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SCT - Sluggish Cognitive Tempo / CDS - Cognitive Disengagement Syndrome

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SCT - Sluggish Cognitive Tempo / CDS - Cognitive Disengagement Syndrome

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Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero

SCT (Sluggish Cognitive Tempo) / CDS (Cognitive Disengagement Syndrome) used to be regarded as a kind of sub-case or extreme case of ADHD-I. However, this view is outdated. However, this view is outdated. SCT is a disorder in its own right and occurs in around 25 to 50% of people with ADHD, both with and without comorbid ADHD. SCT is not yet an official disorder according to the DSM.
In the presence of ADHD comorbidity, SCT seems to occur as frequently in people with ADHD-HI as in people with ADHD-I.
SCT was renamed CDS in 2022.1

We consider the term “slowed thinking” or “sluggish cognitive pace” to be inaccurate and inappropriate in relation to SCT. Rather, we perceive a slower decision-making process. The ability to think quickly is fundamentally present; we consider - as an unverified hypothesis - an excessive blockade of the PFC by noradrenaline and possibly other neurotransmitters via the alpha-1 adrenoceptor to be possible.

SCT (Sluggish Cognitive Tempo) / CDS (Cognitive Disengagement Syndrome) is characterized by various symptoms, including fatigue, hypoactivity, daydreaming, concentration problems, poorer sleep quality, increased daytime sleepiness, lower memory performance and slower information processing speed.

SCT can be diagnosed with valid questionnaires and shows specific neurophysiological features. SCT can affect various aspects of life, including occupational performance and social withdrawal, and is best treated with multimodal therapy. Atomoxetine showed significant improvement in SCT symptoms, while SCT people with ADHD are more often reported to be non-responsive to methylphenidate.

1. Symptoms of SCT

In the following list of SCT symptoms, the numbers indicate how frequently the respective symptom occurs in SCT according to Becker et al.2. Lee et al.3 also name several of the symptoms as typical for SCT:

  • Quickly tired or exhausted 1.02
  • Low activity level, hypoactivity 0.97
  • Stares into space 0.96
  • Dozy, sleepy, yawning (during the day) 0.95
  • Forgets what he/she wanted to say 0.94
  • Inertia, slow movements 0.92
  • Quickly confused 0.91
  • Lost in the fog 0.89
  • Daydreams 0.88
  • Loses the thread of thought 0.86
  • Slow thinking 0.82
  • Quickly gets confused 0.85
  • Gets lost in thought 0.81
  • Switch off mentally 0.82
  • Difficulty expressing thoughts 0.78
  • Often considerable decision-making difficulties (sluggish - in our experience)
  • Social seclusion45

A comprehensive review article found 13 independent and distinct symptoms for SCT from ADHD, but not distinct enough to be used diagnostically.6

One study found the Adult Concentration Inventory (ACI) to be suitable for diagnosing SCT. 7 SCT was clearly associated with:

  • Stronger internalizing symptoms
  • Time management and self-organization difficulties
  • Poorer quality of sleep
  • Shorter sleep duration
  • Lower sleep efficiency
  • More daytime sleepiness.

SCT is not synonymous with reduced cognitive performance. There are highly gifted people with ADHD. This is consistent with the finding that SCT does not correlate with slow processing speed.8

The slower cognitive performance specific to the sluggish/underarousal subtype does not mean that intelligence is reduced to the same extent. This means that SCT is not simply the result of reduced intelligence. We know of several people we perceive as SCT who have PhDs or are otherwise highly intelligent or even highly gifted. Rather, it seems that decision-making processes are slowed down or made more difficult. Conversely, a high IQ could mitigate the symptoms of SCT. A study confirms this.9

The ADxS.org online SCT test (as of September 2022) clearly showed a negative correlation between SCT symptoms and the highest IQ test score given.

IQ Subjects (n) SCT symptoms (out of 26)
150 and higher 7 13.6
140 - 149 54 13.9
130 - 139 158 15.2
120 - 129 162 15.5
110 - 119 88 15.8
100 - 109 33 16.1
90 - 99 15 16.9
80 - 89 8 16.3

A total of 78 (out of 381) subjects with an IQ of 120 or more had 20 SCT symptoms or more (out of 26).

