is threatened by the idea a very small percentage of those labeled ADHD-I may have a slightly different disorder, then that speaks to their issues, and not the validity of ADD-SCT.

In none of the reading I have done since coming across ADHD or ADD-SCT have I ever found anything that says "this disorder is completely unlike anything ever seen before in the history of mankind". Indeed, what I see often are articles, such as "Sluggish Cognitive Tempo Predicts a Different Pattern of Impairment in the Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type" that compare and contrast ADHD and ADD-SCT, and state where they have similarities and differences. If we want to set up ADHD and ADD cliques, then I would guess articles such as that could be seen as a way to divide people up. I think most researchers would vomit at finding such a use for their work, as they are more likely interested in what is going to help people have better lives.

The question is not "does the ADHD community lose out if ADD-SCT is found to be a distinct disorder?" but, "what information can be shared and found helpful for both?" That does not require that we all be alike. Nor does it mean that any of us should limit where we look for answers to only what is provided by neurology and psychiatry, or even be content with what is in the DSM-IV-R. One of the positive characteristics noted among those with ADHD is a wide range of interests, and being able to look for ideas and similarities in dissimilar information is a strength to be used for our benefit. Others do. Indeed, one of the most active ideas in psychology right now deals with the ideas of "mindfulness" which has its roots in Zen Buddhism, a tradition centuries old. As I pointed out in an early post, some of symptoms that heavy crystal meth users describe are very similar to the SCT framework, and there are several interventions being tried to deal with those issues, including giving those people Addreall. It seems foolish to me to say, well, they are crystal meth addicts and therefore it is of no help. What makes more sense is to say, do they have a similar problem, is what is tried helpful, and can I do something similar? Something that may help some one with hyperactivity, may not help some one dealing with hypoactivity, but something that deals with disorganization may help both.

Regarding how ADD-SCT differs from ADHD, that already has been addressed by scruo's posts at the start of this thread, the Wikipedia summary, and Adele Diamond's article that scruo quoted, and over a hundred articles you can find by looking for "Sluggish Cognitive Tempo" on Google Scholar or PubMed. That those with SCT respond to drugs differently, seem to benefit from different interventions as children, and exhibit differing issues, in my opinion, cannot be made more clear. Whether or not any one makes an individual choice to accept the findings of this research is a matter for that person alone. None of these things make any one with ADD-SCT "better" than some one struggling with ADHD, nor do they mean the similarities both share are any less valid. No one has to lose out by refining what differing individuals struggle with. It comes down to how accepting and supporting a community choses to be. How supportive of those who find the ADD-SCT framework helpful this forum will be is up to its members and administration.

As far as the changes those with ADHD experience in symptoms undergo as they get older, that is beyond what I can address. Indeed, that seems to be something that would require research into developmental neurology. Frankly, it seems only tangentially related to ADD-SCT, as those who are dealing with SCT as adults do not seem to indicate they have experienced much in the way of change in symptoms from childhood to adulthood. By accident, meadd823, you seem to have inadvertently pointed out another difference between these types. How does it feel to have added fuel to the fire? :eek:


Again, I actually have little interest in a debate on if SCT exists or not. As I said in one of my earlier posts, it fits me. While this thread has been moved over to "Diagnosis" from the Adult area, I would like to see it return to the original theme that ericdl58 opened it up with back in 2003, and which I also asked in my first post. What have those who have SCT found helpful in treatment? Honestly, to me, that is really all that matters.

The way you frame the Wikipedia usage does make sense and serves to make the thrust of Crazy~Feet's response much clearer to me. Perhaps it makes even more sense as I had not viewed this as a "debate" forum, but a "support" forum.


Perhaps it is the meaning of debate you misunderstand - I find this to be very common. You are presently engaged in a debate on a support forum. Debates occur here on a regular basis.

Debating is simply a civilized rational way of presenting two opposing opinions. Debating requires intellect, sound reasoning, and the ability to be persuasive - debating is NOT arguing however it is disagreeing but in a civilized respectful manner.





