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Old 10-10-11, 08:13 PM
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Post Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore?!

Two recently-published studies suggest SCT is a separate disorder from ADHD, but co-occurs about 50% of the time -- and in both ADHD-PI and ADHD-C.

This could be filed under "scientific discussions", but I thought it would be of interest to a wider audience, so I put it here.

There's been a lot of talk recently about "sluggish cognitive tempo" or "SCT".

Unlike ADHD, SCT is not a formal diagnosis existing in the DSM-IV.

Rather, it's a collection of symptoms that have often been noticed by clinicians and researchers, often in people who are referred for ADHD evaluations or diagnosed with ADHD.

Symptoms of "SCT", as it is currently conceived, include things like "daydreamy", "processes information slowly", and "lethargic/hypoactive". There's not really a standard definition at the moment.

Some researchers (notably Russell Barkley) have argued that people diagnosed with the "Predominantly Inattentive" subtype of ADHD (ADHD-PI), who lack hyperactive-impulsive symptoms altogether, may really represent a separate group who would be better described by the SCT label than the ADHD label. Others have argued that ADHD really encompasses SCT.

In recent months, there have been a couple of eye-opening studies on SCT, and I wanted to summarize them for y'all.

Study #1:
Skirbekk B, Hansen BH, Oerbeck B, and Kristensen H. The relationship between sluggish cognitive tempo, subtypes of attention-deficit/hyperactivity disorder, and anxiety disorders. Journal of Abnormal Child Psychology 39(4):513-525. May 2011.

What they did:
The authors, working in Norway, identified kids ages 7-13 who were being seen in outpatient clinics for evaluation of ADHD and/or anxiety disorders, as well as some "control" children from nearby schools without any identified psychiatric disorder (total of 141 kids).

They had mothers fill out questionnaires about their kids to get an idea of the kids' ADHD symptoms, anxiety symptoms, and SCT symptoms. They also gave the kids a variety of neuropsychological tests at their clinic to examine intelligence, attention, executive functions, and processing speed.

They were very strict about classifying kids as ADHD-PI to try to avoid including "subthreshold ADHD-C" kids (those kids who fit the "combined type" pattern but just miss the symptom cut-off).

What they found:
Kids with both ADHD + anxiety were more likely to have SCT symptoms than kids with only ADHD or only anxiety.

Kids with both ADHD-C and ADHD-PI were about equally likely to have SCT symptoms.

Kids with SCT didn't seem to have slower reaction times than other kids, but they had more variable spatial memory.

Study #2:
Barkley RA. Distinguishing sluggish cognitive tempo from attention deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology(advance online publication). May 2011.

What he did:
Russell Barkley hired a firm to recruit a "nationally-representative" sample of adults, about half male and half female, ages 18+ from across the U.S.

The adults completed questionnaires to assess ADHD symptoms, SCT symptoms, executive function, functional impairment, and demographics and social variables.

He based his classification of "SCT" on a score in the 95th percentile or higher (meaning these adults were in the top 5% for SCT symptoms) based on questionnaire responses. ADHD was also classified based on a similar cut-off using his questionnaire.

What he found:
Of these adults, 33 had SCT but not ADHD, 46 had ADHD but not SCT, and 39 had both SCT + ADHD.

Of the adults with ADHD, they were evenly split by subtype: ~1/3 ADHD-PI, ~1/3 ADHD-HI, and ~1/3 ADHD-C (different from most studies of adults, which find very few ADHD-HI cases).

Adults with ADHD + SCT were about equally likely to have ADHD-PI or ADHD-C (but not many had ADHD-HI) -- and about 2/3 of both the ADHD-PI and ADHD-C people had SCT.

Adults with SCT alone seemed to have more difficulty with organization and problem-solving than adults with ADHD alone, but adults with ADHD + SCT had worse problems with these things.

Similarly, in terms of some life outcomes (occupational status, etc.), ADHD + SCT produced an extra whammy.

Take-home messages:
Maybe about 1/2 to 2/3 of people with ADHD who have a lot of impairing inattentive symptoms -- that includes both people with "Combined Type" and those with "Predominantly Inattentive Type" -- have high levels of SCT symptoms.

People can also have high levels of SCT symptoms without having high levels of classic ADHD symptoms.

The combination of ADHD + SCT seems to be associated with increased levels of anxiety, more difficulties in certain types of executive functions (which are not always affected by ADHD alone), and poorer functional outcomes in some areas.

We still have a lot to learn!

...But it's a start, and one that opens up the possibility of looking at SCT in a new way -- it's not the "opposite" of hyperactivity-impulsivity, but may in fact coexist with it.

Check this space for updates...and feel free to add questions, comments, or new information you come across!

Just a few of many caveats:
Keep in mind this is preliminary information about SCT. There is no scientific consensus yet on what it is, and what it's relationship is to ADHD.

Like a lot of cutting-edge info, it is likely to be refined and modified as more in-depth studies happen and scientists and clinicians get a better idea of what this thing (SCT) really is. Also, though these two papers were peer-reviewed and published in scientific journals, the researchers do have particular points of view that shaped the way they asked their questions.

Both studies also had limitations (which I won't discuss in detail because my head is tired) -- decisions the authors made when they conducted the studies, and the populations they studied, that make it more difficult to understand how their results might reflect the broader picture of messy real-world cases. This is almost always true of studies like this, not a flaw specific to this research. But as these were fairly small studies of a condition that no one is quite sure how to define, it's likely 10 years from now, we'll look back on these papers and get a better sense of just how far we've come in understanding this thing.
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adhd-c, adhd-pi, inattentive, sct, sluggish cognitive tempo

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