The Difference Between Sluggish Cognitive Tempo and Inattentive ADD

The Difference Between Sluggish Cognitive Tempo and Inattentive ADD
I have been posting to 'Primarily Inattentive ADD' very infrequently.  The main reason for this is that I found about a year ago, after I finished my second book, Commanding Attention, that I had written about most of what I had to say.  At that time I decided I would only post if some new Inattentive ADD news story warranted coverage.

I do not have any amazing new discoveries to post about but I wanted to address a question that I get emailed a lot.  The question of the difference between Inattentive ADD and Sluggish Cognitive Tempo (SCT).  These conditions are different but they are equally difficult to treat as they both often fail to respond to stimulants.  New studies suggest that Strattera, a non-stimulant ADHD medication, may help SCT as well as helping Inattentive ADD but the amount of benefit that any individual ADD or SCT patient may get from Strattera is still highly variable.

My short answer to, What is the difference between SCT and Inattentive ADD? has always been this, Children and adults with Inattentive ADD are normally active.  Not hyperactive, not hypo-active.  The difficulty in diagnosing children with either condition (and with hyperactive ADHD for that matter) is that many children under the age of 12 have a normal development lag in their ability to regulate their activity levels.  To make matters more complicated, teenagers can be perpetually tired because of all sorts of normal developmental issues (sleep deprivation, anxiety, depression, etc) and these same issues can cause some teenagers to be hyperactive.

There is no doubt in my mind that there are adults and children who are legitimately and concernedly sluggish but I believe that we are only now in the infancy or our medical understanding of the cause and possible solutions to this sluggishness.  Until we understand better the causes of mental sluggishness, we cannot begin to treat it.

I am in classrooms a lot.  In every third Kindergarten through 12th grade classroom there is at least one student who appears unable to stay awake.  Teaching a child like this is obviously impossible but does every child who is half asleep have a diagnosis of SCT.  I do not think so.  Inattentive ADD is, in my opinion, more prevalent.  You can find a Inattentive ADD kid in every K-12 classroom if you know what to look for.  That kids is not falling asleep.  That kid looks like he/she even may be paying attention.  The problem is, that Inattentive ADD kid is paying attention to something going on in their head, NOT to what is going on in the classroom.

In an April article on SCT in the New York Times, Alan Schwarz reported that Psychiatrists and drug companies are "claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems".  In his article, Schwarz reports that Steve S. Lee, an associate professor of psychology on the editorial board of The Journal of Abnormal Child Psychology, is concerned that SCT may be diagnosed in children with common behaviors that are the result of common youthful problems such as lack of sleep."  Of course, the same concerns can be said of the diagnosis of both hyperactive ADHD and ADD.  

So there is a difference but the take home message here is this.  There are hyperactive kids and adults, there are inattentive kids and adults and there are sluggish (and usually inattentive) kids and adults and we know a lot more about the former two than we know about the latter.

Media Review of Coffee and Inattentive ADHD

Coffee Bean Image By:
I am not posting much these days as my work schedule has been a bear.  I, however, wanted to post today about an interesting article that I read in the Atlantic about caffeine.  Regular blog readers will know that I am a regular coffee drinker and that I use caffeine to help me focus, to motivate me and to keep me on track throughout my day.

The Atlantic article focuses on the use of caffeine in Athletics.  They come to the conclusion that caffeine helps performance but, as we all know, caffeine is also addictive.  Their recommendation is that it be used carefully and purposefully.  I would have to totally agree.

My 15 year old son is now making his own morning cup of coffee.  He drinks it black.  He seems to do fine with just that one cup though he just went through finals week and I did notice that on a few days he made himself a cup at 3:30 pm as well.  He always has trouble falling asleep so it is unclear if the coffee kept him awake.

As you will remember, I am also a devout believer in exercise for ADHD.  My younger son has taken up Lacrosse which thankfully he loves.  My eldest is walking home from school every day now so he is getting 2.5 miles of exercise a day as well.

The road is always a bit bumpy when you are watching kids with ADHD mature and find their way.  It seems that their lives are filled with periods of clear sailing, periods of  dead winds and periods of hurricane winds.  Well, come to think of it, that is probably true of all of our lives...

You can find more information on why caffeine may help ADHD in this post about caffeine and the brain and I briefly address caffeine and Sluggish Cognitive Tempo is this other post.

I hope you are having a happy Spring!