Sluggish cognitive tempo is a long-time component believed to either be a part of attention deficit hyperactivity disorder, or may be its own stand-alone concern.
Parts of what we now call sluggish cognitive tempo (SCT) has been around since the 1960s, but it was in the late 1980s — long before any attention deficit hyperactivity disorder (ADHD) medications existed — when researchers first demonstrated that SCT symptoms are probably a unique condition or sub-type of ADHD (Lahey et al., 1988; Neeper & Lahey, 1986).
In other words, the scientific foundation for sluggish cognitive tempo has been around for nearly 30 years. It’s not new. And it’s hardly news. Scientists regularly identify dozens of proposed syndromes or symptom constellations in their research. Only a tiny minority of them ever go on to become a recognized mental disorder or diagnosis.
But does SCT really exist? Is it its own condition or disorder?
Scientific research in the study of psychological disorders is a slow and painful process. It takes dozens — and often hundreds — of studies in order to demonstrate a new constellation of symptoms is unique and significantly impacts a person’s daily functioning. Researchers regularly identify syndromes that are interesting to note (like a personality factor), but don’t really seem to negatively affect a person’s life. These never turn into disorders.
Other times, researchers identify syndromes that seem to have clinical significance — they are really messing up people’s lives.
One such thing is attention deficit hyperactivity disorder. Nearly since its inception as a clinical disorder, researchers have argued whether this condition is best reflected by a two- or three-factor model. These factors are derived through statistical analysis by looking at people who complete symptom-based questionnaires and structured clinical interviews.
To date, the two-factor model has won out. That’s why today we consider attention deficit hyperactivity to have two primary presentations: inattentive and hyperactive/compulsive (a third type — combined — is simply a combination of these two).
But some researchers have long believed that another factor is also statistically significant in this discussion — sluggish cognitive tempo (SCT). This term refers to a person who exhibits slow cognitive processing, sluggishness, apathy, drowsiness, and inconsistent alertness in their everyday activities. SCT should not be confused with another disorder, daytime sleepiness, that research has suggested that, while related, are distinct disorders (see Landberg et al., 2014).
Since it was first proposed in the 1980s, dozens of scientific studies have been conducted on SCT — the vast majority of which have had no connection to the pharmaceutical industry.
So Why is SCT Suddenly News Now?
So it was a bit of a disconnect to read an entire article about sluggish cognitive tempo over at the New York Times:
Yet now some powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. […]
The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming that the question of its existence “seems to be laid to rest as of this issue.”
Ah, I see. Because a scientific, peer-reviewed journal decided to devote most of an issue to this topic, it’s suddenly a “new disorder” that deserves the attention of the New York Times. ((Not mentioned in the article is that peer-reviewed journals regularly devote entire issues to special topics — some of which are disorders, some of which are not. Devoting most of an issue to a single topic doesn’t, in itself, mean anything in particular.)) Is anyone awake at the fact-checking desk over there?
Why this attention to SCT now? Because the article tries to make a link between the suggestion this will suddenly become a new disorder — an unlikely prospect — and the fact that there’s been one or two studies funded by pharmaceutical companies on how best to treat SCT.
In logic, we call this sort of sloppy argument an example of “poisoning the well.” It’s a logical fallacy that suggests because pharmaceutical companies are involved in a tiny minority of studies on SCT, SCT must be a made-up disorder whose only purpose will be to push more ADHD medications. The journalist offers no proof for this association or assertion. Simply making the assertion is enough. ((Perhaps surprising to no one, few of the researchers in this area would agree to speak to the journalist.))
Why Nobody Needs to Worry About SCT Any Time Soon
Despite a single researcher claiming the question of the disorder’s existence “seems to be laid to rest,” nothing of the sort has happened. A research constellation of symptoms doesn’t become a diagnosis quite so easily.
Instead, disorders need to go through a lengthy scientific peer-review process. This isn’t a process that takes years — it can take decades. The last time the DSM — the diagnostic manual for psychiatric disorders — was updated was in 1994. It took 19 years before a new edition, the DSM-5, came out just last year.
Sluggish cognitive tempo disorder — or as a sub-type of ADHD — isn’t even mentioned in the DSM-5. ((The DSM has a section entitled Conditions for Further Study. Before a disorder moves into the main DSM, it will first appear in this section, in order to give researchers and clinicians time to study it more, report on it in clinical encounters, etc. ))
Since sluggish cognitive tempo isn’t even in the DSM, it’s unlikely we’re going to see SCT suddenly become a new disorder any time soon. It may be decades — with dozens of additional supporting studies — before it makes that leap.
That doesn’t mean, however, that SCT might not be a legitimate and pressing concern in your life. It may be significantly, negatively impact your daily functioning.
