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  #106  
Old 02-08-18, 04:10 PM
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Re: Questions about so called SCT?

Quote:
Originally Posted by mildadhd View Post
3 adults have SCT/ADD symptoms (without ADHD symptoms)

6 adults have SCT/ADD symptoms and ADHD symptoms

3 adults have ADHD symptoms (without SCT/ADD symptoms)

Total of 12 people



M
I just took another listen to Dr. Barkley's video (posted in this thread) and
heard something that my brain circuits did not integrate the first time.

In his opinion there is no comorbidity. He thinks SCT symptoms are what we
are now calling ADHD-PI. That comes up at the 4 minute mark in the video.

Researchers are thinking SCT may not be anything like classic ADHD. It may,
in fact, be a different disorder. A second kind of attention problem.

I hunted back for the chart I posted on your 'ADHD statistics' thread, and it
shows that in adults about half are diagnosed with the inattentive presentation
of ADHD.

So if half of those diagnosed with ADHD of any presentation actually have a
different disorder called SCT for now, then we really only have 2 groups to
consider ...


... this has been absolutely the most confusing issue I've contemplated in a
very long time. My brain is exhausted.
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  #107  
Old 02-08-18, 05:26 PM
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Re: Questions about so called SCT?

Lunacie, I don't think ^that^ is quite accurate, either. (It is confusing and exhausting, so the inaccuracies can certainly be excused -- and I don't claim to have it totally straight, myself!)

In the video, towards the very beginning, he points out that "30-50% of those put into the inattentive type do not have ADHD. They have another disorder." (They have SCT/CDD -- only! -- instead.)

That leaves 50-70% of people with ADHD-PI whom he believes really DO have ADHD.

He considers anyone who ever met the criteria for combined type to have ADHD -- even if they currently present as "predominantly inattentive". He also considers anyone who almost ever met the criteria for combined type (the "subthreshold" combined types) to have ADHD. And of course, those who still meet the criteria for ADHD (combined presentation) also have ADHD.

So this 30-50% of people incorrectly labeled ADHD-PI when they really have SCT instead (per Barkley) -- plus whoever may have had SCT and went undiagnosed with anything -- give us our "SCT only" group.

That group doesn't have comorbid ADHD. They just have SCT, but "the reason they were getting put into the ADHD bin is that there's no other attention disorder...so anyone with inattentiveness is being dropped in here". In other words, SCT is not currently a formal diagnosis, so clinicians grasping for a diagnosis for people with SCt alone latched onto ADHD-PI as the next closest thing.

However...

At ~1:20 in the video, Barkley explicitly states that SCT "can be comorbid with ADHD".

At ~3:45: If you have 5 or more frequent, impairing SCT symptoms, you have SCT, and that's 5.1% of the adult population in the U.S. "This is as common as ADHD [...] Now, interestingly, half of these people qualified for one of the ADHD types. ...most often, 3/4 of the time, the inattentive type."

In the video, after minute 4, he does suggest the possibility that the people with SCT who qualified for ADHD-PI might actually have SCT (only) instead of SCT and comorbid ADHD, and that they've been mislabeled.

At ~4:50, he states, "We're not sure if it's true comorbidity, or problems with definition and diagnostic criteria."

He goes on to say that ADHD and SCT might be "like anxiety and depression -- worth keeping separate, and conceptualizing them as disorders -- but understanding that over time the two disorders start to converge: the older you are with one, the more likely you are to have the other...and yet we conceptualize them as unique, but correlated, disorders that can be comorbid. That may be how we're going to start looking at SCT and ADHD, but we need to sort out that conceptual confusion first.".

At ~5:40, he points out that 1/4 of the adults in his study "who met criteria for SCT did have the combined type of ADHD, so that may be the true level of comorbidity".




...Now, that video is from 2011. Since then, he and other researchers have done a lot more work to "sort out that conceptual confusion and get a handle on just how much real comorbidity is here".



It appears that by 2013 he had been persuaded that ADHD and SCT/CDD were actually different, but highly comorbid, disorders.

