Mental Health & ADHD Comorbidities

What is Sluggish Cognitive Tempo? SCT Symptoms and Treatments

Sluggish Cognitive Tempo is an attention disorder defined by Russell Barkley, Ph.D., as distinct from — but often overlapping with — ADHD. It is characterized by day-dreamy, confused, or sleepy/lethargic behavior.

Tired Adult

What Is Sluggish Cognitive Tempo?

Sluggish Cognitive Tempo (SCT) is an attention disorder associated with the following symptoms that resemble signs of inattentive ADHD: excessive day dreaming; behaving lethargically; poor memory retrieval; trouble staying alert in boring situations; slow processing of information; and acting withdrawn.

Roughly half of all patients diagnosed with SCT also have attention deficit disorder (ADHD or ADD); studies also suggest that 30 to 63 percent of patients with inattentive-type ADHD also have high levels of SCT. However, SCT “is far more likely to be linked to symptoms of anxiety and extreme sadness and far less likely to be associated with disruptive, oppositional conduct or antisocial symptoms than is ADHD,” says Russell Barkley, Ph.D., who has written extensively about SCT and advocates for its consideration as a diagnosis separate from ADHD.

The term SCT was first coined in 1984, following research of attention problems not always associated with ADHD. Dr. Barkley has advocated for an alternative name — Concentration Deficit Disorder (CDD) — and for greater research and consideration within the medical community.

How is SCT Diagnosed?

SCT does not appear in diagnostic literature such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), however it may be diagnosed by a psychiatrist or psychologist following careful observation of a child or adult’s inattentive behavior in the context of little hyperactivity or impulsivity. Family members may also be asked to complete a questionnaire regarding the patient’s behavior. There is no official diagnostic tool for SCT, so symptoms are usually compared to those of other conditions — such as ADHD, mood disorders, and anxiety — in order to reach an accurate diagnosis.

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In 2012, Barkley developed his own SCT rating scale for adults, and followed it up with a 12-item rating scale of SCT symptoms for children, which he initially gave to a representative sample of 1,922 U.S. parents to complete. Other researchers have expanded the list to include the following 16 symptoms in children:

  1. Behavior is slow (e.g., sluggish)
  2. Lost in a fog
  3. Stares blankly into space
  4. Drowsy or sleepy (yawns) during the day
  5. Daydreams
  6. Loses train of thought
  7. Low level of activity (e.g., underactive)
  8. Gets lost in own thoughts
  9. Easily tired or fatigued
  10. Forgets what was going to say
  11. Easily confused
  12. Lacks motivation to complete tasks (e.g., apathetic)
  13. Spaces or zones out
  14. Gets mixed up
  15. Thinking is slow
  16. Difficulty expressing thoughts (e.g., gets “tongue-tied”)

Though SCT is not well studied, evidence suggests it is genetic. As such, family history is also explored during an SCT evaluation.

How Is SCT Treated?

There is no standard treatment plan for SCT, and no studies yet exist linking stimulant or nonstimulant medications to significant symptom improvement. That said, many professionals recommend some combination of the following to help to address symptoms of SCT and overlapping conditions including ADHD, extreme sadness, and anxiety:

  • Stimulants like Ritalin address overlapping ADHD symptoms.
  • The non-stimulant atomoxetine, a norepinephrine reuptake inhibitor, reduces SCT symptoms in patients with both ADHD and dyslexia, ADHD only, and dyslexia only.
  • SSRIs and Cognitive Behavioral Therapy could treat overlapping anxiety and extreme sadness.
  • Luvox could treat mind wandering.
  • Healthy sleep habits, diet, and exercise can help with lethargy and concentration problems.

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