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Should SCT Be Included in the DSM? Maybe. Maybe Not.

— May 24, 2021

Proponents and critics argue over making sluggish cognitive tempo a ‘disorder.’

Sluggish Cognitive Tempo (SCT) is an attention disorder associated with the following symptoms similar to inattentive ADHD, including daydreaming; lethargy, poor memory, trouble staying alert, slow information processing and acting withdrawn.  Research shows roughly “half of all patients diagnosed with SCT also have attention deficit disorder (ADHD or ADD)” and “30 to 63 percent of patients with inattentive-type ADHD also have high levels of SCT.”  And yet, SCT is not included in latest edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).

“SCT is far more likely to be linked to symptoms of anxiety and extreme sadness and far less likely to be associated with disruptive, oppositional conduct or antisocial symptoms,” Russell Barkley, Ph.D., added of its relationship with ADHD and why it presents differently than many cases.

Should SCT Be Included in the DSM? Maybe. Maybe Not.
Photo by Andrew Neel from Pexels

SCT is currently considered a “clinical construct,” rather than a diagnosis.  However, advocates believe that if this construct became an official DSM diagnosis, it would be easier for those who suffer from these symptoms to get the help they need.  Critics of this have argued that the study of SCT is still in its early stages and, thus, they can’t yet support a formal diagnosis.

Clinical psychologist Russell Barkley of Virginia Commonwealth University Medical Center is the leading advocate for SCT.  “The name sluggish cognitive tempo,” Barkley said, “comes from a 1984 dissertation and a related 1986 study that tested a teachers’ rating scale to identify traits associated with student behavioral concerns.  One of these was ‘sluggish tempo’ and seemed to define a distinct group of students.”

He believes it will make it into the DSM. “I’m willing to go out on that limb, as I did in the year [2001],” he said. “If this pattern continues the way it is right now, this will be a new disorder.”

Stephen Becker, an associative professor of pediatrics at the Center for ADHD at Cincinnati Children’s Hospital Medical Center and a frequent collaborator of Barkley’s, disagreed.  He said, “I think there’s just a huge amount of research that needs to be done to support a new mental health disorder.  It’s still quite a small field.”

An outspoken critic of including SCT is Allen Frances, a professor emeritus and former chair of the department of psychiatry at Duke University.  He is part of the taskforce considering new submissions for diagnoses in the DSM.  Frances said he has reviewed “hundreds of proposals” and calls SCT “one of the dumbest.”  He argues that the symptoms are associated with many neurological and physical conditions.

“That should itself be a wake-up call for how silly this diagnosis is,” said Frances. “You wouldn’t want to be focusing on the sluggish cognitive phenomena on their own.  You’d say, what’s causing it?  I think the concept is so fatally flawed that there’s no amount of research that could ever rescue it.”

Alan Schwarz, who wrote the 2016 book ADHD Nation, touches on the issue of over-pathologizing, saying, “I certainly am in no position to deny that there are people, not only children but adults probably also, [who] struggle with tasks large and small … and that we should try to help them.  But codifying SCT as a disorder is a very significant step when the disorders already created appear to be massively misdiagnosed.”


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