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Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology

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Abstract

Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies, and growing evidence demonstrates SCT to be associated with impairment in both children and adults. However, it remains unclear how SCT should optimally be conceptualized. In this article, we argue that multiple models of psychopathology should be leveraged to make substantive advances to our understanding of SCT. Both categorical and dimensional approaches should be used, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) nosology, the Research Domain Criteria (RDoC) initiative, and hierarchical models of psychopathology. Studies are needed to determine whether individuals categorized with SCT can be reliably identified and differentiated from individuals without SCT in pathophysiological, neuropsychological, behavioral, and daily life functioning. Studies are also needed to evaluate the validity and utility of SCT as a transdiagnostic and dimensional construct. In considering SCT as a dimensional and potentially transdiagnostic construct, we describe ways in which SCT might be examined within the RDoC framework, including negative valence systems, cognitive systems, and arousal/regulatory systems, as well as within hierarchical models of psychopathology. Conceptualizing SCT within both categorical and dimensional models of psychopathology will help to better understand the causes, developmental pathways, and clinical implications of SCT, both as a construct in its own right and also in relation to other psychopathologies.

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Acknowledgements

Dr. Becker is supported by grants from the National Institute of Mental Health (NIMH; K23MH108603 and R03MH109787) and the Institute of Education Science (IES; R305A160064 and R305A160126). Dr. Willcutt is supported by grants from the National Institute of Child Health and Human Development (NICHD; P50HD27802, R01HD68728; R24HD75460).

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Authors and Affiliations

  1. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA

    Stephen P. Becker

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA

    Stephen P. Becker

  3. Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA

    Erik G. Willcutt

  4. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45229, USA

    Stephen P. Becker

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Becker, S.P., Willcutt, E.G. Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. Eur Child Adolesc Psychiatry 28, 603–613 (2019). https://doi.org/10.1007/s00787-018-1136-x

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