Out of a total of 2039 subjects, only the 1640 subjects who stated that they did not have ADHD or who stated that they were not taking ADHD medication were included. Of these, 524 had reported their highest IQ test score.
It can be assumed that subjects with lower IQ scores reported these less frequently. The values in the two IQ groups below 100 should be viewed with caution due to the low number of test subjects.
The overall results are limited by the fact that the subjects took part in the SCT online test linked to ADxS.org out of their own interest.
The massive overrepresentation of high IQ scores is probably due to the high participation rate of members of Mensa e.V. Germany, an association for the highly gifted (IQ 130 and above).
Data as of September 2022 (c) ADxS.org

The term Sluggish Cognitive Tempo therefore does not really seem appropriate. Barkley also disagrees with the term SCT.10 SCT was renamed CDS (Cognitive Disengagement Syndrome) in 2022. In our opinion, Sluggish Decisioning Might be more appropriate.

Our impression is that people with ADHD fail particularly often as self-employed persons.

2. SCT (Sluggish Cognitive Tempo) as an independent Disorder

SCT was previously described as an extreme manifestation of the ADHD-I subtype or an ADHD-I-like type with slowed cognitive performance.11

However, an increasing number of studies are coming to the conclusion that SCT is a separate and distinct Disorder from ADHD.12131415161718192021222324 Strong distinctiveness from ADHD-I was found for 13 of the 15 SCT symptoms.2526

2 studies found evidence that SCT could be considered a group of symptoms that occur in various mental disorders.27 When ADHD, depression, anxiety disorder, sleep disorders and alcohol and cannabis abuse were removed, less than 5% of subjects were left with high levels of SCT.28
Children with ADHD, ASD or ASD+ADHD (AuADHD) showed similar CDS symptom scores. However, AuADHD children showed stronger cognitive CDS symptoms than children with ADHD alone. Both the general CDS traits and the cognitive CDS symptom subgroup were associated with greater social difficulties regardless of diagnosis, particularly associated with social withdrawal, higher levels of repetitive behaviors, and more sensory sensitivities.29

A meta-analysis of 9 studies found acceptable to excellent reliability and high structural validity (high loading on an SCT factor and low loading on an ADHD-HI inattention factor) for the majority of SCT items.14

A large study of over 2,000 families found that in children, only 48% of those with SCT also had ADHD and only 35% of those with ADHD-HI also had SCT. The persons with SCT without ADHD had higher levels of anxiety, depression, shyness and sleep disturbances than those with ADHD without SCT. In contrast, people with ADHD without SCT had greater executive functions deficits and more frequent ODD than those with SCT. SCT and ADHD did not differ in terms of friendships or social or academic impairment.30

The Sluggish Cognitive Tempo Self-Report Scale is a valid and reliable self-report scale for the diagnosis of SCT.31

However, SCT and ADHD appear to have considerable comorbidity. One report suggests that 30 to 63% of people with ADHD-I also have significant SCT symptoms.3233

Barkley had already argued in the early 2010s that SCT was a separate Disorder, which has since been confirmed. In the early 2000s, however, he had also argued that ADHD-I was a separate disorder from ADHD-HI, which has not proved to be the case.

The previous results of the ADxS.org online questionnaire on SCT (as of September 2022) also indicate that although SCT has a high correlation with ADHD overall, it is largely independent of the ADHD-HI / ADHD-C or ADHD-I subtypes. The mean scores of the n = 180 subjects with ADHD-HI / ADHD-C and the n = 241 subjects with ADHD-I are almost identical (ADHD-HI / ADHD-C: 15.4; ADHD-I: 16.9 out of a possible 26 SCT symptoms when assessed as they are when not taking ADHD medication). When persons with ADHD rated themselves as they are when taking ADHD medication, ADHD-HI sufferers had 13.5 symptoms (n = 52, minus 12.3 %), while ADHD-I sufferers had 15.4 symptoms (n = 62, minus 8.9 %). This suggests that ADHD medication may also have some positive influence on SCT symptoms and that this is greater in people with ADHD with hyperactivity.
In contrast, the n = 33 participants who stated that they definitely did not have ADHD or SCT achieved an average SCT score of 12.5. To date, no participant has stated that they definitely have SCT and no ADHD. This is not surprising given the unfamiliarity of the disorder.

Men achieved an average of 15.7 symptoms (n = 713), women an average of 15.4 symptoms (n = 1,250) out of 26 possible symptoms.

