The internal, external, and diagnostic validity of sluggish cognitive tempo: a meta-analysis and critical review
Open accessAbstract
Objective To conduct the first meta-analysis evaluating the internal and external validity of the sluggish cognitive tempo (SCT) construct as related to or distinct from attention-deficit/hyperactivity disorder (ADHD) and as associated with functional impairment and neuropsychological functioning.Method Electronic databases were searched through September 2015 for studies examining the factor structure and/or correlates of SCT in children or adults. The search procedures identified 73 papers. The core SCT behaviors included across studies, as well as factor loadings and reliability estimates, were reviewed to evaluate internal validity. Pooled correlation effect sizes using random effects models were used to evaluate SCT in relation to external validity domains (i.e., demographics, other psychopathologies, functional impairment, and neuropsychological functioning).Results Strong support was found for the internal validity of the SCT construct. Specifically, across factor analytic studies including more than 19,000 individuals, 13 SCT items loaded consistently on an SCT factor as opposed to an ADHD factor. Findings also support the reliability (i.e., internal consistency, test-retest reliability, interrater reliability) of SCT. In terms of external validity, there is some indication that SCT may increase with age (r = 0.11) and be associated with lower socioeconomic status (r = 0.10). Modest (potentially negligible) support was found for SCT symptoms being higher in males than females in children (r = 0.05) but not in adults. SCT is more strongly associated with ADHD inattention (r = 0.63 in children, r = 0.72 in adults) than with ADHD hyperactivity-impulsivity (r = 0.32 in children, r = 0.46 in adults), and it likewise appears that SCT is more strongly associated with internalizing symptoms than with externalizing symptoms. SCT is associated with significant global, social, and academic impairment (r = 0.38-0.44). Effects for neuropsychological functioning are mixed, although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits.Conclusion This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is currently not enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research.
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When ADHD-IN is covaried, SCT is either unrelated or negatively related to ADHD-HI.
“SCT is unassociated or negatively associated with ADHD-HI when covarying ADHD-IN10”
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 [10]
In Results, under “SCT in Relation to Other Psychopathologies,” the review says several studies found SCT unassociated or negatively associated with hyperactivity-impulsivity after controlling for ADHD inattention. Its summary says this pattern occurs “often,” whereas the citing sentence states it without that qualifier. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSCT is strongly related to depression in dimensional analyses of children and adults, with meta-analytic correlations of .49 to .50.
“SCT is strongly related to depression in dimensional analyses of both children and adults (meta-analytic rs=.49–.50)”
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 [10]
The Results section, “SCT in Relation to Other Psychopathologies” (page unavailable), reports meta-analytic correlations between SCT and other symptom dimensions in children and adults. The Discussion calls the SCT–depression association strong. The passages in our copy do not give the claimed depression-specific correlations of .49–.50, so those figures cannot be verified. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSCT has small but significant associations with a range of externalizing behaviors, with meta-analytic correlations from .21 to .36.
“Studies show small but significant associations between SCT and a range of externalizing behaviors (meta-analytic rs = .21–.36),10”
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 [10]
The Results section on SCT in relation to other psychopathologies reports significant, small-to-medium correlations with measured psychopathology dimensions, including externalizing symptoms. It refers to weighted correlations in Table 5, but the passages available from our copy do not give the claimed .21–.36 range, so that numerical detail cannot be verified. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSCT is associated with informant ratings of overall academic impairment in childhood, with a medium pooled effect size of .44.
“SCT is associated with informant ratings of overall academic impairment in childhood, with a medium pooled effect size (overall r = .44).10”
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 [10]
The Results section on functional impairment reports a moderate pooled association between SCT and academic impairment in children and adolescents, within a range of weighted correlations of 0.38–0.44 across global, social, and academic domains. The available passage does not assign 0.44 specifically to overall academic impairment or establish that this estimate is limited to informant ratings. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA meta-analysis indicates SCT is associated with significant global impairment and lower quality of life in children and adults, with pooled correlations of .40 to .50.
“A meta-analysis indicates that SCT is associated with significant global impairment and lower quality of life in children and adults (pooled rs = .40–.50).10”
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 [10]
The Results section on functional impairment reports significant global impairment in children and adolescents (weighted rs = 0.38–0.44) and adults (r = 0.52). It also reports poorer quality of life in adults, but not children, and does not give a pooled quality-of-life correlation. Thus the claimed pooled range of .40–.50 does not accurately describe all the stated outcomes and populations. Page numbers were unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Meta-analytic results suggest a small but significant correlation between SCT and lower general intellectual ability, with an overall r of .24.
