To conduct the first meta-analysis evaluating the internal and external validity of the sluggish cognitive tempo (SCT) construct as related to or distinct from attention-deficit/hyperactivity ...disorder (ADHD) and as associated with functional impairment and neuropsychological functioning.
Electronic databases were searched through September 2015 for studies examining the factor structure and/or correlates of SCT in children or adults. The search procedures identified 73 papers. The core SCT behaviors included across studies, as well as factor loadings and reliability estimates, were reviewed to evaluate internal validity. Pooled correlation effect sizes using random effects models were used to evaluate SCT in relation to external validity domains (i.e., demographics, other psychopathologies, functional impairment, and neuropsychological functioning).
Strong support was found for the internal validity of the SCT construct. Specifically, across factor analytic studies including more than 19,000 individuals, 13 SCT items loaded consistently on an SCT factor as opposed to an ADHD factor. Findings also support the reliability (i.e., internal consistency, test-retest reliability, interrater reliability) of SCT. In terms of external validity, there is some indication that SCT may increase with age (r = 0.11) and be associated with lower socioeconomic status (r = 0.10). Modest (potentially negligible) support was found for SCT symptoms being higher in males than females in children (r = 0.05) but not in adults. SCT is more strongly associated with ADHD inattention (r = 0.63 in children, r = 0.72 in adults) than with ADHD hyperactivity-impulsivity (r = 0.32 in children, r = 0.46 in adults), and it likewise appears that SCT is more strongly associated with internalizing symptoms than with externalizing symptoms. SCT is associated with significant global, social, and academic impairment (r = 0.38-0.44). Effects for neuropsychological functioning are mixed, although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits.
This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is currently not enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research.
Abstract Although research demonstrates sluggish cognitive tempo (SCT) symptoms to be statistically distinct from other child psychopathologies (including attention-deficit/hyperactivity disorder ...ADHD, anxiety, depression, and oppositionality) and associated with social impairment, all studies conducted to date have been cross-sectional. Thus, while extant research demonstrates an association between SCT and social functioning, it is entirely unknown whether or not SCT longitudinally predicts increases in social impairment. This study provides an initial examination of the prospective association between SCT symptoms and children׳s peer functioning. Teachers of 176 children in 1st–6th grades (ages 6–13; 47% boys) provided ratings of children׳s psychopathology (i.e., SCT, ADHD, anxious/depressive, and oppositional/conduct problems) and peer functioning (i.e., popularity, negative social preference, peer impairment), and peer functioning was assessed again 6 months later. Multilevel modeling analyses indicated that, above and beyond child demographics, other psychopathologies, and baseline peer functioning, SCT symptoms were significantly associated with poorer peer functioning at the 6-month follow-up. In addition, 75% of children with high levels of SCT were rated as functionally impaired in the peer domain, in contrast to only 8% of children with low SCT. Further research is needed with larger samples to examine SCT over a longer developmental period and with other domains of adjustment.
Becker discusses the opportunities and challenges for understanding and treating heterogeneity in adolescents with attention-deficit/hyperactivity disorder (ADHD). While there are many substantial ...interest in understanding and treating ADHD in the important developmental stage of adolescence, still many gaps remain in part because many studies examining ADHD during the adolescent period have relied on small or clinically referred samples that lack representativeness or adequate statistical power for sophisticated analyses. Here, he reflects on a study by Sultan et al which is an important and welcoming contribution to the field.
This study examined remote learning practices and difficulties during initial stay-at-home orders during the COVID-19 pandemic in adolescents with and without attention-deficit/hyperactivity disorder ...(ADHD).
Participants were 238 adolescents (132 males; 118 with ADHD) aged 15.64–17.99 years and their parents. Adolescents and parents completed questionnaires in May/June 2020 when in-person schools were closed in the U.S.
Twenty-two percent of families incurred financial costs to support remote learning, and only 59% of school-based services received before COVID-19 continued during COVID-19 remote learning. Adolescents with ADHD had fewer routines and more remote learning difficulties than adolescents without ADHD. Parents of adolescents with ADHD had less confidence in managing remote learning and more difficulties in supporting home learning and home–school communication. Thirty-one percent of parents of adolescents with ADHD with an Individualized Education Program (IEP) or receiving academic accommodations (504 Plan) reported remote learning to be very challenging, compared with 18% of parents of adolescents with ADHD without an IEP/504 Plan, and only 4% of parents of adolescents with neither ADHD nor an IEP/504 Plan. Fewer adolescent routines, higher negative affect, and more difficulty concentrating because of COVID-19 were each associated with greater adolescent remote learning difficulties only in adolescents with ADHD.
This study provides initial findings of the nature and impact of remote learning during the COVID-19 pandemic. It is imperative for schools and communities to provide the necessary supports to adolescents, particularly those with mental health and/or learning difficulties, and to their parents.
Abstract
Study Objectives
To prospectively examine changes in adolescent sleep before and during the COVID-19 pandemic in adolescents with and without ADHD.
Methods
Participants were 122 adolescents ...(ages 15–17; 61% male; 48% with ADHD). Parents reported on adolescents’ sleep duration and difficulties initiating and maintaining sleep (DIMS); adolescents reported on sleep patterns, sleep duration, delayed sleep/wake behaviors, and daytime sleepiness before (September 2019 to February 2020) and during (May–June 2020) COVID-19. Adolescents also reported on their health behaviors, COVID-19-related negative affect, and difficulties concentrating due to COVID-19.