Recent research shows that SCT is thought to differ from ADHD-I in the following ways:

  • SCT appears to correlate significantly more frequently than ADHD-I with
    • Later withdrawal from addictive substances18
    • Internet addiction and internet gaming disorder34
    • Fear1718 30
      • In contrast, one study found no correlation between SCT and anxiety symptoms.23
    • Depression3517183023
    • Neuroticism36
    • Increased BIS36
    • Increased BAS fun-seeking36
  • SCT appears to be even more strongly associated with later internalizing behaviors than ADHD-I.171825
  • SCT is said to correlate (differently or more strongly than ADHD-I) with later shyness1830 or internalizing symptoms17 as well as lower extraversion36.
  • While externalizing symptoms were associated with hyperactivity / impulsivity symptoms of ADHD-HI in one study, internalizing symptoms were significantly correlated with SCT in children and adolescents with ADHD. Although social withdrawal was statistically significantly correlated with ADHD-I and inattention (compared to ADHD-HI), this relationship was mediated by the severity of SCT.37
  • SCT, like ADHD-I, is said to correlate with later social difficulties,1718 but this has not been confirmed by other studies.30
  • According to one study, SCT shows even greater social withdrawal than ADHD,3839 which another study only partially confirms.30
  • ADHD-I correlated with later poorer math performance and slower processing speed, while SCT more consistently predicted later poorer reading performance.18
  • SCT correlated (unlike other ADHD symptoms) with suicidal tendencies, which in turn correlated with depression.4025
  • SCT showed lower memory performance than ADHD-I and non-affected individuals.41
  • Motor speed and reaction times
    • SCT showed not quite as reduced psychomotor speed and a better neurocognitive index compared to ADHD-I.41
    • SCT showed faster reaction times than ADHD-I.41
    • Slower psychomotor speed and longer reaction times correlated with the degree of inattention.41
    • In contrast to ADHD, the variance in reaction speed is not increased in SCT42
    • The unimpaired variance in reaction times at least tends to be consistent with a report that SCT showed less impairment in executive functions (like reaction time variance mediated by working memory) than ADHD.30
  • SCT should, unlike ADHD
    • Occur equally frequently in men and women43
    • Occur just as frequently in adults as in children and adolescents, even if it occurs somewhat later than ADHD. There is therefore no partial disappearance of symptoms in a subgroup of people with ADHD.43
    • In contrast, a 7-year longitudinal study of 639 twins found that SCT is usually short-lived (1 - 2 years) and has no lasting detrimental effects on academic achievement.17
  • SCT showed deviations in HRV compared to ADHD, which could indicate problems with arousal.44 Based on the symptoms of CDS, we suspect strong correlations with arousal impairments.
  • SCT showed reduced conscientiousness.36
  • People with SCT who also have ADHD are said to be particularly frequent MPH nonresponders. In particular, elevated SCT sluggish/sleepy factor values are said to indicate MPH nonresponding. In contrast, neither increased SCT daydreamy symptoms nor the ADHD subtype (ADHD-HI or ADHD-I) differed in the MPH response rate (which argues against the hypothesis of SCT as a subtype of ADHD-I).45
  • SCT, like ADHD, begins in early childhood, although in SCT symptoms increase moderately after the age of 5, while inattention remained more constant.46 SCT was distinguishable from ADHD thereafter, although highly correlative. Lower parental education correlated with higher teacher ratings of SCT. African Americans had higher inattention and lower teacher SCT ratings.
  • Unlike ADHD-I, SCT is said to have no features of emotional dysregulation.25
  • In a comprehensive study, SCT symptoms correlated with more frequent47
    • Mind wandering
    • Brooding
    • Daydreaming.
      The study further found the first empirical evidence of a unique and robust association between SCT symptoms and non-task-related thinking, while suggesting that the link between ADHD-HI and mind-wandering may be less robust than previously thought.
  • SCT is unremarkable in relation to time representation, repetition of non-words and recall of sentences. Instead, SCT appears to be more closely associated with features of a social (pragmatic) communication disorder.48