“Meta-analytic results suggest a small but significant correlation between SCT and lower general intellectual ability (overall r = .24).10”
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 [10]
The Results section on neuropsychological and executive functioning reports a significant, relatively small association between SCT symptoms and lower general-intelligence test scores in children and adolescents. It gives a range of weighted correlations (r = 0.19–0.29), not the claimed overall r = .24, and does not establish the same finding across all ages. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSCT symptoms are strongly associated with internalizing symptoms.
“SCT symptoms are strongly associated with internalizing symptoms (Becker, Leopold, et al., 2016), and there is growing evidence that SCT may be best conceptualized within the internalizing spectrum of psychopathology (Becker & Willcutt, 2019; Lee, Burns, Beauchaine, & Becker, 2016).”
From Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity During Social and Cognitive Stressor Tasks (2020) · cites this paper as Becker, Leopold, et al., 2016
The Results section (‘SCT in Relation to Other Psychopathologies’; page unavailable) finds a robust association between SCT and internalizing symptoms, including after controlling for ADHD symptoms. But it describes the correlations as small to medium, so ‘strongly associated’ overstates their reported magnitude. (LLM, conf=0.82)
Experimental — accuracy not yet measuredChildren with SCT are characterized by amotivation and apathy.
“Children with SCT are characterized by amotivation and apathy (Becker, Leopold, et al., 2016)”
From Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity During Social and Cognitive Stressor Tasks (2020) · cites this paper as Becker, Leopold, et al., 2016
In Methods, under “Measurement of SCT: The Universe of SCT Items” (page not provided), the review identifies apathetic behavior and low motivation as potential SCT features, but says items assessing them appeared in only a minority of studies. In the Discussion’s diagnostic-validity section, it says an agreed-upon SCT symptom set does not exist. The claim therefore presents these features as more established characteristics of children with SCT than the review supports. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe CBCL SCT scale is frequently used.
“the CBCL SCT scale is frequently used”
From Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity During Social and Cognitive Stressor Tasks (2020) · cites this paper as Becker, Leopold, et al., 2016
The Discussion (‘What is the Current State (and Future Possibility) of SCT?’; page unavailable) says the vast majority of SCT studies relied on rating scales. It does not establish that the CBCL SCT scale specifically was frequently used; searches for ‘CBCL’ and ‘Child Behavior Checklist’ found no supporting passage. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe CBCL SCT scale captures the daydreaming and underactive facets of SCT.
“captures the daydreaming and underactive facets of SCT (Becker, Leopold, et al., 2016)”
From Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity During Social and Cognitive Stressor Tasks (2020) · cites this paper as Becker, Leopold, et al., 2016
The Discussion (‘What is the Diagnostic Validity of SCT?’) identifies daydreaming and underactivity as cognitive and behavioral aspects of SCT. Our copy does not establish that the CBCL SCT scale specifically captures both facets, so the scale-specific attribution is unsupported. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSCT is most clearly associated with increased internalizing symptoms, especially depression.
“To date, studies have found SCT to be most clearly associated with increased internalizing symptoms (especially depression) and social isolation/withdrawal, and a growing number of studies also document associations between SCT symptoms and academic difficulties (Barkley, 2014; Becker & Barkley, 2018; Becker et al., 2016).”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
The Results section on SCT and other psychopathologies reports a robust association with internalizing symptoms, stronger than the association with externalizing symptoms. The Discussion identifies depression as one associated condition, but our copy does not establish that SCT is associated with depression more strongly than with other internalizing symptoms, as “especially depression” suggests. No page number is available in the indexed passages. (LLM, conf=0.82)
Experimental — accuracy not yet measuredEvidence 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 [10]
The association between SCT and depression remains after covarying ADHD symptoms.
“and associations remain when covarying for ADHD symptoms.10”
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 [10]
SCT and ADHD-IN are empirically distinct constructs.
