Key differences between PI and SCT?

[Verile]

Can anyone explain to me or link an explanation detailing exactly what the difference is? At first glance they appear very similar.

What distinguishes the two?

[Verile]

Er, sorry about that. Further reading reveals it's just a matter of label revision. I'd delete this if I could.

[ana futura]

http://www.pensivepediatrician.com/2...tempo-vs-adhd/

All you need to know.

[Verile]

Thanks, that was perfect. Succinct and bulleted just the way I like it.

[mctavish23]

PI is considered to be a "waste basket" for many different features; some of

which may represent recognizable ADHD related Executive Function impairments

(i.e., Executive Dysfunction), while others may be artifacts of possible comorbid

conditions; or even degrees of Hyperactivity - Impulsivity symptoms.

The main reason is that attentional problems are ubiquitous to virtually all mental

health conditions; which is why ADHD PI can be such a tough diagnosis (unless

you know what to look for).

As for SCT, also please remember that this is merely a theroretical construct at

present.

As for the two "real" SCT kids I've seen and diagnosed with ADHD PI, with features

of SCT, (anecdotally) I'd say they "stood out" as being (literally) in slow motion.

I know that's condensed, but it's about all I can think of (or say).

Hope that helps.

tc

mctavish23

(Robert)

[shamrock]

I stuggle with this too Verile. I relate to Sct in a lot of ways but when they talk about SCT people moving slowly they lose me. I dont move slowly. I fly along. If they invent a fast moving Sct then I am in otherwise I am staying Add PI/Sct because I really cant call it. These are the 8 symptoms that keep drawing me to Sct

Daydreaming excessively
Trouble staying alert in boring situations
Easily confused
Spacey; Mind seems to be elsewhere
Stares a lot
More Tired than others
Underactive, less energy than others
Apathetic or withdrawn; less engaged in activities; Gets lost in thought.


That is me to a tee. Wow is it ever!

These next symptoms turn me off because my response to them ranges from "No not me "to "hmmm maybe" at an outright push.


Slow moving
Doesn’t seem to process information as quickly or accurately as others
Slow to complete tasks; needs more time than others
Lacks initiative to complete work or effort fades quickly .... (What work? Housework yes. Academic work no.)


So is that Sct or severe Pi? Answers on a postcard please...

[shamrock]

For those who suspect that they might have SCT or are at least considering it which symptoms draw you in and which of the above symptoms if any leave you a bit cold? It might be worth reading Ana futuras link.

[Verile]

Sluggish Cognitive Tempo (SCT):

• Daydreaming excessively
• Trouble staying alert in boring situations
• Easily confused
• Spacey; Mind seems to be elsewhere
• Stares a lot
• More Tired than others
• Underactive, less energy than others
• Slow moving
• Doesn’t seem to process information as quickly or accurately as others
• Apathetic or withdrawn; less engaged in activities; Gets lost in thought
• Slow to complete tasks; needs more time than others
• Lacks initiative to complete work or effort fades quickly

I'm all of the above, Shamrock. Specifically to describe the symptoms you don't have, I'm always the last one. I never rush anywhere until I'm running late. I'm slow-witted and have to prepare conversation in advance, using likely scenarios, before I go to meet people. I'm always the last to finish tests; oftentimes I don't finish. Despite being good at math it takes me much longer than my peers to complete. I'm always being outpaced when walking with friends. Everything for me takes an unreasonable amount of time due to a combination of zoning out, losing focus, wanting to give up, getting confused, lethargy, etc.


The worst offender is the last one, the lacking initiative to do anything, even things that are interesting on a conceptual level but lacking instant gratification. While all of the symptoms are manageable to some degree it's that last one I accuse of ruining my life and the one I'm most desperate to address. I cannot motivate myself to do anything that I consider to be of value. It's like...this inability to move the way you want. A heaviness. You feel like you have a leaking supply of will power. Doing anything, even the things you want/like to do is a struggle. And the more I talk to people about this, the better I understand that's not how it's supposed to be.



I think it's the last 4 symptoms you say you don't have that really distinguish SCT from PI. It's those last 4 that make me identify so strongly with SCT rather than PI.


So if I'm to go with my thoughts and opinions, you're not SCT. Granted, maybe SCT is just PI + comorbid disorder and I'm not SCT either. As the research gets done time will tell but as of now SCT fits me like a glove.

[Fortress]

Originally Posted by shamrock

I stuggle with this too Verile. I relate to Sct in a lot of ways but when they talk about SCT people moving slowly they lose me. I dont move slowly. I fly along. If they invent a fast moving Sct then I am in otherwise I am staying Add PI/Sct because I really cant call it. These are the 8 symptoms that keep drawing me to Sct

Daydreaming excessively
Trouble staying alert in boring situations
Easily confused
Spacey; Mind seems to be elsewhere
Stares a lot
More Tired than others
Underactive, less energy than others
Apathetic or withdrawn; less engaged in activities; Gets lost in thought.


