Sluggish Cognitive Tempo an Overview

SCT Overview
The diagnosis of Sluggish Cognitive Tempo is made in individuals who process information slowly. These individuals appear to be in a constantly under aroused state. They appear as though they are in a fog and are slow with both the input and the output of information. Individuals with SCT seem to lack energy and motivation.

There is currently no formal mental health diagnosis for Sluggish Cognitive Tempo (SCT). SCT is currently a sub-category of the Inattentive type of ADHD (ADHD-PI) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is published by the American Psychiatric Association. The current version of the DSM-IV is due for revision and the new DSM-V is due to be published in 2012.

The American Psychiatric Association is reconsidering the current classification of SCT and it is likely that this mental health condition will likely have its own category separate from the Inattentive ADHD category in the 2012 DSM-V.

It is unknown how many individuals with ADHD-PI have symptoms of SCT. Some researchers have put the estimate at 30% and others at as high as 50%. What is clear, however, is that the majority of people with ADHD-PI do not also have SCT. This is important because many authorities in the field of ADHD, including Russell Barkley, have proposed that these two conditions are all part of one diagnosis.

I admit to being reluctant, up until now, about writing about SCT. My first reason had to do with not wanting to give credibility to the notion that these two conditions are one and the same problem.  The second reason had to do with a personal protest of sorts. When my ADHD-PI son was in second grade my son's teacher gave us this piece of paper with a narrative description of a child that needed treatment for ADHD.  This narrative was to serve as an introduction to parents of an ADHD child without hyperactive ADHD.   I  had the same issue with this narrative as I had with Winnie the Pooh being used to describe ADHD-PI. 

Those two descriptions, in my opinion, perfectly describe a child with SCT and do not describe ADHD-PI at all.  My eldest son does not have SCT symptoms and I was, as person with ADHD-PI, unhappy with a teacher (who had over 40 years of teaching experience) lumping these two conditions together. I wanted, on this site, to educate people that ADHD-PI occurs without symptoms of SCT.  I wanted to separate the two conditions from one another and I therefore have, purposely, until now neglected to write about SCT.

The symptom of Sluggish Cognitive Tempo in combination with the diagnosis of Inattentive ADD is a combination of symptoms a little like the symptom of Hyperactivity in a person with the diagnosis of combined type of ADHD (ADHD-C). People with ADHD-C have significant symptoms of Inattention and impulsiveness and they are hyperactive. People with Inattentive ADD and SCT have significant symptoms of Inattention and they have sluggish processing.

People with a diagnosis of ADHD Hyperactive/Impulsive have significant symptoms of hyperactivity and Impulsiveness without a significant amount of inattention. People with ADHD-PI have significant symptoms of Inattention without hyperactivity, sluggishness, or impulsiveness.

The ADHD-PI with Sluggish Cognitive Tempo should probably have been a 4th subtype.


To Summarize:

ADHD-HI: Symptoms of hyperactivity and Impulsiveness without a significant amount of inattention.

ADHD-C: Symptoms of Inattention, hyperactivity, and impulsiveness.

ADHD-PI: Symptoms of Inattention without hyperactivity, sluggishness, or impulsiveness.

ADHD-PI/SCT: Symptoms of Inattention and slow processing without symptoms of impulsiveness

There is not much research that I have found on Sluggish Cognitive Tempo but there is some and I will attempt to summarize what we know if the next post. 

30 comments:

  1. I have most of the symptoms of SCT, co-morbid anxiety and very mild OCD (was much worse when I was a child), but I am also impulsive. Currently taking Strattera and Valdoxan, which work together really well and more or less fix everything.

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  2. It is interesting to me that some people with SCT do not have inattentiveness as a main symptom. I have written about the individuals with hyperactivity and impulsiveness but little inattention. Is there also a subgroup with sluggish cognitive tempo symptoms and impulsiveness but little inattention?

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  3. Thank you very much for writing about SCT, but i still don't get it. From what I know ADHD-PI is either SCT or a "C" missing some "H" symptoms (not enough to be classified as combined).