"us Hyperactives"

I often use this phrase to show which sub-type I fall into while acknowledging that not all with in the ADD population will experience {what ever} - "us hyperactives" isn't presented as being separate or removed from the ADD population but it is acknowledging that some individuals with ADD are NOT hyperactive. For me as a person it is an attempt at brevity as some of my post can be um ur lengthy.






To pound the point home, while we may share some characteristics, and have some things in common, there are many differences. We take different meds, we use different compensations, and adjust as individuals to how this disorder affects us as individuals. There is not one drug that works for all, there is not one intervention or compensation that works for all. We are all not the same.




"We" meaning the entire ADD population or we as in SCT sub-type, or is it both - sorry I read solely in context, individual words have no meaning for me so I may have to ask for clarifications that may seem obvious to many other readers. I shall pick the meaning I think you mean {oh boy}

We are all individuals of this I agree - no two hyperactive ADDers are exactly alike any more than two inattentive or combined ADDers of this I agree. However we all have BA = boredom aversion - we simply can not apply our selves to the unstimulating mundane boring to the point of mental/physical death by merely "willing" our selves to - while inattentive ADDers are often accused of being lazy hyperactive ADDers and often seen as being rebellious while both are often accused of being "uncaring" / "unwilling / uncooperative/ self centered/ ect. . . .which can set up an entire unpleasant chain of events.




To be blunt, if the ADHD community is so insecure that it is threatened by the idea a very small percentage of those labeled ADHD-I may have a slightly different disorder, then that speaks to their issues, and not the validity of ADD-SCT.

Please do remember

The ADD community is made up of individuals who are reacting according to their individual feelings and experience - I presented several reasons in response to your question that is all I did.





You stated the point very well {and concise too} IN my experience the lack of clarity as to weather or not SCT is a part of the ADD population is the one of the things that baffles most and causes the great amount of "debates" and emotional reactions about this subject of SCT.


are we then are we "ADD at all?"


Well, I guess that comes down too how wide is the umbrella?

Yes enquiring minds want to know how big if the umbrella any way?

My point is the SCT boundaries are ill defined at best - which only serves to confuse the ADD condition.





I think most researchers would vomit at finding such a use for their work, as they are more likely interested in what is going to help people have better lives.


I think most researchers would be ambivalent - their jobs are all about identifying differences with in groups however even they can create a lot of controversies with in the general population if their findings are not presented correctly and in a tactful manner {Barkely is guilty of presenting things in a tactless manner IMHO} -

Responses are a reaction not only to what you say but how you say it - as a dyslexic I know this all too well.






It comes down to how accepting and supporting a community choses to be. How supportive of those who find the ADD-SCT framework helpful this forum will be is up to its members and administration.


The administration does it's best to provide a free thinking forum where each member {even ADDF members who happen to also be staff members} is entitled to their own personal opinion and feelings as long as that opinion is communicated with respect to other members. This is why debates are allowed however flaming is not.

One of the largest supplies of information can be found in a debate done right - as two opposing opinions are presented in a civilized manner each carrying their own line of reasoning and often coming complete with documentation and sources.







As far as the changes those with ADHD experience in symptoms undergo as they get older, that is beyond what I can address. Indeed, that seems to be something that would require research into developmental neurology. Frankly, it seems only tangentially related to ADD-SCT, as those who are dealing with SCT as adults do not seem to indicate they have experienced much in the way of change in symptoms from childhood to adulthood. By accident, meadd823, you seem to have inadvertently pointed out another difference between these types. How does it feel to have added fuel to the fire?


No you said it right the first time = there is not enough research to address this question at present time. Besides NOT ALL ADDers symptoms change from childhood to adult hood only the difficulties they cause - remember my comment was about hyperactive ADDers having their hyperactive traits turn into inattentive traits My example wasn't about the entire ADD population - many with the combined subtype do not experience any changes in their ADD either - besides changes only seem to affect hyperactive traits and those changes occur most in those of us who have hyperactive impulsive symptoms apart from which sub-type we fall into - don't forget many with the combined ADD type have hyperactive traits while other combined ADDers do not.

