What Is Cognitive Disengagement Syndrome?
Cognitive disengagement syndrome (CDS) – previously called “sluggish cognitive tempo”— describes a unique cluster of attentional symptoms that, while associated with ADHD, is distinct and separate. Up to 40% of children with ADHD exhibit symptoms of CDS, including excessive daydreaming and slowed behaviors.
Attention difficulties manifest differently in children and adolescents who have ADHD. Some are distracted by external stimuli or have problems with sustained effort. Others are preoccupied by what is going on in their own minds — they frequently daydream, get lost in thought, stare, or zone out. These children may appear sleepy, confused, and take longer to finish activities. This distinct set of symptoms, originally called sluggish cognitive tempo (SCT), is now known as cognitive disengagement syndrome (CDS). (In 2022, a group made up of international researchers and clinicians decided to change the name from SCT to CDS to better reflect its core feature — being “cognitively disengaged” from the current task or the environment.1 )
It is important to note that CDS is not recognized as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM), and this has implications for diagnosis and treatment.
Studies show that elevated CDS symptoms are present in 25 to 40% of youth with ADHD2 3 4, though CDS can be present in children who do not have ADHD. Though both CDS and ADHD impact one’s ability to pay attention, there are key distinctions.
[Take This Self-Test: Could Your Child Have Inattentive ADHD?]
Cognitive Disengagement Syndrome vs. ADHD: Comparing Symptoms
| Symptom | ADHD | CDS |
|---|---|---|
| Lack of Focus | Trouble sustaining attention on tasks and using executive function skills, like planning and working memory | Excessive internal distractibility — being lost in thought, mentally confused, foggy, and zoning out |
| Poor Task Completion | Trouble starting and following through on tasks due to external distractibility, forgetfulness, or difficulties with sustained mental effort | Taking longer to complete day-to-day activities due to a slower pace of movement and activity and/or internal distractions |
| Comorbid Complications | At risk for anxiety, depression, and emotional dysregulation, leading to temper outbursts and argumentative behaviors | At elevated risk for depression, anxiety, peer withdrawal, social skills deficits, and daytime sleepiness1 |
Cognitive Disengagement Syndrome: Interventions
Many pediatricians and mental health care providers are less familiar with CDS, perhaps because the DSM-5 has not recognized it as an official disorder, meaning there are no guidelines for diagnosis and treatment. However, studies show that interventions designed for children with inattentive ADHD may also help those with CDS. For instance, behavioral parent training (e.g., giving effective commands, using visuals, simplifying daily routines), homework and organization skills training, and sleep interventions may address symptoms of CDS.5 6 7 These studies were designed for youth with ADHD and should be replicated for CDS.
Other promising interventions for CDS include mindfulness and cognitive behavioral therapy (CBT).8 9 Mindfulness may help youth increase awareness of internal distractions, such as mind wandering, and re-engage their attention in the present moment. CBT may work on recognizing unhelpful thinking patterns and using behavioral strategies to promote attention and social engagement.
Studies have found that stimulant medication may not help children with CDS as much as it helps children with ADHD.10 11 Results from two studies suggest that atomoxetine (Strattera), a non-stimulant, may be effective for reducing CDS symptoms, but more research is needed to draw firm conclusions.12 13
[Read: 5 Overlooked Signs of ADHD – the Inattentive Type]
For educators, we often recommend providing students with attention and comprehension checks, verbal or visual prompts, extended time on assignments, structured check-ins or daily goals, simplifying language, and attention breaks.
If you suspect your child or teen has symptoms of CDS, it’s best to work with a provider specializing in inattentive ADHD from a behavioral treatment or pharmacological perspective, since these interventions appear to be most effective to date.
Cognitive Disengagement Syndrome: Next Steps
- Read: What Is Sluggish Cognitive Tempo?
- Free Download: In-Depth Guide to Inattentive ADHD
- Read: Maladaptive Daydreaming vs. Inattentive ADHD — Comparing Symptoms, Treatments
Joseph W. Fredrick, Ph.D., is a clinical psychologist at Cincinnati Children’s Center for ADHD, which offers evaluation and treatment services for children and adolescents with symptoms of CDS.
