Sluggish Cognitive Tempo a Distinct Attention Disorder?

Megan Brooks

January 28, 2014

Sluggish cognitive tempo (SCT) is likely a distinct attention disorder, not a subtype of attention-deficit/hyperactivity disorder (ADHD), although there is notable overlap with ADHD, 2 researchers from the Medical University of South Carolina in Charleston say.

Catherine Saxbe, MD, and Russell A. Barkley, PhD, base their conclusion on a review of nearly 3 decades' worth of research on SCT and their own clinical experience.

"We believe that SCT may represent an exciting new frontier in psychiatry," they write in the January issue of the Journal of Psychiatric Practice.

Given the evidence, they predict that SCT may "eventually be accepted as an identifiable attention disorder with its own diagnostic criteria that distinguish it from ADHD."

Like ADHD, SCT typically presents in childhood. Characteristic features described in the literature include being daydreamy, mentally foggy, easily confused, and staring frequently. Affected individuals may also have symptoms of hypoactivity, lethargy, slow movement, and even sleepiness. Children with SCT also appear to have slow processing speed and reaction times.

Most clinicians who assess and treat cases of ADHD have likely seen and treated someone who falls within the parameters of SCT, the researchers note.

There are no officially endorsed criteria for SCT, but that may change in the "foreseeable future," Dr. Saxbe and Dr. Barkley predict. For that to happen, however, "far more research" is needed on the cognitive deficits that underlie the behavioral symptoms of SCT, they write.

"I'd like to know more about the neurological activity of patients presenting with SCT and if it differs from established arousal patterns," Dr. Saxbe told Medscape Medical News. "Also, which areas of the brain are most active when the patient appears the most distracted ― in essence, where does the mind go?"

"Also, as our knowledge of SCT expands and clinicians learn to recognize it, I hope that a better, less pejorative term will replace 'sluggish cognitive tempo,' " Dr. Saxbe said.

No Effective Treatment

Stephen P. Becker, Department of Psychology, Miami University in Oxford, Ohio, who was not involved in the review, agrees that more research is needed.

"The idea of adding any new diagnosis to the psychiatric nomenclature should be approached cautiously," he told Medscape Medical News. "Although much work has been done regarding the SCT construct over the last few decades, I do not yet believe we have enough evidence to support a distinct disorder of SCT (or concentration deficit disorder)," Becker said.

In the meantime, Dr. Saxbe said "increased awareness of SCT and how clinicians can distinguish this attention disorder from ADHD is important for several reasons." Chief among them is that an effective treatment plan must be based on a correct identification of the problem.

"Commonly, any attention disturbance in school-aged kids is lumped in with ADHD," Dr. Saxbe said. "Since SCT symptoms have not been shown to improve with stimulants, the treatment of choice for ADHD, prescribing practitioners will need to discriminate one from the other to provide patients with proper management. At this time, more research is needed to identify the best medication for SCT; at present, atomoxetine may hold some promise," she noted.

Increased awareness of SCT will also enable clinicians to educate families who may be seeking to understand their child's poor attention and tendency to daydream. "Parent networks can then emerge to exchange information, thus refining our understanding of how this attention disorder impacts the daily lives of patients and their families," Dr. Saxbe said.

Becker also believes it is "important for psychiatrists and other medical professionals to learn about SCT." Echoing Dr. Saxbe, he also suspects that many clinicians "see SCT in their practices but are unaware of the literature examining these symptoms."

Becker praised Dr. Saxbe and Dr. Barkley for their "excellent work" in this area and for laying out some "excellent suggestions for future research that I hope will spur further research."

He also noted that the current issue of the Journal of Abnormal Child Psychology includes a special section on SCT.

Dr. Saxbe reports no relevant financial relationships. Dr. Barkley reports that he has been a paid speaker for Eli Lilly and Shire and a paid consultant to Theravance and receives royalties from Guilford Publications for his books, newsletter, rating scale, and videos related to ADHD. One of those rating scales for adult ADHD evaluates SCT. Stephen Becker reports no relevant financial relationships.

J Psychiatric Prac. 2014;20:38-49. Abstract

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