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Originally published Saturday, April 12, 2014 at 5:29 PM

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Idea of new attention disorder spurs research, debate

Sluggish cognitive tempo is said to be characterized by lethargy, daydreaming and slow mental processing.


The New York Times

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With more than 6 million U.S. children having received a diagnosis of attention deficit hyperactivity disorder, or ADHD, concern has been rising that the condition is being significantly misdiagnosed and overtreated with prescription medications.

Yet some powerful figures in the mental-health world are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems.

Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps 2 million children.

Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship ADHD drug might treat it.

The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the condition, with the lead paper claiming the question of its existence “seems to be laid to rest as of this issue.”

Psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of ADHD’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”

In an interview, Dr. Keith McBurnett, a professor of psychiatry at the University of California, San Francisco, and co-author of several papers on sluggish cognitive tempo, said: “When you start talking about things like daydreaming, mind-wandering, those types of behaviors, someone who has a son or daughter who does this excessively says: ‘I know about this from my own experience.’ They know what you’re talking about.”

Yet some experts, including McBurnett and some members of the journal’s editorial board, say there is no consensus on the condition’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications.

“We’re seeing a fad in evolution: Just as ADHD has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances, an emeritus professor of psychiatry at Duke University. “This is a public-health experiment on millions of kids.”

Interest in condition

Although the concept of sluggish cognitive tempo, or SCT, has been researched sporadically since the 1980s, it has never been recognized in the Diagnostic and Statistical Manual of Mental Disorders, which codifies conditions recognized by the American Psychiatric Association. The editor-in-chief of The Journal of Abnormal Child Psychology, Charlotte Johnston, said in an email that recent renewed interest is what led the journal to devote most of one issue to “highlight areas in which further study is needed.”

Barkley declined repeated requests for interviews about his work regarding sluggish cognitive tempo. Several of the field’s other key researchers, Stephen Becker, of Cincinnati Children’s Hospital Medical Center, Benjamin Lahey, of the University of Chicago, and Stephen Marshall, of Ohio University, also declined to comment.

Papers have proposed that a recognition of SCT could help resolve some longstanding confusion about ADHD, which despite having “hyperactivity” in its name includes about 2 million children who are not hyperactive, merely inattentive. Some researchers propose that about half of those children would be better classified as having SCT, with perhaps 1 million additional children, who do not meet ADHD’s criteria now, having the new disorder, too.

“These children are not the ones giving adults much trouble, so they’re easy to miss,” McBurnett said. “They’re the daydreamy ones, the ones with work that’s not turned in, leaving names off of papers or skipping questions, things like that, that impinge on grades or performance.”

But McBurnett added that SCT remained many years from any scientific consensus. “We haven’t even agreed on the symptom list,” he said.

Emphasis questioned

Steve Lee, an associate professor of psychology at the University of California, Los Angeles, who serves on the editorial board of The Journal of Abnormal Child Psychology, said in an interview that he was conflicted about the journal’s emphasis on SCT. He expressed concern that ADHD had already grown to encompass too many children with common youthful behavior, or whose problems are derived not from a neurological disorder but from inadequate sleep, a different learning disability or other sources.

About two-thirds of children with an ADHD diagnosis take daily medication such as Adderall or Concerta, which often quells severe impulsiveness and inattention but also carries risks for insomnia and, among teenagers and adults, abuse or addiction.

“The scientist part of me says we need to pursue knowledge, but we know that people will start saying their kids have it, and doctors will start diagnosing it and prescribing for it long before we know whether it’s real,” Lee said. “ADHD has become a public-health, societal question, and it’s a fair question to ask of SCT. We better pump the brakes more diligently.”

McBurnett recently conducted a clinical trial paid for and overseen by Eli Lilly that investigated whether proposed symptoms of SCT could be treated with Strattera, the company’s primary ADHD drug. His study, published in The Journal of Child and Adolescent Psychopharmacology, concluded: “This is the first study to report significant effects of any medication on SCT.”

Barkley has financial ties to Eli Lilly; he received $118,000 from 2009 to 2012 for consulting and speakings, according to propublica.org. While detailing SCT in The Journal of Psychiatric Practice, Barkley stated Strattera’s performance on SCT symptoms was “an exciting finding.”

He declined to discuss his financial interests in the condition’s acceptance.

“I have no doubt there are kids who meet the criteria for this thing, but nothing is more irrelevant,” Frances said. “The enthusiasts here are thinking of missed patients. What about the mislabeled kids who are called patients when there’s nothing wrong with them? They are not considering what is happening in the real world.”



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