Sluggish cognitive tempo in adolescents with and without ADHD: differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains

Becker, Stephen P.; Burns, G. Leonard; Smith, Zoe R.; Langberg, Joshua M.

doi:10.1007/s10802-019-00603-9

Cited by 81Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentDevelopmental and Educational Neuropsychology

Sluggish cognitive tempo in adolescents with and without ADHD: differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains

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Becker, Stephen P., Burns, G. Leonard, Smith, Zoe R., Langberg, Joshua M.·2020·Journal of Abnormal Child Psychology

DOI 10.1007/s10802-019-00603-9PMC PMC7007365

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Abstract

A growing number of studies support the internal and external validity of youth self-reported sluggish cognitive tempo (SCT) symptoms. However, no study has examined SCT in adolescents without ADHD, examined whether adolescent self-reported SCT is distinct from adolescent self-reported ADHD inattention (ADHD-IN), or evaluated whether links between SCT and internalizing problems differ for adolescents with or without ADHD. The present study is the first to (1) determine the convergent and discriminant validity of self-reported SCT and ADHD-IN symptoms in both adolescents with and without ADHD, (2) test the invariance of SCT and ADHD-IN symptoms across ADHD and comparison groups, (3) examine SCT as uniquely related to a range of internalizing-relevant domains, and (4) evaluate if the association between SCT with internalizing correlates differs for adolescents with or without ADHD. Participants were adolescents (M age = 13 years) with (n = 162) and without (n = 140) ADHD. Adolescents and parents completed measures of internalizing symptoms and emotion dysregulation; adolescents completed measures of rumination and suicidal ideation. Analyses indicated that 13 of the 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN, and SCT and ADHD-IN demonstrated invariance across the ADHD and comparison groups and across sex. SCT, but not ADHD-IN, was uniquely associated with greater adolescent-reported internalizing symptoms and suicidal ideation. Both SCT and ADHD-IN were uniquely associated with adolescent-reported emotion dysregulation and parent-reported internalizing symptoms. Only ADHD-IN was uniquely associated with parent-reported emotion dysregulation. Findings support the differentiation of adolescent-reported SCT and ADHD-IN and demonstrate associations between SCT and increased internalizing problems in adolescents with and without ADHD.

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Evidence indicates SCT increases across development: a meta-analysis found a small significant association with age (r = .11), and two longitudinal studies showed modest increases with age.
“There is some indication that SCT increases across development. A meta-analysis found a small yet significant association between SCT and age (r = .11)10 and two longitudinal studies showed a modest increase in SCT with increasing age.35,36”
From Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome (2023) · cites this paper as [36]
The Anxiety and depression section says SCT symptoms increase during adolescence, supporting the general developmental point. The Methods > Procedures section says this study used only baseline data, so it does not itself show a longitudinal increase. The meta-analysis and r = .11 are attached to a different citation in the citing sentence, not this source. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Recent studies highlight CDS's predicting role in increasing depressive symptoms in youths.
“with recent studies also highlighting its predicting role in increasing depressive symptoms in youths [55-57]”
From Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies (2025) · cites this paper as [55]
CDS has been associated with deficits in emotional self-regulation when measured with self-reports from both children and adults.
“Furthermore, CDS has been associated with deficits in emotional self-regulation when measured with self-reports from both children and adults [55,66].”
From Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies (2025) · cites this paper as [55]
CDS is increasingly viewed as belonging to the internalizing rather than externalizing spectrum of psychopathology.
“CDS is increasingly conceptualized as falling under the internalizing rather than externalizing umbrella of psychopathology [16, 67-69]”
From Pharmacologic Management of Cognitive Disengagement Syndrome (CDS) and Implications for Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment: Emerging Treatments and Recommendations for Future Research (2023) · cites this paper as [68]

