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What is Sluggish Cognitive Tempo?

My son was diagnosed with ADHD years ago and is taking medication. I've recently heard about another disorder called sluggish cognitive tempo. Can you explain what this is and whether it relates to ADHD?

Answer (Published 7/29/2014)

Sluggish cognitive tempo (SCT) is a condition claimed to be characterized by lethargy, daydreaming and slow mental processing, and is said to affect as many as two million children. While it hasn't been recognized as a medical diagnosis, some pharmaceutical companies are reportedly investigating drugs to address symptoms and conducting studies to see if medications currently being prescribed for Attention Deficit Hyperactivity Disorder (ADHD) are effective for SCT. Some experts have suggested that this disorder may soon become the "new attention disorder."

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From what I've learned, there is no consensus on whether or not the disorder actually exists, nor on its exact symptoms. It is not listed in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), the most authoritative compendium of mental disorders. Even so, I've read that some researchers have suggested that SCT could encompass some two million children who have been diagnosed with ADHD, even though they are not hyperactive, as well as another one million children who haven't been diagnosed with ADHD.

Many in the psychiatric field don't agree with this. Alan Francis, M.D., emeritus professor of psychiatry at Duke University School of Medicine wrote a scathing blog entry about the subject on the Psychology Today website characterizing SCT as the "dumbest and most dangerous diagnostic idea I have ever encountered," and maintaining that "the very same experts who succeeded in promoting ADHD have now concocted and are promoting a new diagnosis that would be a terrific bonanza for pharmaceuticals, but terrible for the kids who would be misdiagnosed and over-treated."

Perhaps the biggest boost SCT has received came from the Journal of Abnormal Child Psychology, which filled 136 pages of its January 2014 issue with papers describing the disorder. The lead paper claimed that the question of its SCT's existence "seems to be laid to rest as of this issue."

Despite the fact that SCT hasn't been accepted as a legitimate disorder, some doctors are trying to figure out how to treat it. I've read that the stimulants used to treat ADHD don't help with kids thought to have SCT.

We'll have to see if daydreaming and lethargy mean that something is really wrong with a lot of children, justifying drug treatment. I'm skeptical. More alarming is the paragraph below from Dr. Francis' blog:

"A prospective study using DSM-IV found that by age 21, 81 percent of kids had already qualified for one diagnosis of mental disorder. DSM-5 recently made things much worse when it turned normal temper tantrums into Disruptive Mood Dysregulation Disorder. The last thing our kids need is to be misdiagnosed with Sluggish Cognitive Tempo and bathed in even more stimulant meds."

I agree.

Andrew Weil, M.D.

Alan Schwarz, "Idea of New Attention Disorder Spurs Research, and Debate", New York Times, April 11, 2014, accessed June 12, 2014.

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