Sluggish cognitive tempo and peer functioning in school-aged children: A six-month longitudinal study

Abstract

Although research demonstrates sluggish cognitive tempo (SCT) symptoms to be statistically distinct from other child psychopathologies (including attention-deficit/hyperactivity disorder [ADHD], anxiety, depression, and oppositionality) and associated with social impairment, all studies conducted to date have been cross-sectional. Thus, while extant research demonstrates an association between SCT and social functioning, it is entirely unknown whether or not SCT longitudinally predicts increases in social impairment. This study provides an initial examination of the prospective association between SCT symptoms and children׳s peer functioning. Teachers of 176 children in 1st–6th grades (ages 6–13; 47% boys) provided ratings of children׳s psychopathology (i.e., SCT, ADHD, anxious/depressive, and oppositional/conduct problems) and peer functioning (i.e., popularity, negative social preference, peer impairment), and peer functioning was assessed again 6 months later. Multilevel modeling analyses indicated that, above and beyond child demographics, other psychopathologies, and baseline peer functioning, SCT symptoms were significantly associated with poorer peer functioning at the 6-month follow-up. In addition, 75% of children with high levels of SCT were rated as functionally impaired in the peer domain, in contrast to only 8% of children with low SCT. Further research is needed with larger samples to examine SCT over a longer developmental period and with other domains of adjustment.

Introduction

Sluggish Cognitive Tempo (SCT) is defined by daydreaming, drowsiness, lethargy, mental confusion, and seeming to be in a world of one׳s own. Although initially identified as a set of symptoms hypothesized to be useful for identifying a distinct set of children with Attention-Deficit/Hyperactivity Disorder (ADHD) Predominately Inattentive Type (ADHD-I) (McBurnett et al., 2001, Carlson and Mann, 2002), recent studies do not convincingly support the hypothesis that the presence of elevated SCT is useful for identifying a subset of children diagnosed with ADHD-I (Marshall et al., 2014, Willcutt et al., 2014). Still, SCT has recently gained attention for its broader relevance for child adjustment (Becker, 2013, Barkley, 2014, Becker et al., 2014b). In support of the increased attention devoted to the SCT construct, multiple studies using a variety of sample types and age ranges have demonstrated SCT to be statistically distinct from DSM-IV ADHD (Willcutt et al., 2012, Barkley, 2013) as well as symptoms of anxiety and depression (Burns et al., 2013, Becker et al., 2014a, Lee et al., 2014, Willcutt et al., 2014). Further, a growing body of research demonstrates that SCT is not only separable from ADHD and other psychopathologies but also related to a range of psychosocial impairments (see Barkley, 2014, Becker, 2013, for reviews). Given these findings, it has been suggested that SCT may be itself a distinct psychiatric disorder (Concentration Deficit Disorder; Barkley, 2014), although much more research is needed before determining precisely what role SCT should ultimately have in psychiatry, psychology, and developmental psychopathology.

One of the most consistent findings to date is that of an association between SCT and social impairment. Multiple studies have documented a significant relation between SCT symptoms and general social problems (Bauermeister et al., 2012, Becker and Langberg, 2013, Burns et al., 2013, Becker et al., 2014a, Lee et al., 2014, McBurnett et al., 2014, Willcutt et al., 2014). SCT symptoms have also been shown to be significantly associated with sensitivity to punishment broadly and shyness/fear specifically (Becker et al., 2013a). Other studies have shown that among youth with ADHD-I, those with high levels of SCT are more socially withdrawn (and less aggressive) than those without high SCT (Carlson and Mann, 2002, Marshall et al., 2014). In line with these findings, Willcutt and colleagues (2014) found SCT symptoms to be uniquely associated with social isolation after controlling for inattentive and hyperactive-impulsive symptoms. Finally, SCT symptoms were associated with a poorer perception of subtle social cues and less memory for a laboratory-based chat room conversation (Mikami et al., 2007).

Although these studies suggest that SCT is an important construct for understanding youth׳s social adjustment, a significant limitation of SCT-related research conducted to date is that all studies have used a cross-sectional design. Thus, while extant research demonstrates an association between SCT and social functioning, it is entirely unknown whether or not SCT longitudinally predicts increases in social impairment. Therefore, the purpose of the present study was to provide an initial examination of the longitudinal association between SCT symptoms and children׳s peer functioning. Since the use of clinic-based samples of children diagnosed with ADHD make it “difficult to identify distinctive features that may be associated with SCT” (Barkley, 2013, p. 162), a non-referred school-based sample of children was used in the present study. Specifically, the teachers of children in first through sixth grades participated in a 6-month longitudinal study examining SCT in relation to subsequent peer functioning. In addition to being the first study to examine SCT as a longitudinal predictor of children׳s adjustment, multiple domains of peer functioning were examined (i.e., popularity, negative social preference, impairment in the peer domain). Since SCT is linked to social withdrawal, mental confusion, and slow processing, it was hypothesized that SCT symptoms would predict poorer peer functioning over a 6-month period, even after controlling for baseline peer functioning and other psychopathologies (i.e., ADHD inattentive, ADHD hyperactive-impulsive, anxious/depressive, and conduct/oppositional symptoms). Additional analyses were conducted that compared children with high levels of SCT to children with low levels of SCT, with the expectation that children with elevated SCT would have higher levels of other psychopathology symptoms and functional impairment in the peer domain than children without elevated SCT.