As we often do, we reviewed the research, did our own analyses, and came up with a new test for this mental health concern: the Sluggish Cognitive Tempo Quiz.
Take it now and see for yourself in about a minute’s time if this is a concern you may have.
Read the full article: Idea of New Attention Disorder Spurs Research, and Debate
References
Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, A., Hynd, G. Lorys-Vernon, A. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 330 — 335. doi:10.1097/00004583-198805000-00011
Langberg, J. M., Becker, S. P., Dvorsky, M. R., & Luebbe, A. M. (2014). Are Sluggish Cognitive Tempo and Daytime Sleepiness Distinct Constructs? Psychological Assessment. Advance online publication. http://dx.doi.org/10.1037/a0036276
Neeper, R., & Lahey, B. B. (1986). The Children’s Behavior Rating Scale: A factor analytic developmental study. School Psychology Review, 15, 277 — 288.
19 comments
SCT: Sluggish Cognitive Tempo
cause: an uninteresting life, boring work, too much or too little stress
symptom: apathy, disinterest
cure: coffee, stimulating conversation with good friends, outdoor activity and play
That’s the same thing people who don’t know anything about adhd or depression say about those illnesses, so I guess sct has one thing in it’s favor…
I hope it gets more recognition and possible DSM inclusion simply because those who meet the criteria don’t qualify for any other disorder. I see students frequently who have slowed processing speed, but don’t meet ADHD criteria (or any other learning disorder). These kids are denied accommodations or special services in school because they don’t have an “official” diagnosis, though testing clearly shows they have a deficit. If they had a head injury with the same symptoms they’d qualify, but because it’s developmental they don’t. Further research is certainly justified.
I read many of the comments on the New York Times article. People were overwhelmingly against finding more ways to drug kids. A very few comments were more understanding.
Healthy people don’t seem to understand some people do need help biologically. SCT deserves more study scientifically. Drugs today are relatively crude, and no one really wants to see kids drugged, but some kids really do struggle to pay attention beyond other kids. The best tools available, as crude as they may be, can be worth considering in some cases. SCT seems more complex than ADHD since it seems to be more of a whole-brain issue. Mapping how the brain is wired neuron for neuron may be required to understand how people’s brains are wired differently to be able to understand SCT. Even then, changing the wiring may not be easily fixed with drugs. For depression, one crude technique has been to simply induce to brain to create more connections. If all the brain needs is new connections in specific regions, maybe drugs could be developed to target specific pathways but doing so may be a long shot.
Diagnosis is currently an arbitrary threshold of questions, but if people legitimately need help in some areas to be able to support themselves in school or work, society would benefit from further research and therapy.
Thank you for your comment!
Having been one of those kids myself, struggling without medication because of a misdiagnosed, I couldn’t agree more! My hole life could have been a lot better!
All my life I’ve felt like I’ve had a slow processor. I scored as a moderate on
the quiz. In 2013 I had 20 neurofeedback sessions because I believed that recent
years of trauma and stress were causing cognitive difficulties with verbal fluency,
mental fog and confusion. I do feel liked they helped and a friend described me seeming less befuddled and brighter. Now I wonder if I have more treatments if
It will help correct the sluggish cognitive function I have felt my whole life. I have plans to attend graduate school so can use all the help I can get. Any thoughts on this?
I strongly believe that my son has this disorder and has been struggling with it all of his life. In short, his executive function does not work like most of ours. He just never gets out of low gear, struggles with school work and generally doesn’t have the “spark” that most people have. Unfortunately this has lead to a real low sense of self esteem and a strong anxiety around being with people. He essentially dropped out of high school because he couldn’t hack the stress and now is limping along doing online school, but he has no sense of urgency with it and is extremely evasive and difficult to motivate. I really wish this syndrome didn’t exist, but I have proof that it does.
Hi renokid8,
thank you for this interesting description of your son’s situation. I am a 27 year old with ADHD-PI and can relate very much to what you wrote.
It was a real eye opener for me that it may be exactly this inability to be “sparkling”, act spontaneous and “to think on your feet” (like the other people around you) that leads to social anxiety and avoidance in people with SCT.
This seems to be indeed different to “classic” ADHD…
If that’s true then maybe this social and school avoidance gets better through direct treatment of SCT symptoms.
Have you had any luck in that regard with your son (and with medications like for example Modafinil etc.)?
Best wishes,
Daydream27
I have never heard about that condition before but it makes sense to what i have been feeling my whole life. My father was diagnosed recently with ADHD and so was myself. But SCT makes more sense with me. I need more time to learn anything, i forget what i am doing all the time, my brain seems to feel like fog frequently and since I was a child people make fun of me being slow to understand things. Math and every subject with numbers was insanely hard no matter how much i studied. Since i started training martial arts i got a little better but at the same time it makes me feel more frustrated because i just forget things i should remember, in the middle of practice. But I feel more alert after the practice, probably is the exercise? Anyway, i would like to see more research about it, it is quite frustrating not being able to understand myself a little better.
