Slow sluggish cognitive tempo symptoms are associated with poorer academic performance in children with ADHD
Open accessAbstract
Sluggish cognitive tempo (SCT) symptoms may confer risk for academic impairment in attention-deficit/hyperactivity disorder (ADHD). We investigated SCT in relation to academic performance and impairment in 252 children (ages 6–12, 67% boys) with ADHD. Parents and teachers completed SCT and academic impairment ratings, and achievement in reading, math, and spelling was assessed. Simultaneous regressions controlling for IQ, ADHD, and comorbidities were conducted. Total SCT predicted parent-rated impairments in writing, mathematics, and overall school but not reading. Parent-rated SCT Slow predicted poorer reading and spelling, but not math achievement. Teacher-rated SCT Slow predicted poorer spelling and math, but not reading achievement. Parent-rated SCT Slow predicted greater academic impairment ratings across all domains, whereas teacher-rated SCT Slow predicted greater impairment in writing only. Age and gender did not moderate these relationships with the exception of math impairment; SCT slow predicted math impairment for younger but not older children. Parent and teacher SCT Sleepy and Daydreamy ratings were not significant predictors. SCT Slow appears to be uniquely related to academic problems in ADHD, and may be important to assess and potentially target in intervention. More work is needed to better understand the nature of SCT Slow symptoms in relation to inattention and amotivation.
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In an RCT with middle school students, a school-based organization/homework intervention reduced SCT symptoms per parent report but not per adolescent report.
“In an RCT with middle school students, school-based organization/homework intervention reduced SCT symptoms per parent but not adolescent report.147”
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 [147]
The Methods (Subjects and Procedures; page unavailable) describe 252 children aged 6–12 recruited through an outpatient ADHD clinic, with parent and teacher ratings and academic testing—not an RCT with middle school students. The Discussion (Limitations and future directions; page unavailable) says the study did not have information on homework completion or organization and recommends adding child self-reports in future studies. It reports no intervention or parent-versus-adolescent treatment effect. (LLM, conf=0.87)
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Becker, S. P., Willcutt, E. G., Leopold, D. R., Fredrick, J. W., Smith, Z. R., Jacobson, L. A., Burns, G. L., Mayes, S. D., Waschbusch, D. A., Froehlich, T. E., et al. (2023) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.07.821 · Cited by 175 · see citing works
Self-citationSystematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade
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Self-citationSáez, B., Servera, M., Becker, S. P., & Burns, G. L. (2019) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2017.1416619 · Cited by 89 · see citing works
“…at least some items (e.g., lacks initiative, effort on tasks fades quickly) that are not optimal for assessing SCT, at least as distinct from ADHD-IN, which has made it difficult to draw conclusions from the emerging findings (Becker & Langberg, 2014; Smith & Langberg, 2017; Tamm et al., 2016).”
ResultSelf-citationBecker, S. P., Burns, G. L., Leopold, D. R., Olson, R. K., & Willcutt, E. G. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12946 · Cited by 81 · see citing works
“Given mixed findings in previous research, we tentatively hypothesized that trait SCT would uniquely predict lower reading and mathematics achievement scores, but would not uniquely predict processing speed or working memory test scores (Bauermeister et al., 2012; Hartman et al., 2004; Tamm et al., 2016; Willcutt et a…”
BackgroundResultSelf-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
“Thus, the slow aspect of SCT may be a primary contributor to academic problems even when comprehension is high (Becker, Ciesielski, et al., 2016; Fenollar Cortés, Servera, Becker, & Burns, 2014; Langberg, Becker, & Dvorsky, 2014; Tamm et al., 2016).”
BackgroundSelf-citationFroehlich, T. E., Becker, S. P., Nick, T. G., Brinkman, W. B., Stein, M. A., Peugh, J., & Epstein, J. N. (2018) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.17m11553 · Cited by 51 · see citing works
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“, 2016), school-aged youth (Barkley, 2013; Becker et al., 2015, 2016b; Bernad et al., 2014; Burns et al., 2017; Fenollar Cortés et al., 2017; Hossain et al., 2022; Jacobson et al., 2012; Khadka et al., 2016; Lee et al., 2014, 2016, 2018; O'Hare et al., 2021; Sáez et al., 2019a, 2019b; Tamm et al., 2016; Willcutt et al…”
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Self-citationAcademic functioning in children with and without sluggish cognitive tempo
Becker, S. P., Epstein, J. N., Burns, G. L., Mossing, K. W., Schmitt, A. P., Fershtman, C. E. M., Vaughn, A. J., Zoromski, A. K., Peugh, J., Simon, J. O., et al. (2022) · Journal of School Psychology · doi:10.1016/j.jsp.2022.10.001 · Cited by 27 · see citing works
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“, slow task completion and low initiative) are strongly related to academic performance.(39) These features may overlap less with daytime sleepiness, potentially contributing to unique associations of SCT with academic performance.”
