Talk:Sluggish cognitive tempo

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Contents 1 What is SCT 2 Causes (citation needed) 3 Treatment 4 Learning difficulties? 5 ADD and SCT 5.1 References

[edit] What is SCT

This is a very misunderstood condition with very little information compared to "regular" ADHD. It will probably be in the next version of the DSM.—Preceding unsigned comment added by Scuro (talk • contribs) 18:13, 11 December 2006

I never heard of this before seeing it on Wikipedia. Are you aware of any literature published on it? -- Tim D 01:15, 12 December 2006 (UTC)

I do not think that they should be conceived of as physically sluggish -- after all there is some correlation between hyperactivity (as measured by DSM-IV criteria) and SCT (eventhough it is not as strong as the correlation with inattentiveness). See eg. Hartman et al. (2004) Journal of Abnormal Child Psychology, Vol. 32, No. 5, October 2004, pp. 491–503. To my knowledge, no study has shown reduced physical activity along with increased SCT. (Of course, they are sluggish compared to the hyperactive ADHD/HI subtype, but not when compared to your 'average' child.)--89.253.76.55 (talk) 12:37, 14 March 2008 (UTC)

This is not a new concept or designation. Dr. Russell Barkley in his lecture notes from 2000, speaks with authority on SCT. [1] Download the pdf and go to the second section entitled:"Is inattentive ADHD really another Disorder"? I believe researchers were already aware of this group back at the time of the formation of the DSM3 and that the critera for inattentive in that version match SCT more closely. When each version of the DSM is updated, they make final decisions by committee. Sometimes the best decisions are not made.

SCT does not equal inattentive ADHD. --Scuro 03:23, 12 December 2006 (UTC)

I agree that ADHD-I is likely something very different from ADHD, but I couldn't find his mention of "sluggish cognitive tempo" in those lecture highlights. Does he ever mention it by name? From what I've seen so far, it appears that if anything it could be a subset of ADHD-I -- Tim D 05:20, 12 December 2006 (UTC)

Actually here's a good article that summarizes the current situation concerning SCT. It looks to me that SCT is more of a factor that can help diagnose someone, rather than a diagnosis in itself. Perhaps in the future it will play a part in differentiating between ADHD-I and some other kind of inattention disorder, but at least according to the article cited above, it weighs pretty heavily with what's we see now as ADHD-I. -- Tim D 06:50, 12 December 2006 (UTC)

Sounds like when the next version of the DSM comes out, SCT will either be a separate disorder, or the inattentive subtype will be for "pure" inattentive ADHD (SCT) from birth.

The problem right now is that SCT does not equal inattentive ADHD. You can be SCT and qualify for the inattentive diagnosis but so could an adult ADHDer who formerly was hyperactive. Let me explain, a Hyperactive ADHDer in later life gets their first diagnosis, and they may well get a diagnosis of inattentive ADHD. Why?, a good number of those ADHDers who are hyperactive as children, lose their hyperactivity as adults. Remember, ADHD is a developmental disorder, things change. One of the major things to change is that ADHD kids often lose their hyperactivity but hang on to other ADHD traits. So going back to my example, this adult who formerly would have gotten a diagnosis of hyperactive ADHD, now could have enough inattentive symptoms to get the inattentive diagnosis and may not have enough of the Hyperactive symptoms to qualify for the other two types of ADHD. These former hyperactive ADHDers are very different from SCT's in most ways. THEY ARE NOT THE SAME.

SCT most likely was just a descriptor that someone researcher came up with so that you wouldn't get the the inattentive ADHDers from birth mixed up with the hyperactive ADHDers who may qualify for that diagnosis later in life. It is not a true designation nor can you diagnosis someone with it. Did that make sense? :)

--Scuro 04:51, 13 December 2006 (UTC)

Right, I understand those things. Although the whole developmental part of ADHD isn't quite clear cut. Adults who grew up with ADHD may not "lose" their hyperactivity, per se; they simply develop skills to better cope with it as they mature. Many maintain their impulsiveness throughout their life, although often to a lesser and controlled degree. The inattention then may become the dominating feature of the disorder. But still, SCT does appear to be something that can be present in anyone with ADHD, but weighs heavily with the primarily inattentive subtype. It's an interesting construct, but I think think that it can be expressed better in this article.

By the way, do you have any resources saying that SCT may show up in the DSM-V? I haven't come across any yet.

-- Tim D 06:31, 14 December 2006 (UTC)

I took another wack at the article. Some of my previous edits were kind of messy. Some information also needed to be changed and some was added. I hope that reads a lot better. Yes, you are right about coping skills. Some ADHDers in adulthood will find more acceptable ways to deal with that hyperactive urge or will choose enviornments to work in that don't require silence and sitting still. Still other ADHDers will lose most or all of their hyperactivity. Some have suggested that the degree to which hyperactivity remains in adulthood , indicates in a general way, the level of ADHD within that individual.

