With more than six million American children having received a diagnosis of attention deficit hyperactivity disorder, concern has been rising that the condition is being significantly misdiagnosed and overtreated with prescription medications.
Yet now some powerful figures in mental health 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 two 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 A.D.H.D. drug might treat it.
The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming that the question of its existence “seems to be laid to rest as of this issue.” The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”
Continue reading the main storyIn an interview, 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 Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’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 — problems that A.D.H.D. already faces.
“We’re seeing a fad in evolution: Just as A.D.H.D. 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.”
Though the concept of sluggish cognitive tempo, or S.C.T., 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 in the condition is what led the journal to devote most of one issue to “highlight areas in which further study is needed.”
Dr. Barkley declined repeated requests for interviews about his work and statements regarding sluggish cognitive tempo. Several of the field’s other key researchers, Stephen P. Becker of Cincinnati Children’s Hospital Medical Center, Benjamin B. Lahey of the University of Chicago and Stephen A. Marshall of Ohio University, also declined to comment on their work.
Papers have proposed that a recognition of sluggish cognitive tempo could help resolve some longstanding confusion about A.D.H.D., which despite having hyperactivity in its name includes about two million children who are not hyperactive, merely inattentive. Some researchers propose that about half of those children would be better classified as having sluggish cognitive tempo, with perhaps one million additional children, who do not meet A.D.H.D.’s criteria now, having the new disorder, too.
“These children are not the ones giving adults much trouble, so they’re easy to miss,” Dr. 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. So anything we can do to understand what’s going on with these kids is a good thing.”
But Dr. McBurnett added that sluggish cognitive tempo remained many years from any scientific consensus: “We haven’t even agreed on the symptom list — that’s how early on we are in the process.”
Steve S. 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 over the journal’s emphasis on sluggish cognitive tempo. He expressed concern that A.D.H.D. 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 A.D.H.D. diagnosis take daily medication such as Adderall or Concerta, which often quells severe impulsiveness and inattention but also carries risks for insomnia, appetite suppression 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,” Dr. Lee said. “A.D.H.D. has become a public health, societal question, and it’s a fair question to ask of S.C.T. We better pump the brakes more diligently.”
Dr. McBurnett recently conducted a clinical trial funded and overseen by Eli Lilly that investigated whether proposed symptoms of sluggish cognitive tempo could be treated with Strattera, the company’s primary A.D.H.D. drug. (One of Strattera’s selling points is that it is not a stimulant like Adderall and Concerta, medications more susceptible to abuse.) 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 S.C.T.”
An Eli Lilly spokeswoman said in an email, “Sluggish cognitive tempo is one of many conditions that Lilly scientists continue to study to help satisfy unmet medical needs around the world.”
Representatives of the drug companies that make the best-selling medications for A.D.H.D. — Shire (extended-release Adderall and Vyvanse), Novartis (Focalin) and Janssen (Concerta) — said they are not currently conducting research into sluggish cognitive tempo. However, because the new condition shares so many symptoms with A.D.H.D., these products might easily be repositioned to serve the new market.
Dr. Barkley, who has said that “S.C.T. is a newly recognized disorder,” also has financial ties to Eli Lilly; he received $118,000 from 2009 to 2012 for consulting and speaking engagements, according to propublica.org. While detailing sluggish cognitive tempo in The Journal of Psychiatric Practice, Dr. Barkley stated that Strattera’s performance on sluggish cognitive tempo symptoms was “an exciting finding.” Dr. Barkley has also published a symptom checklist for mental health professionals to identify adults with the condition; the forms are available for $131.75 apiece from Guilford Press, which funds some of his research.
Dr. Barkley, who edits sluggish cognitive tempo’s Wikipedia page, declined a request 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,” Dr. 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.”
An article on Saturday about the debate surrounding the idea of a new attention disorder, sluggish cognitive tempo, misidentified the institution with which one researcher of the disorder, Stephen A. Marshall, is affiliated. It is Ohio University, not Miami University in Ohio. The article also misspelled the given name of another researcher. He is Stephen P. Becker, not Steven.
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Jim
Richboro, Pennsylvania April 11, 2014It would now be far more interesting to know what is considered normal.
Alison Case
Williams College, MA April 11, 2014As a lifelong daydreamer ("born and raised on cloud nine," my mother used to say) I am immensely grateful that this was not then treated as a pathology in need of powerful pharmaceutical intervention. Especially since in my school days this generally resulted not from cognitive "sluggishness" but from sheer boredom with the level of intellectual stimulation on offer. How many future writers, artists and inventors will we medicate out of existence before they have a chance to develop out of those daydreams?
Madelyn
Detroit, MI April 11, 2014As an adult who was diagnosed with ADD (the non-hyperactive ADHD) I think that this could be helpful for other kids like me.
I wasn't a troublemaker, but I never did well in my classes because absent mindedness and lack of concentration consistently plagued me.
If there was some way to solve this, medication or no, it could be incredibly helpful to people who are also held back by these things.
I agree that for many people, ADHD is mostly an issue of lack of self-control, which develops with age and maturity. Some people have a genuine problem that simply "working harder" doesn't solve. Those people deserve help, even if they do not display hyperactivity (otherwise known as troublesome behavior, the real reason so many kids are diagnosed.)
China doubter
Portland, OR April 11, 2014Yes, I'm an MD. Not a fan of DSM-V. This feels like trying to make anyone who is not high functioning pathological. There is a spectrum to normal human behavior; being inattentive, daydreaming, not being smart, are all part of normal. Our society and work place are becoming ever more demanding. I think this is part of why people who can't function well in demanding situations are now being given diseases that are actually part of the normal spectrum.