    For example:

    This is a lecture by Russell Barkley:
    http://www.youtube.com/watch?v=q3d1SwUXMc0

    He shows the different PI subtypes in min 22. It is very hard to read (perhaps you can do it), but what i can read is that there are either SCT or some sort of ADHD-C - there is no "regular" PI. In addition he talks about the SCT as completely different disorder not just as a PI+sluggishness.

    From Wikipedia:

    "In the DSM-III, sluggishness, drowsiness, and -->daydreaming<-- were listed as characteristics of ADHD. The symptoms were removed from the ADHD criteria in DSM-IV because, although those with ADHD-PI were found to have these symptoms, this ---> only <--- occurred with the absence of hyperactive symptoms" meaning ADHD-PI without the H = SCT and that "daydreaming" is an SCT symptom.

    Anyway is the PI you've talked about is hypoactive or only the SCT is?

    Maybe some SCTs have qualities that compensate their sluggishness, still they are slower then they should be.

    I want to clarify that I value your opinion and experience very much, so please correct me if you know other.

    Thank you!

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  4. You are absolutely correct about what Russell Barkley believes to be true. He has stated that there is inattentive ADHD and that always goes along with SCT symptoms and if it does not then the person is not truly ADHD-PI. He believes that any person with Predominantly Inattentive ADHD who does not have Sluggish Cognitive symptoms is actually some sort of a 'closet' combined type.

    There are a number of researchers that very much disagree with him and studies that have shown that only 30% to 50% of people with ADHD-PI also have SCT symptoms. I have nothing but respect for Dr. Barkley and he is right about mostly everything but I believe that he got this ADHD-PI/SCT thing wrong.

    The fact that the pyschiatrist writing the DSM-V are looking into separating out BOTH Sluggish Cognitive Tempo and Inattentive ADHD from the category of ADHD and giving them each their own category points to the belief that not only are these disorders different from each other but also that they can and do occur independent of each other.

    You are confused about this because there is a lot of confusion regarding this subject. There are many people is Russell Barkley's camp who swear that SCT is ADHD-PI and vice-versa. Hopefully the new DSM-V will shed some light on this matter.

    Thanks so much for taking the time to write. Tess

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  5. How can a 10 yr old girl be evaluated for SCT? She was ADHD diagnosed 3 years ago.A lot of SCT symptoms fits her performance. What is the treatment for this condition? Anxiety and Depression need to be addressed to? She is doing kind of good at school, according to the grades....but,... who really knows where those grades came from?.... because she will probably repeat 3rd grade by 2nd time.According with the school, she will be unable to pass the main test, although her grades are "ok" What is the path to surpass this situation?????

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  6. The first step would be to make certain she had a complete physical by her pediatrician. Her pediatrician can perform or start the referral process for any additioanl test and evaluations if there is any concern regarding:

    Thyroid problems
    Anemia
    Vision Problems
    Hearing Problems
    Sensory Intergration Problems
    Anxiety and Depression Problems
    Allergy Issues, etc

    If any of these need evaluation or addressing, they should be evaluated and addressed before a diagnosis of ADD or SCT is confirmed. Once those diagnosis are confirmed, a psychiatrist can determine if cognitive training would help or if she would benefit from medication.

    I know this is a lengthy process but there ARE things that should happen before that, in the classroom, to help her.

    Have her teacher sit her at the front of the classroom.

    Meet with the teacher and school to form a plan to keep her engaged during school (have teacher tap her on the shoulder if she is lost in thought, keep learning active, give her frequent movement breaks, etc). If you search my site for the word 'classroom' or 'school' (search without the quotes), you will find other suggestions that work well to keep SCT and ADD kids attentive.

    If you have not yet supplemented her diet with Zinc, magnesium and a Omega-3, please do so. Also try herbal preparations such as Bacopa, Ginseng Energy, Pycnogenol, coffee or tea. These all help a bit and have helped my son and I.

    Please let me know if you have any other questions that I might help with.