From his ~2013 fact sheet:
Quote:
Originally Posted by Barkley
Overlap of ADHD and CDD (SCT)
The majority of research on CDD (SCT) selected cases from among children referred to clinics for concerns about ADHD; indeed in some a diagnosis of some type of ADHD (via DSM-IV criteria) was the starting point. As noted above, this can automatically make it seem as if CDD (SCT) is a subtype of ADHD in the results of such research if any differences emerge at all. It also means one cannot study the overlap or independence of the disorders. But if CDD (SCT) cases are selected from general population or clinic samples, there is the opportunity for CDD (SCT) to be seen independently of ADHD and so the comorbidity between the two can be studied. I did so in my two national surveys (Barkley, 2012a, 2013) where I found that more than half (59%) of the children qualifying for a research diagnosis of CDD (SCT) met research criteria for having ADHD. [...] Again, these findings agree with prior studies of children (Garner et al., 2010; Hartman et al., 2004) and adults (Barkley, 2012a). For instance, a recent survey of U.S. adults (Barkley, 2012a) found that 5.8% of the sample met criteria for high CDD (SCT) symptoms. Approximately half (54%) of those participants qualifying for CDD (SCT) had ADHD, yet nearly half did not. The overlap arose mostly with those subtypes of ADHD having significant IN. Similarly, approximately half of individuals qualifying for ADHD of any type (46%) also qualified for CDD (SCT). Once more, the overlap with CDD (SCT) mainly involved individuals having high symptoms of the ADHD IN, as would be expected given the moderate correlation between these two symptom dimensions. It seems here that the relationship of CDD (SCT) to ADHD is one of co-morbidity between two relatively distinct but related or partially coupled disorders, such as exists between anxiety and depression, and not one of subtyping within a single shared disorder. More research will help clarify if this is, in fact, the case.
(Note here that when he talks about overlap in "subtypes of ADHD having significant IN [inattention]", he is referring to BOTH combined and predominantly inattentive presentations, since BOTH have high levels of inattentive symptoms. He's just excluding those with a predominantly hyperactive-impulsive presentation.


In adults, he claims that he sees a population prevalence of about 5.8% of SCT, of whom 54% ALSO had ADHD.

Conversely, among those with ADHD, 46% ALSO had SCT.



...So we're back to where we were a couple of pages ago, with something like roughly half of each group in the center of that Venn diagram (because they have BOTH conditions, and thus fit into BOTH groups).


Some time when I have more free time, I'll look to see what developments have occurred since 2013 -- whether Barkley still believes that this is the case, and what other researchers have to say.

But I'm exhausted, too.

Maybe we can all agree that "more research is needed to clarify..." :wink:


P.S. Interestingly, one thing Barkley noted in the video was that problems with emotional regulation and time-management seem to be much more prevalent in ADHD, and not in people with SCT only.

Last edited by namazu; 02-08-18 at 05:44 PM..
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  #108  
Old 02-08-18, 05:44 PM
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Re: Questions about so called SCT?

Quote:
Originally Posted by namazu View Post
Lunacie, I don't think ^that^ is quite accurate, either. (It is confusing and exhausting, so the inaccuracies can certainly be excused!)

In the video, towards the very beginning, he points out that "30-50% of those put into the inattentive type do not have ADHD. They have another disorder." (They have SCT/CDD -- only! -- instead.)

That leaves 50-70% of people with ADHD-PI whom he believes really DO have ADHD.

He considers anyone who ever met the criteria for combined type to have ADHD -- even if they currently present as "predominantly inattentive". He also considers anyone who almost ever met the criteria for combined type (the "subthreshold" combined types) to have ADHD. And of course, those who still meet the criteria for ADHD (combined presentation) also have ADHD.

So this 30-50% of people incorrectly labeled ADHD-PI when they really have SCT instead (per Barkley) -- plus whoever may have had SCT and went undiagnosed with anything -- give us our "SCT only" group.

That group doesn't have comorbid ADHD. They just have SCT, but "the reason they were getting put into the ADHD bin is that there's no other attention disorder...so anyone with inattentiveness is being dropped in here". In other words, SCT is not currently a formal diagnosis, so clinicians grasping for a diagnosis for people with SCt alone latched onto ADHD-PI as the next closest thing.

However...

At ~1:20 in the video, Barkley explicitly states that SCT "can be comorbid with ADHD".