That is me to a tee. Wow is it ever!

These next symptoms turn me off because my response to them ranges from "No not me "to "hmmm maybe" at an outright push.


Slow moving
Doesn’t seem to process information as quickly or accurately as others
Slow to complete tasks; needs more time than others
Lacks initiative to complete work or effort fades quickly .... (What work? Housework yes. Academic work no.)


So is that Sct or severe Pi? Answers on a postcard please...

I have all those symptoms. Regarding slow moving, do you have doubt because you rush between your various destinations as you hate losing time? Regarding how you lack initiative to complete work, is it because your academic work stimulates you (you are really interested by it?)

If so, then I don't think those points are contradictions to the theoretical diagnosis. Regarding the other two points about processing information slowly and completing tasks slowly, if you are fast when thinking/doing completely logical tasks but slow when doing things that you don't have much interest in/that require more technical complexity, then I don't think those are contradictions either.

Just sayin'.

[LaMbaL]

I only feel put off by the "Doesn’t seem to process information as quickly or accurately as others". Maybe I am just interpreting this wrongly, as to me its sounding like "slow and stupid", like the one puzzled face in a classroom where everyone else gets it. If so, that is quite the opposite of how I view myself.

On the other hand, I know I have slow reaction speed compared to most people. So if it just refers to the process of converting sensory information into 'brain language' I can respond to, this might be correct. Like, throw a ball at me unexpectantly, and I will have a far higher chance of it hitting me on the head rather than catching it than most people would, if this makes any sense.

[Caleb666]

A little bit of history as I understand it:

ADHD first appeared in DSM II as a "hyperkinetic reaction of childhood", which indicates that it was at its core a dysfunction of excess motor activity.

In DSM III it was renamed to ADD, having two subtypes: ADD/H and ADD/WO (without hyperactivity). The problem was that there wasn't really enough literature on the ADD/WO subtype, and yet doctors were seeing children with such attention problems, so they decided to throw it under the ADD umbrella to promote further research into the disorder.

And indeed, more and more research was being released that showed that ADD/WO was really a valid behavioral disorder.

Surprisingly enough, in DSM-III-R they have unified both disorders into one - ADD. After the release of this DSM edition, evidence became accumulating once again that ADHD might be a multidimensional disorder, which could be grouped into hyperactivity-impulsivity and inattention.

When DSM-IV came out, ADD was renamed to ADHD and the three subtypes were born: ADHD/HI (hyeractive-impulsive), ADHD/C (combined) and ADHD/I (inattentive). ADHD/C corresponded to the ADD/H of DSM-III and ADHD/I corresponded to ADD/WO of DSM-III, and ADHD/HI didn't really correspond to either of them. It seems like the definition of ADHD/HI was motivated purely by future research interests (sorta like ADD/WO was).

When you look at ADHD/I and ADHD/C you clearly see that the dimension of attention is different. Both of them are inattentive, but for different reasons. There are also major personality differences and behavioral differences between both "subtypes", one has more externalizing behavior (extrovert) while the other has internalizing behavior (withdrawn, quiet, prone to anxiety), although there are some similarities too (both are prone to depression, for example).

Researchers like Russell Barkley are trying to come up with a theory of ADHD that would explain the disorder from childhood to adulthood, and ADHD/I simply does not fit into at all, which is one reason why it could be a 2nd disorder of attention, that has some overlap with ADHD, but can also exist on its own, and he calls it SCT.

Note that in DSM-V they are now no longer looking at ADHD from the subtype perspective. Instead of subtypes they now use "presentations". In order to encourage more research for SCT, they've add a presentation called "Inattentive Presentation (Restrictive)" which focuses on people that have inattention symptoms and at most 2 hyperactivity/impulsiveness symptoms. Maybe in the next DSM revision we will see ADHD/I removed and SCT as a separate disorder!

[ana futura]

Originally Posted by Caleb666

When you look at ADHD/I and ADHD/C you clearly see that the dimension of attention is different. Both of them are inattentive, but for different reasons. There are also major personality differences and behavioral differences between both "subtypes", one has more externalizing behavior (extrovert) while the other has internalizing behavior (withdrawn, quiet, prone to anxiety), although there are some similarities too (both are prone to depression, for example).

No, if a person truly has ADHD PI, and not a misdiagnosed thyroid disorder, or whatever Barkley is calling SCT, then they are both inattentive for the exact same reasons. The source of the innattention is the same, although the manifestation might be a little different. True ADHD PI looks a lot like ADHD C, it's just "softer".

Edit: maybe I have misread you. When you said ADHD I are you refering to PI or what Barkley calls SCT?

