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Sluggish Cognitive Tempo (SCT): Symptoms, Causes, and Treatment

Sluggish cognitive tempo in adults
Written by:

Umar Javed

Dr. MBBS
Reviewer:

Dr. Bradley Noon

MD

Content

Medical Disclaimer
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs. Read more

Highlights

  • Sluggish cognitive tempo, or cognitive disengagement syndrome, is not officially recognized as a medical diagnosis.
  • SCT is similar to the predominantly inattentive presentation of ADHD, but it is considered to be a separate condition.
  • Common SCT symptoms include slow cognition, lethargy, brain fog, low motivation, and frequent mind-wandering.
  • Treatment for SCT can include medication (stimulants used to manage ADHD symptoms), psychotherapy (especially cognitive-behavioral therapy), and lifestyle changes.

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo (SCT), is a syndrome closely related to attention deficit hyperactivity disorder (ADHD) but causes a lower tendency for hyperactivity or impulsivity. These conditions share many symptoms, but unlike ADHD, SCT is not a medical diagnosis.

Unmanaged SCT can decrease general quality of life, including higher stress levels, diminished academic and professional performance, lower socioeconomic status, and, in severe cases, suicidal thoughts or behaviors [1*] . Read on to fully understand sluggish cognitive tempo in adults, from common symptoms and causes to available treatment options.

Get the most suitable treatment, including medication chosen according to your symptoms, diagnosis, and health history.

What Is Sluggish Cognitive Tempo?

Sluggish cognitive tempo, also called a concentration deficit disorder or cognitive disengagement syndrome, has been known since 1984. However, it is not officially recognized as a medical diagnosis.

Individuals affected by SCT/CDS often find it difficult to pay attention and focus. They may experience apathy, daydreaming, and slow cognition, or feel lethargic. Also, the study suggests that 30% to 63% of patients with predominantly inattentive ADHD often have high levels of sluggish cognitive tempo. So, the diagnostic process usually starts with assessing a person for attention deficit hyperactivity disorder and some other mental health conditions.

History of SCT

Historical traces of attention disorders date back to 1798 when Sir Alexander Crichton first described attention problems in his book. It was one of the building blocks in research related to ADHD.

Scientific studies of sluggish cognitive tempo began later, in the 1980s, when the 3rd edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) was published. This DSM edition subdivided ADHD into two categories:

  • ADHD that came with hyperactivity.
  • ADHD that came with inattentiveness, which allowed the diagnosis of ADHD without hyperactivity.

The researchers were determined to find the differences between the two. A clinical psychologist Russell Alan Barkley proposed that the initial name, sluggish cognitive tempo, be altered to concentration deficit disorder, and added as a specific condition in DSM. Still, SCT wasn’t recognized as a diagnostic condition, and today, the three currently recognized ADHD subtypes in the DSM’s 5th edition include:

Russell Alan Barkley continued his research and is still an advocate for SCT recognition, having studies on the symptoms of this condition, its assessment, differentiation from attention deficit hyperactivity disorder, and long-term consequences.

In 2022, it was decided to replace the term SCT with CDS [2*] —cognitive disengagement syndrome.

Symptoms

SCT is commonly referred to as difficulties with self-organization, problem-solving, and processing information. Individuals having this condition are thought to have a hypoactive (less active) character.

In 2012, Barkley created an SCT symptoms rating scale for adults. According to it, there are 16 common signs of this condition:

  1. Slow or sluggish behavior
  2. Brain fog
  3. Staring blankly
  4. Drowsiness
  5. Thoughts blocking
  6. Low activity levels
  7. Mind-wandering
  8. Getting tired easily
  9. Forgetting what they were about to say
  10. Getting confused easily
  11. Low motivation to complete tasks
  12. Zoning out
  13. Cognitive disorientation
  14. Slow thinking
  15. Daydreaming
  16. Difficulties expressing thoughts

SCT and Mind-wandering

Although there are other symptoms of sluggish cognitive tempo, mind-wandering or daydreaming is the most common one. Unlike earlier research, currently, there is a recognized link between mind-wandering, sluggish cognitive tempo, and inattentive ADHD.