    Tess

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  7. I also believe I have ADHD-PI and SCT. Reading the information and studies on it describe me to a t. I do have one interesting question. I did full blood work to see why I was tired all the time and the only thing that came up was that I have Gilbert's syndrome. That is when you have more bilirubin in your blood than the normal person. Supposedly it is found in up to 5% of the population. The thing I am wondering about is some of the main symptoms reported by those with Gilbert's syndrome are fatigue and difficulty concentrating. See the Wikipedia link below in the "Debated signs and diffuse symptoms" section. I have always had a hunch that the two might be related. Unfortunately Gilbert's syndrome is not life threatening so not many studies have been done. What do you all think?

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  8. My research on Pubmed found a link between Gilbert's Disease and an increase in the secretion of glutamate which in turn caused inflammation in the brain and which could cause fatigue, memory problems and learning problems. In the last five years, a link has been found between increased rates of schizophrenia in people with Gilbert's disease and researchers are speculating that what they once considered a benign problem of mildly elevated bilirubin could, in fact, be not benign. We know that bilirubin at high levels is neurotoxic and it may be likely that prolonged levels of slightly elevated bilirubin is also toxic. Common medicine such as Tyelenol as well as many antibiotics, hypertensive medications and high cholesterol treatments will further increase the levels of bilirubin in people with Gilbert's disease and this will not be conducive to healthy brain functioning either. As far as I know there is no way to lower mildly elevated bilirubin except for exposure to sunlight and I am not certain if that treatment works as well in Gilbert's disease as it does in newborn infants with elevated bilirubin levels. I found no info on possible treatment but I would be very interested to learn more as would all my readers. Thanks so much for this valuable information. This is just one more example of something that causes ADD like symptoms that is actually the result of another medical problem. Thanks again! Tess

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  9. Thanks so much Tess Messer for the reply! That would make a lot of sense. I would really like to help out as many people as I can. If more people found this link between Gilbert's Syndrome and ADHD symptoms, that would be interesting. How many people have done a full extensive blood work? Not very common. I would have never know I had Gilbert's Syndrome had I not done the blood work. I wish more studies had been done on Gilbert's Syndrome. I would take part in them myself if I could. Wish I had more connections to those in the ADHD research field. Even if I could meet with an expert to do a thorough examination to make a diagnosis, that would be great. Every time I go to the doctor, they are in a rush and need to move on to the next patient. I have usually been told to just take more vitamins and such. I do have one question. Does SCT cause physical fatigue, or just mental? It is hard for me to understand by the description. It seems to be talking about energy in the sense of motivation and mental power rather than physical energy. I fit many of the symptoms of ADHD-PI and SCT, but I wonder if that is because of my Gilbert's Syndrome. I have well over double the recommended maximum amount of bilirubin in my blood. Not sure if that is common levels for this syndrome. I wonder which symptoms apply to what. If physical fatigue is not a symptom of SCT, I may be able to attribute that to Gilbert's Syndrome. A few of my siblings, and my mother have been diagnosed with ADHD. I know ADHD is highly genetic, but I do not know if the same is true for Gilbert's syndrome. My mother and some of my siblings also have physical fatigue and the symptoms of ADHD-PI and SCT. I sometimes wonder if I have ADHD-PI, SCT, Gilbert's Syndrome, and all the symptoms that go along with them. Triple whammy. Do you think it is possible to have all these? Well, a huge post already. Just a lot to take into account. I would like to understand exactly what is going on. Do I have ADHD, Gilbert's Syndrome, or both? It would be nice to be able to know. Sorry for the long and quite unorganized post. Hope it sheds some light onto more things.

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  10. Alex,

    You are right. I am in the process of writing a long blog on things that can look ike ADHD but that are actually other medical problems and I was inspired to do this by your story.

    The majority of people do not get lab testing or any othe work up. SCT can cause physical fatigue for the same reason that depression can cause physical fatigue. Your body and mind are intimately connected and things that cause you to be mentally fatigued can also make you physically fatigued.

    There is a genetic component to Gilbert's Syndrome and yes you can have Gilbert's syndrome and symptoms of SCT and ADHD-PI. About 30% of people with ADHD-PI symptoms also have symptoms of SCT. It seems as though Gilbert's Syndrome can cause symptoms that look just like SCT so yes you can have all of this.