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Becker, S. P., Webb, K. L., & Dvorsky, M. R. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1630836 · Cited by 39 · see citing works
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Brooding, Inattention, and Impulsivity as Predictors of Adolescent Suicidal Ideation
Sarkisian, K. L., Hulle, C. A. V., & Goldsmith, H. H. (2018) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-018-0435-5 · Cited by 39 · see citing works
Toward Establishing a Standard Symptom Set for Assessing Sluggish Cognitive Tempo in Children: Evidence From Teacher Ratings in a Community Sample
Becker, S. P., Burns, G. L., Schmitt, A. P., Epstein, J. N., & Tamm, L. (2019) · Assessment · doi:10.1177/1073191117715732 · Cited by 33 · see citing works
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Evaluation of the interplay between homework motivation and sluggish cognitive tempo in youth with ADHD: associations with homework performance
Smith, Z. R., Breaux, R. P., Green, C. D., & Langberg, J. M. (2019) · Journal of Attention Disorders · doi:10.1177/1087054718763722 · Cited by 32 · see citing works
Self-citation
Internal and External Validity of Sluggish Cognitive Tempo and ADHD Inattention Dimensions with Teacher Ratings of Nepali Children
Khadka, G., Burns, G. L., & Becker, S. P. (2015) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-015-9534-6 · Cited by 31 · see citing works
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Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children
Becker, S. P., Withrow, A. R., Stoppelbein, L., Luebbe, A. M., Fite, P. J., & Greening, L. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12580 · Cited by 31 · see citing works
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Are sluggish cognitive tempo, ADHD, and oppositional defiant disorder trait- or state-like constructs from prekindergarten to fourth grade?
Burns, G. L., Becker, S. P., Geiser, C., Leopold, D. R., & Willcutt, E. G. (2020) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1567348 · Cited by 29 · see citing works
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The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD
Becker, S. P., Schindler, D. N., Holdaway, A. S., Tamm, L., Epstein, J. N., & Luebbe, A. M. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9702-6 · Cited by 26 · see citing works
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Administering and Evaluating the Results of the Adult ADHD Self-Report Scale (ASRS) in Adolescents
Adler, L. A., & Newcorn, J. H. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10081tx2c · Cited by 23 · see citing works
Evaluating the Construct Validity of Adult ADHD and SCT Among College Students
Leopold, D. R., Bryan, A. D., Pennington, B. F., & Willcutt, E. G. (2014) · Journal of Attention Disorders · doi:10.1177/1087054714553051 · Cited by 22 · see citing works
Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task?
Becker, S. P., Marsh, N. P., Holdaway, A. S., & Tamm, L. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01446-x · Cited by 22 · see citing works
Self-citation
Sluggish cognitive tempo and student-teacher relationship quality: short-term longitudinal and concurrent associations
Holdaway, A. S., & Becker, S. P. (2018) · School Psychology Quarterly · doi:10.1037/spq0000245 · Cited by 20 · see citing works
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Research works printed but not linked: 3

Becker SP (2015). Child Concentration Inventory, Second Edition (CCI-2). Cincinnati, OH: Author.
Becker SP, & Fogleman ND (2019). Psychiatric co-occurrence (comorbidity) in adolescents with ADHD In Becker SP (Ed.), ADHD in adolescents: Development, assessment, and treatment (pp. 170– 203). New York: Guilford Press.
Muthén LK, & Muthén BO (1998–2018). Mplus user’s guide (Eigth ed.). Los Angeles, CA: Muthén & Muthén.