Oh yea NOT being able to answer my question does not constitute "making a point" nor does turning around the evidence {I will admit it is a nice maneuver though- it might work except I have used it too often myself}



According to your sources some of the inattentive would fall into the SCT category while others would not - what evidence is their that this is a separate condition in itself apart from simply having a secondary condition in addition to ADD? Bi-polar combined with ADD can drastically change the appearance of ADD even though bi-polar and ADD are two separate conditions.





The amount of difference between some one who qualifies for SCT and some one who does not can be one impulsive trait?????? Also SCTers I have read on this thread take the same schedule two narcotics the rest of the ADD population does????? SCTers take these medications so they can focus {just like I do} while claiming not to have ADD???? This equals the late great wtf????? Your own discussions and exchanges create the doubts and questions. Different symptoms are not causing any heated exchanges I believe it is attitudes about those differences that ignites the bad memories and creates conflicts - I am not pointing fingers I am saying before "pounding in a point" intentions may want to be checked at the door - remember I came on this thread only to answer a question you had and try to clear up a misunderstanding because I could see both sides - I asked a few questions of my own - I believe I had four maybe five - and the reaction is????? {point pounding?}

Now to close the meadd823 way -

Bottom line - To date there is not enough scientific evidence to indicate SCT to be a separate diagnosis unto itself apart from ADD-PI,{sources provided upon request - persently I have a baby kitten I have to go feed - he is screaming starvation} I do understand research is still being done. Although some "experts" maybe pushing for SCT to be included in the next issue of the DSMV at present SCT like Dr. Amen's six ADD subtypes is not recognized as a "proper diagnosis" In reality that is the only fact I need to make my point valid.

Have a good day :) - now to go feed Mr Starvation. . . . . . . :faint:

re WIKIPEDIA

Wikipedia is NOT an authoritative source.

Recently, the entry for George Bush was hacked to describe him as a "Muppet in a monkey suit".

Funny, perhaps, but it just shows how people with biases or non-authoritative information can 'hack' the site.

Upon searching, I do not find "real" scientific journal titles (psychology, neurscience, psychiatry) describing this term as a real current diagnosis.

Sorry.

Go search MEDLINEplus yourself, I guess. (I pulled "0" entries.)

Have you had testing? (These results may uncover the mystery of this SCT thing.)

I'm betting my money on it being a sleep/wake/arousal (raphe nucleus? ARAS?) problem or an EF deficit or a 'processing disorder'.

In at least three different posts on this thread, I have stated clearly that my interest in this forum and thread is for those who find the SCT framework to fit them, what have they found helpful as far as treatment? I have also stated, I think very clearly, that I am not interested in a debate over if SCT exists or not.

I have provided links, most of which had already been sited by others on this thread, (see the very first five posts on page one of this thread), which describe what SCT is, and provide some of the research on it.

It is very easy to find a great deal of research on Sluggish Cognitive Tempo. Google Scholar lists over five hundred articles, and the National Institute of Health's PubMed directly sites fifteen. Never mind the over twenty thousand links Google has listed, or other articles on Blackwell and other search engines. But I am not here to get into a link and citation war either. If SCT interests you, you know where to look. If it doesn't, don't waste your time.

There are specific sub-forums on this board devoted to arguing and debating over the research and definiton of disorders, including SCT. I've looked at them, they don't fit my need, so they are not where I post.

I am not here to argue over how useful or not Wikiepedia is, define the word "We" so that it clearly includes all, or speculate on what enlightenment the future of neurology will provide.

Once again - I am here to find out what works for those with SCT. If you look at the very first post on this thread, that is what the orginal theme was, and what I asked about in my very first post.