    Does one cause the others, maybe. We don't know enough about Gilbert's syndrome to know this but if you can afford to see a Hepatologist (liver specialist) it might be worth it as they will know more about how your levels of bilirubin are affecting you neurologically and if there is anything that can be done to lower your bilirubin levels. For years Gilbert's syndrome was considered benign but Hepatologist are now seeing it in a very different light.

    The problems with ADHD, ADHD-PI and SCT is that there are other conditions that cause these symptoms or symptoms that look just like these and if we do not treat the underlying cause, in those cases, we cannot treat the ADHD, ADHD-PI or SCT symptoms.

    Can you see a specialist?? General Internist have so little time but sub-specialist such as Hepatologist often spend more time with each patient and are better prepared to answer questions about rare conditions such as this one.

    Let me know if I can help in any way. Tess

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  11. Tess,
    Well this is all very interesting for me as I try to find out what is wrong with my 15 year old daughter. She has been diagnosed with Gilberts Syndrome when she was having bouts of reflux at about age 7 or 8. She has also had cyclic vomiting ( when she was about 4)and as I mentioned reflux , sleep apnea. In the last couple of years I became aware of Dr. Brownstein (iodine- check it out) and thyroid issues and I drove her to Michigan and she was diagnosed as hypothyroid and also her hormones (especially pregnenelone) were very low - so she is taking thyroid and pregnenlone. She takes an enormous amount of vitamins ect every day - we eat organically ect- believe me she get the fish oil, and just about every vitamin known :)
    She has 2 older brothers that have both been diagnosed with inattention ADD or whatever it is called and one OCD. My oldest son was not able to finish college until he was put on Adderall and he now has a great job in the engineering field and takes his meds daily. My other son refused meds but has his own business and has strategies to deal with his issues (he also graduated in engineering from VTech) By the way I was also diagnosed about the same time but take nothing but coffee.
    I guess I felt I really that ADD was a name for issues that could be treated naturally and felt there was no way I would do this to my daughter- but here I am taking her tomorrow for help because I have tried everything and she still can't seem to focus on what she is reading, memorize her math facts (although she can remember tunes easy) She like my sons works better with background music (plain weird:)
    We also have 2 cousins that take meds and are doing well , so I feel almost bad that I tried everything else first. It isn't that she does not have all these other issues but she might have attention deficit disorder too? She scores high on verbal skills and is social and has not suffered a depression yet (both of my sons suffered major depressions).
    Well I just appreciate your blog and I guess I wish there was a for sure test for ADD- she is all encouraged that "this might be the help for her".
    P.S. She has been told by her sleep doctor that she has hypersomnia because she can't seem to wake up and she is very fatigued- she would say very sluggish. She told me the other day she would like to know what ADD-hyper felt like!
    pat

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  12. I wrote this huge post and then it would not post as being too large- stress!!!! My daughter (15) has Gilberts Syndrome, is fatigued, hypo-thyroid, and being tested for inattentive ADD tomorrow. She has 2 older brothers that have the same and one just was able to graduate college when he was put on Adderall. My daughter takes a ton of vitamins and Armour thyroid but she is still not able to focus and learn as she has to (she is home-schooled) and can't get her math facts in her head.
    Pat

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  13. Well for heavens sake I see it posted after all :) feeling like an idiot!

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  14. Hi Pat,

    As I mentioned before, physicians have long considered the Gilbert's hyperbilirubinemia to be a benign condition but lately they have noticed an increased incidence of schizophrenia in people with Gilbert's and they are considering the fact that even low levels of bilirubin act on the neurotransmitters in such as way that symptoms such as fatigue, inattention and hypersomnalence are occurring.

    The study that I found on the cause of this speculated that the bilirubin even at low levels was exerting a persistent negative effect on the neural brain pathways.

    I am not surprised at all about the hormone issues because the Hypo-pituitary axis work in conjuction with the neurotransmitters and what afffects a neurotransmitter will often affect a hormone and vice-versa. Cortisol is the stress hormone that can make all this run amuk but the other hormones play a huge role as well.

    Does anyone else in the family have Gilbert's? Have they been tested?

