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      Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings

      1 , 1 , 2 , 3
      Journal of Clinical Child & Adolescent Psychology
      Informa UK Limited

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          Abstract

          A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention-deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), limited prosocial emotions (LPE), anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study – consistent across mother, father, and teacher ratings – appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.

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          Most cited references44

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          The validity of the multi-informant approach to assessing child and adolescent mental health.

          Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record
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            Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity.

            Controversy continues as to whether sluggish cognitive tempo (SCT) is a subtype of attention-deficit/hyperactivity disorder (ADHD) or a distinct disorder. This study examined differences between these disorders in demographics, executive functioning (EF), impairment, and prior professional diagnoses to address the issue. There were 1,800 children 6 to 17 years of age of both sexes from various U.S. ethnic backgrounds who were divided into four groups: (a) high SCT but not ADHD (N = 41), (b) high ADHD but not SCT (N = 95), (c) high in both SCT and ADHD (N = 61), and (d) the control group (N = 1,603). Besides providing demographics, parents completed scales assessing ADHD and SCT symptoms, EF deficits, and psychosocial impairment and reported their child's history of professional diagnoses. SCT symptoms formed two distinct but interrelated factors separate from those for ADHD. SCT differed from ADHD in demographics (age, sex ratio, parental education, income). ADHD was associated with more severe and pervasive EF deficits than SCT, whereas SCT was chiefly associated with mild deficits in Self-Organization. ADHD contributed far more variance to EF deficits than did SCT. Both disorders were impairing, but ADHD was more severely and pervasively so than SCT, especially in Home-School domains; SCT was most impairing in Community-Leisure domains. Different patterns of comorbidity were evident between SCT and ADHD. SCT showed less comorbidity and was particularly associated with depression. SCT may comprise a distinct disorder from ADHD but both may coexist in 39% to 59% of cases each.
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              Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type.

              Compared 2 groups of children with attention deficit hyperactivity disorder, predominantly inattentive type (ADHD/IA)--those with high scores on a composite measure of sluggish cognitive tempo (SCT) and those without--using a large, school-based sample of children for which previous comparisons between ADHD subtypes have been reported. Although the 2 groups did not differ on level of attention or learning problems, high-SCT ADHD/IA children were rated by teachers as showing less externalizing behavior and higher levels of unhappiness, anxiety/depression, withdrawn behavior, and social dysfunction. Thus, SCT identifies a more homogeneous subgroup of ADHD/IA children who are, relative to the entire Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) diagnosed ADHD/IA group, more similar to those classified in previous research as "attention deficit disorder without hyperactivity." These results support a reconsideration of SCT symptoms as a component of diagnostic criteria for a category of nonhyperactive attention deficit disorder.
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                Author and article information

                Journal
                Journal of Clinical Child & Adolescent Psychology
                Journal of Clinical Child & Adolescent Psychology
                Informa UK Limited
                1537-4416
                1537-4424
                February 16 2018
                February 16 2018
                : 1-15
                Affiliations
                [1 ] Department of Psychology and Research Institute on Health Sciences, University of the Balearic Islands
                [2 ] Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine
                [3 ] Department of Psychology, Washington State University
                Article
                10.1080/15374416.2017.1416619
                6599489
                29452000
                0751ab75-06ca-4747-a8f7-3b23849703b7
                © 2018
                History

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