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Sluggish Cognitive Tempo and ADD
Attention Deficit Disorder is categorized by inattention, hyperactivity, or both. Adults with ADD/ADHD are diagnosed by using their adult symptoms and also reminiscences from their childhoods. Ratings scales can be used. In the United States one major tool for diagnosing ADD/ADHD in adults is the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR). The DSM-V is under construction and is slated for publication in 2013.
This diagnostic manual is a work in progress, and it has had many changes through the years. There are researchers who believe that Attention Deficit Hyperactivity Disorder should be separated from Attention Deficit Disorder that is Predominantly Inattentive. Some researchers believe that there is a sub-category of the inattentive type of ADD called Sluggish Cognitive Tempo (SCT) or Sluggish Type ADD. This proposed sub-category is characterized by sleepiness and under-arousal, slow processing speed and reaction time, lack of focus and daydreaming; these symptoms are combined with selective memory difficulties.
How is this different from the Predominantly Inattentive type of ADD? With inattentiveness comes disorganization that follows naturally from constantly reacting to external stimuli. People with this type of ADD often go from one project to another to another, and they donít finish very much of what they start. Sometimes, they canít remember what they started or why they wanted to do it. Focus is so difficult for them that they may not start projects, since they find working through a maze of details too painful. From one minute to the next, depending on the day and what they have going on in their lives, they may not be able to remember what they are doing. People who work or live with them will ask, ďReally? You donít remember that? You just did it, how can you not remember?Ē The term dysexecutive syndrome describes the problem that these forgetful and disorganized people have. The executive function of the brain, the part that controls organizational abilities, does not function the same way that it does in their neurotypical peers. External stimuli pull these people this way and that, with the result that their lives are often chaotic.
People with SCT seem to be responding to internal, rather than external, stimuli. Their own thoughts pull them off-task. In addition to their slower processing, lack of focus, and problems with selective memory, there are other differences from the generally accepted definition of the Predominantly Inattentive Type of ADD. They are withdrawn and have more problems with social behaviors. Furthermore, their anxiety levels are higher and they have more depression. Although they might be bright and have above average intelligence, these negative traits of SCT make school life difficult for students. While they might be expected to do well, based on IQ, their academic careers may possibly be confounded by their slow cognitive tempo.
Girls do seem to have the inattentive type of Attention Deficit Disorder at a higher rate than they have the hyperactive type. Current research has shown that more girls are inattentive and sluggish than boys. Boys seem to be either inattentive or sluggish.
Some researchers believe that SCT is a subset of the Predominantly Inattentive Type of ADHD. Others feel that it is in a separate category. Dr. Russell Barkley, in a Q & A session with the Attention Deficit Disorder Association (ADDA) said that SCT may overlap ADD in ďas many as 50% of the cases.Ē Many people with ADD also have SCT, however having ADD does not necessarily mean that they have SCT. This fact could have implications for the pharmacological treatment of these brain differences. If SCT is distinct from ADD, then the currently used medications for ADD could be ineffective for SCT. This would argue for a way to separate the diagnosis of Attention Deficit Disorder from Sluggish Cognitive Tempo. While both seem to respond to behavioral interventions, the optimal medication could be different for each. More research needs to be completed.
This book is highly recommended for those who want to know more about executive functioning in children and young adults.
Late, Lost, and Unprepared: A Parents' Guide to Helping Children with Executive Functioning
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