I'm sorry if I haven't made myself clearer about SCT. SCT can not be present in all of those with ADHD. Barkley has stated that all ADHDers who have, or once had, a "wiff" of hyperactivity, should be excluded from this grouping. My guess is that once the Researchers finally started to look just at the charcteristics of inattentive subtype kids, they saw two different types of kids with two different profiles.

I believe Barkley was on the team that came up with designations for ADHD in the DSM3 and DSM4. He most likely will also part of that team for the DSM5. Barkley has stated that he would prefer that inattentive ADHD be kept for pure SCT for the present time. It is big mess now, and he has stated as much in any lecture he gives. He has also stated that he believes that it could be a different disorder in which case it would get it's own designation in the new DSM5. The jury is still out. Is SCT still part of ADHD? They are very different profiles yet I believe they share some impulsive traits. Personally, I believe that SCTers also have some degree of inhibition problems with emotions and some other areas. The two conditions do not share hyperactivity. Most of what I have stated beyond opinion, can be found in the PDF lecture notes of Russell Barkley in SF 2000. The link is in the external link section. --Scuro 03:55, 15 December 2006 (UTC)

There have been a number of new additions and changes since my last post. I believe I have this condition and have had great difficulty finding good information on this disorder. I have shared the best sources in the external link section and have tried to make concise and meaningful posts. I hope that the original posters can see where my motivation is coming from and generally accept the additions and deletions that I have made to make the article better. If you have better or newer info, please add!--Scuro 06:58, 17 December 2006 (UTC)

[edit] Causes (citation needed)

I wrote "citation needed" in the sentence of causes, because I wonder in what way it is similar to ADHD when different genes and different regions of the brain are affected. Lova Falk 19:03, 8 April 2007 (UTC)

[edit] Treatment

This sentence is not clear: "Roughly one in five responds with a therapeutic decrease in symptoms, while two thirds of this population will show mild benefits."
Do you mean the following:
"Only roughly one in five with SCT responds with a therapeutic decrease in symptoms, while two thirds of the other types of ADHD will show mild benefits." Lova Falk 20:03, 8 April 2007 (UTC)

[edit] Learning difficulties?

I edited this sentence: "Those with SCT symptoms show a qualitatively different kind of attention deficit more typical of a true information input and output problem that one sees with a learning disability, than from those who have had a significant history of hyperactivity-impulsivity."
I found this sentence confusing, so I checked the reference: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811
Neither "input and output problem", "learning disability", nor "history" is mentioned in this article. So I removed all those parts and left an abbreviated version of this sentence.
Great source by the way! Lova Falk 14:47, 27 April 2007 (UTC)

Perhaps the sentence could be improved... if that is the main beef. Would you like to do an edit?

I didn't want to read through the initial source again so instead I've inserted another source where the word input and output is used explictly. Simply open up the pdf and search those words. Barkley clearly states that there are input problems with focus and also states that those with ADHD have an output problem eg they have difficulty doing work. As an aside he also states that those with SCT symptoms more frequently have LD's. With regards to the phrase, "those who had a significant history of hyperactivity"...this make reference to the fact one can be hyperactive as a child but show few or no hyperactive symptoms as an adult....thus there are those who ADHD who have a history of hyperactivity and those that don't. --scuro 20:09, 27 April 2007 (UTC)

[edit] ADD and SCT

I reverted the edit by "24.6.174.110" that substituted ADD for SCT. There is no consensus (yet?) that ADD = SCT, and therefore the terms cannot simply be substituted. So if articles are referenced in which the treatment of ADD are described, we cannot just write SCT instead. In fact, at least one of the referenced articles says there is a difference between ADD and SCT: "Many ADD children, although not all, appear sluggish, drowsy, spacey, lethargic, and markedly hypoactive. They fit the criteria for having a sluggish cognitive tempo (SCT)." (Italics done by me).^[1] In this article, the term ADD is used for "the truly inattentive type of ADHD (not simply the subthreshold combined type)". So apparently, according to Adele Diamond, not all ADD children fit the criteria for SCT. Lova Falk 06:48, 13 June 2007 (UTC)

I can't wait until the DSM-V comes out. Diamond took it upon herself to identify (SCT) as ADD. It makes sense because SCT is a true Attention deficit type disorder BUT Barkley has argued against using the term. SO...we go with what there is and what is currently used.

Officially every type of ADHD is all referred to as AD/HD and then categorized with the different subtypes. SCT as it is currently described would be a homogeneous group with the inattentive ADHD but SCT is not in the DSM4 for now and it is only a discriptive term. The way I would describe some displaying those symptoms would be that they have SCT tendencies or symptoms. The recent edits and deletions have changed the meaning somewhat.--scuro 15:56, 13 June 2007 (UTC)

[edit] References