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  #16  
Old 11-12-11, 04:04 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

Additional studies on SCT:

~Evaluating the Utility of Sluggish Cognitive Tempo in Discriminating Among DSM-IV ADHD Subtypes.

Kelly M. Harrington & Irwin D. Waldman



Intro:

Under current DSM definitions, ADHD/IT appears to subsume both children who are subthreshold on the hyperactive-impulsive symptoms necessary for ADHD/CT and those who display symptoms of inconsistent alertness, orientation, and underactivity.

Specifically, SCT contributed to an inattentive factor in girls but represented a separate factor for boys, suggesting the potential need for sex-based differences in diagnostic criteria when using a continuum approach to classification.

Their results revealed that the SCT subgroup could not be distinguished from the remainder of the ADHD/IT group by their performance on a battery of neuropsychological tests measuring executive functions, motor speed, and language processing.
Given the small sample size of the high-SCT ADHD/IT group, however, it is possible that this study lacked sufficient power to detect subgroup differences within the ADHD/IT.



Study Design:

“These SCT symptoms were described on the ECRS as follows: 1) “forgets what he or she is doing during daily activities,” 2) “stares into space and daydreams,” and 3) “seems to be tired, sleepy, or have no energy.”


Results:


Pearson correlation coefficients were calculated among the ADHD symptom dimensions—the inattentive symptom dimension and the hyperactive-impulsive symptom dimension—and the SCT symptom scale.

High correlations were found between the inattentive symptom dimension and both the SCT symptom scale (r=0.77, p<0.001) and hyperactive/impulsive symptom dimensions (r =0.69, p<0.001).


A moderate correlation was found between the hyperactive/impulsive symptom dimension and the SCT symptom scale (r=0.47, p<.001).
These correlations were consistent with those reported by Hartman et al. (2004).


The high- and low-SCT ADHD/IT groups were found to have a significantly higher mean age-of-onset than the ADHD/HT and ADHD/CT groups, which is consistent with the extant literature


Indeed, the high-SCT ADHD/IT group did show significant elevations in symptoms of depression, generalized anxiety, social phobia, and obsessions relative to a normal comparison group. This pattern of findings suggests that the SCT subgroup may be associated with higher levels of a specific subset of internalizing disorder symptomatology.


This begs the question of whether the SCT construct, at least as measured in the current study, might be capturing overlapping symptom variance with internalizing disorders such as major depressive disorder and generalized anxiety disorder.

Alternatively, perhaps SCT is tapping increased risk for the subsequent development of co-occurring depressive and anxiety disorders which most often emerge during or after adolescence.



Limitations, Clinical Implications, and Future Directions:


ADHD diagnoses were based on symptom ratings by parents alone. The lack of complementary teacher ratings imposes limits on our ability to determine the extent to which functional impairment was present in two or more settings.


In addition, it is possible that if teacher ratings had been included in the current study, we would have reached different conclusions given that studies utilizing teacher reports have yielded more promising findings with respect to the utility of SCT symptoms for discriminating subgroups within ADHD/IT.





Reference:
Harrington, K., & Waldman, I. (2010). Evaluating the utility of sluggish cognitive tempo in discriminating among DSM-IV ADHD subtypes.*Journal of Abnormal Child Psychology,*38(2), 173-84. doi:10.1007/s10802-009-9355-8
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  #17  
Old 12-07-11, 02:47 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

don't know. You could break this down case by case infinitely. I'm not sure if the road would lead you anywhere concrete. It's a coin toss. If your slow then your slow and have learning disabilities and alot of children have learning delays and are mis labeled adhd . I'm sorry, but that's a fact. Spatial disorders are different because it's not really that your slow it's just your using different parts of your mind, "ie" the wiring is different, but slow is not something that describes it. A couple of other things that I want to add. Anxiety can slow down others, the anxiety could come from shynesss , upbringing, confidence or a host of tons of other things related to learning or even cognitive delays which is really not a long term disorder. Additionally, anything that slows you mentally is going to affect the working memory. So if you have adhd and they give you an ssri for anxiety and you show signs of slowness then it's probably a seesaw effect from the wrong medication. Something that may help would be tenex or intuniv with a stimulant. Oh , and all the symptoms described are both of the hyperactive and inattentive criteria. The bottom line is most of the symptoms of inattention involve "the ability to stay on task" who cares about how many of each you have it's add or adhd and it's really too close to call folks. Every person with adhd thats more hyper or more inattentive are going to miss details and space out . Some kids are just going to be a bit more rowdy . Means nothing in my opinion if one has adhd. They both do , and they are both treated the same. They are just different kids , tons of people out there have the brain issue and some are more energetic than the next. Don't overanalyze it to death.
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Old 12-07-11, 04:11 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