    Thanks for your interesting comment. I am hopeful, given that you seem to be totally on top of all this, that she will get the help she needs. Let me know if I can help in any way.

    Tess

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  15. Well her appointment today was with a sleep/ allergy doctor. We were there before when she had sleep apnea as a child (had tonsils out) and last August for extreme fatigue. At that time he suggested she possibly had hypersomnia and had me keep track of her sleep and how many times she could fall asleep a day when I woke her up every hour I think and kept her awake for 15 minutes. He has set up a sleep study for her on the 27th- that night she will be doing the normal sleep study to make sure there is no apnea/ restless legs ect. Then they wake her at 6:00 and start a nap study to see how many naps she takes. He told me this could mimic ADD- the drug they use he said is Nuvgil. He did say she could possible have both Add and hypersomnia. I will let you know what we find out :)
    Thanks Pat

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  16. Thanks for the update. Let us know how it goes.

    Tess

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  17. Interesting. Very, very interesting.
    I am 19 years old and I was been diagnosed with Gilbert's Syndrome a couple years ago. I often noticed that usually, I'd be up and ready to take on the world, but then there were days where I simply felt like a zombie: mindlessly shuffling to classes, not paying attention, the works. In my freshman year at college, I could not focus on my work and ultimately felt sluggish and miserable. This led to me failing my freshman year. My doc diagnosed me with ADHD-PI and depression (which I'm pretty sure is actually this SCT you mentioned above, since I do not have depression). Another interesting complication is that i sustained a Traumatic Head Injury (TBI) with no complications (i literally left the hospital a few hours after arriving)the previous year and so he blames it all on that(even though I've had these "problems" all my life).
    So, to wrap up: I have GS, I've been diagnosed with ADHD-PI and Depression (should be SCT), I sustained a TBI, and my life is pretty much stagnated b/c my parents and Doc believe the ADHD-PI & SCT is a result of the TBI and totally reject it having anything to do with Gilbert's Syndrome, though I know for a fact that the TBI was more of an IBI (Inconvenient Brain Injury) since all of my personal quirks were labeled "abnormal" and caused by my TBI and that i shouldn't be ashamed of myself and all that crap.
    -Rob

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  18. Hey Rob,

    I have answered some of your questions on the post about 'Stimulant Use in Normal Patients'.

    The connection between Gilbert's disease and SCT symptoms is interesting. I don't think it is a coincidence that three people in these comments have SCT symptoms and Gilberts. There is probably a connection though the biology of this is not understood as of yet.

    I will write Charles Parker about this. He has performed many lab studies on patients with ADHD symptoms and he may shed some light on this for us.

    Rob, thanks for writing in and please do not lose hope. The Traumatic Brain Injury could not have helped anything but I agree with you, I doubt it is the main contributor to your symptoms.

    Keep us posted and I will post in these comments when I hear from Dr. Parker.

    Tess

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  19. Hi,
    I too think that SCT should be labeled separately from ADD-inattentive. I have SCT and ADD-inattentive together..and it is the worst of all. I'am constantly in a fog, slow processing, slow learner, memory and concentration problems, and lack motivation and energy. All these years i feel like a idiot in school and whenever i talk to people. I was born in america, but yet my writing and talking is like a foreigner. When hanging out in a group, I'm always so quiet. Sometimes i can't keep up with what they are saying and have nothing to contribute. I can't remember new words to use for future conversations...i think this is caused by slow working memory of SCT. When i speak, i only talk in short sentences and never in a long conversation with hard vocabulary. My brain is constantly in a fog that i can't even pay attention to road, directions when sitting on the passenger side even though i really tried so hard to pay attention...it just can't get in my head. I have hard them remembering directions to go to places and often get close when trying to get back. I have mood swing that makes me feel so lifeless, depressed, slow response and shy. Which make people think that i'm not interested...and have a bad impression of me. This cause me to be anti social. I really hate feeling like a idiot all the time. I tried many supplements but still haven't find the right one yet. Tried adderall before but after it worn out, i feel worst then before..and it doesn't seem to be as effective anymore.