“SCT and ADHD-IN are empirically distinct and correlated more strongly (meta-analytic rs = .63 and .72 in children and adults, respectively) than SCT and ADHD-HI (meta-analytic rs = .32 and .46 in children and adults, respectively).10”
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 [10]
Most associations between SCT and externalizing behaviors become nonsignificant or negative after covarying ADHD symptoms.
“though most of these associations become nonsignificant or even negative when symptoms of ADHD are covaried (for reviews, see3,10).”
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 [10]
SCT correlates more strongly with ADHD-IN than with ADHD-HI in both children and adults, with meta-analytic correlations of .63 and .72 for ADHD-IN and .32 and .46 for ADHD-HI, respectively.
“SCT and ADHD-IN are empirically distinct and correlated more strongly (meta-analytic rs = .63 and .72 in children and adults, respectively) than SCT and ADHD-HI (meta-analytic rs = .32 and .46 in children and adults, respectively).10”
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 [10]
SCT is associated with global social impairment, with medium effect sizes in children and adults, pooled correlations of .37 to .38.
“SCT is associated with global social impairment, with overall medium effect sizes in studies of children and adults (pooled rs = .37–.38).10”
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 [10]
A conclusion about whether CDS is a transdiagnostic factor, important for ADHD heterogeneity, or its own psychiatric disorder cannot currently be made from existing evidence.
“Although a conclusion regarding these possibilities cannot currently be made based on the existing evidence (see Table 1 limitations of existing research and discussion of diagnostic validity in Becker et al.10)”
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 [10]
SCT is more strongly associated with internalizing symptoms than with externalizing behaviors.
“Rather, SCT is more strongly associated with internalizing symptoms than with externalizing behaviors (Becker et al., 2016), and SCT symptoms are associated with increased anxiety/depressive symptoms in adults (Becker, Burns, et al., 2018; Becker, Langberg, et al., 2014; Kamradt et al., 2017; Leikauf & Solanto, 2017; Wood, Lewandowski, et al., 2017).”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
SCT and ADHD-IN are strongly correlated empirically.
“SCT and ADHD-IN are strongly correlated empirically (Becker et al., 2016)”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
SCT is strongly related to but distinct from both ADHD-IN and internalizing symptoms of depression and anxiety.
“Initially considered to be an aspect or specifier of attention-deficit/hyperactivity disorder (ADHD), it is now clear that SCT is strongly related to but distinct from both ADHD inattention (IN) and internalizing symptoms of depression and anxiety (Becker et al., 2016).”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
SCT is associated with social isolation/withdrawal.
“To date, studies have found SCT to be most clearly associated with increased internalizing symptoms (especially depression) and social isolation/withdrawal, and a growing number of studies also document associations between SCT symptoms and academic difficulties (Barkley, 2014; Becker & Barkley, 2018; Becker et al., 2016).”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
SCT symptoms are associated with academic difficulties.
“To date, studies have found SCT to be most clearly associated with increased internalizing symptoms (especially depression) and social isolation/withdrawal, and a growing number of studies also document associations between SCT symptoms and academic difficulties (Barkley, 2014; Becker & Barkley, 2018; Becker et al., 2016).”
From Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model (2018) · cites this paper as Becker et al., 2016
SCT is associated with various daily life impairments, including social withdrawal, loneliness, emotion dysregulation, poorer sleep quality, increased daytime sleepiness, and lower grades, with most associations holding after controlling for ADHD and other psychopathology symptoms.
“there is growing evidence that SCT is also related to a range of daily life impairments, including social withdrawal and loneliness, increased emotion dysregulation, poorer sleep quality and increased daytime sleepiness, and lower grades, with most associations between SCT and impairment remaining after controlling for ADHD and other psychopathology symptoms [5,12,13].”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
A meta-analysis found that 13 candidate SCT items consistently loaded on an SCT factor rather than an ADHD-IN factor.
“A recent meta-analysis found that 13 putative SCT items consistently loaded on an SCT factor as opposed to an ADHD-IN factor [5].”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
SCT is linked to impairment in both children and adults.
“growing evidence demonstrates SCT to be associated with impairment in both children and adults”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
Sluggish cognitive tempo is distinguishable from ADHD and other forms of psychopathology.
“Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
These youth did not show other neuropsychological impairments, and SCT has not been convincingly associated with neuropsychological deficits.