3. Neurophysiological characteristics of SCT

  • The specific SCT symptoms (sluggish, underarousal) could be caused by a noticeable deficit in the uptake of dopamine and noradrenaline.11
  • SCT is thought to correlate with inactivity in the superior parietal lobe (SPL).32
  • Sluggish Cognitive Tempo is said to correlate with attention problems, but not with hyperactivity or aggression problems. Sleep problems are also said to be less frequent.49
  • Sluggish Cognitive Tempo - unlike ADHD - is not conspicuous in the frontal and frontocentral theta-beta ratio of the EEG.50
  • According to one study, SCT correlates with impaired information processing capacity and slower (visual) information processing speed.51
    Another study found no correlation between SCT and reduced information processing speed, but a correlation with reduced working memory speed and increased inhibition speed. A combination of slowed working memory and accelerated inhibition was therefore suspected.52
  • A high working memory load significantly impairs information processing speed. Nevertheless, in ADHD, manipulations of working memory were found to impair information processing speed just as little as vice versa. This suggests that working memory impairments and information processing speed impairments in ADHD are caused by different areas of brain function.53
  • An interesting report mentions partial brain sleep as a possible cause of some SCT symptoms or mind wandering.54
  • Sleep problems are highly correlative with SCT/CDS55
  • Adolescents with SCT completed the Wechsler Symbol Search and Coding subtests and the Grooved Pegboard Test. Their parents did not report any symptoms related to symbol search or coding scores for the persons with ADHD, while the persons with ADHD themselves reported significantly decreased coding scores. Both parents and persons with ADHD consistently reported symptoms that correlated significantly with slower grooved pegboard time. The hypothesis is that SCT correlates more clearly with performance on the processing speed task as motor demands increase.56
  • A study of children with ADHD aged 8 to 12 years measured SCT symptoms in relation to autonomic nervous system responses under social and cognitive stress. Respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity were measured. SCT symptoms did not correlate with RSA reactivity in any stress variant. In social rejection stress, greater SCT symptoms correlated with greater SCL reactivity. This pattern was independent of ADHD-HI symptoms, internalizing symptoms, medication status, or gender. The authors conclude that there is a link between SCT symptoms and sympathetic nervous system reactivity and greater activation of the BIS.57

Among 169 children and adolescents with spina bifida (SB, open back), 18% were found to have SCT. The study replicated the 3-factor structure of SCT proposed by Penny with the components slow, sleepy and daydreaming. Slow overlapped strongly with inattention, sleepy and daydreaming differed significantly from inattention and internalizing symptoms. A myelomeningocele (congenital malformation of the spinal cord due to lack of closure of the neural tube with open vertebral arches and protrusion of the dural sac) and the presence of a shunt (short circuit connection with fluid spillover between normally separate vessels or cavities) correlated with more severe SCT symptoms.58

4. Medication for SCT

  • In one study, atomoxetine significantly improved 7 of 9 symptoms of the Kiddie-Sluggish Cognitive Tempo Interview (K-SCT) in SCT. The symptom improvement in SCT was completely independent of ADHD symptoms.59 This also suggests that SCT is an independent disorder or has an independent cause of disorder and can coexist with ADHD.
  • According to one study, people with SCT are particularly frequent MPH nonresponders; in contrast, ADHD-HI and ADHD-I did not differ in the MPH response rate in this study, which is controversial.45
  • One study found an improvement in SCT symptoms with MPH only in relation to the school environment. Daydreaming and oppositional behavior correlated with a lower MPH response in SCT.60
  • The results of the ADxS.org SCT online test suggest that ADHD medications may provide some improvement in SCT symptoms (see above).

  1. Becker, Willcutt, Leopold, Fredrick, Smith, Jacobson, Burns, Mayes, Waschbusch, Froehlich, McBurnett, Servera, Barkley (2022): Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome. J Am Acad Child Adolesc Psychiatry. 2022 Aug 19:S0890-8567(22)01246-1. doi: 10.1016/j.jaac.2022.07.821. PMID: 36007816. ↥

  2. Becker, Burns, Schmitt, Epstein, Tamm (2017): Toward Establishing a Standard Symptom Set for Assessing Sluggish Cognitive Tempo in Children: Evidence From Teacher Ratings in a Community Sample. Assessment. 2017 Jun 1:1073191117715732. doi: 10.1177/1073191117715732. ↥

  3. Lee, Burns, Snell, McBurnett (2014): Validity of the sluggish cognitive tempo symptom dimension in children: sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. J Abnorm Child Psychol. 2014 Jan;42(1):7-19. doi: 10.1007/s10802-013-9714-3. ↥