No where on this board, I have found a single person who identified with ADD-SCT saying anything disparging or derogatory about any one who does NOT have ADD-SCT, or attacking the validity of the ADHD issues. Nor has any one who states they have ADD-SCT expressed relief that they some how are not "ADHD". Indeed, they are looking for information on an ADHD/ADD board.

No one has critizied those with ADHD-Hyperactive, for having their own little group. No one has complained that those with ADHD-Combined are throwing an exclusive party. Yet, for the very few looking to get more information on Sluggish Cognitive Tempo, there is an immediate and what I find to be rather hostile, response.

The only ones who have expressed any hostility or anxiety over the SCT definition are those for whom it does not fit.

Again, as Unleashed, and others have stated, and any review of the research papers you can pull up will confirm. ADD-SCT represents at most 30 to 50 percent of those with ADHD-I. Not every one that is ADHD-I is ADD-SCT. The defintions are not equivalant. It is disingenuous at this point for any one to use them as synonyms.

To me, there is no "mystery" about SCT, other than what helps with treatment of it. It has a very clear and much more thorough definition than most of the current definitions found the DSM. My practioner who has one of several articles, research papers, and letters to academic journals he has published quoted directly in a different thread, agrees.

I have clearly stated in an earlier post that ADD-SCT is a provisional diagnosis not yet officially adopted. That does not mean it is any less valid, or that seeking information about it hurts me or any one else. Again, as I have stated previously, you do not self-diagnose ADHD, it is something that is done by a doctor in concert with the patient.

I have presented my point of view on why I find it absurd for any one to be threatened or upset that a small group of users here would be seeking information and support about ADD-SCT. Looking for what works and what support can be gained does not diminish the ADHD/ADD community at all, and may even help those with a differing diagnosis.

If some one has information on what is helpful for those with SCT, I will be interested to see what you share here. A scientific debate on some other topic I MAY engage in on a different thread if it is of interest to me. I feel no obligation to post, reply or participate in each and every discussion here, or questions not related to what I am trying to find out.

If you are interested in providing information, support and assistance, I look forward to what you have to share. That's what I came here for.

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Just heard Dr. Barkley talk about it yesterday at an LD/ADHD forum. They are still in process of researching and not much info yet. The wikipedia info is about all that was listed in the notes for the Western North Carolina Symposium's keynote speaker, Dr. Barkley himself.

Reading and language deficits and problems with mental mathematical calculations are more commonly comorbid with ADD than with ADHD.
Can someone explain to me what is meant by reading deficits? I can read outloud very fast and clear, but understanding what I'm reading at the same time is an entirely different thing. I can read extremely fast, but I usually drift off, not knowing what the text was about.

Hi everyone, this is my first posting, hope I don't violate any rules! :eyebrow:

The posts by Jeremynd and Luthien especially resonate with me. I was diagnosed with ADD back in Jan '05.....and I have read tons of stuff on the subject, trying to understand it better....and it wasn't till just LAST WEEK that I first encountered the term:

"Sluggish Cognitive Tempo"

........but it describes sooooo many facets of me, it is spooky!

Like Luthien's description, I have been "tested out" as having "a high IQ" (for whatever that is worth), supposedly over 140. HOWEVER, once I got past High School freshman algebra, learning math beyond that was like pulling teeth.

(I tortured and browbeat myself all the way thru Calculus III in college...failing Calc I and Calc II once each before passing....just to "prove to myself I could do it." Of course, within one week after each course was over, I probably forgot 95% of everything).

I'm super good at recalling things that "interest me," or that I "care about," or that "resonate with me"......

.......of course, how to define each of those categories is a whole 'nother story.

I often say, "my brain has a mind of its own," in the sense that I usually feel like there is something like an "inner gyroscope" in my head that has its OWN agenda about what it does and does NOT care about....and that my "conscious mind" can run itself ragged trying to "force" myself to get interested in this or that, or study this or that...but it is like "pounding sand down a rathole."