BackgroundNeuro-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
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“, anxiety and depression), social problems, and academic learning difficulties (1, 4).”
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“…Eiraldi, Becker, & Power, 2014) or that only some but not all SCT dimensions show association with reported academic impairment (e.g., Slow SCT; Tamm et al., 2016) or grade point average (e.g., SCT Slow factor associated with reduced grades, while the Daydreamy factor was associated with…”
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“Likewise, SCT symptoms may confer risk for academic difficulties across domains (Jacobson & Mahone, 2019; Tamm et al., 2016).”
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“For example, it has been shown that university students with ADHD symptoms tend to exhibit low academic achievement, as they find it difficult to concentrate on their studies and complete assignments (9), (10) .”
Öğütlü, H., Kaşak, M., Doğan, U., Atasoy, S., & McNicholas, F. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231158869 · Cited by 11 · see citing works
“…remain and include reliance on post hoc measures consisting of a small and varied number of items (Carlson & Mann, 2002), includion of items not uniformly considered integral or suf fi ciently discriminatory to the condition, (Becker & Langberg, 2014; Smith & Langberg, 2017; Tamm et al., 2016).”
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“Consistent with the pres-ent study, previous studies indicated that CDS symptoms are associated with slow psychomotor speed in younger children (Tamm et al., 2016).”
Luedke, J., Vargas, G., Jashar, D., Morrow, A. K., Malone, L., & Ng, R. (2023) · Child Neuropsychology: A Journal of Normal and Abnormal Development in Childhood and Adolescence · doi:10.1080/09297049.2023.2252967 · Cited by 7 · see citing works
“…used in the most sample types (Becker, 2021) including community (e.g., Garner et al., 2017), clinical (e.g., Jacobson et al., 2012, 2018; Koriakin et al., 2015; Peterson et al., 2022; Simpson et al., 2023; Smith & Langberg, 2017; Tamm et al., 2016), and school samples (e.g., Becker et al., 2015).”
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“(Tamm et al., 2016) concluded that "teacher attitude affected the relationship in the classroom and level of interventions provided, and those teachers who viewed ADHD related behaviors as directly related to the classroom environment and support provided were able to have a positive classroom…”
BackgroundBarakat, M., Mashmoushi, R., Oghgassian, G., & Shamseddeen, W. (2021) · Child Neuropsychology · doi:10.1080/09297049.2020.1841146 · Cited by 7 · see citing works
“Finally, the effect of SCT on academic achievement has been explored by several authors: for example, students with SCT were found to present significant academic problems that were beyond the contribution of ADHD inattention symptoms ((Tamm et al., 2016); (McBurnett et al.”
BackgroundInfluentialTahıllıoğlu, A., Bılaç, Ö., Erbaş, S., Sevin, İ. B., Aydınlıoğlu, H. M., & Ercan, E. S. (2024) · Applied Neuropsychology Child · doi:10.1080/21622965.2024.2323647 · Cited by 7 · see citing works
“Some studies report that academic failure results from the symptom cluster of slug-gishness rather than daydreaming, although they have not directly examined SLD (Smith & Langberg, 2017; Tamm et al., 2016).”
Wang, Y., Liu, X., Wu, T., Zheng, D., Chen, Q., & Chen, C. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01559-0 · Cited by 7 · see citing works
“Firstly, the inclusion of individuals’ intelligence quotient (IQ) as a covariate could enhance the analysis, as IQ is known to significantly contribute to academic achievement and has been considered in other studies focusing on SCT (Becker et al. 2018; Marshall et al. 2014; Tamm et al. 2016).”
Clinical and neurophysiological manifestations of sluggish cognitive tempo in children
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“…problems (Becker, Luebbe, et al., 2014; Langberg et al., 2014) poorer academic performance (Becker et al., 2019; Belmar et al., 2017; Lee et al., 2018; Tamm et al., 2016) sensitivity to punishment (Becker et al., 2013) and suicidal ideation (Becker et al., 2018; Becker, Withrow, et al., 2016).”