    I think that sometimes, when i read people saying that they think they have SCT, i don't think they do..probably just have inattentive/concentration problems. They can drive and don't have speaking/writing problems... SCT is much serious and worse...

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  20. Fixed typo errors:

    I have hard time remembering directions to go to places and often get lost when trying to get back. I have mood swing that makes me feel so lifeless, depressed, slow response and shy. Which make people think that i'm not interested...and have a bad impression of me. This cause me to be anti social. I really hate feeling like a idiot all the time. I tried many supplements but still haven't find the right one yet. Tried adderall before but after it worn out, i feel worst then before..and it doesn't seem to be as effective anymore.

    I think that sometimes, when i read people saying that they think they have SCT, i don't think they do..probably just have inattentive/concentration problems. They can drive and don't have speaking/writing problems... SCT is much serious and worse...

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  21. I wonder if anyone has linked ADHD and sleep disorders (the combined effect of apnea and/or restless leg etc) causing a cumulative lack of quality sleep for years. Could this also account for Sluggish Cognitive Tempo. Already adhd and on meds, after few months of apnea machine, I noticed a definite reduction in the "brain fog" I got prior to taking my daily meds (Adderall). I wonder if they will do studies on sleep quality in kids before they end up adults with 40 years of low quality REM sleep. It isn't likely a complete fix, but what if the slow cog. tempo is a combination of adhd and sleep disorder. Wouldn't it help to test for sleep disorders too. I would be curious to see how correcting sleep disorders has an effect on Inattentive type adhd in kids or anyone, really.

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  22. I just wrote the last message and then read more of the ones above and the one about the woman's daughter having the sleep study on the 27th. I also read she had hypothyroidism. I also had this at birth and have been on synthroid since about 7 weeks of age. Interesting the combination of hypothyroidism, sleep issues, adhd. I have heard of others with hypothyroidism also finding out later they had ADHD. I'd love to hear how the sleep lab went for Anonymous with the little girl.

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  23. Sleep disorders and thyroid disorders are some of the common conditions that are currently misdiagnosed as ADHD. I have written a few posts about the restless leg and sleep issues. It turns out that the genetic variations that bring on restless leg syndrome also bring on ADHD symptoms. Many kids with ADHD have sleep issues. Some of these kids have sleep onset problems but night terrors and restless leg syndrome are common as well. Hypothyroidism has also been seen with a bunch of auto-immune type conditions and some people (like Dr. Charles Parker) have found a significant overlap between auto-immune conditions and ADHD. Thanks for your comments!!

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  24. Hi -56 here, started grad school last fall.

    I remember as a child Dad calling me Molasses because i was slow in some way. I also remember the staring, zoning out, but as i got older, I started seeing this positively as just Zen practice of being "here now". not thinking about future or past. I started thinking i was actually ahead of the curve of meditators... what many were all worked up about learning, i had done all my life. Maybe just rationalizing for my self-esteem...

    LAte teens early 20s had some that glucose test- neg. and blood tests fro hypothyroiidism- neg to inconclusive. Somehow though, for a year or so i took tiny synthroid pills. Didn't seem to help much with the sleepiness. MAybe it helped with mental speed but the sleepiness ruled. It seems doctors minds are so full of opinions and information and they seem to look how to fit what i say into their existing world instead of considering the opportunity to possibly add to their knowledge and think more creatively. Tess, i like that you and Dr. ? are open to learning from the experts- the patients.

    Iv'e been struggling with an ADD "diagnosis" - who knows what i have?...- and been on Focalin for the past 6 months and, man, it seems as if the meds make my procrastination WorsE! And it seems to do nothing for my mental abilities. The only huge benefit is that i can stay awake through classes and i can drive home, to school, to visit friends and not have horrible struggles staying awake. All my life i have had this sleepiness problem either after eating a meal or after physical activity. Seems to have something to do w insulin and blood sugar.

