Journal of Abnormal Child Psychology

, Volume 40, Issue 5, pp 683–697

Validity of the Sluggish Cognitive Tempo, Inattention, and Hyperactivity Symptom Dimensions: Neuropsychological and Psychosocial Correlates

  • José J. Bauermeister
  • Russell A. Barkley
  • José A. Bauermeister
  • José V. Martínez
  • Keith McBurnett
Article

Abstract

This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment.

Keywords

Attention deficit hyperactivity disorder (ADHD) Sluggish cognitive tempo (SCT) Inattentive subtype Diagnostic classification Executive function 

References

  1. Achenbach, T. M. (1991a). Manual for the child behavior checklist/4-18, and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
  2. Achenbach, T. M. (1991b). Manual for the teacher’s report form and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
  3. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision.). Washington, DC: Author.Google Scholar
  5. Baeyens, D., Roeyers, H., & Walle, J. V. (2006). Subtypes of attention-deficit disorder (ADHD): Distinct or related disorders across measurement levels? Child Psychiatry and Human Development, 36, 403–417.PubMedCrossRefGoogle Scholar
  6. Barkley, R. A. (1997). Niños desafiantes [defiant children]. New York: Guilford.Google Scholar
  7. Barkley, R. A. (2011). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology. Advance online publication. doi:10.1037/a0023961
  8. Barkley, R. A., & Fischer, M. (2011). Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: Self-reported executive function (EF) deficits versus EF tests. Developmental Neuropsychology, 36, 137–161.PubMedCrossRefGoogle Scholar
  9. Barkley, R. A., Du Paul, G. J., & McMurray, M. B. (1991). Attention deficit disorder with and without hyperactivity: Clinical response to three dose levels of methylphenidate. Pediatrics, 87, 519–531.PubMedGoogle Scholar
  10. Barkley, R. A., Grodzinsky, G., & Du Paul, G. J. (1992). Frontal lobes function in attention deficit disorder with and without hyperactivity: A review and research report. Journal of Abnormal Child Psychology, 20, 163–188.PubMedCrossRefGoogle Scholar
  11. Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L. (2001). Executive functioning, temporal discounting, and sense of time in adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). Journal of Abnormal Child Psychology, 29, 541–557.PubMedCrossRefGoogle Scholar
  12. Bauermeister, J. J. (1994). Development and utilization of the School Behavior Inventory (SBI) for Puerto Rican children. San Juan: Atención, Inc.Google Scholar
  13. Bauermeister, J. J., Matos, M., Reina, G., Salas, C. C., Martínez, J. V., Cumba, E., & Barkley, R. (2005). Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. Journal of Child Psychology and Psychiatry, 46, 166–179.PubMedCrossRefGoogle Scholar
  14. Bentler, P. M. (2008). EQS 6.1 for windows. Encino: Multivariate Software.Google Scholar
  15. Boomsma, A. (2000). Reporting analyses of covariance structures. Structural Equation Modeling, 7, 461–483.CrossRefGoogle Scholar
  16. Breslau, J., Miller, E., Breslau, N., Bohnert, K., Lucia, V., & Schweitzer, J. (2010). The impact of early behavior disturbances on academic achievement in high school. Pediatrics, 123, 1472–1476.CrossRefGoogle Scholar
  17. Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child and Adolescent Psychology, 31, 123–129.PubMedGoogle Scholar
  18. Carr, L., Henderson, J., & Nigg, J. T. (2010). Cognitive control and attentional selection in adolescents with ADHD versus ADD. Journal of Clinical Child and Adolescent Psychology, 39, 726–740.PubMedCrossRefGoogle Scholar
  19. Chhabildas, N., Pennington, B. F., & Willcutt, E. G. (2001). A comparison of neuropsychological profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29, 529–540.PubMedCrossRefGoogle Scholar
  20. Conners, C. K. (1995). Conners’ continuous performance test. Canada: Multi-Health Systems.Google Scholar
  21. Denckla, M. B., & Rudel, R. (1974). Rapid “automatized” naming of pictured objects, colors, letters, and numbers by normal children. Cortex, 10, 186–202.PubMedGoogle Scholar
  22. Derefinko, K. J., Adams, Z. W., Milich, R., Fillmore, M. T., Lorch, E. P., & Lynam, D. R. (2008). Response style differences in the inattentive and combined subtypes of attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 36, 745–758.PubMedCrossRefGoogle Scholar
  23. Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal of Learning Disabilities, 40, 49–65.PubMedCrossRefGoogle Scholar
  24. Friedman-Weieneth, J. L., Harvey, E. A., Youngwirth, S. D., & Goldstein, L. H. (2007). The relation between 3-year old children’s skills and their hyperactivity, inattention, and aggression. Journal of Educational Psychology, 99, 671–681.CrossRefGoogle Scholar