BackgroundSluggish Cognitive Tempo in Pediatric Sickle Cell Disease
Hardy, S. J., Forman, S. M., Hardy, K. K., & Schatz, J. C. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.867437 · Cited by 5 · see citing works
“In addition to having different neurocognitive profiles, SCT symptoms have been noted to confer additional functional impacts on academic performance not captured by classic ADHD symptoms, are more likely to be comorbid with internalizing disorders, and are associated with lower family socioeconomic status (23, 29, 30…”
BackgroundResultPsycholinguistic profiling of children with sluggish cognitive tempo
Russell, K. M. H., Redmond, S. M., & Ash, A. C. (2022) · Clinical Linguistics & Phonetics · doi:10.1080/02699206.2022.2092422 · Cited by 5 · see citing works
“Although there are areas of ongoing disagreement among researchers, consensus exists currently on the validity for SCT as a separate but related disorder to ADHD (Başay et al., 2021; Barkley, 2013; Becker et al., 2016; Belmar et al., 2017; Lee et al., 2018; Tamm et al., 2016).”
Cid-Duarte, S., Departamento de Psicología, U. D. O. (., Areces, D., Departamento de Psicología, U. D. O. (., Núñez, J. C., & Departamento de Psicología, U. D. O. (. (2022) · Revista de Psicología y Educación - Journal of Psychology and Education · doi:10.23923/rpye2023.01.232 · Cited by 6 · see citing works
"Mislim, realno, tko voli školu?"
Bartolac, A. (2021) · Hrvatska Revija za Rehabilitacijska Istraživanja · doi:10.31299/hrri.57.1.1 · Cited by 3 · see citing works
“This includes impaired working memory and cognitive sluggishness that make it difficult to follow classes and instructions, difficulties with notetaking and completing homework, immature executive functioning that make it difficult to organize learning materials and plan learning time, generally lower grades and resul…”
BackgroundLi, F., Luo, J., Qi, Y., Huang, H., Wu, Y., Xu, G., Liu, Z., He, F., & Zheng, Y. (2023) · Scientific Reports · doi:10.1038/s41598-023-43225-4 · Cited by 4 · see citing works
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
“…et al., 2020, 2021; Bernad Mdel et al., 2016; Fredrick et al., 2022), more autistic traits (Ekinci et al., 2021), and has impacts on overall academic success (Becker et al., 2022; Becker, Langberg, et al., 2014; Flannery et al., 2017; Hossain et al., 2022; Langberg et al., 2014; Tamm et al., 2016).”
Yung, T. W. K., Lai, C. Y. Y., & Chan, C. C. H. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.875064 · Cited by 3 · see citing works
“, 2014, 2018a), and academic learning difficulties (Langberg et al., 2014; Tamm et al., 2016).”
BackgroundSensory Modulation: a Window to Sluggish Cognitive Tempo Symptoms Among Children
Yung, T. W. K. (2021) · Current Developmental Disorders Reports · doi:10.1007/s40474-021-00238-w · Cited by 2 · see citing works
Karaman, A. K., Sarıgedik, E., Eryılmaz, O. K., Küçükdağ, M., & Naldemir, İ. F. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.01.024 · Cited by 2 · see citing works
Pre-service teachers’ perceptions of sluggish cognitive tempo
Meisinger, R. E., & Lefler, E. K. (2016) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-016-0207-4 · Cited by 2 · see citing works
“2014), but many do suggest that SCT symptoms uniquely contribute to academic problems (Barkley 2013a; Langberg et al. 2014a, b; Marshall et al. 2014; Tamm et al. 2016; Willcutt et al. 2014).”
BackgroundZhang, D., Hartas, D., Sideropoulos, V., & Palikara, O. (2026) · Neurodiversity · doi:10.1177/27546330261462279 · Cited by 1 · see citing works
“…(Becker et al., 2018), while a third study demonstrated that different SCT dimensions (slow daydreaming, sleepy) showed differential associations with reading, writing, and mathematics among 5-to 16-year old CYP with ADHD, although these models did not control for other EF (Tamm et al., 2016).”