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Prospective impact of COVID‐19 on mental health functioning in adolescents with and without ADHD: protective role of emotion regulation abilities
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Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome
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Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade
Becker, S. P. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.10.016 · Cited by 117 · see citing works
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Sluggish cognitive tempo and ADHD symptoms in relation to task-unrelated thought: Examining unique links with mind-wandering and rumination
Fredrick, J. W., Kofler, M. J., Jarrett, M. A., Burns, G. L., Luebbe, A. M., Garner, A. A., Harmon, S. L., & Becker, S. P. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.01.016 · Cited by 52 · see citing works
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A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference
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Cognitive Disengagement Syndrome (Sluggish Cognitive Tempo) and Social Withdrawal: Advancing a Conceptual Model to Guide Future Research
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Self-citation
Sluggish Cognitive Tempo (Cognitive Disengagement Syndrome) and Academic Functioning: A Systematic Review and Agenda for Future Research
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Self-citation
Atypical sensory processing in adolescents with Attention Deficit Hyperactivity Disorder: A comparative study
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Sluggish Cognitive Tempo Symptoms, But Not ADHD or Internalizing Symptoms, Are Uniquely Related to Self-Reported Mind-Wandering in Adolescents With ADHD
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Self-citation
Internal and External Validity of Self-Report and Parent-Report Measures of Sluggish Cognitive Tempo in South Korean Adolescents
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Sluggish Cognitive Tempo and Depressive Symptoms in Children and Adolescents Predict Adulthood Psychopathology
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Clarifying ADHD and Sluggish Cognitive Tempo Item Relations with Impairment: A Network Analysis
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Validity of sluggish cognitive tempo in Turkish children and adolescents
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Sluggish Cognitive Tempo among Iranian Children and Adolescents: A Validation Study of the Farsi Child and Adolescent Behavior Inventory (CABI)–Parent Version
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Longitudinal association of sluggish cognitive tempo with depression in adolescents and the possible role of peer victimization
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Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task?
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The Moderating Role of Emotional Regulation on the Relationship between School Results and Personal Characteristics of Pupils with Attention Deficit/Hyperactivity Disorder
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Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample
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Low School Support Exacerbates the Association between Peer Difficulties and Sluggish Cognitive Tempo in Adolescents
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Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo
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Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research
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Pharmacologic Management of Cognitive Disengagement Syndrome (CDS) and Implications for Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment: Emerging Treatments and Recommendations for Future Research
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Validation of the Farsi Version of the Adult Concentration Inventory for Assessing Cognitive Disengagement Syndrome
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Correlates of sluggish cognitive tempo among clinic-referred youth: expanding awareness of somatic symptoms and stress in the clinical picture
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Reliability, Factor Validity, and Neuropsychological Correlates of the Child Concentration Inventory–2 in a Community Sample of Italian Adolescents
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Comparing Cognitive Disengagement Syndrome Growth in Youth With and Without Spina Bifida
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Working memory and cognitive flexibility predict growth trajectories of sluggish cognitive tempo in youth with spina bifida
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Cognitive Disengagement Syndrome is Clinically Distinct from ADHD Presentations within Childhood and Adolescence
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The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder
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Resting-State Functional Connectivity in a Community Sample of Children With a Range of Cognitive Disengagement Syndrome Symptoms
