Sluggish Cognitive Tempo
Little-known but life-affecting, SCT needs more study
We all suffer from "brain fog" from time to time, but imagine living 24/7 in a cogntive haze, wondering how others can think, plan, act and react so darned quickly. That's life for kids and adults with a syndrome researchers are calling Sluggish Cognitive Tempo.
People with Sluggish Cognitive Tempo are daydreamy and spacy much of the time, with staring spells. They tend to be underactive and lethargic, moving slowly. They process information more slowly than others, too. As part of their overall mental "fogginess," they can be easily confused and error prone. Socially, they tend to be reticient or withdrawn.
While it looks as though SCT did not make it into the new Diagnostic and Statistical Manual of Mental Disorders (released in May 2013), it may someday be categorized at a distinct disorder, separate from the inattentive ADHD it often "lives with" in the same individuals. Here, a look at what is known, or at least believed, about Sluggish Cognitive Tempo.
(image ~ Aaron Logan, lightmatter.net/gallery/albums.php, via Creative Commons ~ cropped for shape)
Sluggish Cognitive Tempo vs. "Type i" ADHD
What's the difference?
According to Russell Barkley, PhD, one of what seems to be a very small pool of ADHD researchers looking seriously at this condition, Sluggish Cognitive Tempo is present in 30 to 50% of those who have the inattentive subtype of ADHD. So not all those with inattentive ADHD will have SCT. Nor will all those with SCT meet the criteria for inattentive ADHD. To confuse things even more, at least one study has found that SCT correlates with overall inattentiveness in kids, regardless of the ADHD subtype they are diagnosed with (e.g., predominantly hyperactive-impusive, predominantly inattentive, or combined type).
Experts have gone back and forth on whether SCT is a subtype of ADHD type I (in other words, a subtype of a subtype) or its own disorder. But it seems reasonable to speculate that both of these could be true. SCT is really just a descriptive phrase for a certain set of day-to-day symptoms or challenges.
Here are some differences that researchers like Barkley have found to date:
~ Information processing with SCT is slower and can be more error prone than with inattentive ADHD without SCT.
~ SCT correlates with a higher risk of anxiety problems than with inattentive ADHD without SCT, and possibly a higher risk of depression.
~ ADHD stimulant medications tend to be less effective for those with SCT, but behavioral therapies possibly more effective.
~ Those with SCT can get along with others but are often socially withdrawn.
~ High levels of SCT are found in kids diagnosed with both ADHD and an anxiety disorder.
SCT, ADHD & Anxiety
What's up with the SCT brain?
In one YouTube clip, a self-diagnosed SCT sufferer explains that his trouble, cognitively, is not so much distractibility as exhaustion: mentally, getting "too exhausted to go through anything hard."
Researcher Adele Diamond has argued that the inattentive ADHD/ SCT mind is chronically underaroused and gets very easily bored.
It's important to note that the foggy, sluggish qualities characteristic of SCT can sometimes stem from a completely different problem. For instance:
~ Thyroid problems: An underactive thyroid gland can absolutely cause chronic mental fogginess and lethargy. A blood test can rule this out.
~ Seizures: The staring that is common with SCT can actually be a symptom of absence (or "petit mal") seizures. Doctors conduct EEGs to detect these.
~ Sleep problems: Chronic poor sleep (because of getting to bed too late, trouble falling asleep, trouble staying asleep, or restless sleep) can produce many of the same effects as SCT. A sleep physician can diagnose an actual sleep disorder, but often this is just a matter of turning off the electronics & hitting the hay -- every night. Or getting more exercise during the day. Or cutting out the caffeine.
~ Depression: SCT and depression can sometimes coexist, or the SCT can be a symptom of depression (confusing, I know). "Slowed thinking, speaking or body movements" can be a symptom of depression, as can "decreased concentration." If these go hand in hand with issues like a loss of interest in activities previously enjoyed, chronic sadness, and irritability over even small matters, a doctor should evaluate for depression.
How is Sluggish Cognitive Tempo treated?
Just as the genetic basis of SCT and which neurotransmitters are involved are still big question marks, little is known at this point about how to treat SCT effectively.
Russell Barkley has said it may respond well to behavioral interventions and cognitive behavioral therapy, but admits there are very few studies on this.
He also has seen a less "clinically impressive" response to stimulant medications than with ADHD sufferers in general. Barkley estimates that 65% of SCT patients experience some improvement with these medications, but only 20% have a strong clinical response. Some stimulants may work better than others for both SCT and inattentive ADHD--and sometimes at lower doses than normally prescribed for other ADHD subtypes--so it's important to consult a doctor experienced in treating these conditions.
Neurofeedback treatment to counteract excessive theta (daydreaming) brainwaves holds promise, but it's expensive, time consuming and not clinically proven.
SCT vs. ADHD in Adults
Does SCT get better over time?
As parent of a bright, loveable teen with SCT and inattentive ADHD, I've researched this at length but (sadly) come up emptyhanded. The SCT profile really started to be defined only 20-30 years ago, which in medical research time is not long at all.
With ADHD overall, an estimated 35-70% of kids will get better by adolescence or adulthood. But with SCT? Nobody seems to know.
For now, our SCT teen relies on an IEP at school with accommodations such as extended time for exams (which routinely take him 1.5 to 3x as long as his peers), has to severely limit extracurriculars to finish his homework (which takes him at least twice as long as typical classmates), and is happy with a couple of close friends and some creative outlets that offset the mental fatigue he fights every day. I am worried about how, or if, this academically & artistically talented but very speed-challenged kid will navigate college and the world of employment, but for now we're taking it one day at a time.
SCT and ADHD
~~ parenting an SCT kid? ~~
I have yet to see a book on Sluggish Cognitive Tempo specifically, but this one comes close. Filled with "realistic, science-based, compassionate" tips -- per inattentive ADD guru Russell Barkley -- it's bound to become a bible for parenting kids whose brain "CEO" (executive functioning) is slow, scattered or both.
Are you living with Sluggish Cognitive Tempo? Or do you know someone who is? Please share your experiences, what people should know about this condition, and what (if anything) has helped. Even if there are no "answers" yet, comparing experiences with others in a similar boat can help.