Review
Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade

https://doi.org/10.1016/j.jaac.2020.10.016Get rights and content

Objective

To conduct a systematic review of the measures designed to assess sluggish cognitive tempo (SCT) since the first SCT scale using careful test-construction procedures was published in 2009.

Method

MEDLINE (PubMed), Embase, PsychINFO, and Web of Science databases were searched from September 2009 through December 2019. Articles reporting on reliability (internal consistency, test-retest, and interrater reliability), structural validity (an aspect of construct validity focused on items’ convergent and discriminant validity), concurrent and longitudinal external validity, invariance, or intervention/experimental findings were included.

Results

Full criteria for data extraction and inclusion were met by 76 studies. Nine measures for assessing SCT were identified (7 assessing parent report, teacher report, and/or self-report in children and 2 assessing self-report and/or collateral informant report in adults). Each measure demonstrated acceptable to excellent reliability. All or at least the majority of SCT items on each measure also had structural validity (high loadings on an SCT factor and low loadings on an attention-deficit/hyperactivity disorder [ADHD] inattention factor). Studies have supported the invariance of SCT across sex and time, and there is initial evidence of invariance across informants, youths with ADHD and youths without ADHD, and ADHD presentations. The Child and Adolescent Behavior Inventory (CABI), Child Concentration Inventory, Second Edition (CCI-2), and Barkley Adult ADHD Rating Scale-IV (BAARS-IV) have particularly strong support for assessing parent/teacher-reported, youth self-reported, and adult self-reported SCT, respectively.

Conclusion

The SCT measures included in this review share numerous positive properties, have promising psychometric support, and have proven useful for examining the external correlates of SCT across the life span. Although substantial progress has been made over the last decade, work remains to be done to further improve the assessment of SCT and key directions for future research are provided.

Section snippets

Method

A systematic search of the literature was completed to identify all studies that included data relevant to the psychometric properties of measures specifically developed for the assessment of SCT. Because the first carefully constructed SCT scale was published in September 2009,20 computer searches were performed for the dates September 2009 through December 2019 in the MEDLINE (PubMed), Embase, PsychINFO, and Web of Science databases. “Sluggish cognitive tempo” was used as the primary search

Included Studies

Figure 1 shows the PRISMA flow diagram. The systematic search identified 274 unique records for title and abstract screening. Of these, 165 records were retained for full-text screening, and 76 met full criteria for data extraction and inclusion in the review. Among studies excluded from this review, by far the most common reason was because the study used the CBCL/TRF measure of SCT (n = 39). Details of the 76 included studies are provided in Table S1, available online.

Overview of Measures for Assessing SCT

Nine SCT rating scales

Discussion

Findings from this systematic review demonstrate that substantial work has been done in the past decade to develop and validate rating scale measures for assessing SCT. Scales to assess parent and teacher perceptions of children’s SCT symptoms as well as self-perceptions using youth or adult self-report scales have been developed and examined. Collectively, these measures have promising psychometric support and have proven useful for examining the external correlates of SCT across the life span.

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    Dr. Becker is supported by grants from the National Institute of Mental Health (NIMH; K23MH108603) and the Institute of Education Sciences (IES; R305A160064, R305A160126, R305A200028). The content is solely the responsibility of the author and does not necessarily represent the official views of the US National Institutes of Health (NIH) or the US Department of Education.

    ORCID: https://orcid.org/0000-0001-9046-5183

    The author extends appreciation to Ellen Kneeskern, BA, Nicholas Marsh, BA, Kandace Mossing, BA, and Katherine Taylor, BA, all of Cincinnati Children’s Hospital Medical Center, for their assistance with the screening and coding of articles, and to G. Leonard Burns, PhD, of Washington State University, for providing feedback on a previous version of this manuscript.

    Disclosure: Dr. Becker has received grant funding from the IES, US Department of Education, the NIMH, and the Cincinnati Children’s Research Foundation. He has received book honoraria from Guilford Press. He is an author or co-author on several of the measures reviewed in this manuscript, though he has received no financial benefit from these measures, as they are freely available.

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