What Is Mind-wandering?

Mind-wandering, or daydreaming, is reduced attention to external stimuli and active focus on internal events and thoughts. It can be either intentional, used for constructive purposes, or unintentional when it disrupts focus and leads to procrastination. It diverts a part of your working memory to think about other things and concerns while trying to perform the task, slowing progress.

Mind-Wandering vs Daydreaming

Daydreams are a similar term because they happen when an individual’s mind wanders. Daydreaming involves visual imaginations of the self in the future, present, or past, and attention shifts to these thoughts instead of the primary task. It often occurs in individuals with SCT as they tend to distract themselves from tiring tasks.

Sluggish Cognitive Tempo vs ADHD

Sometimes, it is possible for individuals with predominantly inattentive ADHD to exhibit a subset of symptoms like mental fogginess and sedentary behavior associated with SCT. But, despite the overlap in these two conditions, which makes it difficult for sluggish cognitive tempo to get official recognition, they are distinct. For instance, a meta-analysis [3*] done by Becker et al. through studying 19,000 children and adults determined that ADHD symptoms were different from those of SCT.

Proponents argue for SCT’s official recognition and the need for an official diagnosis that will make it easier for individuals with SCT to get the help they need, including therapy and proper medication. However, critics dismiss the condition stating that it can lead to wrong medical prescriptions.

ADHD Symptoms vs SCT Symptoms

Here is a list of symptoms of both inattentive ADHD and sluggish cognitive tempo.

Symptoms

ADHD

SCT

Short attention span

Poor attention to detail

Failure to finish tasks

Does not listen carefully when spoken directly

Poor organization skills

Avoiding tasks that require lots of mental work

Forgetfulness

Multiple distractions from extraneous stimuli

Sleepiness

Laziness

Easily confused

Daydreaming

Note that the manifestations may vary and indicate different mental disorders. Only a healthcare provider can assess your inattentive symptoms comprehensively and make a correct diagnosis.

Our healthcare providers are ready to examine your symptoms online and develop an individual treatment plan.

SCT Causes

Why do people get affected by sluggish cognitive tempo? What is the underlying reason behind the sluggish behavior and daydreaming? Unfortunately, the general causative reasons have not yet been found. Only a handful of studies have been conducted regarding the condition, and more research needs to be done regarding its etiology.

It’s been noted that there are various causes for each case, and they involve both environmental and non-environmental factors. Let’s review the most common ones below.

Heredity

Heredity is a potential cause of SCT, but there isn’t much evidence. For example, a study [4*] conducted by Moruzzi et al. in 2013 tabled some evidence on the possibility of heredity, but it was limited by the short number of symptoms used to identify SCT. So, while it can be heritable or genetically influenced, it is also likely to involve a more significant contribution of environmental factors.

Prenatal Exposure to Alcohol

Alcohol affects developing fetuses in many ways, and one of them involves their cognitive development. The research found an increase [5*] in sluggish cognitive tempo in children who had experienced prenatal alcohol exposure.

Brain Structure and Function

More research needs to be done regarding SCT’s neurobiology. However, some studies [6*] show the symptoms of this condition can be associated with altered anatomy of the frontal lobe. Also, research states that these alterations are different from those usually related to ADHD.

Acute Lymphoblastic Leukemia

Some evidence [7*] suggests a higher rate of SCT in survivors of acute lymphoblastic leukemia, a type of blood cancer. This correlation could be partly or wholly explained by radiation treatments that affect the individual’s brain. People receiving such treatments are at risk of developing neurocognitive problems compared to those who only receive chemotherapy. They may develop symptoms like motor skill problems, a slow processing speed, and attention difficulties.

Problematic Childhood

Environmental factors like problematic childhood have been known to play a role in mental deficiencies. In this case, a child could choose to dissociate themselves from environments that they may perceive as too stressful. They focus their thoughts on other events as a defense mechanism.

How Is It Diagnosed?

Since SCT isn’t included in the DSM, psychiatrists and psychologists are extra careful while assessing inattentive symptoms because it can be a sign of different mental disorders. There are standardized diagnostic tools and scales they could use to measure an individual’s symptoms and diagnose a specific condition.

