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.


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  2. From personal observation I would say body type plays a significant factor in whether someone with attention problems would be normally active or sluggish.

    People with attention problems and slim or muscular builds will be more likely to have normal activity levels. For example I have inattentive ADD, anxiety and a slim/lean build and am fairly physically restless and fidgety. Conversely, slightly overweight people with attention problems, do seem to be quite physically slow and are more likely to complain about things being too fast paced for them.

    Introversion and extroversion will also play a part in how fast someone thinks and acts. Introverts think more slowly and deeply, extroverts think and act faster but often at a more superficial level. For example, I'm an introvert and do find that highly extroverted people think and act more quickly than I am comfortable with, although I'm ok with the speed at which most introverts and mild extroverts think and act.

    Hence, at one extreme of the ADD spectrum you're likely to find a slim or athletic, extroverted kid who is very hyperactive, fast thinking and impulsive and at the other end you're more likely to find an overweight, highly introverted, individual who thinks and moves noticeably slowly.


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