Sluggish cognitive tempo: an examination of clinical correlates for adults with autism
Open accessAbstract
Adults with autism spectrum disorder often experience co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as impairments in executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder. This study was designed to assess sluggish cognitive tempo in young adults with autism spectrum disorder. Specifically, we sought to establish a preliminary estimate of clinically significant sluggish cognitive tempo symptoms and to better understand its phenomenology and associations with executive function and psychiatric symptoms in the context of autism spectrum disorder. Young adults with autism spectrum disorder ( n = 57; age 16–25 years; 84.2% male) completed a laboratory-based executive function task, and parents and participants completed measures of the participants’ sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms. Nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were significantly correlated, findings suggest the constructs are distinct. Results also suggest that increased sluggish cognitive tempo is related to executive function impairment and depression, but not anxiety symptoms. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed. Lay abstract: Adults with autism spectrum disorder often experience a range of co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as difficulties with executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder, and limited research has suggested that individuals with autism spectrum disorder may experience sluggish cognitive tempo. We examined co-occurring mental health problems and executive function in 57 young adults with autism spectrum disorder, aged 16–25 years to better understand sluggish cognitive tempo in autism spectrum disorder. Parents of the young adults answered questions about their children’s sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms, and the young adults completed tests of their executive function. Results demonstrated that nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were related, our findings suggest they are not the same constructs. Increased sluggish cognitive tempo is related to more difficulties with executive function and increased depression, but not anxiety symptoms. Results demonstrate that sluggish cognitive tempo may pose heightened difficulties for adults with autism spectrum disorder, making it an important construct to continue studying. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.
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13-16% of children with high CDS symptoms also meet criteria for an autism diagnosis, while 30-49% of children with autism present with elevated CDS symptoms.
“Studies indicate that 13-16% of children with high CDS symptoms also meet the criteria for an autism diagnosis, while 30-49% of children with autism present with elevated CDS symptoms [62-65].”
From Emotional Dysregulation and Cognitive Disengagement Syndrome: Exploring Their Relationship Through the Lens of Twin Studies (2025) · cites this paper as [64]
The Discussion (page unavailable) reports that about one-third of young adults with autism had clinically elevated SCT symptoms by parent report, and cites a similar finding in adolescents with autism. This supports a figure near the lower end of the claimed 30–49% range, but not that full range for children. The paper does not report that 13–16% of children with high SCT symptoms meet criteria for an autism diagnosis. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn college students and adults, SCT is uniquely related to global sleep problems, shorter sleep duration, and increased daytime sleepiness.
“In college students and adults, SCT is uniquely related to global sleep problems, shorter sleep duration, and increased daytime sleepiness.18,122–124”
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 [122]
The Abstract and Current Study and Hypotheses sections describe SCT in young adults with autism and examine ADHD, depression, anxiety, and executive function—not sleep outcomes. Searches for sleep problems, shorter sleep duration, daytime sleepiness, and sleep found no passage in our copy reporting the claimed associations; sleep appears only in reference titles. (LLM, conf=0.75)
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- Authors
- Brewe, A. M., Simmons, G. L., Capriola-Hall, N. N., & White, S. W.
- Affiliations
- University of Alabama (US)
- Corresponding author
- Brewe, Alexis M
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2020-02-07
- Volume
- 24
- Issue
- 6
- Pages
- 1373-1383
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- PMC
- PMC7375897
- OpenAlex
- W3005084962
- Cited by
- 31
- References
- 45
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 2 · 2020: 4
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH104337)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- sluggish cognitive tempo, autism spectrum disorder, young adults, attention deficit hyperactivity disorder, executive function, depression, anxiety, psychiatric comorbidity, daydreaming, clinical significance, parent report, executive function assessment, construct validity
- MeSH terms
- Autism Spectrum Disorder, Attention Deficit Disorder with Hyperactivity, Autistic Disorder, Child, Cognition, Humans, Young Adult, Executive Function
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