Gandomani, R. A. (2021) · Practice in Clinical Psychology · doi:10.32598/jpcp.9.1.705.1 · Cited by 1 · see citing works
Temporal Processing And Sluggish Cognitive Tempo In College Students
Sorrell, A. (2019) · NC Digital Online Collection of Knowledge and Scholarship (The University of North Carolina at Greensboro) · doi:10.71889/5fylantbak.29863631 · Cited by 1 · see citing works
PROMOÇÃO DA SAÚDE OCULAR EM CRIANÇAS E ADOLESCENTES: RELATO DE EXPERIENCIA DE ESTUDANTES DE MEDICINA
de Almeida, A. C., Bispo, V. N., Nanes, G., Leão, A., Ramos, A. M., de Souza, G. C. R. M., Lopes, F. S., Lima, M. D. O., Rosa, S. P., Navarro, T. W. D. M., et al. (2021) · doi:10.22533/at.ed.67921020917
CONHECIMENTO E ATITUDES DOS ESTUDANTES DO INTERNATO DE MEDICINA SOBRE VENTILAÇÃO MECÂNICA
Coelho, A. M. C., Rita, L. L. D. S., Cardoso, M. B., & Andriolo, B. N. G. (2021) · doi:10.22533/at.ed.6792102098
de Souza, S. G. D., de Figueiredo, J. F. C., & Barroso, L. K. V. (2021) · doi:10.22533/at.ed.67921020915
Jacovine, L. S., Crepalde, D. F., de SOUZA, L. P., & de Castro, I. F. (2021) · doi:10.22533/at.ed.67921020918
de Avila, F. E., Paes, A. L. F. D., Motta, A. B., da Silva, A. Z., de Jesus, C. W., Moura, L. C., Pinto, N. S. N., de Barros, F. F., & Franco, A. C. (2021) · doi:10.22533/at.ed.67921020916
TELECONSULTORIA E TELEATENDIMENTO NO SUS: UMA REVISÃO INTEGRATIVA
Lima, J. D. C., Gazzola, L. D., Ehrat, L., da Veiga, M. C. G. O., Meira, V. B. R., & Gomes, A. P. F. (2021) · doi:10.22533/at.ed.67921020919
A IMPORTÂNCIA DA MONITORIA DURANTE A FORMAÇÃO DO GENERALISTA: UM RELATO DE EXPERIÊNCIA
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Hofmeister, S. T., Paes, A. L. F. D., Cavalheiro, C. K., Gomar, G. G., Fangueiro, G. F., da Silva, K. M. T., Pugsley, L. C. F., Perche, M. F. D. M., Borini, N. K., Fujii, P. C. Y. S., et al. (2021) · doi:10.22533/at.ed.6792102091
Cerigatto, E. T., Roecker, A. L., Stuginski, C. A. S., Correia, M. M., & Rozin, L. (2021) · doi:10.22533/at.ed.67921020913
A PESQUISA INTERDISCIPLINAR NA MEDICINA COMO PILAR FUNDAMENTAL PARA A PROMOÇÃO DA SAÚDE
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Sassi, F. M., Ferreira, A. C. A., Nazário, F. A. S., da Silveira, I. H., Pereira, I. L., Davet, L. A., Savaris, G. H., Ribeiro, D. G. S., & Franco, A. C. (2021) · doi:10.22533/at.ed.6792102096
Magalhães, F. M., Cid, B. T., da Silva, S. S. R. P., Mascarenhas, E. B., de Albuquerque, B. P., Leite, I. M. D. S. R., Machado, L. P., Moreira, J. F., Lopes, L. B. M., Nogueira, V. M. G., et al. (2021) · doi:10.22533/at.ed.6792102095
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TELEMEDICINA COMO PARTE DA FORMAÇÃO MÉDICA MODERNA
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Ferreira, M. D. S. D., & Juliano, I. A. (2021) · doi:10.22533/at.ed.67921020911
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“CDS symptoms have been linked to adverse behavioral and social outcomes in typically developing children (Becker, 2014; Becker et al., 2019; Fredrick et al., 2022; Tamm et al., 2016).”
Zeyrek, İ., Köksal, O., & Ozaslan, A. (2026) · Applied Neuropsychology Child · doi:10.1080/21622965.2026.2680437
Jurgelis, M., Copko, M., Leaver, C., White, L., & Krieg, J. (2026) · Educational Psychology · doi:10.1080/01443410.2026.2695197 · Cited by 1 · see citing works
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Neurocognitive characteristics in children with sluggish cognitive tempo
Chutko, L. S., Yakovenko, E. A., Surushkina, S. Y., & Щеглова, Л. В. (2026) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202612609152
- Authors
- Tamm, L., Garner, A. A., Loren, R. E. A., Epstein, J. N., Vaughn, A. J., Ciesielski, H. A., & Becker, S. P.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Tamm, Leanne
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 242
- Pages
- 251-259
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC6431536
- OpenAlex
- W2418810549
- Semantic Scholar
- cb65c529d953e8b6466d150058f5edb521ca2515
- Cited by
- 64
- References
- 38
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 26 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 2 · 2016: 2
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Ohio Department of Mental Health (ODMH#12.1281)
- NIMH (K24MH064478, K23MH108603)
- 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, academic performance, academic impairment, children, reading achievement, mathematics achievement, spelling, writing, parent and teacher ratings, inattention, amotivation
- MeSH terms
- Academic Performance, Achievement, Attention Deficit Disorder with Hyperactivity, Child, Cognition, Female, Humans, Male, Parents, Schools, Cognitive Dysfunction
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