Mental Health & ADHD Comorbidities

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.

A boy in the backseat of a car looking out the passenger window daydreaming

Register here for “Cognitive Disengagement Syndrome: A Distinct Kind of Inattention” with Dr. Joseph Fredrick

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

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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