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Originally Posted by hollywood View Post
don't know. You could break this down case by case infinitely. I'm not sure if the road would lead you anywhere concrete.
On the one hand, I think you're missing the point.

On the other hand, I think you have a point.

Here's where I think you're missing the point:

The deal with SCT is that it seems to be what Barkley likes to call "a separate disorder of attention" -- that is, it seems to affect some different attentional/arousal/executive function (?) processes than ADHD does (though there is a lot of overlap, due to some combination of frequent comorbidity, and possibly imprecise definitions/distinction between ADHD vs. SCT symptoms).

But SCT also appears to be somewhat distinct from other processing disorders specific to visual/spatial, phonological/linguistic, and motoric modalities. In that way, it appears to be a different entity from widely-described LDs such as dyslexia and dysgraphia. Again, though, there's undoubtedly some overlap -- but I don't think there's good research on this yet (and even the "well-known" LDs like dyslexia are only beginning to really be understood).

SCT also appears to be distinct from being "slow" in the sense of having globally-limited intellectual abilities -- that is, like with ADHD, a person could have a normal or above-average IQ and still have SCT.

I do think it's important to look into this further, and I don't think it's necessarily splitting hairs or overanalyzing. If SCT represents an attention/processing/arousal disorder that exists independent of ADHD, involving at least some different processes in the brain, then the most appropriate treatments for it may be different. Misdiagnosing people with one when they have the other could lead to delays in finding effective treatments and increase the likelihood of problematic reactions to medications.

Also, if a lot of people with SCT-only are being identified as ADHD-PI, then studies looking at ADHD-PI that don't separate out those with "true" ADHD and those with SCT, the studies will end up with some rather confused results.

Of course, as the linked studies suggest, there does appear to be a lot of comorbidity, with maybe half of people with ADHD also showing symptoms of SCT, and vice-versa. That may suggest some shared pathways, or effects of ADHD on development, or linked genes -- who knows? Taking SCT into account (like acknowledging LDs such as dyslexia, or other coexisting problems like anxiety, depression, OCD, tics, addictions, etc.) may help explain why some people with ADHD struggle with certain problems while others don't -- even if they both clearly have ADHD. And it may provide insight into how to provide more helpful therapy or disability-management suggestions for people with ADHD and/or SCT.


...So, that said, I do think you make a good point that what's most important is finding ways to deal with the problems, rather than focusing on the labels. Understanding the causes of problems will likely be helpful in dealing with the problems, since more accurate diagnosis of the underlying causes may help people get to the proper treatments more quickly.

But I agree that greater acceptance that people's brains come in a wide variety of flavors* -- on the part of the general public, and especially the medical, educational, occupational, and legal establishments -- is also crucial, and it would be help anyone with any kind of neuropsych disability, regardless of its label(s).



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  #19  
Old 12-08-11, 06:34 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

[quote]
Quote:
Originally Posted by namazu View Post
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.
Signs and symptoms are to different things,

SCT and ADHD have similar signs but different symptoms.

If there is a total lack of hyperactivity and impulsiveness it is not ADHD.



Quote:
[The relationship between sluggish cognitive tempo, subtypes of attention-deficit/hyperactivity disorder, and anxiety disorders.[/url] Journal of Abnormal Child Psychology 39(4):513-525. May 2011.


People with ADHD don't live as long as the average population.

Because we are born more sensitive and stressed more frequently.

ADHD is a neurological syndrome,

we are neurologically sensitive throughout the body and brain.

To internal and external environments.




There is a thread about fifty different medical issues that mimic(have signs of) ADHD.