Stephen P. Becker, Ph.D., is a psychologist and researcher at Cincinnati Children’s Hospital Medical Center, specializing in ADHD and CDS.
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1 Becker, S. P., Willcutt, E. G., Leopold, D. R., Fredrick, J. W., Smith, Z. R., Jacobson, L. A., Burns, G. L., Mayes, S. D., Waschbusch, D. A., Froehlich, T. E., McBurnett, K., Servera, M., & Barkley, R. A. (2023). Report of a work group on sluggish cognitive tempo: key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 629–645. https://doi.org/10.1016/j.jaac.2022.07.821
2 Barkley R. A. (2013). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. Journal of Clinical Child and Adolescent Psychology, 53, 42(2), 161–173. https://doi.org/10.1080/15374416.2012.734259
3Burns, G. L., & Becker, S. P. (2019). Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches. Journal of Clinical Child & Adolescent Psychology, 50(2), 267–280. https://doi.org/10.1080/15374416.2019.1678165
4 Servera, M., Sáez, B., Burns, G. L., & Becker, S. P. (2018). Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. Journal of Abnormal Psychology, 127(8), 818–829. https://doi.org/10.1037/abn0000375
5 Pfiffner, L. J., Yee Mikami, A., Huang-Pollock, C., Easterlin, B., Zalecki, C., & McBurnett, K. (2007). A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 1041–1050. https://doi.org/10.1097/chi.0b013e318064675f
6 Smith, Z. R., & Langberg, J. M. (2020). Do sluggish cognitive tempo symptoms improve with school-based ADHD interventions? Outcomes and predictors of change. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 61(5), 575–583. https://doi.org/10.1111/jcpp.13149
7 Becker, S. P., Duraccio, K. M., Sidol, C. A., Fershtman, C. E. M., Byars, K. C., & Harvey, A. G. (2022). Impact of a behavioral sleep intervention in adolescents with ADHD: feasibility, acceptability, and preliminary effectiveness from a pilot open trial. Journal of Attention Disorders, 26(7), 1051–1066. https://doi.org/10.1177/10870547211056965
8 Becker, S. P., & Barkley, R. A. (2021). Field of daydreams? Integrating mind wandering in the study of sluggish cognitive tempo and ADHD. JCPP Advances, 1(1), e12002. https://doi.org/10.1111/jcv2.12002
9 Becker, S. P., & Barkley, R. A. (2018). Sluggish cognitive tempo. Oxford Textbook of Attention Deficit Hyperactivity Disorder, 147-153. (View article.)
10 Fırat, S., Gul, H., & Aysev, A. (2021). 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? Journal of Attention Disorders, 25(9), 1321–1330. https://doi.org/10.1177/1087054720902846
11Froehlich, T. E., Becker, S. P., Nick, T. G., Brinkman, W. B., Stein, M. A., Peugh, J., & Epstein, J. N. (2018). Sluggish cognitive tempo as a possible predictor of methylphenidate response in children with ADHD: a randomized controlled trial. The Journal of Clinical Psychiatry, 79(2), 17m11553. https://doi.org/10.4088/JCP.17m11553
12Wietecha, L., Williams, D., Shaywitz, S., Shaywitz, B., Hooper, S. R., Wigal, S. B., Dunn, D., & McBurnett, K. (2013). Atomoxetine improved attention in children and adolescents with attention-deficit/hyperactivity disorder and dyslexia in a 16 week, acute, randomized, double-blind trial. Journal of Child and Adolescent Psychopharmacology, 23(9), 605–613. https://doi.org/10.1089/cap.2013.0054
13McBurnett, K., Clemow, D., Williams, D., Villodas, M., Wietecha, L., & Barkley, R. (2017). Atomoxetine-related change in sluggish cognitive tempo is partially independent of change in attention-deficit/hyperactivity disorder inattentive symptoms. Journal of Child and Adolescent Psychopharmacology, 27(1), 38–42. https://doi.org/10.1089/cap.2016.0115
