Sluggish Cognitive Tempo. Depression, Immaturity or Executive Dysfunction

The symptoms of Sluggish Cognitive Tempo, under arousal, mental fogginess, under activity, and inattention are seen in about 30% to 50% of people with the Inattentive subtype of ADHD. It appears that SCT will earn a place in the soon to be published psychiatric diagnostic manual, the DSM-V. The appearance of SCT in the DSM-V will enable researchers to study people with these types of symptoms more carefully. This is important as very little is known about SCT.

While it is clear that not everybody with the Inattentive subtype of ADHD (ADHD-PI) has SCT, it is unclear if Inattentive ADHD will be separated from the combined type of ADHD (ADHD-C) and Hyperactive/Impulsive type of ADHD (ADHD-HI) in the DSM-V.

Some researchers have speculated that the diagnosis of Sluggish Cognitive Tempo (SCT) is simply the presentation of Inattentive ADHD in a person who is also depressed. Other researchers have proposed that anxiety can present as under arousal and can look like the symptoms of SCT.

A study performed at the University of Alabama at Birmingham by researchers Annie Garner MA, Sylvie Mrug, and Bart Hodgens Ph.D. set out to answer the question of the relationship between SCT and depression and anxiety. The researchers looked at seventy-three children with SCT and administered questionnaires to both the children and their parents inquiring about symptoms of depression and anxiety.

What the researcher found was interesting. They found that there was not relationship between reported anxiety and SCT and no relationship between reported depression and SCT in kids diagnosed with Sluggish Cognitive Tempo. The researchers did find that parents of kids diagnosed with SCT were more likely to report that their children were depressed but not that they were anxious. The researchers were unsure if this was because kids with SCT tend to 'look' depressed or if this was because parents were more aware and knowledgeable of the symptoms of depression.

I have heard of SCT referred to as a disorder that children 'outgrow'. In this context it is a developmental disorder tied to an immaturity of the part of the brain that manages motor and mental arousal levels. Using this model, the Hyperactive/Impulsive ADHD child would be at one end of the spectrum and the Sluggish Cognitive Tempo person would be at the other end of the spectrum.

SCT have been referred to as a mood disorder tied to the internalizing behaviors of anxiety and depression often seen in people with Inattentive ADHD. We have discussed this model above. Using this model, the symptoms of "sluggishness" would improve in people diagnosed with SCT if their anxiety and depression was treated.

The third model of SCT is a model that involves a problem with the part of the part of the brain that manages stores, organizes and retrieves information. These activities are called the executive functions of the brain. In general, the executive functions orchestrate numerous aspects of thought, memory, learning, emotion, arousal and action. When SCT is thought of as a problem of executive brain function it fits much more concretely in the ADHD camp.

It is important to determine whether the symptoms of Sluggish Cognitive Tempo are the result of an Executive Function problem as opposed to a problem with immaturity or a problem with a mood disorder as properly treating these symptoms depend on these determinations.


  1. I want to thank you for this post. I was diagnosed with ADHD-Inattentive Type about ten years ago, but this week is the first time I learned about Sluggish Cognitive Tempo (which is what led me to your website). I'm in my 40s, and it seems clear to me that Sluggish Cognitive Tempo is not something I have outgrown. Do you know of any studies on SCT in adults currently seeking participants?

  2. PS: Also, have you seen any studies or speculation linking SCT to chronic lateness, dysfunctional circadian clocks, or other temporal disorders?

  3. Problems with time management and the perception of time are one of the key symptoms seen in all people with ADHD. This is an Executive Function that is very poorly developed in all folks with this condition.

    I do not know of any ongoing studies but I will keep my ears and eyes open and let you know if I find any.


  4. Is it possible to have SCT at 25 but just have inattentive ADD at at 50? I seem to have lost the unbearable lethargy I had as a young adult but I still have inattentive type ADD? I would kind of like to know about those studies on SCT myself. Also I know in ADD, kids mature slowly but do adults mature slowly too. I mean like a 40 year old acts 20 and when they are 50 they act 30........that type thing. And I know we are more creative because we love to think nonstop....but do more of us statistically draw, paint better? Why? I would appreaciate any of these questions that you can answer. THanks Tess.

  5. Kids and adults both mature slowly and researchers have found that our Executive functions that control our alertness and our attention continue to develop into our 40s. What that means practically is that a fifty year old adult can act like a 30 year old because they have only recently learned how to manage and organize their lives. The upside of this is that you are 'forever young' or immature which can sometimes make us more spontaneous and fun. I think that inattentive ADDers spend a lot of time in their head and that we process information differently.

    I do not know of any study that has looked at artistic ability or creativity and Inattentive ADHD but I do know that many of us have issues with dysgraphia (trouble forming letters and writing with pen and paper) and spacial perceptions. If I had to guess I would say that people with ADHD-PI were NOT more likely to draw and paint because of these issues but I could be totally wrong.

    Thanks so much for reading and writing in. Tess

  6. Did you ever notice that 80 percent of us are In THE human service field? Why is that? Is it because people with ADD are trying to figure out what is wrong with them? Is it because we are oppressed everywhere else and we need to work with the handicapped so that we will be around people who finally don't also oppress us? Do you see any cure for this in the future? How can we tell what neurotransmitter that we need to increase? How do you deal with yours Tess? You know more than most people about this awful stuff?

  7. I think that many people with ADHD are in the medical field for a number of reasons. The main reason that I went into medicine is that I found that the "Emergency" part of medicine kept my mind from wondering. I know that there are a lot of fire fighters, paramedics, and police officers with ADHD as well.

    The neurotransmitters likely at work are:


    Low levels of any of these can give you sluggishness and inattentiveness. All the neurotransmitters work together and interact so it is sometimes hard to pinpoint the problem. The fact that hormones, stress, environmental issues and genetics all play a role also makes the exact problem difficult to pin down.

    Urine levels of neurotransmitters can often be helpful for finding the exact neurotransmitter that is amiss.

    Not all low neurotransmitter levels can be 'fixed' because we do not have medications that correct for low levels.

    Some researchers believe that low levels are the result of vitamin deficiencies, mineral deficiencies, gut absorption issues related to food reactions or allergies or hormonal imbalances. Evaluating for all these things is possible and would mean getting a complete physical that included:

    A complete blood count
    A complete metabolic profile
    Thyroid test
    Iron levels
    Vitamin D levels
    Zinc and Magnesium Levels
    Allergy IgG Testing
    Urine Neurotransmitter Testing

    This would probably cost a small fortune but insurance companies might pay for it and at the end of the evaluation, there might emerge a picture of what was causing the problem.

    I hope this helps and thanks for writing!



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