That can be misinterpreted as signs of ADHD,

but really could be symptoms of one of these 50 medical issues.


I do agree if the symptoms point to another medical issue and not ADHD,

then it is not ADHD.



But also consider the opposite,

any of the signs of these 50 different medical issues could be symptoms of ADHD.


A person could have signs of ADHD caused by allergies,

but also signs of allergies caused by ADHD.

(I think this is one reason why some people think that ADHD is caused by allergies)

Because they had signs of ADHD.

Not symptoms.

And when they avoid the allergic substance,

the signs of ADHD go away,

and they claim ADHD is not real.

When they never had ADHD in the first place.


Reactive Attachement Disorder has signs of ADHD,

And ADHD has signs of reactive attachment disorder.

But they both have different symptoms.



If we look at the comparison between signs of diabetes and signs of ADHD,

some signs are also over lapping and similar.


Signs are not symptoms.

That is why they are different medical conditions.

That is why ADHD is not SCT



Quote:
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.

SCT and ADHD are two different things.

It makes sense that any person born ADHD sensitive,

who has anxiety issues could be subconsciously tuning-out/disassociating physiologically,

as a reaction to stress over load.


If we are talking about people with ADHD ,

and the sensitive "fight, freeze or flight" stressors response system of people born with ADHD?



The question I would focus on in the parents questionaire,

is why the anxiety in the children?


Separation, rejection, fear..etc?


After birth and not before,

real and not real* implicit memories,

in early childhood internal and external experiences are stored in the subconscious mind during the first 3 years of life.

80% of the adult human brain develops before the age of three as well as implicit emotions and memories.

Implicit memories are memories that we don't consciously remember,

and are shaped by environmental conditions and level of attunement in the infants life.


In general humans use almost 100% our individual brains.

Our minds work approx 10% consciously,

and 90% subconsciously.

This is why ingrained addictions, anxieties , fears , depressions etc,

are hard to stop.

We are directed 90% by the subconscious implicit memory ,

during daily living which is programmed in early life.


Conscious emotions are a minority,

ruled by the subconscious emotional majority.

Resulting in internal struggles emotional self regulation..



Both people with anxiety and without anxiety,

subconsciously live/act out,

implicit memories everyday from our own unique environments and early life experiences.

Anxiety can be one of the results.


Again the difference is the sensitive temperament people with ADHD are born with.

our sensitive response to stress,

also effects our the inability to deal with some situations,

and coping mechanisms like tuning out or acting out can be the result. Etc.


No sure about SCT.

Categories of ADHD types may help on a macro level some understanding and research for ADHD.


But I think in regards to treatment and lessening of severity of comorbids.


Learning how the brain develops in interaction with individual's own personal environment,

and developing accommodations to account for the predisposed ADHD sensitive temperament,

in our daily environment,

would be goals to attain.


I don't think all these different sub types are different types of ADHD.

But different "branches" from each individual personal environment ,

effecting/reacting with different severity of ADHD temperaments.


For a better self understanding of ADHD,

I think it is more important for people to learn how the brains develops after birth,

in regards to social-emotional self regulation,

and their own internal and external environment.

Than to spend much time on different sub-types.


I find that I can have any of these sub-types of ADHD.

Depending on the environmental circumstances that I am exposed to.

Last edited by mildadhd; 12-08-11 at 06:53 PM..
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  #20  
Old 12-27-11, 02:56 AM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

Quote:
(As a side-note, I think the reason I am so lethargic and tired all the time is because I can't "skip ahead" in thoughts related to day-to-day life, like driving, taking out the trash, doing dishes, etc. It's much easier to disengage completely and "turn off" the mind than face the anxiety and frustration that would result.)<!-- / message -->
<!-- controls -->
This sounds exactly like me! If I sit down and try to 'think' things through, I eAsily lose track of what I'm thinking about and become so frustrated!! Its all about the current moment. That's when things get done.

I've noticed that I get tired very easily... Even with 8-10 hours of sleep the night before! Now when I (try) to monitor myself during social interactions, i easily find myself uninterested in what that person has to say. even when i attempt to force myself to pay attention, rarely do i find that i do any better. I was always told that this is just my bodie's natural rhythm, and people get tired like this normally. Now i know better! I hope.more information is revealed about this! Vyvanse seems to help my focus but unfortunately SCT is kicking my inattentive, day dreamy, lethargic, socially inept butt!!!!