Diagnosis by a Mental Health Professional

A psychiatrist can make an SCT diagnosis, distinguishing it from ADHD and other cognitive issues. Usually, an evaluation includes filling out a questionnaire about behavioral patterns. In addition, a healthcare professional may ask you about your emotions and reactions, your childhood symptoms and experiences, and will assess other symptoms to determine the probability of anxiety, attention deficit hyperactivity disorder, and depression.

Scales Used for Diagnosing SCT

The Barkley Sluggish Cognitive Tempo Scale

This is the first norm-referenced, experimentally-based test designed to assess the symptoms of sluggish cognitive tempo like the inability to focus, recurrent daydreaming, and general lethargy in children and adolescents aged 6 to 17. The scale takes a few minutes to complete.

The Adult Concentration Inventory

The ACI or adult concentration inventory is a measure where adults can self-report SCT symptoms. In contrast, the CCI-2 is the child concentration inventory used to measure SCT symptoms in children. The ACI is similar to the CCI-2, with only a few modifications in the anchors and four extra impairments related to SCT.

The Comprehensive Behavior Rating Scale for Children (CBRSC)

This scale is designed to provide an entire overview of the child’s or adolescent’s disorders and concerns. It provides an informed assessment of young adults and children across various settings and is used to measure aggressive behavior, emotional stress, impulsivity and hyperactivity, academic difficulties, social problems, and compulsive behaviors.

Possible Effects on Daily Life

The American Psychological Association, through the Diagnostic and Statistical Manual of Mental Disorders, states that for any condition to be termed a mental disorder [8*] , there should be evidence of disturbance in a patient’s emotional regulation, behavior, and cognition. While symptoms are ways through which a disorder is expressed, impairments refer to the consequences as a direct or indirect result of the symptoms.

Sluggish cognitive tempo can affect individuals in several ways, from their mental health and functioning to their academic, professional, and social life.

Socioemotional Functioning

SCT symptoms are linked to social problems, specifically social withdrawal. There may also be poor student-teacher relationships, peer rejection, and decreased perception of subtle social cues. Children with SCT will more likely be isolated or socially withdrawn because of their social disinterest or shyness.

Mental Functioning

Forgetfulness is one of the primary symptoms of SCT. Also, those diagnosed with this condition tend to develop distractible speech, easily distracted thoughts, or brief and unelaborated responses to questions. They may also find specific tasks and timed tests more challenging.

Academic Functioning

Studies [9*] have found a prevalent relationship between individuals affected by sluggish cognitive tempo and poor academics. Students with SCT often have difficulties completing their homework assignments and self-organization. They also develop poor learning skills and display deficits in self-regulation study strategies. They may have problems with written language, word reading, and mathematics.

How to Treat Sluggish Cognitive Tempo

SCT treatment is not standardized, and healthcare professionals use individualized approaches to help patients manage and overcome their symptoms. More in-depth research needs to be done on the treatments and prognosis, but currently, the most common and appropriate treatments involve medication, lifestyle changes, and psychotherapy.

Medication

If a healthcare provider defines the need for medication as SCT treatment, they usually prescribe stimulants used for ADHD. These include Adderall (amphetamine), Ritalin (methylphenidate), and Strattera (atomoxetine), a non-stimulant ADHD medication. These medications help to focus and pay attention better, making individuals feel more alert, awake, energetic, and confident.

If a person with SCT also has another mental condition, like depression or anxiety, they receive additional appropriate medications to alleviate their symptoms. These may include antidepressants and anxiolytic medications.

Therapy

Individuals affected by sluggish cognitive tempo often benefit from talk therapy sessions. Psychologists and counselors can help them learn better ways to process information, improve social skills, and boost organizational habits. A specialist can provide techniques for coping with pessimistic or self-critical thoughts, cognitive distortions, and irrational self-beliefs.

Cognitive-behavioral therapy (CBT) is considered to be helpful for SCT. It helps patients improve their way of thinking by identifying flawed thought processes and reprogramming them into healthier behavioral responses toward triggers.