  4. Fredrick, Becker (2022): Cognitive Disengagement Syndrome (Sluggish Cognitive Tempo) and Social Withdrawal: Advancing a Conceptual Model to Guide Future Research. J Atten Disord. 2022 Aug 4:10870547221114602. doi: 10.1177/10870547221114602. PMID: 35927980. ↥

  5. Becker SP, Vaughn AJ, Zoromski AK, Burns GL, Mikami AY, Fredrick JW, Epstein JN, Peugh JL, Tamm L (2024): A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome. J Clin Child Adolesc Psychol. 2024 Jan 9:1-16. doi: 10.1080/15374416.2024.2301771. PMID: 38193746. ↥

  6. Becker, Leopold, Burns, Jarrett, Langberg, Marshall, McBurnett, Waschbusch, Willcutt (2016): The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo: A Meta-Analysis and Critical Review. J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):163-78. doi: 10.1016/j.jaac.2015.12.006. n > 19000 ↥

  7. Fredrick, Burns, Langberg, Becker (2021): Examining the Structural and External Validity of the Adult Concentration Inventory for Assessing Sluggish Cognitive Tempo in Adults. Assessment. 2021 Jul 9:10731911211027224. doi: 10.1177/10731911211027224. PMID: 34243678. n = 286 ↥

  8. Cook, Braaten, Vuijk, Lee, Samkavitz, Doyle, Surman (2019): Slow Processing Speed and Sluggish Cognitive Tempo in Pediatric Attention-Deficit/Hyperactivity Disorder: Evidence for Differentiation of Functional Correlates. Child Psychiatry Hum Dev. 2019 Jun 21. doi: 10.1007/s10578-019-00904-6. ↥

  9. Tamm L, Epstein JN, Orban SA, Kofler MJ, Peugh JL, Becker SP (2023): Neurocognition in children with cognitive disengagement syndrome: accurate but slow. Child Neuropsychol. 2023 Mar 2:1-20. doi: 10.1080/09297049.2023.2185215. PMID: 36864603. n = 263 ↥

  10. Vortrag Barkley (2014) an der Lynn University, Minute 1:44 ↥

  11. Diamond: Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit (with hyperactivity), Development and Psychopathology 17 (2005), 807–825, Seite 810 ↥ ↥

  12. Fredrick JW, Jacobson LA, Peterson RK, Becker SP. Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research. Child Neuropsychol. 2023 Sep 15:1-35. doi: 10.1080/09297049.2023.2256052. PMID: 37712631. REVIEW ↥

  13. Cerny BM, Reynolds TP, Chang F, Scimeca LM, Phillips MS, Ogram Buckley CM, Leib SI, Resch ZJ, Pliskin NH, Soble JR (2022): Cognitive Performance and Psychiatric Self-Reports Across Adult Cognitive Disengagement Syndrome and ADHD Diagnostic Groups. J Atten Disord. 2023 Feb;27(3):258-269. doi: 10.1177/10870547221136216. PMID: 36354066. ↥

  14. Becker (2020): Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade. J Am Acad Child Adolesc Psychiatry. 2020 Oct 31:S0890-8567(20)32062-1. doi: 10.1016/j.jaac.2020.10.016. PMID: 33166623. REVIEW ↥ ↥

  15. Burns, Becker (2019): Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches. J Clin Child Adolesc Psychol. 2019 Oct 31:1-14. doi: 10.1080/15374416.2019.1678165. ↥

  16. Takeda, Burns, Jiang, Becker, McBurnett (2019): Psychometric properties of a sluggish cognitive tempo scale in Japanese adults with and without ADHD. Atten Defic Hyperact Disord. 2019 Mar 25. doi: 10.1007/s12402-019-00300-z. ↥

  17. Vu, Thompson, Willcutt, Petrill (2019): Sluggish cognitive tempo: longitudinal stability and validity. Atten Defic Hyperact Disord. 2019 Feb 20. doi: 10.1007/s12402-019-00287-7. ↥ ↥ ↥ ↥ ↥ ↥ ↥

  18. Becker, Burns, Leopold, Olson, Willcutt (2018): Differential impact of trait sluggish cognitive tempo and ADHD inattention in early childhood on adolescent functioning. J Child Psychol Psychiatry. 2018 Jun 29. doi: 10.1111/jcpp.12946. ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥

  19. Garner, Peugh, Becker, Kingery, Tamm, Vaughn, Ciesielski, Simon, Loren, Epstein (2017): Does Sluggish Cognitive Tempo Fit Within a Bi-Factor Model of ADHD? J Atten Disord. 2017 Jun;21(8):642-654. doi: 10.1177/1087054714539995. n=168 ↥

  20. Barkley (2014): Sluggish cognitive tempo (concentration deficit disorder?): current status, future directions, and a plea to change the name; J Abnorm Child Psychol. 2014 Jan;42(1):117-25. ↥

  21. Capdevila-Brophy, Artigas-Pallarés, Navarro-Pastor, García-Nonell, Rigau-Ratera, Obiols (2014): ADHD predominantly inattentive subtype with high sluggish cognitive tempo: a new clinical entity? J Atten Disord. 2014 Oct;18(7):607-16. doi: 10.1177/1087054712445483. ↥

  22. McFayden, Jarrett, White, Scarpa, Dahiya, Ollendick (2020): Sluggish Cognitive Tempo in Autism Spectrum Disorder, ADHD, and Their Comorbidity: Implications for Impairment. J Clin Child Adolesc Psychol. 2020 Feb 6:1-8. doi: 10.1080/15374416.2020.1716365. PMID: 32027539. ↥

  23. Brewe, Simmons, Capriola-Hall, White (2020): Sluggish cognitive tempo: An examination of clinical correlates for adults with autism. Autism. 2020 Feb 7:1362361319900422. doi: 10.1177/1362361319900422. PMID: 32028780. n = 57 ↥ ↥ ↥

  24. Kılıçoğlu AG, Zadehgan Afshord T, Derin S, Ertas E, Coskun P, Aktas S, Guler EM (2023): Comparison of Possible Changes in Oxidative Stress, DNA Damage, and Inflammatory Markers in Children/Adolescents Diagnosed with Sluggish Cognitive Tempo and Children/Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol. 2023 Aug 17. doi: 10.1089/cap.2022.0081. PMID: 37590480. ↥

  25. Becker, Burns, Smith, Langberg (2019): Sluggish Cognitive Tempo in Adolescents with and without ADHD: Differentiation from Adolescent-Reported ADHD Inattention and Unique Associations with Internalizing Domains. J Abnorm Child Psychol. 2019 Dec 9. doi: 10.1007/s10802-019-00603-9. n = 302 ↥ ↥ ↥ ↥

  26. Sadeghi-Bahmani D, Mohammadian Y, Ghasemi M, Bahmani LS, Piri N, Brühl AB, Becker SP, Burns GL, Brand S (2022): Sluggish Cognitive Tempo among Iranian Children and Adolescents: A Validation Study of the Farsi Child and Adolescent Behavior Inventory (CABI)-Parent Version. J Clin Med. 2022 Oct 27;11(21):6346. doi: 10.3390/jcm11216346. PMID: 36362574; PMCID: PMC9654992. ↥

  27. Nelson JM, Lovett BJ (2022): Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors. J Atten Disord. 2022 Dec 28:10870547221142458. doi: 10.1177/10870547221142458. Epub ahead of print. PMID: 36576055. ↥

  28. Lovett, Wood, Lewandowski (2020): Differential Diagnosis of Sluggish Cognitive Tempo Symptoms in College Students. J Atten Disord. 2020 Jan 6:1087054719896856. doi: 10.1177/1087054719896856. n = 910 ↥

  29. Carpenter KLH, Davis NO, Spanos M, Sabatos-DeVito M, Aiello R, Compton SN, Franz L, Schechter JC, Summers J, Dawson G (2024): Cognitive Disengagement Syndrome in Young Autistic Children, Children with ADHD, and Autistic Children with ADHD. J Clin Child Adolesc Psychol. 2024 Jun 20:1-12. doi: 10.1080/15374416.2024.2361715. PMID: 38900723. ↥

  30. Burns, Becker (2019): Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches. J Clin Child Adolesc Psychol. 2019 Oct 31:1-14. doi: 10.1080/15374416.2019.1678165. n = 2056 befragte Mütter ↥ ↥ ↥ ↥ ↥ ↥ ↥

  31. Gozpinar N, Cakiroglu S, Gormez V (2023): Sluggish Cognitive Tempo Self Report Scale (SCT-SR): Development and Initial Validation Study. J Atten Disord. 2023 Mar;27(5):510-520. doi: 10.1177/10870547231153879. PMID: 36799440. ↥