“these youth did not display other neuropsychological impairments [79], just as SCT has not been convincingly associated with neuropsychological deficits [5].”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
SCT is associated with apathy, amotivation, psychomotor retardation, and withdrawal.
“SCT is associated with apathy, amotivation, psychomotor retardation, and withdrawal [5,10,56]”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
SCT and ADHD-IN are strongly correlated, but when controlling for the other, SCT is consistently associated with increased internalizing symptoms while ADHD-IN is consistently associated with increased externalizing symptoms.
“SCT and ADHD-IN are themselves strongly correlated, yet when controlling for the other, SCT is consistently associated with increased internalizing symptoms whereas ADHD-IN is consistently associated with increased externalizing symptoms [3,5,12,13].”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
Sluggish cognitive tempo (SCT) shows a stronger association with internalizing symptoms than with externalizing symptoms, with the exception of ADHD-inattentive presentation.
“SCT is more strongly associated with internalizing symptoms than with externalizing symptoms (with the exception of ADHD-IN) [5]”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
SCT may show increases from childhood through adolescence and into adulthood, similar to depression.
“SCT may parallel depression in increasing across the transition from childhood to adolescence and adulthood [5,31]”
From Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology (2019) · cites this paper as [5]
CDS symptoms uniquely predict internalizing symptoms and social withdrawal beyond ADHD symptoms.
“CDS symptoms uniquely predict internalizing symptoms and social withdrawal over and beyond ADHD symptomology”
CDS is distinct from ADHD, as shown by different structures, phenomenology, neuropsychological profiles, and correlates.
“Still, research has shown that CDS is unique from ADHD, as evidenced by many studies documenting different structures and phenomenology [2, 10, 11], neuropsychological profiles [10, 12-14], and correlates”
There is some evidence that individuals with elevated CDS symptoms make more omission errors on sustained attention tasks, though not all studies support this association.
“There is some evidence that individuals exhibiting elevated CDS symptoms make more omission errors on sustained attention tasks [2, 10, 14, 39, 44], though again, not all studies have found support for this association [29].”
People with cognitive disengagement syndrome may be prone to errors in signal detection.
“individuals with CDS may have a propensity toward signal detection errors [2, 10, 14, 39, 44]”
People with CDS have a higher prevalence of anxiety and depression.
“higher prevalence of anxiety and depression in individuals experiencing CDS [1, 2, 6, 10, 11, 15, 16]”
Bupropion may address CDS-related signal detection deficits by reducing omission errors.
“This includes potentially addressing CDS-related deficits in signal detection by reducing errors of omission [2, 10, 14, 39, 44, 71]”
CDS and anxiety/depression share symptoms such as lethargy and alertness difficulties.
“overlapping symptoms (e.g., lethargy, difficulties with alertness) [1, 2, 6, 10-12, 15, 16]”
SCT frequently co-occurs with ADHD (about half of the Barkley sample) and with anxiety, depressive, and learning disorders.
“SCT is common in adults; Barkley found a population rate of 5.8% and SCT frequently co-occurs with ADHD (about half of the Barkley sample) as well as anxiety, depressive, and learning disorders (1, 2, 5).”
From Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function (2023) · cites this paper as [2]
Even when accounting for both ADHD severity and comorbid anxiety, SCT remained independently associated with EF deficits and emotional self-control.
“Even when accounting for both ADHD severity and co-morbid anxiety, SCT remained independently associated with EF deficits and emotional self-control (2, 9–11).”
From Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function (2023) · cites this paper as [2]
The population rate of SCT in adults is 5.8%.
“SCT is common in adults; Barkley found a population rate of 5.8% and SCT frequently co-occurs with ADHD (about half of the Barkley sample) as well as anxiety, depressive, and learning disorders (1, 2, 5).”
From Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function (2023) · cites this paper as [2]
In prior studies of adults with ADHD and SCT, SCT was associated with global EF deficits.
“In the few prior studies of adults with ADHD + SCT, SCT was associated with EF deficits in problem-solving and organization (9, 10) and in global EF (1, 2, 9–13).”
From Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function (2023) · cites this paper as [2]
Wu et al. found no clear CDS-neurocognition associations, while ADHD was linked to sustained attention, response inhibition, and working memory deficits.
“A more recent study by Wu et al. similarly reported no clear associations between CDS and neurocognitive deficits, whereas ADHD was associated with deficits in sustained attention, response inhibition, and WM [9].”