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Cognitive disengagement syndrome in pediatric patients with long COVID: associations with mood, anxiety, and functional impairment
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The Associations Between Sluggish Cognitive Tempo, Internalizing Symptoms, and Academic Performance in Children With Reading Disorder: A Longitudinal Cohort Study
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ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents
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A Twin Study of the Relationships between Cognitive Disengagement Syndrome and Anxiety Phenotypes in Childhood and Adolescence
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Self-citation
Longitudinal Associations Between Sluggish Cognitive Tempo and Academic Achievement in Adolescents: A Mediated Moderation Model
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Networks of ADHD and SCT Symptoms in Emerging Adulthood
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Exploring Subfactors of Adult Cognitive Disengagement Syndrome and Impact on Neuropsychological Performance
Khalid, E., VanLandingham, H. B., Basurto, K. S., Nili, A. N., Gonzalez, C., Guilfoyle, J. L., Ovsiew, G. P., Durkin, N. M., Ulrich, D. M., Resch, Z. J., et al. (2024) · Journal of Attention Disorders · doi:10.1177/10870547231218945 · Cited by 6 · see citing works
Examining Food Insecurity in Relation to ADHD and Cognitive Disengagement Syndrome Symptoms in Early Adolescents
Green, C., Martinez, A. C., & Becker, S. P. (2024) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01226-5 · Cited by 6 · see citing works
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Exploring the comorbidity between internalizing/externalizing dimensions and cognitive disengagement syndrome through twin studies: a narrative review
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Examining Cognitive Disengagement Syndrome in Relation to Social Problem Solving in Young Adults
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The relationship between cognitive disengagement syndrome and social withdrawal in adolescents: the mediating role of social anxiety and the moderating role of gender
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Associations Between Physical Activity, Insomnia, and Cognitive Disengagement Syndrome (CDS) Among Young Adults Using the Adult Concentration Inventory (ACI)
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The longitudinal role of sleep on self‐harm during adolescence: A birth cohort study
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Report of a Work Group on Nonverbal Learning Disability: Consensus Criteria for Developmental Visual-Spatial Disorder: Reconceptualizing Nonverbal Learning Disability for DSM Consideration
Fisher, P. W., Litwin, H. D., Riddle, M. A., & Margolis, A. E. (2025) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.01.007 · Cited by 4 · see citing works
The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors
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Prospective impact of COVID‐19 on mental health functioning in adolescents with and without ADHD: protective role of emotion regulation abilities
(2021) · doi:10.13056/acamh.15788 · Cited by 4 · see citing works
Cognitive Disengagement Syndrome in Young Autistic Children, Children with ADHD, and Autistic Children with ADHD
Carpenter, K. L. H., Davis, N. O., Spanos, M., Sabatos‐DeVito, M., Aiello, R. E., Compton, S. N., Franz, L., Schechter, J. C., Summers, J., & Dawson, G. (2024) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2024.2361715 · Cited by 3 · see citing works
Exploring the impact of trauma exposure on cognitive disengagement syndrome (CDS) in Black and/or Latiné youth with ADHD: a multilevel investigation
Smith, Z. R., O’Daniel, V. R. G., Flax, M., & Leviyah, X. (2026) · Child Neuropsychology · doi:10.1080/09297049.2026.2626378 · Cited by 3 · see citing works
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Cognitive Disengagement Syndrome and Depressive Symptoms in Early Adolescents: Examining the Moderating Role of a Negative Interpretation Bias
Miller, M. C., Baron, O., Epstein, J., Tamm, L., Nyquist, A. C., & Becker, S. P. (2025) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/jcpp.14156 · Cited by 5 · see citing works
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Evaluation of cognitive disengagement syndrome in children with obsessive-compulsive disorder: Clinical implications
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Adult Concentration Inventory (ACI) Brazilian Portuguese version: cross-cultural adaptation and validation study
Godoy, V. P., Silva, L. D. P., Serpa, A. L. D. O., & Malloy‐Diniz, L. F. (2022) · Debates em Psiquiatria · doi:10.25118/2763-9037.2022.v12.421 · Cited by 3 · see citing works
Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies
De Giuli, G., Amico, C., De Francesco, S., Giani, L., Tüzün, G., Galli, F., Caputi, M., Forresi, B., & Scaini, S. (2025) · Applied Sciences · doi:10.3390/app15116067 · Cited by 2 · see citing works
Does the coexistence of attention deficit hyperactivity disorder and sluggish cognitive tempo affect the treatment response in children?
