Global InformationCognitive disengagement syndrome information
| Cognitive disengagement syndrome | |
|---|---|
| Other names | Sluggish cognitive tempo (outdated) |
| Specialty | Psychiatry |
| Symptoms |
|
| Duration | Permanent |
| Causes | Genetics and to a lesser extent, environmental factors |
| Differential diagnosis | ADHD |
| Management | Medication, accommodations |
| Medication | Atomoxetine |
| Frequency | 5.1% (hypothesized[1]) |
Cognitive disengagement syndrome (CDS) is an attention syndrome characterised by prominent dreaminess, mental fogginess, hypoactivity, sluggishness, slow reaction time, staring frequently, inconsistent alertness, and a slow working speed. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.[2]
Since 1798, the medical literature on disorders of attention has distinguished between at least two kinds, one a disorder of distractibility, lack of sustained attention, and poor inhibition (that is now known as ADHD) and the other a disorder of low power, arousal, or oriented/selective attention (now known as CDS).[3]
Although it implicates attention, CDS is distinct from ADHD. Unlike ADHD, which is the result of deficient executive functioning and self-regulation,[4][5][6] CDS presents with problems in arousal, maladaptive daydreaming, and oriented or selective attention (distinguishing what is important from unimportant in information that has to be processed rapidly), as opposed to poor persistence or sustained attention, inhibition and self-regulation.[7] In educational settings, CDS tends to result in decreased work accuracy, while ADHD impairs productivity.[8]
CDS can also occur as a comorbidity with ADHD in some people, leading to substantially higher impairment than when either condition occurs alone.
In contemporary science today, it is clear that this set of symptoms is important because it is associated with unique impairments, above and beyond ADHD. CDS independently has a negative impact on functioning (such as a diminished quality of life,[9] increased stress and suicidal behaviour,[10] as well as lower educational attainment and socioeconomic status[11]). CDS is clinically relevant as multiple randomised controlled clinical trials (RCTs) have shown that it responds poorly to methylphenidate.[12][13][14][15]
Originally, CDS was thought to represent about one in three persons with the inattentive presentation of ADHD,[16] as a psychiatric misdiagnosis, and to be incompatible with hyperactivity. New studies found that it can be comorbid with ADHD – and present in individuals without ADHD as well. Therefore, some psychologists and psychiatrists view it as a separate mental disorder. Others dismiss it altogether or believe it is a distinct symptom group within ADHD (like Hyperactivity, Impulsivity or Inattention). It even may be useful as an overarching concept that cuts across different psychiatric disorders (much like emotional dysregulation, for example).[17]
If CDS and ADHD coexist together, the problems are additive: Those with both (ADHD + CDS) had higher levels of impairment and inattention than adults with ADHD only,[18] and were more likely to be unmarried, out of work or on disability.[19] CDS alone is also present in the population and can be quite impairing in educational and occupational settings, even if it is not as pervasively impairing as ADHD. The studies on medical treatments are limited, however, research suggests that atomoxetine[20][21][22][23] and lisdexamfetamine[20][24] may be used to treat CDS.
The condition was previously called Sluggish Cognitive Tempo (SCT). The terms concentration deficit disorder (CDD) or cognitive disengagement syndrome (CDS) have recently been preferred to SCT because they better and more accurately explain the condition and thus eliminate confusion.[19][25]
- ^ "APA PsycNet".
- ^ Becker, Stephen P.; Willcutt, Erik G.; Leopold, Daniel R.; Fredrick, Joseph W.; Smith, Zoe R.; Jacobson, Lisa A.; Burns, G. Leonard; Mayes, Susan D.; Waschbusch, Daniel A.; Froehlich, Tanya E.; McBurnett, Keith; Servera, Mateu; Barkley, Russell A. (June 2023). "Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome (CDS)". Journal of the American Academy of Child and Adolescent Psychiatry. 62 (6): 629–645. doi:10.1016/j.jaac.2022.07.821. ISSN 0890-8567. PMC 9943858. PMID 36007816.
- ^ [1] 'Mind in general' by Sir Alexander Crichton (hal.science)
- ^ "APA PsycNet". psycnet.apa.org. Retrieved 2024-03-28.
- ^ Antshel, Kevin M.; Hier, Bridget O.; Barkley, Russell A. (2014), Goldstein, Sam; Naglieri, Jack A. (eds.), "Executive Functioning Theory and ADHD", Handbook of Executive Functioning, New York, NY: Springer, pp. 107–120, doi:10.1007/978-1-4614-8106-5_7, ISBN 978-1-4614-8106-5, retrieved 2024-03-28
- ^ Cecil CA, Nigg JT (November 2022). "Epigenetics and ADHD: Reflections on Current Knowledge, Research Priorities and Translational Potential". Molecular Diagnosis & Therapy. 26 (6): 581–606. doi:10.1007/s40291-022-00609-y. PMC 7613776. PMID 35933504.
