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Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo

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Abstract

Sluggish cognitive tempo (SCT) was originally identified as a construct that characterized the inattention problems of some children with attention deficit disorder (ADD). Research has indicated that using SCT symptoms to identify a subset of youth with attention-deficit/hyperactivity disorder, predominately inattentive type (ADHD-IT) may elucidate distinct patterns of impairment and thereby improve the external validity of ADHD subtypes. The objective of the current study was to investigate whether youth with clinically-assessed ADHD-IT and high levels of SCT exhibit unique social and academic impairments. In a clinic-referred sample of youth (N = 209; 23 % female) aged 6 to 17 years, participants who met criteria for three different groups were identified: ADHD, Combined Type (ADHD-CT; n = 80), ADHD-IT with low SCT symptoms (n = 74), and ADHD-IT with high SCT symptoms (n = 55). These groups were compared on indicators of social and academic functioning while considering the effects of co-occurring internalizing and disruptive behavior disorders. Youth with ADHD-IT high in SCT exhibited uniquely elevated withdrawal, as well as low leadership and low peer-directed relational and overt aggression, which were not accounted for by co-occurring disorders. This high-SCT group was also the only group to have more homework problems than the ADHD-CT group, but only when other disruptive behavior disorders were absent. The distinctiveness of the high-SCT group, which was primarily evident in social as opposed to academic functioning, provides partial support for the external validity and clinical utility of SCT.

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Notes

  1. Results were unchanged when participants not meeting the DSM-IV age of onset criterion were removed from the analyses.

  2. The method used to identify high-SCT would have classified 25 % of the ADHD-CT group as also having high SCT. Using comparable methods, other studies have found similar rates of high-SCT within ADHD-CT groups, ranging from 8 % to 22 % (Carlson and Mann 2002; Hinshaw et al. 2002). The initial size of this subgroup was too small (n = 20) to treat separately in the analyses. It is noteworthy that we re-ran all omnibus and pairwise criterion tests excluding these 20 cases, and significance determinations for all results did not change. In addition, only 9 (11 %) of the 85 cases failing to meet ADHD diagnostic criteria would have met criteria for high SCT. Finally, it should be noted that the forgetful item used here and in other SCT studies (e.g., Harrington and Waldman 2010; Hinshaw et al. 2002) is part of the DSM-IV list of inattention symptoms. However, it appears justified to use the forgetful item to represent SCT because it was identified as an SCT symptom prior to being added to the DSM-IV definition of ADHD (APA 1991; Lahey et al. 1988). Further, after the DSM-IV was published, studies continued to find that the forgetful item loaded on a distinct SCT factor (e.g., McBurnett et al. 2001) or to cross-load with SCT and DSM-IV inattention factors (e.g., Jacobson et al. 2012). Nevertheless, we tested the impact of using the forgetful item in the current sample. When using criteria based only on the sluggish/drowsy and daydreams items (i.e., requiring at least 1 of these 2 SCT items), 68 (53 %) of youth in the ADHD-IT group met criteria for HSCT. When using the full criteria in this study based on the sluggish/drowsy, daydreams, and forgetful items (i.e., requiring at least 2 of these 3 SCT items), 55 (43 %) of the ADHD-IT group met criteria for HSCT. Therefore, using the forgetful item had a small, conservative effect on the size of the HSCT group.

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Acknowledgment

We would like to thank Terah Schamberg and Elyss Pickenheim for their assistance with this project.

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Authors and Affiliations

  1. The Children’s Hospital of Philadelphia/Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA

    Stephen A. Marshall, Ricardo B. Eiraldi & Thomas J. Power

  2. Department of Psychology, Ohio University, Center for Intervention Research in Schools, Porter Hall 200, Athens, OH, 45701, USA

    Steven W. Evans

  3. Department of Psychology, Miami University, Oxford, OH, USA

    Stephen P. Becker

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  1. Stephen A. Marshall
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Correspondence to Stephen A. Marshall.

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Marshall, S.A., Evans, S.W., Eiraldi, R.B. et al. Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo. J Abnorm Child Psychol 42, 77–90 (2014). https://doi.org/10.1007/s10802-013-9758-4

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