From Neurocognition in children with cognitive disengagement syndrome: accurate but slow (2024) · cites this paper as [9]
These null results for CDS with planning, cognitive interference accuracy, and response inhibition match prior child studies that found no CDS link to planning tasks, Stroop accuracy, or response inhibition.
“These findings are consistent with previous work in children which reported no association of CDS and planning tasks (Tower of Hanoi [19] and CANTAB Stockings Task [9]), Stroop accuracy [19], or response inhibition [5,8,61].”
From Neurocognition in children with cognitive disengagement syndrome: accurate but slow (2024) · cites this paper as [9]
Sluggish cognitive tempo is empirically distinct from ADHD inattention and independently associated with internalizing psychopathologies and psychosocial impairment across childhood, adolescence, and adulthood.
“Sluggish cognitive tempo (SCT), characterized by excessive daydreaming, mind-wandering, confusion or fogginess, and staring behaviors, is empirically distinct from ADHD inattention and independently associated with internalizing psychopathologies and domains of psychosocial impairment across childhood, adolescence, and adulthood (for a review, see (Becker et al., 2016).”
From Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo (2020) · cites this paper as Becker et al., 2016
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Self-citationThe Relation Between Sluggish Cognitive Tempo and DSM-IV ADHD
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Self-citationDimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo
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Self-citationAre sluggish cognitive tempo and daytime sleepiness distinct constructs?
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Self-citationTopical review: sluggish cognitive tempo: research findings and relevance for pediatric psychology
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Self-citationDifferentiating SCT and inattentive symptoms in ADHD using fMRI measures of cognitive control
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Self-citationBrief report: sluggish cognitive tempo among pediatric survivors of acute lymphoblastic leukemia
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Self-citationExecutive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD
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The relationship between sluggish cognitive tempo and impairment in children with and without ADHD
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The Children's Behavior Rating Scale: a factor analytic developmental study
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Self-citationDoes Sluggish Cognitive Tempo Fit Within a Bi-Factor Model of ADHD?
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Self-citationSluggish cognitive tempo in survivors of pediatric brain tumors
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Self-citationEvaluating the Construct Validity of Adult ADHD and SCT Among College Students
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Self-citationEEG and Neurofeedback Findings in ADHD
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Self-citationSystematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade
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Self-citationFlannery, A. J., Luebbe, A. M., & Becker, S. P. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22406 · Cited by 72 · see citing works
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Self-citationSluggish cognitive tempo, processing speed, and internalizing symptoms: the moderating effect of age
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Tamm, L., Garner, A. A., Loren, R. E. A., Epstein, J. N., Vaughn, A. J., Ciesielski, H. A., & Becker, S. P. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.05.054 · Cited by 64 · see citing works
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Self-citationWhat cognitive processes are “sluggish” in sluggish cognitive tempo?
Kofler, M. J., Irwin, L. N., Sarver, D. E., Fosco, W. D., Miller, C. E., Spiegel, J. A., & Becker, S. P. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000446 · Cited by 61 · see citing works
Self-citationAre sluggish cognitive tempo symptoms associated with executive functioning in preschoolers?
Tamm, L., Brenner, S. B., Bamberger, M. E., & Becker, S. P. (2018) · Child Neuropsychology · doi:10.1080/09297049.2016.1225707 · Cited by 61 · see citing works
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Self-citationBaytunca, M. B., Inci, S. B., Ipci, M., Kardas, B., Bolat, G. U., & Ercan, E. S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.03.038 · Cited by 51 · see citing works
Fredrick, J. W., Yeaman, K. M., Yu, X., Langberg, J. M., & Becker, S. P. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13568 · Cited by 50 · see citing works
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Self-citationSluggish Cognitive Tempo and Neuropsychological Functioning
Creque, C. A., & Willcutt, E. G. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00810-3 · Cited by 46 · see citing works
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Self-citationDvorsky, M. R., Becker, S. P., Tamm, L., & Willoughby, M. T. (2021) · Assessment · doi:10.1177/1073191119872247 · Cited by 43 · see citing works
Self-citationExecutive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder
Kofler, M. J., Soto, E. F., Singh, L. J., Harmon, S. L., Jaisle, E. M., Smith, J. N., Feeney, K. E., & Musser, E. D. (2024) · Nature Reviews Psychology · doi:10.1038/s44159-024-00350-9 · Cited by 51 · see citing works
“Cognitive disengagement syndrome refers to a constellation of symptoms that include slowed behaviour and/or thinking, reduced alertness, excessive daydreaming and getting lost in one’s thoughts 189–191 .”
Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder
Duncan, A., Tamm, L., Birnschein, A. M., & Becker, S. P. (2019) · Autism · doi:10.1177/1362361318811329 · Cited by 42 · see citing works
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Self-citationGarner, A. A., Hansen, A., Baxley, C., Becker, S. P., Sidol, C. A., & Beebe, D. W. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.09.003 · Cited by 37 · see citing works
“This suggests that prior correlational links between SCT and sleep [10] may reflect true cause-effect relationships.”
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Self-citationEast, P. L., Doom, J. R., Blanco, E., Burrows, R., Lozoff, B., & Gahagan, S. (2023) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1969653 · Cited by 36 · see citing works
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Self-citationBrain structure and function in school-aged children with sluggish cognitive tempo symptoms
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Lee, S., Burns, G. L., & Becker, S. P. (2017) · Journal of Attention Disorders · doi:10.1177/1087054716680077 · Cited by 33 · see citing works
Self-citationSluggish cognitive tempo and speed of performance
Wood, W. L. M., Potts, H. E., Lewandowski, L. J., & Lovett, B. J. (2017) · Journal of Attention Disorders · doi:10.1177/1087054716666322 · Cited by 33 · see citing works
Smith, Z. R., Zald, D. H., & Lahey, B. B. (2020) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-020-00692-x · Cited by 32 · see citing works
Becker, S. P., Pfiffner, L. J., Stein, M. A., Burns, G. L., & McBurnett, K. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2015.11.011 · Cited by 32 · see citing works
Self-citationFredrick, J. W., Burns, G. L., Langberg, J. M., & Becker, S. P. (2022) · Assessment · doi:10.1177/10731911211027224 · Cited by 33 · see citing works
Self-citationSmith, 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-citationSluggish 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
Self-citationSluggish cognitive tempo: an examination of clinical correlates for adults with autism
Brewe, A. M., Simmons, G. L., Capriola-Hall, N. N., & White, S. W. (2020) · Autism · doi:10.1177/1362361319900422 · Cited by 31 · see citing works
Validity of sluggish cognitive tempo in Turkish children and adolescents
Başay, Ö., Çiftçi, E., Becker, S. P., & Burns, G. L. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-01110-5 · Cited by 31 · see citing works
Self-citationSluggish cognitive tempo and exposure to interpersonal trauma in children
Musicaro, R. M., Ford, J., Suvak, M. K., Sposato, A., & Andersen, S. (2020) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2019.1695124 · Cited by 31 · see citing works
Becker, S. P., Mossing, K. W., Zoromski, A. K., Vaughn, A. J., Epstein, J. N., Tamm, L., & Burns, G. L. (2020) · Psychological Assessment · doi:10.1037/pas0000946 · Cited by 30 · see citing works
Self-citationBurns, 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
Self-citationSmith, Z. R., & Langberg, J. M. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13149 · Cited by 28 · see citing works
Self-citationEkinci, O., İpek Baş, S. A., Ekinci, N., Doğan, Ö. İ., Yaşöz, C., & Adak, İ. (2021) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2020-0965 · Cited by 29 · see citing works
Mayes, S. D., Waschbusch, D. A., Fernandez-Mendoza, J., & Calhoun, S. L. (2021) · Journal of Pediatric Neuropsychology · doi:10.1007/s40817-021-00109-7 · Cited by 27 · see citing works
Self-citationFredrick, J. W., Langberg, J. M., & Becker, S. P. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00923-3 · Cited by 28 · see citing works
Self-citationBarkley, R. A., Willcutt, E., & Jacobson, L. A. (2022) · The ADHD Report · doi:10.1521/adhd.2022.30.2.1 · Cited by 27 · see citing works
Self-citationO'Hare, K., White, N., Harding, R., Galland, B., Sellbom, M., Shine, B., & Schaughency, E. (2021) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000948 · Cited by 26 · see citing works
Kamradt, J. M., Momany, A. M., & Nikolas, M. A. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-017-9631-9 · Cited by 26 · see citing works