I took the quiz and scored a 25 – moderate SCT. That doesn’t surprise me at all.
I first noticed my sluggishness in high school, when my natural curiosity faded a bit. Up until then, my curiosity and intellect had done great things for me. But post-puberty, I just wasn’t as engaged. Later in life I found out I was also low testosterone (for a female.)
I did well in college, but I was noticeably slow to study. It just took me a LOT longer to get through assigned readings. I had to choose the coldest, most isolated study carel in the library, in hopes of staying awake and minimizing distractions. I was scared that I wouldn’t make it after college – I just had so much trouble concentrating – though nice I had the concepts, I had them down PAT. My grades were excellent.
I was never diagnosed as anything as a kid – years after college, I was Dx’d as ADHD/PI. Meanwhile, ADHD of all types ran rampant and untreated in my immediate family tree. A cousin who went to AA was the first of us to figure out his ADD (as it was called then.) Years before, my brother was called “hyperactive”, and given a guitar to focus on – it really helped him as a kid, but not so much later. He had chronic low self-esteem about having bad grades, and used charm and copious amounts of weed to feel better about himself – well into his 30s+.
These days, I depend on: green tea, choline, SAM-e, B-vitamins, the Pomodoro technique, and to some extent, Provigil to get work done. I notice I do best in a structured environment, but those type of work environments tend to bore me, too – so it’s a catch-22.
I’ve done freelance work almost my whole work career. I can’t imagine working a 9-5, despite the structure I need.
I’m doing the best I can, but my nagging lethargy is scary and stressful. I’m afraid I’ll lose my ability to make a lining. If anyone can make headway on this, I’d be very grateful.
Corrected for type-os:
I took the quiz and scored a 25 – moderate SCT. That doesn’t surprise me at all.
I first noticed my sluggishness in high school, when my natural curiosity faded a bit. Up until then, my curiosity and intellect had done great things for me. But post-puberty, I just wasn’t as engaged. Later in life I found out I was also low testosterone (for a female.)
I did well in college, but I was noticeably slow to study. It just took me a LOT longer to get through assigned readings. I had to choose the coldest, most isolated study carel in the library, in hopes of staying awake and minimizing distractions. I was scared that I wouldn’t make it after college – I just had so much trouble concentrating – though once I had the concepts, I had them down PAT. My grades were excellent.
I was never diagnosed as anything as a kid – years after college, I was Dx’d as ADHD/PI. Meanwhile, ADHD of all types ran rampant and untreated in my immediate family tree. A cousin who went to AA was the first of us to figure out his ADD (as it was called then.) Years before, my brother was called “hyperactiveâ€, and given a guitar to focus on – it really helped him as a kid, but not so much later. He had chronic low self-esteem about having bad grades, and used charm and copious amounts of weed to feel better about himself – well into his 30s+.
These days, I depend on: green tea, choline, SAM-e, B-vitamins, the Pomodoro technique, and to some extent, Provigil to get work done. I notice I do best in a structured environment, but those type of work environments tend to bore me, too – so it’s a catch-22.
I’ve done freelance work almost my whole work career. I can’t imagine working a 9-5, despite the structure I need.
I’m doing the best I can, but my nagging lethargy is scary and stressful. I’m afraid I’ll lose my ability to make a living. If anyone can make headway on this, I’d be very grateful.
I have tried a lot of natural remedies. High quality foods, you name it.
The one thing that makes the sleep go away is Vyvanse. I strongly recommend it. If you spend one day with the fog and sleepiness gone, it will shock you to see just how pernicious this problem is.
First draft to demonstrate my error prone processing.
I fit the SCT bill, and have done a lot of research on the topic. SCT isn’t that impairing in my life, however in my schooling and work it can interfere with your life. And, having been on stimulants I haven’t seen much improvement, although the meds do give you the stamina to keep doing what your doing.
My best conceptualization is that SCT is a disorder of attending to a specific task with your undivided attention. for whatever reason your mind wonders off and you have to constantly tell yourself get back to what your doing. Worst of all you give your attention to a task all your attention and for whatever reason you made a mistake and your unable to figure out when you went wrong.
Main problems:
– tend to wonder off/daydream when I am doing important tasks such as test taking, copying information, etc. This is all the time.
—————————–
I fit the SCT bill, and have done a lot of research on the topic. SCT isn’t that impairing in my life, however in my schooling and work it can interfere with my life. And, having been on stimulants I haven’t seen much improvement, although the meds do give you the stamina to keep doing what your doing.
