By Rebecca Sohn, STAT News
For Abby Williard, school always felt like a slog. Growing up in a small town in central Pennsylvania, Williard couldn’t seem to complete her schoolwork or stop daydreaming in class. Although she has anxiety and depression, she felt like something else was at play.
“I would cry in class because I just couldn’t handle it, I couldn’t take it,” she said.
At points, Williard gave up on trying to succeed in school: She nearly failed several classes and was so quiet that teachers would sometimes mark her absent. But one day when she was 16, years of confusion gave way to “a huge moment of clarity.”
Williard took note as her mother mentioned a file from her school psychologist during a counseling appointment. She watched as her mom handed the file to the social worker to make a copy, then stuck the papers back in her purse. Later that night, Williard rummaged through the purse to find the file, a psychological evaluation from when she was 12. On that file was a mysterious classification, one neither her mother nor her school’s psychologist had since talked to her about: sluggish cognitive tempo.
“I had never heard of that my whole life,” Williard, now 19, recalled.
Williard sometimes thought that she had ADHD, or attention deficit hyperactivity disorder — though she was never diagnosed — because she had trouble paying attention, but other symptoms, like hyperactivity, didn’t fit her well. As she researched sluggish cognitive tempo, or SCT, online, the symptoms seemed just right: a problem with focusing was there, too, but also daydreaming, slow or “foggy” thinking, and a general lack of energy.
“I was just like, oh, my gosh, that makes so much sense,” Williard said. “Everything just started to fall into place.”
But SCT is not an officially recognized diagnosis. It’s currently what’s called a clinical construct — a term used in psychology to define a group of behaviors. Since its emergence nearly four decades ago, the study of SCT has been led by a small group of researchers, chief among them a controversial psychologist and ADHD expert who is adamant that SCT is a separate disorder potentially affecting millions of children and adults. If SCT became an official diagnosis, proponents argue, it could make it easier for those with symptoms of the construct to get the help they need, whether that be assistance in school or work or a medication that is more likely to work for them. But many researchers say the study of SCT, which is still in its early stages, can’t yet support a formal diagnosis. Critics dismiss the construct as fatally flawed and argue that SCT is an outgrowth of misdiagnosis of ADHD that could result in many being prescribed inappropriate medications.
While SCT remains in categorical limbo, Williard and others aren’t waiting for a scientific consensus. Many have found validation in a growing online community for SCT — a Facebook group counts more than 800 members, while an SCT community on Reddit has over 4,000. In their view, SCT has negatively shaped their lives, affecting everything from their mental health to their ability to pursue a fulfilling career. And in the absence of approved treatments, members crowdsource potential therapies.
“It really was nice to find other people that were like me,” said Williard.
The leading advocate for SCT, clinical psychologist Russell Barkley of Virginia Commonwealth University Medical Center, has been working for years to get the construct recognized and investigated by other psychologists. He’s written extensively on SCT, both in academic journals and online resources; given numerous talks on the construct; and has developed a rating scale for SCT in children and another for adults.
In the 1980s, a debate emerged among ADHD researchers as to whether two subtypes of ADHD, called predominantly hyperactive/impulsive and predominantly inattentive, could actually be separate disorders. Ever since, some researchers have examined that predominantly inattentive subtype and found that related characteristics — those eventually associated with SCT, like drowsiness, daydreaming, and lack of energy — seemed to be different than those associated with ADHD. 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.
Stirred by an influential 2001 paper on differences between predominantly inattentive ADHD and its other subtypes, Barkley argued in a related commentary that some people with symptoms of this inattentive subtype were very different than others with ADHD, which he thought could indicate that the inattentive subtype was a distinct disorder. Over time, he said he and others found that what distinguished these people were their SCT symptoms, and that it could be SCT, not inattentive ADHD, that was separate. By 2013, he had developed rating scales for SCT in both adults and children, which includes symptoms like losing one’s train of thought and tending to stare off into space.
“I’m willing to go out on that limb, as I did in the year ,” Barkley said in an interview. “If this pattern continues the way it is right now, this will be a new disorder.”
But Barkley is one of the few, if not the only researcher who is willing to call SCT a disorder. Even 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, believes it is too soon.
“I think there’s just a huge amount of research that needs to be done to support a new mental health disorder,” said Becker. “It’s still quite a small field.”
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