[Caleb666]

Originally Posted by ana futura

No, if a person truly has ADHD PI, and not a misdiagnosed thyroid disorder, or whatever Barkley is calling SCT, then they are both inattentive for the exact same reasons. The source of the innattention is the same, although the manifestation might be a little different. True ADHD PI looks a lot like ADHD C, it's just "softer".

Edit: maybe I have misread you. When you said ADHD I are you refering to PI or what Barkley calls SCT?

When I said ADHD/I, I was referring to PI.

Thanks for correcting me, I should have consulted the most recent papers before writing that post. According to Barkley's recent 2011 paper, ADHD/HI is merely an earlier stage of ADHD/C; ADHD/I and ADHD/C are possibly just variations in severity (in some cases); A subset of those classified as ADHD/I might be grouped under the SCT umbrella.

I remember reading an older review paper from 2001 that was claiming that the ADHD/I subtype is a different disorder than ADHD, but I guess that the reality now is a bit more complicated.

Edit: To explain my confusion, here's a Barkley commentary from 2006: http://onlinelibrary.wiley.com/doi/1...4.489/abstract
Here's a bit of text from the beginning of the paper that pretty much says exactly what I have in my original post:

The article by Milich and colleagues (this issue) culminates 20 years of research and debate on the taxonomic
status of the predominantly inattentive type (PIT) of attention-deficit hyperactivity disorder (ADHD), providing a refreshing, timely, and well-reasoned approach to this controversy. The paper will undoubtedly foment, if
not fulminate, further debate on this issue. But it is at least clear now that substantial evidence has accrued to argue,
persuasively I believe, for the position that PIT is not a subtype of ADHD at all but a qualitatively distinct condi-
tion if properly defined. As Milich et al. make plain, PIT demonstrates a distinctly di ff erent pattern of symptoms
(daydreams, stares, easily confused, hypoactive, etc.), comorbidities (markedly reduced probability of oppo-
sitional and conduct disorder), peer relations, and cognitive sequelae (sluggish and error-prone information
processing, impaired focused attention). And there is every reason to suspect that it will demonstrate a considerably
di ff erent developmental course and set of adult outcomes in view of the relative absence of deficits in response
inhibition that so typify the other types of ADHD (hyperactive-impulsive and combined types). For it is the
inhibitory deficits in those other types that apparently predispose toward a markedly greater risk for oppositional
defiant disorder, conduct disorder, delinquency, and other antisocial correlates and outcomes (peer rejection, school
suspensions/expulsions, early substance experimentation, adverse driving outcomes, etc.; Barkley, 1998). This is a
position I have held for sometime (Barkley, 1990) based largely on my own research (Barkley, DuPaul, & McMur-
ray, 1990, 1991) and early reviews of the emerging scientific literature (Barkley, Grodzinsky, & DuPaul, 1992;
Carlson, 1986; Goodyear & Hynd, 1992). Needless to say, it pleases me to be joined by such good company and with
so much more evidence to back up this position.

It is not just the compelling evidence, however, that makes the arguments of Milich et al. reasonably convincing—it is their starting point: PIT never had any evidence of being a subtype of ADHD from the beginning. At thetime of its invention in 1980 in the DSM-III (American Psychiatric Association, 1980) it was simply an intriguing idea. Many cases of children were being referred to clinics with problems in the realm of attention who were not classically impulsive or hyperactive. Something needed to be done to acknowledge the existence and legitimacy of a valid disorder. That was the extent of it. No data, no background or history, and no logic existed at the time to make a sound scientific case that this should be a subtype of ADHD. Clinical anecdote was all there was to it.

From your example, you said you were impulsive and not very hyperactive... well, then you should be ADHD/C and not ADHD/I, that's a misdiagnosis.

If you look up the literature you will see abundant papers that all claim that ADHD/I is a different disorder.

[ana futura]

Yes, the majority of people diagnosed as ADHD PI have "true" ADHD, but their impulsiveness/ hyperactivity is not as noticeable. It's still there though.

Barkley thinks that a minority of people with the PI diagnosis don't have ADHD at all, they have SCT or another disorder exclusively.

[ana futura]

Originally Posted by Caleb666

From your example, you said you were impulsive and not very hyperactive... well, then you should be ADHD/C and not ADHD/I, that's a misdiagnosis.

If you look up the literature you will see abundant papers that all claim that ADHD/I is a different disorder.

Some ADHD I is a different disorder yes, but it occurs far less often then people seem to think it does. I was diagnosed correctly under the current DSM. When the DSM changes, I will be considered ADHD C. A lot of people diagnosed as ADHD PI just miss the cut off for being considered PI. I've read that if you have any impulse control/ emotional regulation issues at all (no matter how slight) you should be considered ADHD C.