RR
Guam April 12, 2014This sounds like me -- somewhat lethargic, slow to process, and (especially) daydreaming.
And guess what? After living 59 years I can say with confidence that these are some of my best qualities. They got me through graduate school (PhD in Biology). "Daydreaming" -- and largely that alone -- is my source of creativity and it allowed me to make some significant contributions to my field of research.
One person's "slow and lethargic" just might be another persons "thoughtful, engaged, and creative." Only time will tell, so for goodness sake skip the drugs and encourage children to be what they are.
Sebastien
Atlanta, GA April 12, 2014I am enraged by many of the disparaging comments posted here.
My own son fits the profile for SCT. We're not talking about simple laziness or daydreaming here. This is seriously affecting his performance at school. The teachers don't know how to deal with him. His behavior in class is exemplary, but he just cannot focus on a task for more than a few minutes, and needs constant encouragement and redirection. Doing homework take hours, and is a constant struggle. He tries so hard but can't understand why this is happening to him, why he keeps getting distracted, why focusing on a job requires so much effort and energy from him. ADD medications were no help. Sometimes he cries because he feels like he is a burden to me and his teachers. It is heartbreaking; you have to live it to understand it.
Let me emphasize again: this is NOT your typical daydreaming. If you don't have the condition, you don't know what it's really like.
So listen all you dismissive people, with your sarcasm and snide comments. A mental disorder is a condition that prevents you from leading a normal life. Period. That the disorder is a brain condition doesn't make in any less real, any less painful when you suffer from it. Try telling someone with cancer that they should just shrug it off, that chemotherapy is a sham of the pharmaceutical industry, and that they should just get a hold of themselves and get over it...
Yes, this is the same thing. I feel offended.
Orangina
Philadelphia April 12, 2014Maybe we're missing the point here. "Daydreaming" is awesome until you want to stop but can't.
Disheartened
Pasadena April 12, 2014It is so disheartening to read the ignorant comments of those who clearly have no idea what children ( and adults) with ADHD and ADD suffer . Just because some are mid-diagnosed and because big Pharma can make obscene profits from their medications, it doesn't mean the illness isn't real. It doesn't mean the children are stupid, as some accuse: mine are gifted but process very slowly. It doesn't mean the parents are self- absorbed- I gave up my career to stay-at-home with my children and spend endless hours working to organize and help with homework. The current possible new diagnosis sounds like ADD- what is the difference? I'm sorry that my children have to grow up in a world with such ignorance, intolerance, and stupidity. There is definitely a shortage of empathy in our society and a surfeit of hostility.
Christine McMorrow
is a trusted commenter Waltham, Massachusetts April 12, 2014What's a poor kid to do when their "normal" doesn't fit my definition of normal and I'm a parent who can change that?
Children have no weapons to fight back. I'm beginning to think the over medication of youth is becoming a new form of child abuse.
JJ
Bangor, ME April 12, 2014Why is SCT not simply an expression of lack of motivation? That could have multiple reasons, one simply being that the kids have come to realize that they are intellectually unable to follow the increased demand and go into self-protection mode by switching off.
When I lecture on a difficult topic, whether I lose my audience to SCT or lock it in an HCT state depends very much on how I present the topic I am discussing. Depending on the objective of the lecture, that may not be universally achievable.
I guess the ultimate expression of SCT is when my entire audience falls asleep. As a teacher, that would have been my fault then.
I reality, I see the manifestation of SCT almost every day. Much of it is simply caused by the increased demand of intellectual performance. There is only so much we can cram into a human brain. We may be reaching the limits.
ciblu
Los Angeles April 12, 2014These "scientists" seem to be suffering from Excessive Hyperdiagnosing of Normal Variant Behavior Disorder. EHNVBD might be considered benign, if there weren't so much money involved. And so many children drugged for no other reason than to make billions for Eli Lily et al.
Marilyn
Pasadena, CA April 12, 2014Where does this "inattention" often occur? SCHOOL. Did it ever occur to anyone that school is BORING to many kids and their inattention is a way to send their minds to a more interesting place. Bright, creative people who are not robots may well go into survival mode when school becomes so BORING that they're getting nothing out of it, need to get away from it, and use daydreaming as the means of transportation.
Perhaps one answer to this "problem" is bright, creative teachers who are able to tap into the minds of inattentive students -- but I'm not holding my breath until this happens!
The nation's educational systems value robotic, compliant students who will "learn" the required course of study without complaining. The brightest, most imaginative and creative kids either learn how to play the game to get the grades (as many of us used to!) or spend their time "elsewhere".
Does any teacher ever ASK any of these inattentive kids what they're thinking about when they're not thrilled by what's happening in class? Could the teachers handle the answers they'd get? Kids are dreaming up inventions, designs, stories -- all sorts of things -- and may well be smarter than their teachers.
Question: Exactly how does one make the "Congress of Vienna" of vital import to a group of 14-year olds?
Steve
New York April 12, 2014For all those commenters who say they would have considered suffering from this when they were a child or have a child with the symptoms and denounce it being considered to be a disorder, remember that with few exceptions the DSM diagnoses require that the symptoms of the disorder have to cause "significant impairment" in functioning. Are all these people really saying that they or their children had or have this level of impairment?
It's why I always have to laugh when people say everyone fits a least one DSM diagnoses because it would be impossible for the world to function if this were true.
And I note that it is only in discussing psychiatric drugs that The Times so resolutely makes sure that the potential side-effects of drugs are listed in its articles.
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