Yektaş, Ç., Tufan, A. E., Karakaya, E. S. K., Yazıcı, M., & Sarıgedik, E. (2023) · Journal of Clinical Psychiatry · doi:10.5505/kpd.2023.23500 · Cited by 2 · see citing works
Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents’ academic functioning
Becker, S. P., Martinez, A. C., Wiggs, K. K., Langberg, J. M., & Smith, Z. R. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02311-8 · Cited by 2 · see citing works
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Distracted and unfocused driving in supervised and unsupervised teen drivers: Associations with sleep, inattention, and cognitive disengagement syndrome symptoms
Beanland, V., Ritchie, C., Ousset, C., Galland, B., & Schaughency, E. (2024) · Transportation Research Part F: Traffic Psychology and Behaviour · doi:10.1016/j.trf.2023.11.013 · Cited by 3 · see citing works
Cognitive Disengagement Syndrome in Mothers of Children With Attention-Deficit/Hyperactivity Disorder
Yılmaz, Y., & Çiçek, A. U. (2024) · Journal of Attention Disorders · doi:10.1177/10870547231224089 · Cited by 2 · see citing works
Correlates of Functional Impairment in Adolescents with ADHD: Delineating the Relationship Between Cognitive Disengagement Syndrome and Dissociation
Meral, Y., Gökler, M. E., Albayrak, Z. S., Keleş, H. K., Serdengeçti, N., Yazıcı, M. S., & Tarakçıoğlu, M. C. (2025) · Journal of Attention Disorders · doi:10.1177/10870547251349245 · Cited by 1 · see citing works
Exploring the Relationship of Cognitive Disengagement Syndrome and Attention Deficit/Hyperactivity Disorder with Emotional Dysregulation: A Twin Study in Childhood and Adolescence
Scaini, S., Francesco, S. D., Giani, L., Battaglia, M., Medda, E., & Fagnani, C. (2025) · Methods and Protocols · doi:10.3390/mps8040094 · Cited by 1 · see citing works
Mapping the association between cognitive disengagement syndrome and internalizing disorders: A systematic scoping review with meta-analysis and meta-regression
Boccaccio, F. M., Rizzo, R., Pirrone, C., & Buitelaar, J. K. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122159 · Cited by 1 · see citing works
The Two-Factor Structure of the Parent Cognitive Error Questionnaire: A Measure of Parental Cognitive Errors in Relation to Child Problems
Jiang, Y., Delucchi, K., Kaiser, N. M., Hinshaw, S. P., McBurnett, K., & Pfiffner, L. J. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00934-0 · Cited by 1 · see citing works
Using Network Analysis of Adolescent Self-Ratings of ADHD Symptoms to Identify Central Symptoms and Their Associations With Each Other and Global Functioning
Gomez, R., & Houghton, S. J. (2024) · Psychological Reports · doi:10.1177/00332941241308800 · Cited by 1 · see citing works
Teacher perceptions of ADHD causality implication for educational leaders
Bartels, C. (2022) · doi:10.32469/10355/91553 · Cited by 1 · see citing works
Spacetime (in)attention for applied psychologyPreprint
Horne, G., Mogridge, C., & Sharpe, B. T. (2024) · doi:10.31234/osf.io/4byt2 · Cited by 2 · see citing works
Time will tell: Sluggish Cognitive Tempo, attention and timing functioning in adults
Müller, K. (2021) · doi:10.33612/diss.171005987
The Relationship between the Sluggish Cognitive Tempo (SCT) of College Students and their College Life Adaptation: The Sequential Mediating Effects of Experiential Avoidance and Smartphone Overdependence
Jeong, I. S., & Ji Hyun, O. (2024) · The Korean Journal of Community Living Science · doi:10.7856/kjcls.2024.35.1.111
Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome
İzmir, S. B. İ., AKTAN, Z. D., & Ercan, E. S. (2024) · Applied Neuropsychology Child · doi:10.1080/21622965.2024.2341251 · Cited by 1 · see citing works
Comparison of self-regulation in adolescents with and without symptoms of attention deficit/hyperactivity disorder or sluggish cognitive tempo
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Authors: Becker, S. P., Burns, G. L., Smith, Z. R., & Langberg, J. M.
Affiliations: Cincinnati Children's Hospital Medical Center (US)
Washington State University (US)
Virginia Commonwealth University (US)
Corresponding author: Becker, Stephen P.
ORCID: Becker, Stephen P.
Burns, G. Leonard
Smith, Zoe R.
Langberg, Joshua M.
Venue: Journal of Abnormal Child Psychology
Publisher: Springer Science and Business Media LLC
Published: 2019-12-09
Volume: 48
Issue: 3
Pages: 391-406
ISSN: 0091-0627 (ISSN-L)
1573-2835
DOI: 10.1007/s10802-019-00603-9
PMC: PMC7007365
OpenAlex: W2992698801
Cited by: 81
References: 87
Citations by year: 2026: 11 · 2025: 13 · 2024: 15 · 2023: 14 · 2022: 12 · 2021: 7 · 2020: 8 · 2019: 1
FWCI: 5.58
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Research on Child and Adolescent Psychopathology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (K23MH108603)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords: sluggish cognitive tempo, adolescents, internalizing problems, emotional dysregulation, suicidal ideation, rumination, convergent and discriminant validity, self-reported symptoms
MeSH terms: Emotional Regulation, Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cognition Disorders, Female, Humans, Male, Parents, Self Report, Suicidal Ideation

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Sluggish cognitive tempo in adolescents with and without ADHD: differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains

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