  32. Fassbender, Krafft, Schweitzer (2015): Differentiating SCT and inattentive symptoms in ADHD using fMRI measures of cognitive control; Neuroimage Clin. 2015; 8: 390–397; doi: 10.1016/j.nicl.2015.05.007; PMCID: PMC4474281 ↥ ↥

  33. Garner, Marceaux, Mrug, Patterson, Hodgens (2010): Dimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo; J Abnorm Child Psychol. 2010 Nov; 38(8): 1097–1107; doi: 10.1007/s10802-010-9436-8; PMCID: PMC3278310; NIHMSID: NIHMS353172 ↥

  34. Gul A, Gul H (2023): Sluggish cognitive tempo (Cognitive Disengagement Syndrome) symptoms are more associated with a higher risk of internet addiction and internet gaming disorder than ADHD symptoms: A study with medical students and resident doctors. Res Dev Disabil. 2023 Jun 14;139:104557. doi: 10.1016/j.ridd.2023.104557. PMID: 37327573. ↥

  35. Ward, Sibley, Musser, Campez, Bubnik-Harrison, Meinzer, Yeguez (2019): Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD. Atten Defic Hyperact Disord. 2019 Mar 9. doi: 10.1007/s12402-019-00293-9. ↥

  36. Becker, Schmitt, Jarrett, Luebbe, Garner, Epstein, Burns (2018): Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model. J Res Pers. 2018 Aug;75:103-112. doi: 10.1016/j.jrp.2018.06.001. n = 3172 ↥ ↥ ↥ ↥ ↥

  37. Sevincok, Ozbay, Ozbek, Tunagur, Aksu (2019): ADHD symptoms in relation to internalizing and externalizing symptoms in children: the mediating role of sluggish cognitive tempo. Nord J Psychiatry. 2019 Dec 6:1-8. doi: 10.1080/08039488.2019.1697746. ↥

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  40. Becker, Holdaway, Luebbe (2018): Suicidal Behaviors in College Students: Frequency, Sex Differences, and Mental Health Correlates Including Sluggish Cognitive Tempo. J Adolesc Health. 2018 Aug;63(2):181-188. doi: 10.1016/j.jadohealth.2018.02.013. n = 1704 ↥

  41. Ünsel-Bolat, Ercan, Bolat, Süren, Bacanlı, Yazıcı, Rohde (2019): Comparisons between sluggish cognitive tempo and ADHD-restrictive inattentive presentation phenotypes in a clinical ADHD sample. Atten Defic Hyperact Disord. 2019 Mar 25. doi: 10.1007/s12402-019-00301-y. n = 155 ↥ ↥ ↥ ↥

  42. Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 41 ↥

  43. Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 35 ↥ ↥

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  45. Froehlich, Becker, Nick, Brinkman, Stein, Peugh, Epstein (2018): Sluggish Cognitive Tempo as a Possible Predictor of Methylphenidate Response in Children With ADHD: A Randomized Controlled Trial. J Clin Psychiatry. 2018 Feb 27;79(2). pii: 17m11553. doi: 10.4088/JCP.17m11553. ↥ ↥

  46. Dvorsky, Becker, Tamm, Willoughby (2019): Testing the Longitudinal Structure and Change in Sluggish Cognitive Tempo and Inattentive Behaviors From Early Through Middle Childhood. Assessment. 2019 Nov 3:1073191119872247. doi: 10.1177/1073191119872247. ↥

  47. Fredrick, Kofler, Jarrett, Burns, Luebbe, Garner, Harmon, Becker (2020): Sluggish cognitive tempo and ADHD symptoms in relation to task-unrelated thought: Examining unique links with mind-wandering and rumination. J Psychiatr Res. 2020 Apr;123:95-101. doi: 10.1016/j.jpsychires.2020.01.016. PMID: 32045730; PMCID: PMC7047632. ↥

  48. Russell, Redmond, Ash (2022): Psycholinguistic profiling of children with sluggish cognitive tempo. Clin Linguist Phon. 2022 Jun 24:1-17. doi: 10.1080/02699206.2022.2092422. PMID: 35748339. ↥