My best conceptualization is that SCT is a disorder of attending to a specific task without your undivided attention. For whatever reason your mind wonders off and you have to constantly tell yourself get back to what your doing. Worst of all you give your attention to a task and for whatever reason you made a mistake somewhere along the way and your unable to figure out where you went wrong.
Main problems:
– tend to wonder off/daydream when I am doing important tasks such as test taking, copying information, etc. This is all the time, even if I am motivated.
My main concern with SCT is identifying these children in schools and providing them with extra help, as well as assessing these children for LDs,
This totally fits my 10 year old daughter to a capital T!!! I have been torn about possible getting her put on meds for add, and dont want to because I really don’t want to put that into her body. I started noticing it th most about 2 years ago but her teachers said she was fine and normal for her age. Now at age 10, she notices it and is very frustrated with herself and I see her showing signs of depression and very low self esteem. We try so many things as far as structure and healthy living practices but it does’nt seem to matter. I hate seeing her feel so bad about herself and sometimes my husband and I get on her too much about forgetting so many things. It’s so nice to hear that this is real and we aren’t the only ones going through this, which means maybe this disorder will get some recognition and studies will be done and we can get help!
For those who don’t want to apply medication, I understand your fear. If you have tried other things, then it’s time to do what needs to be done.
If you want to face your child as an adult. An adult who suffered through feeling isolated, incapable of learning, confused, missing out on potential, having poor relationships, having the feelings of being too different to ever fit in….
then say to them, well, at least I didn’t medicate you, are you pleased?
Pick one…
A. A life that feels like a confused waste and aggravation
B. Life changing medication that let’s you kid be the best they can, and perhaps have a few side effects that can be managed
This is the first time I ever heard of this condition, so I took the quiz and scored 32- which means I may have strong SCT. I started to notice about it since last year and it’s getting worse when the second semester begun 2 months ago. As a business student in sophomore year, I constantly have to think critically and engage in discussions. However, I realize that I can’t pay attention during lectures and I have to take lots of time just to finish the important tasks no matter how simple it could be. Although I am trying to focus on the task, I find myself daydreaming/brain fog or falling asleep. I also tend to forget things easily and constantly having fatigue as well as frequent headaches even though I don’t do anything. I also take a long time to do house chores and dressing myself up, which I always late to go to the class. I did pretty well in high school and foundation year, I failed two subjects last semester and I may get terminated if I don’t keep up my performance. I am wondering if I can graduate and get my degree certificate if this condition is getting worse. Should I seek any medical treatments about this? I hope there is a further research about SCT so I can learn more about it.
(I’m apologize for my bad English, I had forgotten lots of English words)
I scored 32.
My fatigue and foggy mind have been driving me nuts for years. When my daughter, then later myself, were diagnosed with adhd, I thought I finally had an answer.
The Vyvance ameliorated the fatigue, and that alone is worth the price of medication for me.
However, I have none of the classic symptoms of Adult ADD. It was becoming problematic, so i kept reading.
I saw a list that described SCT symptoms, but I did not know it was related to anything in the ADD/HD lineage. I am a very creative person, so boredom was never a problem. However, everything else was dead on.
My brain feels like there is ten feet of mud caked around the worlds greatest computer. My energy feels like im trapped in a giant egg shaped chamber surrounded by grey october skies. I am underwater and looking up as tugboats float by trying to move cargo.
I can focus just fine, but the lack of energy is not altered by anything. Not diet, exercise, supplements… nothing. In fact, due to a heavy schedule that was about to be required of me, my family pulled over so I could get some energy drinks. They watched me slam two Monsters and even take a natural energy shot… yet within the hour, I was asleep in the front seat while I was waiting for them…
One thing I simply cannot stand are the armchair medical professionals. The ones without degrees. The know-it-alls who are God’s chosen vessels to stamp out ‘the scams of big pharma.
There are lot’s of people who are actually physically and cognitively altered. I and my daughter are two of them.
If you want to go on a soap box rant about false diagnosis or other uneducated generalities, go start a blog and have at it.
I will gratefully take my Vyvance and have actual custody of my mind and body for the day.
All I can say is, if the nervous system is out of whack, that’s a physical issue.
Someone missing half a leg will never walk like someone with two whole legs.
I have a 27 year old son who fits this set of symptoms in every way. We have struggled to get an accurate diagnosis which has impacted his ability to access services. Would you say, if SCT exists, that it is on the autism spectrum? I do have an issue with this article including a check list at the end for a “label” or condition that the author says does not exist but labels it as if it does. That feels irresponsible to me. We would be willing to participate in ANY research that moves proves one way or another whether this is a unique condition with specific set of symptoms. I think it is and deserves more research.
I’ll go a bit further than most and describe my condition as being Dopamine dead. Adderall brings my Hedonic side to life for varying numbers of hours in the day but I return to my analytical side at night “so I can sleep”.