McBurnett, K., Clemow, D., Williams, D., Villodas, M., Wietecha, L., & Barkley, R. (2017) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2016.0115 · Cited by 25 · see citing works
Self-citationNeuro-physiological correlates of sluggish cognitive tempo (SCT) symptoms in school-aged children
Yung, T. W. K., Lai, C. Y. Y., Chan, J. Y. C., Ng, S. S. M., & Chan, C. C. H. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01353-1 · Cited by 23 · see citing works
Neurocognition in children with cognitive disengagement syndrome: accurate but slow
Tamm, L., Epstein, J. N., Orban, S. A., Kofler, M. J., Peugh, J. L., & Becker, S. P. (2024) · Child Neuropsychology · doi:10.1080/09297049.2023.2185215 · Cited by 25 · see citing works
Self-citationPreszler, J., Burns, G. L., Litson, K., Geiser, C., Servera, M., & Becker, S. P. (2019) · Assessment · doi:10.1177/1073191116686178 · Cited by 25 · see citing works
Self-citationEveningness diurnal preference: putting the "sluggish" in sluggish cognitive tempo
Lunsford-Avery, J. R., Sweitzer, M. M., Kollins, S. H., & Mitchell, J. T. (2021) · Journal of Attention Disorders · doi:10.1177/1087054720959697 · Cited by 23 · see citing works
Kim, K., & Kim, H.-J. (2021) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2020.08.003 · Cited by 23 · see citing works
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-citationHoldaway, A. S., & Becker, S. P. (2018) · School Psychology Quarterly · doi:10.1037/spq0000245 · Cited by 20 · see citing works
Self-citationLunsford-Avery, J. R., Kollins, S. H., & Mitchell, J. T. (2021) · Journal of Attention Disorders · doi:10.1177/1087054718787894 · Cited by 21 · see citing works
Jarrett, M. A., Gable, P. A., Rondon, A. T., Neal, L. B., Price, H. F., & Hilton, D. C. (2020) · Journal of Attention Disorders · doi:10.1177/1087054717723986 · Cited by 18 · see citing works
Self-citationYung, T. W. K., Lai, C. Y. Y., Chan, J. Y. C., Ng, S. S. M., & Chan, C. C. H. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.585589 · Cited by 21 · see citing works
Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model
Becker, S. P., Schmitt, A. P., Jarrett, M. A., Luebbe, A. M., Garner, A. A., Epstein, J. N., & Burns, G. L. (2018) · Journal of Research in Personality · doi:10.1016/j.jrp.2018.06.001 · Cited by 20 · see citing works
“To date, studies have found SCT to be most clearly associated with increased internalizing symptoms (especially depression) and social isolation/withdrawal, and a growing number of studies also document associations between SCT symptoms and academic difficulties (Barkley, 2014; Becker & Barkley, 2018; Becker et al., 2…”
BackgroundInfluentialSelf-citationBecker, S. P., & McQuade, J. D. (2020) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-020-00651-6 · Cited by 19 · see citing works
Self-citationSluggish Cognitive Tempo: Longitudinal Stability and Validity
Vu, A., Thompson, L., Willcutt, E., & Petrill, S. (2019) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-019-00287-7 · Cited by 18 · see citing works
Self-citationCook, N. E., Braaten, E. B., Vuijk, P. J., Lee, B. A., Samkavitz, A. R., Doyle, A. E., & Surman, C. B. H. (2019) · Child Psychiatry & Human Development · doi:10.1007/s10578-019-00904-6 · Cited by 18 · see citing works
Ward, A. R., Sibley, M. H., Musser, E. D., Campez, M., Bubnik-Harrison, M. G., Meinzer, M. C., & Yeguez, C. E. (2019) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-019-00293-9 · Cited by 19 · see citing works
Becker, S. P. (2017) · Journal of Attention Disorders · doi:10.1177/1087054717692882 · Cited by 17 · see citing works
Self-citationFredrick, J. W., Becker, S. P., Kofler, M. J., Jarrett, M. A., Burns, G. L., & Luebbe, A. M. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.08.030 · Cited by 17 · see citing works
Self-citationBurns, G. L., Preszler, J., Ahnach, A., Servera, M., & Becker, S. P. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00890-1 · Cited by 17 · see citing works
Self-citationWiggs, K. K., Froehlich, T. E., & Becker, S. P. (2023) · CNS Drugs · doi:10.1007/s40263-023-00999-5 · Cited by 16 · see citing works
