Toward Establishing a Standard Symptom Set for Assessing Sluggish Cognitive Tempo in Children: Evidence From Teacher Ratings in a Community Sample

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Abstract

Despite increasing interest in sluggish cognitive tempo (SCT) in children, the field is stymied by the lack of a standard symptom set that can be used across studies. Without a standard symptom set, it is difficult to determine if differences across studies are due to methodological or sample differences, or simply the way SCT was measured. To move the field toward a standard symptom set, this study evaluates a teacher-report rating scale of SCT revised based on recent meta-analytic findings that identified optimal items for distinguishing SCT from attention-deficit/hyperactivity disorder inattention (ADHD-IN). Participants were 1,349 students (50.7% male) in 2 nd -5 th grades. Teachers provided ratings of SCT, ADHD-IN, academic impairment, and social impairment. Exploratory structural equation modeling found 15 of the 16 SCT items to demonstrate excellent convergent validity and discriminant validity with ADHD-IN. The measurement properties of the SCT construct were also invariant across sex. SCT was uniquely associated with both academic and social impairment above and beyond ADHD-IN and sex. Although replication and extension is needed, the current study provides the strongest evidence to date of a possible standard symptom set that can be used across studies examining SCT in children.

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Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity.

Russell A Barkley (2013)

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.

Brett L. Carlson, V Mann (2002)

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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Developing a measure of sluggish cognitive tempo for children: content validity, factor structure, and reliability.

Ann Penny, Daniel Waschbusch, Raymond M. Klein … (2009)

Sluggish cognitive tempo (SCT) is a construct that some researchers believe may be extremely useful in understanding the inattentive subtype of attention-deficit/hyperactivity disorder, and may even help define a completely new disorder. However, the construct of SCT is as yet inadequately operationally or theoretically defined. The authors took the first steps toward developing an empirically supported measure of SCT in children. In Study 1, potential items to measure SCT were identified from a literature review, content validity of the items was evaluated by a group of experts, and a preliminary set of SCT items were selected. In Study 2, ratings completed by parents and teachers of 335 children (ages 4-13) were used to further develop and evaluate the SCT items by computing factor analyses, item-level analyses, reliability analyses, and preliminary validity analyses. The final SCT scale (14 items) produced a total scale score and 3 subscale scores: Slow, Sleepy, and Daydreamer. These scales were constructed with good content validity and were found to have strong reliability. Future directions include replication, extension into a clinical population, and further examination of validity.