At ~3:45: If you have 5 or more frequent, impairing SCT symptoms, you have SCT, and that's 5.1% of the adult population in the U.S. "This is as common as ADHD [...] Now, interestingly, half of these people qualified for one of the ADHD types. ...most often, 3/4 of the time, the inattentive type."

In the video, after minute 4, he does suggest the possibility that the people with SCT who qualified for ADHD-PI might actually have SCT (only) instead of SCT and comorbid ADHD, and that they've been mislabeled.

At ~4:50, he states, "We're not sure if it's true comorbidity, or problems with definition and diagnostic criteria."

He goes on to say that ADHD and SCT might be "like anxiety and depression -- worth keeping separate, and conceptualizing them as disorders -- but understanding that over time the two disorders start to converge: the older you are with one, the more likely you are to have the other...and yet we conceptualize them as unique, but correlated, disorders that can be comorbid. That may be how we're going to start looking at SCT and ADHD, but we need to sort out that conceptual confusion first.".

At ~5:40, he points out that 1/4 of the adults in his study "who met criteria for SCT did have the combined type of ADHD, so that may be the true level of comorbidity".




...Now, that video is from 2011. Since then, he and other researchers have done a lot more work to "sort out that conceptual confusion and get a handle on just how much real comorbidity is here".



It appears that by 2013 he had been persuaded that ADHD and SCT/CDD were actually different, but highly comorbid, disorders.

From his ~2013 fact sheet:

(Note here that when he talks about overlap in "subtypes of ADHD having significant IN [inattention]", he is referring to BOTH combined and predominantly inattentive presentations, since BOTH have high levels of inattentive symptoms. He's just excluding those with a predominantly hyperactive-impulsive presentation.


In adults, he claims that he sees a population prevalence of about 5.8% of SCT, of whom 54% ALSO had ADHD.

Conversely, among those with ADHD, 46% ALSO had SCT.



...So we're back to where we were a couple of pages ago, with something like roughly half of each group in the center of that Venn diagram (because they have BOTH conditions, and thus fit into BOTH groups).


Some time when I have more free time, I'll look to see what developments have occurred since 2013 -- whether Barkley still believes that this is the case, and what other researchers have to say.

But I'm exhausted, too.

Maybe we can all agree that "more research is needed to clarify..." :wink:
Holy crap, bat-woman! That's even more confuzzling than I realized.

By those statistics, if there were 5 people in the area of overlap, we'd think
that 3 of them originally came from the SCT group and the other 2 originally
came from the ADHD group. Maybe ... possibly ... could be ...

But ... we do know that there are only 5 of them. Right?
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  #109  
Old 02-08-18, 06:21 PM
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Re: Questions about so called SCT?

Quote:
Originally Posted by Lunacie View Post
Holy crap, bat-woman! That's even more confuzzling than I realized.
Yes. Very much ^this^!

Quote:
Originally Posted by Lunacie
By those statistics, if there were 5 people in the area of overlap, we'd think that 3 of them originally came from the SCT group and the other 2 originally came
from the ADHD group. Maybe ... possibly ... could be ...

But ... we do know that there are only 5 of them. Right?
Maybe?

Hmmm....actually, I don't think so.

Background: Barkley did the study he mentions in the general American adult population, so we can ignore (for now) some of the concerns/confusion about possible misdiagnoses that show up in clinical populations.
Quote:
Originally Posted by Barkley
5.8% of the sample met criteria for high CDD (SCT) symptoms. Approximately half (54%) of those participants qualifying for CDD (SCT) had ADHD
If 5.8% (0.058) of the general adult population has SCT, and of those with SCT, 54% (0.54) ALSO had ADHD, we can write:

% of population with SCT x % of SCTers with comorbid ADHD = % of pop. w/comorbid ADHDandSCT
0.058 x 0.54 = 0.031

So 5.8% of U.S. adults have SCT (with or without ADHD), 3.1% of adults have BOTH SCT AND ADHD, and...some percent of adults have ADHD (with or without SCT).

Barkley didn't mention a prevalence figure for ADHD in that section of the fact-sheet, either, which is inconvenient. But we can back-calculate that using proportions.