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  50. Jarrett, Gable, Rondon, Neal, Price, Hilton (2017): An EEG Study of Children With and Without ADHD Symptoms: Between-Group Differences and Associations With Sluggish Cognitive Tempo Symptoms. J Atten Disord. 2017 Aug 1:1087054717723986. doi: 10.1177/1087054717723986. n = 41 ↥

  51. Weiler, Bernstein, Bellinger, Waber (2002): Information processing deficits in children with attention-deficit/hyperactivity disorder, inattentive type, and children with reading disability. J Learn Disabil. 2002 Sep-Oct;35(5):448-61. ↥

  52. Kofler, Irwin, Sarver, Fosco, Miller, Spiegel, Becker (2019): What cognitive processes are “sluggish” in sluggish cognitive tempo? J Consult Clin Psychol. 2019 Nov;87(11):1030-1042. doi: 10.1037/ccp0000446. ↥

  53. Kofler, Soto, Fosco, Irwin, Wells, Sarver (2019): Working memory and information processing in ADHD: Evidence for directionality of effects. Neuropsychology. 2019 Oct 14. doi: 10.1037/neu0000598. ↥

  54. Andrillon, Windt, Silk, Drummond, Bellgrove, Tsuchiya (2019): Does the Mind Wander When the Brain Takes a Break? Local Sleep in Wakefulness, Attentional Lapses and Mind-Wandering. Front Neurosci. 2019 Sep 13;13:949. doi: 10.3389/fnins.2019.00949. eCollection 2019. ↥

  55. Cano-Crespo A, Moreno-García I, Servera M, Morales-Ortiz M (2023): Cognitive Disengagement Syndrome and Child Sleep Problems in ADHD, Anxiety and Depression. Healthcare (Basel). 2023 Jul 14;11(14):2022. doi: 10.3390/healthcare11142022. PMID: 37510463; PMCID: PMC10378907. ↥

  56. Becker, Marsh, Holdaway, Tamm (2019): Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task? Eur Child Adolesc Psychiatry. 2019 Nov 27. doi: 10.1007/s00787-019-01446-x. n = 80 ↥

  57. Becker, McQuade (2020): Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity during Social and Cognitive Stressor Tasks. J Abnorm Child Psychol. 2020 Jul;48(7):923-933. doi: 10.1007/s10802-020-00651-6. PMID: 32328864; PMCID: PMC7306431. n = 61 ↥

  58. Simpson TS, Leopold DR, Wilson PE, Peterson RL (2023): Cognitive disengagement syndrome in pediatric spina bifida. Child Neuropsychol. 2023 Feb 21:1-18. doi: 10.1080/09297049.2023.2181944. Epub ahead of print. PMID: 36803439. ↥

  59. McBurnett, Clemow, Williams, Villodas, Wietecha, Barkley (2017): Atomoxetine-Related Change in Sluggish Cognitive Tempo Is Partially Independent of Change in Attention-Deficit/Hyperactivity Disorder Inattentive Symptoms. J Child Adolesc Psychopharmacol. 2017 Feb;27(1):38-42. doi: 10.1089/cap.2016.0115. n = 124; dieser Artikel ist eine Reaktion auf die Kritik von Yang, Li (2014): Could atomoxetine improve sluggish cognitive tempo symptoms? J Child Adolesc Psychopharmacol. 2014 Oct;24(8):462. doi: 10.1089/cap.2014.0052. PMID: 25285785, in der der ursprüngliche Artikel Wietecha, Williams, Shaywitz, Shaywitz, Hooper, Wigal, Dunn, McBurnett (2013): Atomoxetine improved attention in children and adolescents with attention-deficit/hyperactivity disorder and dyslexia in a 16 week, acute, randomized, double-blind trial. J Child Adolesc Psychopharmacol. 2013 Nov;23(9):605-13. doi: 10.1089/cap.2013.0054. wegen einer Nichtherausrechnung der AD(H)S-Symptome aus der Bewertung der Wirkung von Atomoxetin auf SCT-Symptome kritisiert worden war. ↥

  60. Fırat, Gul, Aysev (2020): An Open-Label Trial of Methylphenidate Treating Sluggish Cognitive Tempo, Inattention, and Hyperactivity/Impulsivity Symptoms Among 6- to 12-Year-Old ADHD Children: What Are the Predictors of Treatment Response at Home and School? J Atten Disord. 2020 Feb 17:1087054720902846. doi: 10.1177/1087054720902846. PMID: 32064995. n = 185 ↥

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