Self-citationMayes, S. D., Seebeck, J., & Waschbusch, D. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05222-2 · Cited by 15 · see citing works
Self-citationCamprodon-Rosanas, E., Ribas-Fitó, N., Batlle, S., Persavento, C., Alvarez-Pedrerol, M., Sunyer, J., & Forns, J. (2020) · Journal of Attention Disorders · doi:10.1177/1087054717702245 · Cited by 15 · see citing works
Sluggish cognitive tempo: the need for global inquiry
Becker, S. P. (2019) · World Psychiatry · doi:10.1002/wps.20639 · Cited by 15 · see citing works
Self-citationÜnsel-Bolat, G., Baytunca, M. B., Kardaş, B., İpçi, M., İnci İzmir, S. B., Özyurt, O., Çallı, M. C., & Ercan, E. S. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2020.1772364 · Cited by 14 · see citing works
Differential diagnosis of sluggish cognitive tempo symptoms in college students
Lovett, B. J., Wood, W. L. M., & Lewandowski, L. J. (2021) · Journal of Attention Disorders · doi:10.1177/1087054719896856 · Cited by 15 · see citing works
Becker, S. P., Dvorsky, M. R., Tamm, L., & Willoughby, M. T. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-020-00728-2 · Cited by 13 · see citing works
Self-citationCallan, P. D., Shepler, D. K., Justice, M. D., & Oliver, C. E. (2020) · Journal of Pediatric Neuropsychology · doi:10.1007/s40817-020-00083-6 · Cited by 13 · see citing works
ADHD and sluggish cognitive tempo: comparing executive functioning response patterns
Collado-Valero, J., Navarro-Soria, I., Delgado-Domenech, B., Real-Fernández, M., Costa-López, B., Mazón-Esquiva, I., & Lavigne-Cerván, R. (2021) · Sustainability · doi:10.3390/su131910506 · Cited by 10 · see citing works
Smith, Z. R., Del Castillo, A., Clark, O. E., & Holmbeck, G. N. (2022) · Child Neuropsychology · doi:10.1080/09297049.2022.2042503 · Cited by 10 · see citing works
Burns, G. L., Becker, S. P., Montaño, J. J., Sáez, B., & Servera, M. (2025) · Journal of Attention Disorders · doi:10.1177/10870547251344719 · Cited by 9 · see citing works
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Krone, B., Adler, L. A., Anbarasan, D., Leon, T., Gallagher, R., Patel, P., Faraone, S. V., & Newcorn, J. H. (2023) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2023.1188901 · Cited by 7 · see citing works
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- Authors
- Becker, S. P., Leopold, D. R., Burns, G. L., Jarrett, M. A., Langberg, J. M., Marshall, S. A., McBurnett, K., Waschbusch, D. A., & Willcutt, E. G.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- University of Colorado Boulder (US)
- Washington State University (US)
- University of Alabama (US)
- Virginia Commonwealth University (US)
- University of California, San Francisco (US)
- Penn State Milton S. Hershey Medical Center (US)
- Corresponding author
- Becker, Stephen P.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 55
- Issue
- 3
- Pages
- 163-178
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC4764798
- OpenAlex
- W2211212874
- Cited by
- 368
- References
- 87
- Citations by year
- 2026: 35 · 2025: 43 · 2024: 42 · 2023: 42 · 2022: 43 · 2021: 28 · 2020: 41 · 2019: 28 · 2018: 26 · 2017: 17 · 2016: 21 · 2015: 2
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH108603)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD068728)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- sluggish cognitive tempo, attention deficit hyperactivity disorder, internal validity, generalizability, diagnostic validity, factor structure, reliability statistics, functional disability, neuropsychological performance, processing speed, sustained attention, metacognitive deficits, internalizing problems, transdiagnostic constructs, children and adults, socioeconomic status, sex differences, age differences, academic impairment, social dysfunction, hyperactivity/impulsivity
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Child, Child Psychiatry, Child, Preschool, Cognition Disorders, Female, Humans, Impulsive Behavior, Male, Neuropsychological Tests, Psychiatric Status Rating Scales, Reproducibility of Results
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