- ^ "Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome".
- ^ Becker, Stephen P.; Willcutt, Erik G.; Leopold, Daniel R.; Fredrick, Joseph W.; Smith, Zoe R.; Jacobson, Lisa A.; Burns, G. Leonard; Mayes, Susan D.; Waschbusch, Daniel A.; Froehlich, Tanya E.; McBurnett, Keith; Servera, Mateu; Barkley, Russell A. (2023-06-01). "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 & Adolescent Psychiatry. 62 (6): 629–645. doi:10.1016/j.jaac.2022.07.821. ISSN 0890-8567. PMC 9943858. PMID 36007816.
- ^ Martha A. Combs; et al. (2014). "Impact of SCT and ADHD Symptoms on Adults' Quality of Life". Applied Research in Quality of Life. 9 (4): 981–995. doi:10.1007/s11482-013-9281-3. S2CID 49480261.
- ^ Becker, Stephen P.; Holdaway, Alex S.; Luebbe, Aaron M. (2018). "Suicidal Behaviors in College Students: Frequency, Sex Differences, and Mental Health Correlates Including Sluggish Cognitive Tempo". Journal of Adolescent Health. 63 (2): 181–188. doi:10.1016/j.jadohealth.2018.02.013. PMC 6118121. PMID 30153929.
- ^ Cite error: The named reference
:10was invoked but never defined (see the help page). - ^ Fırat, Sumeyra (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?". Journal of Attention Disorders. 25 (9): 1321–1330. doi:10.1177/1087054720902846. PMID 32064995. S2CID 211134241.
- ^ Froehlich, Tanya E.; Becker, Stephen P.; Nick, Todd G.; Brinkman, William B.; Stein, Mark A.; Peugh, James; Epstein, Jeffery 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. doi:10.4088/JCP.17m11553. ISSN 1555-2101. PMC 6558969. PMID 29489078.
- ^ Barkley, R. A.; DuPaul, G. J.; McMurray, M. B. (April 1991). "Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphenidate". Pediatrics. 87 (4): 519–531. ISSN 0031-4005. PMID 2011430.
- ^ https://www.peterraabe.ca/docs/SCT_Barkley.pdf
- ^ Cite error: The named reference
:8was invoked but never defined (see the help page). - ^ Cite error: The named reference
:2was invoked but never defined (see the help page). - ^ Silverstein, Michael J. (2019). "The Characteristics and Unique Impairments of Comorbid Adult ADHD and Sluggish Cognitive Tempo: An Interim Analysis". Psychiatric Annals. 49 (10): 457–465. doi:10.3928/00485713-20190905-01. S2CID 208396893.
- ^ a b Russell A. Barkley (2015). Sluggish Cognitive Tempo or Concentration Deficit Disorder (Free Fulltext). Oxford Handbooks Online. doi:10.1093/oxfordhb/9780199935291.013.9. ISBN 978-0-19-993529-1.
- ^ a b Cite error: The named reference
Report of a Work Group on Sluggishwas invoked but never defined (see the help page). - ^ Cite error: The named reference
:13was invoked but never defined (see the help page). - ^ Bleazard, Ryan; et al. (January 2024). "Response to Ribeiro et al. (2023) – the analysis is in fact flawed".
- ^ Cite error: The named reference
:14was invoked but never defined (see the help page). - ^ Adler, Lenard A.; Leon, Terry L.; Sardoff, Taylor M.; Krone, Beth; Faraone, Stephen V.; Silverstein, Michael J.; Newcorn, Jeffrey H. (2021-06-29). "A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHD". The Journal of Clinical Psychiatry. 82 (4): 34965. doi:10.4088/JCP.20m13687. ISSN 0160-6689.
- ^ Becker, Stephen; Willcutt, Erik; Leopold, Daniel; Fredrick, Joseph; Smith, Zoe; Jacobson, Lisa; Burns, G Leonard; Mayes, Susan; Waschbusch, Daniel; Froehlich, Tanya; McBurnett, Keith; Servera, Mateu; Barkley, Russell (21 August 2022). "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): S0890–8567(22)01246-1. doi:10.1016/j.jaac.2022.07.821. PMC 9943858. PMID 36007816. S2CID 251749516.