  25. Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention-deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38, 1097–1107.PubMedCrossRefGoogle Scholar
  26. Golden, C. J. (1978). Stroop color and word test: A manual for clinical and experimental use. Chicago: Stoelting.Google Scholar
  27. Gresham, F., & Elliott, S. (1990). Social skills rating system. Circle Pines: American Guidance Service.Google Scholar
  28. Harrington, K. M., & Waldman, I. D. (2010). Evaluating the utility of sluggish cognitive tempo in discriminating among DSM-IV ADHD subtypes. Journal of Abnormal Child Psychology, 38, 173–184.PubMedCrossRefGoogle Scholar
  29. Hartman, C. A., Willcutt, E. G., Rhee, S. R., & Pennington, B. F. (2004). The relation between sluggish cognitive tempo and DSM-IV ADHD. Journal of Abnormal Child Psychology, 32, 491–503.PubMedCrossRefGoogle Scholar
  30. Herrans, L. L., & Rodríguez, J. M. (1992). Manual EIWN-R de Puerto Rico [WISC-R Puerto Rico manual]. San Antonio: The Psychological Corporation.Google Scholar
  31. Hinshaw, S. P., Carte, E. T., Sami, N., Treuting, J. J., & Zupan, B. A. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: II. Neuropsychological performance in relation to subtypes and individual classification. Journal of Consulting and Clinical Psychology, 70, 1099–1111.PubMedCrossRefGoogle Scholar
  32. Hofvander, B., Ståhlberg, O., Nydén, A., Wentz, E., Degl'innocenti, A., Billstedt, E., & Anckarsäter, H. (2011). Life history of aggression scores are predicted by childhood hyperactivity, conduct disorder, adult substance abuse, and low cooperativeness in adult psychiatric patients. Psychiatry Research, 185, 280–285.PubMedCrossRefGoogle Scholar
  33. Hu, L., & Bentler, P. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  34. Huang-Pollock, C. L., Nigg, J. T., & Carr, T. H. (2005). Deficient attention is hard to find: Applying the perceptual load model of selective attention to attention deficit hyperactivity disorder subtypes. Journal of Child Psychology and Psychiatry, 46, 1211–1218.PubMedCrossRefGoogle Scholar
  35. Kaufman, A. S., & Kaufman, N. L. (1983). K-ABC interpretive manual. Circle Pines: American Guidance Service.Google Scholar
  36. Lahey, B. B., & Willcutt, E. G. (2010). Predictive validity of a continuous alternative to nominal subtypes of attention-deficit/hyperactivity disorder for DSM-V. Journal of Clinical Child and Adolescent Psycholology, 39, 761–775.CrossRefGoogle Scholar
  37. Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, H. A., Hynd, G. W., & Lorys-Vernon, A. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 330–335.PubMedCrossRefGoogle Scholar
  38. Lahey, B. B., Carlson, C. L., & Frick, P. J. (1997). Attention-deficit disorder without hyperactivity. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, & W. Davis (Eds.), DSM-IV sourcebook (pp. 163–188). Washington: American Psychiatric.Google Scholar
  39. Ludwig, H. T., Matte, B., Katz, B., & Rohde, L. A. (2009). Do sluggish cognitive tempo symptoms predict response to methylphenidate in patients with attention-deficit/hyperactivity disorder-inattentive type? Journal of Child and Adolescent Psychopharmacology, 19, 461–465.PubMedCrossRefGoogle Scholar
  40. Martel, M. M., von Eye, A., & Nigg, J. T. (2010). Revisiting the latent structure of ADHD: Is there a “g” factor? Journal of Child Psychology and Psychiatry, 51, 905–914.PubMedCrossRefGoogle Scholar
  41. Massetti, G. M., Lahey, B. B., Pelham, W. E., Loney, J., Ehrhardt, A., Lee, S. S., & Kipp, H. (2008). Academic achievement over 8 years among children who met modified criteria for attention-deficit/hyperactivity disorder at 4–6 years of age. Journal of Abnormal Child Psychology, 36, 399–410.PubMedCrossRefGoogle Scholar
  42. Matos, B. (2000). A study of the psychometric properties of the Tower of Hanoi, Hand Movements, and Simon tests in a sample of Puerto Rican children. Unpublished doctoral dissertation, San Juan, Puerto Rico: Carlos Albizu University.Google Scholar
  43. McBurnett, K., Pfiffner, L. J., Willcutt, E., Tamm, L., Lerner, M., Ottolini, Y. L., & Furman, M. A. (1999). Experimental cross-validation of DSM-IV types of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 17–24.PubMedCrossRefGoogle Scholar
  44. McBurnett, K., Pfiffner, L. J., & Ottolini, Y. L. (2000). Types of ADHD in DSM-IV. In P. Accardo, T. Blondis, & M. A. Stein (Eds.), The attention deficit disorders (pp. 229–240). New York: Marcel Dekker.Google Scholar