    Unfortunately, in desperation- trying to get rid of the post meal sleepiness/sort of brain fog, i quit eating gluten around the time i started the focal in. So i'm not sure what to attribute better wakefullness to. It is fantastic !!! to be able to stay awake to do research BUT! i procrastinate like a super star procrastinator. And my mind still just ticks like a grandfather clock. It is maddening, frustrating and i don't now how much longer i can keep hoping and persevering. I had to take an incomplete to get one of my class papers done. Still struggling! I can't get started! help

    I wonder about all the chemicals we used to fool around with as kids- washing greasy parts in gasoline, cleaning up polyester resin with acetone, breathing leaded gasoline car exhaust in the garage, leaded paint fumes, and who knows what else. It is amazing we all survived. Did those things do something?

    Dad was smart enough to get into Dartmouth but dropped out bc he wouldn't write his english papers. I dropped out of college for the same reason! but didn't know about Dad till afterward. And Dad had a business and for many years, he fell asleep during business meetings! So he really suffered from the post meal sleepiness too. Brother and sister and her 2 kids are all on add meds!

    Never heard of Gilberts syndrome. I find that just a little alcohol beverage can reall help break my mental log jam- only one shot, two is too much. Though i rarely use alcohol and especially with teh focalin and school, rarely have any interest in alcohol.

    I really miss community. not having people who understand me, my quirky thought process and directness. Maybe some call this "blurting" but i am careful to not "blurt" and try to be really logical but even so, my directness is often taken as unfeeling and offensive. Even here in a grad program, i have become super wary of saying anything. Not so good. And so begins again my withdrawal from people which i desperately crave connection with. It is one of the main reasons i came back to school. Talking with people helps me get oriented on projects and get going. In a sense, being myself is the kiss of death.

    There's something to this SCT/add/executive function/ reading/visualising/thinking metaphors and blood sugar/insulin functioning. thanks for the forum Tess and everyone's stories. Thjey help.

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  25. Hi Sunfish!

    Congratulations on going back to school. That is quite an accomplishment. Have you ever had a complete Neurology evaluation or even an EEG done?? There are some conditions such as certain kinds of seizure disorders and sleep disorders that can sometimes cause the type of sleepiness that you are describing. If you could get a referral for this evaluation, that would be a good start.

    I have several readers with SCT who have improved with removal of certain foods from their diets. The most dramatic changes seem to occur with gluten removal but other foods (milk, MSG, food dyes...) have also made a difference for some people.

    Some people with fatigue (from a variety of causes including Lymes disease, Chronic Fatigue Syndrome, Post Viral Syndrome) have benefited from an herbal product called Rhodiola. It is moderately stimulating and has been found in studies to help performace, attention and recovery from stressors.

    Being the huge coffee head that I am I ofcours wonder if you drink coffee. Coffee really helps me get through the days when I have a million things to do or to remember. I do not suggest you take Focalin and coffee though as the cumulative stimulant effect is not safe.

    The family symptoms suggest to me that there is something biological going on but only a really thorough medical evaluation will tell you what the diagnosis is. I am not sure that what you are describing is Sluggish Cognitive Tempo.

    What first came to mind when I read the description of what you are experiencing was some sort of sleep or fatigue problem. The reason that I say this is that people with SCT do not, in general, have "falling asleep" as a main symptom. Their main symptoms tends to be sluggish cognitive processing and overall sluggishness. I realize that the image at the top of the post of Eeyore sleeping is a bit misleading...

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    1. Hi Tess- wow, thank you for the response. I have procrastinated many many hrs... years of sporadic searching for info. I love all teh interesting stuff going on in universities but some things- the chop wood carry water aspects- are SO exhausting. These are the things that do me in. I fail to complete the basic skills or follow up with all the little controlling details and am constantly attracted to connecting dots of all sorts of info. Perfectionism and fear do seem to be issues in the shadows. It does seem a bit dumbfounding and now moreso with the focalin.

      I think, my life long "coping strategy" has been to do things that are active- raft guiding 22 yrs and carpentry. But i really want to master the formal, professional research and writing/communication skills.

      Sitting at the computer is when the slow mind really shows up.

      I have always felt the ADHD diagnosis was significantly not me- the AD part was just not the HD. And i am not sleepy when i am doing something interesting, in fact, when i am engaged, that is when my executive function is most dysfunctional. I don't know when to quit! As in trying to find answers to this stuff.