Results
Parents reported adolescents had more DIMS during COVID-19 than before COVID-19, with clinically elevated rates increasing from 24% to 36%. Both bedtimes and waketimes shifted later during COVID-19, and adolescents reported more delayed sleep/wake behaviors. Adolescents also reported less daytime sleepiness and longer school night sleep duration during COVID-19. In considering differences between adolescents with and without ADHD, adolescents with ADHD did not experience an increase in school night sleep duration and were less likely to obtain recommended sleep duration during COVID-19. In the full sample, controlling for ADHD status, COVID-19-related sadness/loneliness was associated with increases in DIMS, and spending less time outside and more COVID-19-related worries/fears were associated with increases in delayed sleep/wake behaviors during COVID-19.
Conclusions
COVID-19 had negative and positive impacts on adolescent sleep. Adolescents with ADHD did not experience the benefit of increased school night sleep duration during COVID-19 like adolescents without ADHD. Negative affect and health behaviors may be useful intervention targets for reducing negative impacts of COVID-19 for adolescent sleep.
To (1) describe rates of suicidal behaviors in a sample of college students, (2) evaluate sex differences, and (3) provide a preliminary examination of the unique association of sluggish cognitive ...tempo (SCT) symptoms and other mental health dimensions in relation to suicidal behaviors in college students.
Participants were 1,704 college students from two universities who completed measures assessing mental health symptoms and suicidal behaviors (i.e., past ideation/attempts, past-year ideation, disclosure of intent to commit suicide to another person, and likelihood of a future suicide attempt).
Four percent of participants reported a previous suicide attempt and 2.2% indicated that it was likely they would attempt suicide someday. 7.5% reported thinking about killing themselves often in the past year; 41.4% of these participants reported they had never told someone they might attempt suicide. Approximately one quarter (24%) of participants were classified with suicide risk based on an empirically established cutoff score, though rates differed between women (26.1%) and men (20.4%). Women were also more likely than men to report a previous suicide attempt and to tell someone else about their suicidal ideation. In regression models, depression was the strongest correlate of suicidal behaviors. Attention-deficit/hyperactivity disorder symptoms were unassociated with suicidal behaviors when accounting for internalizing symptoms. SCT remained significantly associated with increased suicidal behaviors beyond other mental health dimensions including depression.
A substantial minority of college students report suicidal behaviors, with sex differences dependent on the specific behavior examined. This study provides the first evidence linking SCT to suicidal behaviors in young adults.
Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies, and growing evidence demonstrates SCT to be associated with impairment in ...both children and adults. However, it remains unclear how SCT should optimally be conceptualized. In this article, we argue that multiple models of psychopathology should be leveraged to make substantive advances to our understanding of SCT. Both categorical and dimensional approaches should be used, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) nosology, the Research Domain Criteria (RDoC) initiative, and hierarchical models of psychopathology. Studies are needed to determine whether individuals categorized with SCT can be reliably identified and differentiated from individuals without SCT in pathophysiological, neuropsychological, behavioral, and daily life functioning. Studies are also needed to evaluate the validity and utility of SCT as a transdiagnostic and dimensional construct. In considering SCT as a dimensional and potentially transdiagnostic construct, we describe ways in which SCT might be examined within the RDoC framework, including negative valence systems, cognitive systems, and arousal/regulatory systems, as well as within hierarchical models of psychopathology. Conceptualizing SCT within both categorical and dimensional models of psychopathology will help to better understand the causes, developmental pathways, and clinical implications of SCT, both as a construct in its own right and also in relation to other psychopathologies.
Highlights • This study examines the external validity of child self-reported sleep functioning. • Child-reported sleep was associated with inattention and anxiety/depression. • Child-reported sleep ...was associated with poorer adjustment. • Future studies should further evaluate the clinical utility of child-reported sleep.
Sleep difficulties are common in children with attention-deficit/hyperactivity disorder (ADHD). However, sleep problems are multifaceted and little is known about the variation in sleep difficulties ...across children with ADHD. We examined the profiles of sleep difficulties in children with ADHD and associated clinical factors (e.g. co-occurring mental health conditions, stimulant use and parent mental health).
Data from two harmonised studies of children with ADHD (total: N = 392, ages 5-13 years) were used. Parents completed measures of children's sleep, co-occurring mental health conditions and their own mental health. Both parents and teachers completed measures of child ADHD symptoms and emotional and conduct symptoms. Latent profile analysis was used to identify sleep profiles, and multinomial logistic regression assessed clinical correlates of the groups.
Five sleep profiles were identified: (a) insomnia/delayed sleep phase (36%), (b) generalised sleep difficulties at sleep onset and overnight (25%), (c) high anxious/bedtime resistance difficulties (11%), (d) overnight sleep difficulties including obstructive sleep apnoea and parasomnias (5%) and (e) no sleep difficulties (22%). Compared with the group without sleep difficulties, the generalised, anxious/bedtime resistance and insomnia/delayed sleep phase sleep had greater parent-reported emotional and conduct symptoms, co-occurring anxiety and increased parent mental health difficulties. The generalised and anxious/bedtime resistance groups also had greater parent-reported ADHD symptoms, with the anxious/bedtime resistance sleep group also having more frequent co-occurring depression and teacher-reported emotional symptoms.
The sleep difficulties experienced by children with ADHD are varied. Supports to help children with ADHD need to consider the particular profiles of sleep difficulties experienced and broader clinical characteristics. Tailored intervention approaches are likely needed (including a need to address parent mental health).
A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study ...with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity, oppositional defiant disorder, limited prosocial emotions, anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study-consistent across mother, father, and teacher ratings-appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.
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