|Is Sluggish Cognitive Tempo (SCT) Inattention with Anxiety and Depression?|
Psychiatrists have been trying to figure out what defines Sluggish Cognitive Tempo (SCT). They need to know, among other things, if SCT is just Inattentive ADHD (ADHD-PI) with a coexisting diagnosis of Anxiety and/or Depression and also if SCT is otherwise different from ADHD. They are trying to determine if people who are primarily inattentive need to be removed from the ADHD category all together and be placed in a separate category.
We are a year away from the publication date for the DSM V. You may remember that the DSM is the psychiatric manual, written by the American Psychiatric Association (APA) that defines disorders such as ADHD, depression and Sluggish Cognitive Tempo. The manual was last revised in 2000 and a lot has happened since then. One of the topics that we have been following very closely is the issue of how the American Psychiatric Association will label people with Inattentive ADHD and SCT.
It is clear that from an every day, ADHD-PI symptom management, standpoint, that people with ADHD-PI are different from people with combined type and hyperactive type ADHD. The question the APA is battling with is, are they sufficiently enough different to warrant a whole new disease category. As I write in this post on SCT, this is not the first time the APA has looked at people with Sluggish Cognitive Tempo symptoms and attempted to classify them.
Russell Barkley, a well respected ADHD expert believes that SCT is not ADHD with coexisting anxiety and/or depression and according to the study published in the February 2012, Journal of Attention Disorders, he is correct about this. Researchers looked at kids with Inattentive ADHD and found that these kids were more likely to suffer from depression but that SCT symptoms were independently correlated with Inattention. They concluded that SCT was not Inattentive ADHD with anxiety and/or depression.
Barkley has said that most, if not all, of "TRUE" Inattentive ADD patients should be reclassified as having Sluggish Cognitive Tempo because what defines people with this disorder is inattention and slower cognitive processing. He may be correct but this, as of yet, has not been proven.
I believe that people with Inattentive ADHD are more accurately defined as people with fewer impulsive and Emotional control issues and though about 50% of us do have slower cognitive processing, the other 50% of us with ADHD-PI, do not. I think that as more studies are done using functional magnetic resonance (fMRI) we may soon get to the bottom of this. Unfortunately this may not happen in time for the February 2013 publication deadline for the DSM V.
J Atten Disord. 2012 Feb 24. [Epub ahead of print]
Do Symptoms of Sluggish Cognitive Tempo in Children With ADHD Symptoms Represent Comorbid Internalizing Difficulties?
Garner AA, Mrug S, Hodgens B, Patterson C.
Symptoms of sluggish cognitive tempo (SCT) are correlated with inattention and internalizing difficulties. The purpose of the present study was to determine whether symptoms of SCT reflect comorbid internalizing disorder with ADHD or a separate syndrome. Method: Using a clinical sample of youth evaluated for behavioral and learning difficulties (N = 73), this study examined whether SCT remains associated with symptoms of ADHD after accounting for comorbid symptoms of anxiety and depression reported by children and parents. Results: SCT symptoms were correlated with inattention and parent reports of child depression, but not with parent-reported anxiety or child reports of internalizing problems. Inattention (in the absence of hyperactivity/impulsivity) remained uniquely associated with SCT even after accounting for internalizing problems. Conclusion: The findings confirm SCT as a correlate of inattention and support its construct validity as separate from comorbid internalizing problems. Further research on the clinical utility of SCT is needed.