  45. McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: An argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213.PubMedCrossRefGoogle Scholar
  46. Mikami, A. Y., Huang-Pollock, C. L., Pfiffner, L. J., McBurnett, K., & Hangai, D. (2007). Social skills differences among attention-deficit/hyperactivity disorder types in a chat room assessment task. Journal of Abnormal Child Psychology, 35, 509–521.PubMedCrossRefGoogle Scholar
  47. Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD/combined type and ADHD/predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.CrossRefGoogle Scholar
  48. Moran, M. T. (2003). Arguments for rejecting the sequential Bonferroni in ecolological studies. Oikos, 100, 403–405.CrossRefGoogle Scholar
  49. Newby, R. (1989). The wisconsin selective reminding test. Milwaukee, WI: Author.Google Scholar
  50. Nigg, J. T., Hinshaw, S. P., Carte, E. T., & Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder explainable by comorbid disruptive behavior or reading problems? Journal of Abnormal Psychology, 107, 468–480.PubMedCrossRefGoogle Scholar
  51. Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51–87.PubMedCrossRefGoogle Scholar
  52. Pennington, B. F., Groisser, D., & Welsh, M. C. (1993). Contrasting cognitive deficits in attention deficit hyperactivity disorder versus reading disability. Developmental Psychology, 29, 511–523.CrossRefGoogle Scholar
  53. Penny, A. M., Wachbusch, D., Klein, R. M., Corkum, P., & Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: Content validity, factor structure, and reliability. Psychological Assessment, 21, 380–389.PubMedCrossRefGoogle Scholar
  54. Raykov, T., Tomer, A., & Nesselroade, J. (1991). Reporting structural equation modeling results in psychology and aging: Some proposed guidelines. Psychology and Aging, 6, 499–503.PubMedCrossRefGoogle Scholar
  55. Reeves, C. B., Palmer, S., Gross, A. M., Simonian, S. J., Taylor, L., Willingham, E., & Mulhern, R. L. (2007). Brief report: Sluggish cognitive tempo among pediatric survivors of acute lymphoblastic leukemia. Journal of Pediatric Psychology, 32, 1050–1054.PubMedCrossRefGoogle Scholar
  56. Schmitz, M., Ludwig, H., & Rohde, L. A. (2010). Do hyperactive symptoms matter in ADHD-I? Journal of Clinical Child and Adolescent Psychology, 39, 741–748.PubMedCrossRefGoogle Scholar
  57. Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.PubMedCrossRefGoogle Scholar
  58. Shanahan, M. A., Pennington, B. F., Yerys, B. E., Scott, A., Boada, R., Willcutt, E. G., & DeFries, J. C. (2006). Processing speed deficits in attention deficit/hyperactivity disorder and reading disability. Journal of Abnormal Child Psychology, 34, 585–602.PubMedCrossRefGoogle Scholar
  59. Skirbekk, B., Hansen, B. H., Oerbeck, B., & Kristensen, H. (2011). The relationship between sluggish cognitive tempo, subtypes of attention-deficit/hyperactivity disorder, and anxiety disorders. Journal of Abnormal Child Psychology, 39, 513–525.PubMedCrossRefGoogle Scholar
  60. Stawicki, J. A., Nigg, J. T., & von Eye, A. (2006). Family psychiatric history evidence on the nosological relations of DSM-IV ADHD combined and inattentive subtypes. New data and meta-analysis. Journal of Child Psychology and Psychiatry, 47, 935–945.PubMedCrossRefGoogle Scholar
  61. Wahlstedt, C. (2009). Neuropsychological deficits in relation to symptoms of ADHD: Independent contributions and interactions. Child Neuropsychology, 15, 262–279.PubMedCrossRefGoogle Scholar
  62. Wahlstedt, C., & Bohlin, G. (2010). DSM-IV inattention and sluggish cognitive tempo: Independent and interactive relations to neuropsychological factors and comorbidity. Child Neuropsychology, 16, 350–365.PubMedCrossRefGoogle Scholar
  63. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346.PubMedCrossRefGoogle Scholar
  64. Woodcock, R. W. (1982). Batería woodcock psicoeducativa en Español[woodcock Spanish psycho-educational battery]. Allen: DLM Teaching Resources.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • José J. Bauermeister
    • 1
    • 6
  • Russell A. Barkley
    • 2
  • José A. Bauermeister
    • 3
  • José V. Martínez
    • 4
  • Keith McBurnett
    • 5
  1. 1.Behavioral Science Research Institute and Department of PsychologyUniversity of Puerto RicoSan JuanPuerto Rico
  2. 2.Department of PsychiatryMedical University of South CarolinaCharlestonUSA
  3. 3.Department of Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.Department of PsychologyCarlos Albizu UniversitySan JuanPuerto Rico
  5. 5.Department of PsychiatryUniversity of California, San FranciscoSan FranciscoUSA
  6. 6.University of Puerto RicoSan JuanPuerto Rico

Personalised recommendations