This is good information to read. I am subscribing!

Thank you, Brandon.
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Old 02-22-12, 01:21 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

Barkley's New Rating Scale Incorporates SCT

Barkley Adult ADHD Rating Scale-IV (BAARS-IV)

http://www.guilford.com/cgi-bin/cart...d=606287.10134

Special features include a section of items assessing the newly identified symptoms of sluggish cognitive tempo, also known as the inattentive-only subtype of ADHD.
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Old 02-22-12, 01:29 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

An excellent thread.

I have come to suspect that I have SCT WITHOUT ADHD. This is perfectly reasonable if SCT is a separate, independent disorder.

So GAD + Bipolar-2 + SCT may look like ADHD, but not be, and not respond to traditional ADHD treatment (RItalin) as in my case.

** Bipolar + SCT = the strange, paradoxical creature called Abi
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Old 08-31-12, 12:55 AM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

Quote:
Originally Posted by danpan View Post
I'm diagnosed ADHD-PI, with all the symptoms of SCT, and I really don't mind the name.

I have a lot of trouble following a steam of information continuously, step by step, because my cognitive "tempo" doesn't beat in such short intervals. When people talk, that causes problems for me, just as it does when I'm reading, or trying to do anything else that requires me to manually process a constant stream of information.

I don't think of the term as derogatory, or implying that I'm slow in general, because it is specific and accurate in naming what is sluggish. Once I have internalized enough information, I skip from step 1 to step 5, to step 7, to step 12, so forth and so on, and then, when I reach a conclusion, I go back and fill in the blanks with a retroactive analysis.

In situations where information flow is at my discretion, and in a format suited to skipping around, I perform extremely quickly. Diagnosing problems with computers for example... often it only takes a few seconds to test a hypothesis, and from that, glean more information than a person could provide orally in 5 minutes of continuous chatter.

So my "tempo" is very slow, and the term is accurate, at least for me. It doesn't imply to me that I am a slow thinker. Just that my mind stops to consider new information in longer intervals than most, because it's always trying to skip ahead. It's often a curse, sometimes a boon.

(As a side-note, I think the reason I am so lethargic and tired all the time is because I can't "skip ahead" in thoughts related to day-to-day life, like driving, taking out the trash, doing dishes, etc. It's much easier to disengage completely and "turn off" the mind than face the anxiety and frustration that would result.)
This actually describes me exactly!!
So, is this actually sct or just plain old adhd.
Hmmm. .
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Old 08-31-12, 01:27 AM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

Quote:
Originally Posted by MusicLife View Post
[/right]
This sounds exactly like me! If I sit down and try to 'think' things through, I eAsily lose track of what I'm thinking about and become so frustrated!! Its all about the current moment. That's when things get done.

I've noticed that I get tired very easily... Even with 8-10 hours of sleep the night before! Now when I (try) to monitor myself during social interactions, i easily find myself uninterested in what that person has to say. even when i attempt to force myself to pay attention, rarely do i find that i do any better. I was always told that this is just my bodie's natural rhythm, and people get tired like this normally. Now i know better! I hope.more information is revealed about this! Vyvanse seems to help my focus but unfortunately SCT is kicking my inattentive, day dreamy, lethargic, socially inept butt!!!!

This is good information to read. I am subscribing!

Thank you, Brandon.
Have u had ur thyroid levels checked?
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Old 01-16-13, 11:10 PM
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Re: Sluggish Cognitive Tempo (SCT): Not just for "Predominantly Inattentives" Anymore

I am the worst about threat necromancy, but...

I don't mind the term "sluggish"...I like that it's distinctive and different. Helps to emphasize that it's NOT ADHD. Talk about inaccurate terminology...how can you have a hyperactivity disorder without hyperactivity?

When I was first diagnosed, people would say, "You can't have ADHD...you're not hyperactive." And I'd have to explain that some people with ADHD are actually not H at all...they're sort of the opposite.
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