We know from that calculation we just did that the population prevalence of comorbid ADHD and SCT is about 3.1% (0.031).

Quote:
Originally Posted by Barkley
approximately half of individuals qualifying for ADHD of any type (46%) also qualified for CDD (SCT)
We also know that about 46% (0.46) of ADHDers had comorbid SCT, so we can write a proportion:

0.46 x ADHD prevalence = 0.031

(divide both sides by 0.46 to solve for ADHD prevalence)

ADHD prevalence = 0.031/0.46 = 0.067 or about 6.7%

? Reality-check: Yes, 6.7% sounds reasonable, given prevalence estimates of 5-8% for ADHD elsewhere.

Let's put this together now...

For every 100 people, there are roughly 6 (5.8) with SCT and 7 (6.7) with ADHD.

(But we can't just add 6+7 and get a total, since the 3 (3.1) people with comorbid ADHD and SCT have been counted in BOTH groups. We have to account for them.)

Our new Venn diagram (based on the fact sheet numbers for adults and my calculations) would have
3 on the far left (SCT alone),
3 in the middle (with BOTH SCT AND ADHD) and
4 on the far right (ADHD alone).

And 10/100 people (10%) total would have ADHD, SCT, or both.


I think I'm done for today -- I just about broke my brain.


(Corrections or confirmation would be most welcome!)

(And even if the calculations do work out, it's probably wise not to place too much importance on them, since a lot depends on how the terms are defined and assessed, and we haven't taken into account any new developments in understanding these conditions / symptom clusters that have occurred since 2013!)

Last edited by namazu; 02-08-18 at 06:46 PM.. Reason: Wait, I did screw that up! GAH!!! (I think it's fixed now...corrections still welcome!)
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  #110  
Old 02-08-18, 07:31 PM
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Re: Questions about so called SCT?

Well, I found this, which the site said was to be published in 2014. I barely even started reading it so far. But it seems to suggest another term instead of SCT. Now, it seems that "sluggish" + anything else sounds bad, which I agree with. I don't even know, of course, if I'd fall into that category anyway. And decades after SCT (or any other later name for it) was first considered, there still doesn't seem to be any official diagnosis for this condition. So, maybe there won't be for a long time.

http://russellbarkley.org/factsheets...itiveTempo.pdf
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  #111  
Old 02-09-18, 03:09 AM
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Re: Questions about so called SCT?

Quote:
Originally Posted by SashaBV View Post
Well, I found this, which the site said was to be published in 2014. I barely even started reading it so far. But it seems to suggest another term instead of SCT. Now, it seems that "sluggish" + anything else sounds bad, which I agree with. I don't even know, of course, if I'd fall into that category anyway. And decades after SCT (or any other later name for it) was first considered, there still doesn't seem to be any official diagnosis for this condition. So, maybe there won't be for a long time.

http://russellbarkley.org/factsheets...itiveTempo.pdf
I have already read this, but Ill read it again and see if there's anything worth quoting here. However without wanting to sound patronizing, I have read alot about ADHD in all it's forms and on SCT, not just the articles, I read the scientific data those articles (mis)quoted. Trust me when I tell you:

Namazu has it right, I couldnt have said it better or any shorter, heck there's even a Venn-diagram!

I made a summary of the above text, but when I got to the bottom I found out he made a summary himself, so here's the TL;DR from the text written by Dr. Barkley in 2014:

Quote:
- Sluggish Cognitive Tempo (CDD (SCT)) is an impairment of attention in hypoactiveappearing
individuals, which first presents in childhood. It is characterized by a cognitive
dimension of symptoms comprising daydreaming, sleepy, staring, “spaciness,” and mental
fogginess and confusion, along with a motor dimension of slow movement, hypoactivity,
lethargy, and passivity.
- The symptom dimensions forming CDD (SCT) are distinct from yet partially correlated with
those forming ADHD.
- To avoid giving offense to patients having the condition and to not imply that the cognitive
deficit in CDD (SCT) is known, the condition should be called Concentration Deficit
Disorder, or CDD.
- The history of CDD (SCT) in the medical literature probably dates back to Alexander
Crichton in 1798 or at the very least, to 1980 and the creation of ADD without Hyperactivity
in DSM-III.
- At this time it exists only as a research entity that has yet to debut in diagnostic literature.
- CDD (SCT) is associated with significant impairment, most reliably in social impairment,
primarily social withdrawal. It also makes some contribution to difficulties with academic
performance in children, and by adulthood even more so. It also is associated in adults with
impairment in occupational functioning.
- CDD (SCT) is also significantly associated with risk for internalizing symptoms and
especially anxiety and depression.
- It has no or even a negative relationship to ODD (and hence likely no relationship to CD,
substance use disorders or antisocial personality).
- The etiologies or CDD (SCT) are not well-studied but some evidence suggests a strong
heritability to the disorder but not as much so as seen in ADHD. CDD (SCT) may also be
associated with fetal alcohol exposure and with the treatment of acute lymphoblastic
leukemia.
- Evidence supports the view that CDD (SCT) is distinct from ADHD and not a subtype of it.
But the two conditions can overlap in nearly half of all cases of each.

- Future diagnostic taxonomies, such as the DSM, should create a higher order category of
Attention Disorders under which one would then break out ADHD and CDD as separate,
semi-distinct conditions much like is done now for the supra-category of Learning
Disabilities (LDs) rather than continue the mistaken view that CDD/SCT is a subtype of
ADHD.
- Very little research has been done on treatments for CDD (SCT).
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  #112  
Old 02-09-18, 07:44 AM
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Re: Questions about so called SCT?

Holy hell. I wanted to give my opinion but then I see I might need a math or physics degree to give one. Ill stick to the sidelines. Good job ladies!
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  #113  
Old 02-09-18, 03:29 PM
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Re: Questions about so called SCT?

Who removed my posts in this thread?

And why were my posts removed?




?
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  #114  
Old 02-09-18, 03:41 PM
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Re: Questions about so called SCT?

Hi mildadhd,

As far as I am aware, no posts of yours were removed from this thread.

In the future, please PM a moderator if you have questions about moderation.

Thanks.
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Old 02-09-18, 04:17 PM
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Re: Questions about so called SCT?

Edit ...
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Old 02-09-18, 04:38 PM
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Re: Questions about so called SCT?

Quote:
Originally Posted by mildadhd View Post
Who removed my posts in this thread?

And why were my posts removed?




?
Maybe you're thinking of posts made in another thread? When there's more
than one thread on pretty much the same topic, I get really confused.
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  #117  
Old 02-09-18, 05:18 PM
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Re: Questions about so called SCT?

Quote:
Originally Posted by Lunacie View Post
Maybe you're thinking of posts made in another thread? When there's more
than one thread on pretty much the same topic, I get really confused.
Need more than one thread, to clarify all the different names for ADD.

Selling SCT as a separate disorder is not cool, when SCT and ADD are the same thing.

Giving ADD all these different names is not cool.

Suggesting I have 2 separate disorders is not cool, when they are the same thing (just changed the names)





M
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Old 02-09-18, 05:30 PM
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Re: Questions about so called SCT?

Lunacie and every other ADDF member.

Do you think ADD and ADHD are separate disorders?

Do you think ADD and ADHD are commorbities?







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  #119  
Old 02-09-18, 05:35 PM
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Lunacie Lunacie is offline
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Re: Questions about so called SCT?

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Originally Posted by mildadhd View Post
Need more than one thread, to clarify all the different names for ADD.

Selling SCT as a separate disorder is not cool, when SCT and ADD are the same thing.

Giving ADD all these different names is not cool.

Suggesting I have 2 separate disorders is not cool, when they are the same thing (just changed the names)



M
I don't find it clarifying. I find it confusing.


I'm sorry you're unhappy that scientists, doctors and researchers cannot
agree on one label for one diagnosis. That's just how it is for now.
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  #120  
Old 02-09-18, 05:38 PM
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Lunacie Lunacie is offline
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Re: Questions about so called SCT?

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Originally Posted by mildadhd View Post
Lunacie and every other ADDF member.

Do you think ADD and ADHD are separate disorders?

Do you think ADD and ADHD are commorbities?



M
Why are you asking this when almost no one uses the term 'ADD' anymore?

The current DSM used for diagnosis calls all attention disorders "ADHD" with
three ways of presenting.
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