      I recognize that with teh meds it is so easy to get hooked into the anxiety frenzy / kicking myself in the butt- try HAaRDER! This is a cascade of anxiety that cannot be helpful...makes things worse. New strategy,starting just yesterday, back to the basics, lower doses, exercise EVERY day, get a more regular and sufficient sleep habit, write and review affirmations and next day schedule at bed time and in AM.

      We'll see. Please, if you have any more info about this let me know. If more detail about my life story would be helpful, let me know. Has anyone done a "crowd sourcing" of SCT info? I knowe there might be some IRB/ institutional issues but maybe!

      Again, thanks for the response.

      S

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  26. Oh- no EEG, have cut the gluten could try cutting out dairy :( i love cheeze and yogurt..., sometimes do coffee and tea , sometimes not, will iook into Rhodiola. Definitely something biological at work- besides whatever "nurture" issues. Something with system response to food, even 2 crackers, can cause a sleepy attack. ANd i have hunted for info about sleep and how 15 to 20 minute naps seem to absolutely act as a reset button on my blood sugar?/brain chemicals, sleepiness jags. I tell friends to let me fall asleep for 15 mins then i will be good as new but if they keep me awake or if i push myself to stay awake driving, the sleepiness can go on for a long time and then i am in a bad mood.

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  27. I know this is an old post, but I'm wondering if you've ever tried iodine? I came across iodoral a couple of years ago when my hair started falling out (I'm currently a 47 year old mother of a primarily inattentive 15 year old son). Anyway, the iodine, in addition to stopping my thinning hair had many amazing side effects for me so I really began to research it much further. Many, many people report feeling as if a fog has lifted when they begin taking the iodine.

    Our son has always been inattentive but he's improved steadily over the years and my husband assured me repeatedly he'd outgrow it. The fact that our son consistently made second honors made his problem easy for me to ignore. Now, however, he's started a very rigorous high school and he's falling behind due to his lack of focus and ultra low executive functioning. And it hit me that perhaps I should try the iodine with him. Many people report increased focus as a side effect - not, however, a side effect that's happened for me. But I'm wondering if it's because I don't have ADD.

    Anyway, I would love to hear people's experience, if any, with iodine.

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    1. oh Philly Mom...I was just agonizing with getting started on "everything"!- just happen to be wearing a Philadelphia sweatshirt!- Finally heaved myself back to the desk and there is your post... i'm not a religious person by a long shot but i sometimes i do wonder...iodine? never considered that. If it helps you get a prize.

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  28. My son seems to have all of the symptoms of SCT. He does not have any of the ADD or ADHD components. He was a late talker, walker and potty trainer. Once in school, he made friends easily and was never disruptive or hyperactive. Once reading, he quickly was pointed out to have poor comprehension and interpretive skills. His math was fine but once the higher level reasoning and word problems kicked in, he struggled at times. In High School he was very athletic and was captain of the soccer team and in the marching band. He seemed ok but once the standardized testing started with the state tests and college boards, his issues came to a head. He was tested by the district and while they gave no formal diagnosis, he was given a 504 for extra time for tests and projects as it was determined he had a slow processing speed and poor working memory. He is shy and quiet and is never the first to make plans or initiate anything. He has friends and is well liked but is not as popular as I thought he would be. Now he is in college and he has friends who have ADD and ADHD and they tell him he needs some drugs to help him focus and study for finals. He tried some Focalin (low dose....20mg and he is 180 pounds) and he said it allowed him to focus for up to four hours. He did pretty well on his exams and said he had no other side effects like poor appetite, depression or sleeplessness.
    My question is this: I really feel that my son has SCT. It describes him perfectly. Although my husband and I do not have learning disablities, my brother and father both have sig ADD and OCD and my husband's first cousin has Asperger's. No family is without something! My son also had birth trauma and was stuck in my birth canal for up to four hours before I had a C-section. Aside from the cause, I want to know whether drugs like Focalin and Ritalin can help these issues and if there are any issues with taking them as needed vs. daily. Also interested in long term affects and side effects. Any insight you have on the issue would be greatly appreciated. Glad I found the website!

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