Lifestyle Changes

Everyone can benefit from organizing their lives, from better sleep habits to regular exercise to following a healthy diet. But, people with ADHD symptoms or concentration deficit disorder need such a structure even more.

Here are some of the tips you could apply if you want to lead a more organized life:

  • To get out of a hazy routine, create a list of tasks you need to do the following day before you get to bed.
  • Stay more active and work out regularly. You could begin with a daily 30-minute walk, increasing activity levels when you feel more active, energetic, and focused.
  • Get some fresh air and sunlight every day. The fresh air will help you feel more focused, while the sunlight helps regulate your circadian rhythm, which improves your sleep.
  • Make sure your diet consists of healthy meals. Reduce consumption of processed foods to avoid the high-low dopamine feeling that might make your mind more sluggish.
  • It would also be good to monitor hydration and drink enough water.

Natural Treatment With Supplements

If deemed appropriate by your healthcare provider, you could try natural remedies and supplements. They may provide your brain with the necessary nutrients necessary for optimal functioning. These may include Zinc, Iron, Omega-3 fatty acids, vitamin D, or multivitamins. Note that the use of supplements is based on additional assessments and medical advice.

In Conclusion

Sluggish cognitive tempo is a relatively new concept. However, despite the fact that it’s still not recognized as a mental disorder, its symptoms have been known to significantly affect an individual’s functioning. If you experience prolonged issues with attention and memory, seek professional help to get appropriate treatment.

Frequently Asked Questions

Currently, sluggish cognitive tempo is not officially recognized as a mental health condition and is not added to the Diagnostic and Statistical Manual of Mental Health Disorders. The reason behind that is close similarity with attention deficit hyperactivity disorder (ADHD), but with additional research, it may be recognized in the future. Also, regardless of this fact, mental health professionals can assess individuals for SCT using special questionnaires and offer proper treatment.
SCT differs from ADHD in the symptom profile. Compared to attention deficit hyperactivity disorder, it causes a lower tendency for impulsivity and hyperactivity, but patients may experience more symptoms of inattention.
Sluggish cognitive tempo may coexist with other mental health conditions, such as anxiety disorders or depression. This may complicate the diagnostic process and treatment, so it’s essential to see a healthcare provider who can conduct an accurate assessment.
Sluggish cognitive tempo causes problems with attention and memory. If unmanaged, this can lead to impaired academic and professional performance and overall decreased quality of life. Challenges at work and in social settings may also contribute to the development of other mental health conditions, including depression and anxiety.
Usually, a psychologist or a psychiatrist can diagnose SCT, or cognitive disengagement syndrome, after a detailed assessment.
There is no standard treatment for sluggish cognitive tempo, and healthcare providers choose interventions individually. A treatment plan may include medication (such as stimulants used for attention deficit hyperactivity disorder), therapy (such as cognitive-behavioral therapy), and lifestyle changes.

Sources

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9 sources
  1. Sluggish Cognitive Tempo in Adults: Psychometric Validation of the Adult Concentration Inventory
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  2. Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome
    Source link
  3. Sluggish cognitive tempo in autism, ADHD, and neurotypical child samples
    Source link
  4. A Twin Study of the Relationships among Inattention, Hyperactivity/Impulsivity and Sluggish Cognitive Tempo Problems
    Source link
  5. Prenatal Alcohol Exposure, Attention-Deficit/Hyperactivity Disorder, and Sluggish Cognitive Tempo
    Source link
  6. Brain Structure and Function in School-Aged Children With Sluggish Cognitive Tempo Symptoms
    Source link
  7. Brief Report: Sluggish Cognitive Tempo Among Pediatric Survivors of Acute Lymphoblastic Leukemia
    Source link
  8. What is a mental disorder? An exemplar-focused approach
    Source link
  9. The Association Between Sluggish Cognitive Tempo and Academic Functioning in Youth with Attention-Deficit/Hyperactivity Disorder (ADHD)
    Source link
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Written by:

Umar Javed

Dr. MBBS
Reviewer:

Dr. Bradley Noon

MD
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This article contains scientific references. The numbers
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