Dear Echo -

Although I can't claim any REMARKABLE improvement from my ADHD treatment attempts as of yet, I would like you to know that (if I'm remembering correctly) the SCT subtype really resonates with me as well. And I also cannot understand why anyone here would get so "passionate" about your posts regarding the subject.

I'm sorry you haven't received the kind of replies you were hoping for. I would definitely have been interested in those responses myself.

Sincerely,
Sue

Dear all,
I am a little surprised to read how much emotion this debate is generating; the mentioning of creating in- and out-groups ("purple eyes") etcetera.
For me all this is simply trying to understand myself - not about defining a group and erecting borders of any kind. When I first read about the "SCT profile" it made a lot of sense to me because it described me so well. And of course it is helpful and healing to see all this in others as well.
In the time between this post and my previous in this thread I have received a second opinion diagnosis, and this pdoc was more detailed than the previous one: severely inattentive, and not hyperactive/impulsive at all. He does not use the term SCT, but just ADHD-PI - which is totally fine with me. I don't care what the name of my label is, and I am totally happy to share thoughts, opinions and emotions with all ADD people, hyper, not hyper, what have you.

It may be that the ADHD-PI group will be subdivided in the future. But to me, that is entirely a scientific issue, and therefore an interesting subject for debate. As it is now, the group is indeed quite varied. But that is just an observation, and not something that I resent or feel bad about at all.

I am merely relieved and touched to find that there are also people under the ADD 'umbrella' who are so much like I am.
And that's all there is to it for me.

love & light,
~luthien

<p>...
<p>However, as I am now an adult, without access to such time machine, and more than a little frustrated with the lack of info on what works for Adults with ADHD, I am wondering if any one here has any links to effective strategies, tactics, compensations, approaches or treatments, other than medication, specific to Adults with SCT. Nothing against meds, I'm on a stimulant and it helps, but not enough for me to be functional and stable. </p>
<p>Am looking through the other topics on treatment, but every thing I've found so far has been very generalized, or honestly reads more like a sales pitch for a coach, rather than a treatment module. I'm trying to find a framework of what works and why. Thanks for any pointers or info any one may share.</p>

Hello,

To be frank your post interested me like no other post since almost two years!
I totally agree with your fustration about the help specific to Adults.
I agree ever more since , as a french, i have no treatment and no way to test for add...
...i don't know if i am inattentive, sluggish or whatever type of inattention deficit...
What i know is that since childhood my working memory is awfull. My calculation skills too but i not too bad in maths ...

Now past forty i have more than 20 years of tactics and compensations with this problem.
Briefly what work ? reading, playing chess ( at least trying to ... ), coffee, aspirin and vitamin C ( not all in the same time of course ), sport and manual work.
What don't work ? Alcohol !! stay away of that !!

What improvment during these years ? electronic agendas and definitively smartphones !! The youngs adults have no ideas how it was difficult to juggle with work and agenda before having the possibility to synchronise your pocket phone and your computer..

I'm currently a student at Harvard Law School and have been on adderall since 9th grade. I would absolutely describe myself as a person that perfectly fits the SCT description, which I have only learned about recently. Particularly, the "in a fog" effect is the best characterization I have ever found of my problems. Daydreaming, being socially shy (although I would say that my baseline personality, without the SCT is extroverted - leading to much internal conflict), etc. all fit my issues.

The adderall treatment has worked very well for me, at least work-wise. But it has had adverse effects on my social abilities, as I often feel a lack of emotion that makes me seem very disconnected and "stiff," for lack of a better word, to many of my peers. Since I don't take adderall on the weekends for the most part, many of my friends have mentioned to me how differently I act in social settings on those occasions.

So recently I decided to go a week in school without using adderall. While I have definitely gone for long stretches of time without use of medication (on vacations, etc.), I have never done so while in school or at work. Thus far, I'm finding that the "in the fog" effect