What Is Sluggish Cognitive Tempo?

Sluggish cognitive tempo (SCT) refers to a cluster of symptoms like drowsiness, low energy, daydreaming, and confusion, that sometimes affect people with primarily inattentive forms of attention deficit hyperactivity disorder (ADHD-PI). The cause of SCT is theorized to be dysregulation of norepinephrine and other neurotransmitters, resulting in too little stimulation of the brain. A great deal of commentary has been evoked by the topic of SCT. First, the symptoms are not found in the 2000 Diagnostic and Statistical Manuals-IV® (DSM-IV®), which has created issues regarding diagnosis. Also, some experts argue that SCT is either a reliable subgroup of ADHD or an entirely different disorder.

Daydreaming, confusion, poor work production, and drowsiness may all keep people from staying focused at work or school. These symptoms of sluggish cognitive tempo seem to automatically indicate ADHD. The missing element of the condition, from a diagnostic standpoint, is the overall high energy or spiritedness that almost always present in ADHD patients. It’s not clear why this is missing, and some have argued that SCT is similar to conditions like major depression or dysthymic disorder, instead of being most like ADHD. On the other hand, people with SCT aren’t necessarily depressed, and like other patients with ADHD, they suffer from persistent inattention.

Based on the DSM-IV®, it's been very difficult to diagnose ADHD-PI in anyone with sluggish cognitive tempo features. Many of the SCT symptoms were listed as diagnostic features of ADHD in DSM-III®, but they were removed in DSM-IV®. Use of the DSM-V® will help resolve this issue by re-including most of these symptoms. This should make it easier for practitioners to view someone with sluggish cognitive tempo as likely to have ADHD. There appears to be no organized intent by a large group of mental health practitioners to classify SCT as a different disease, at present, though individual experts have argued for this.

Labeling SCT as another condition may not be to anyone’s advantage. A person with sluggish cognitive tempo features usually responds positively to ADHD medications. Methamphetamine is often the most recommended, because methylphenidate may not provide an effective treatment for this subgroup. Possibly, serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants, like duloxetine and venlafaxine, might also be effective because they interact with norepinephrine levels.

Additional scientific research might change the way SCT is regarded in the future. More information about the connection between these symptoms and depressive disorders could be useful. Another fertile area of study could be comparisons of the psychosocial differences of the identified ADHD subgroups. Genetic research pinpointing the causes of SCT and its relationship to other conditions might answer many questions about this group of symptoms.