Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology

Abstract

Sluggish cognitive tempo (SCT) is separable from attention-deficit/hyperactivity disorder (ADHD) and other psychopathologies, and growing evidence demonstrates SCT to be associated with impairment in both children and adults. However, it remains unclear how SCT should optimally be conceptualized. In this article, we argue that multiple models of psychopathology should be leveraged to make substantive advances to our understanding of SCT. Both categorical and dimensional approaches should be used, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) nosology, the Research Domain Criteria (RDoC) initiative, and hierarchical models of psychopathology. Studies are needed to determine whether individuals categorized with SCT can be reliably identified and differentiated from individuals without SCT in pathophysiological, neuropsychological, behavioral, and daily life functioning. Studies are also needed to evaluate the validity and utility of SCT as a transdiagnostic and dimensional construct. In considering SCT as a dimensional and potentially transdiagnostic construct, we describe ways in which SCT might be examined within the RDoC framework, including negative valence systems, cognitive systems, and arousal/regulatory systems, as well as within hierarchical models of psychopathology. Conceptualizing SCT within both categorical and dimensional models of psychopathology will help to better understand the causes, developmental pathways, and clinical implications of SCT, both as a construct in its own right and also in relation to other psychopathologies.

Differential impact of trait sluggish cognitive tempo and ADHD inattention in early childhood on adolescent functioning

“…Although this is an oversimplification of the complexities of information processing and attention regulation difficulties, as well as their associations with functional outcomes, this possibility warrants empirical scrutiny with laboratory-based measures of mind wandering that can distinguish between internal and external distractors (Smallwood & Schooler, 2015). The separation of SCT and ADHD-IN in their relations to internalizing and externalizing psychopathologies also points to the value of examining SCT and ADHD-IN within hierarchical models of psychopathology, particularly as findings from such efforts may situate SCT within a theoretical framework and guide hypotheses for future work (Becker & Willcutt, 2018). …”

“…These findings raise the possibility that SCT may be its own psychiatric disorder (Barkley, 2014) or a construct of transdiagnostic importance (Becker et al, 2016; Becker & Willcutt, 2018). …”

“…Although SCT and ADHD inattentive (ADHD-IN) symptoms are empirically distinct, they are strongly correlated ( r =0.63) in childhood (Becker et al, 2016). Both SCT and ADHD-IN are conceptualized as reflecting difficulties in attention regulation, though perhaps with different etiologies in attentional brain systems (Barkley, 2014; Becker & Willcutt, 2018). For example, it has been hypothesized that SCT may in part derive from poor efficiency in the orienting network (Becker & Willcutt, 2018), and a recent neuroimaging study found SCT to be associated with hypoactivity in the superior parietal lobe consistent with this possibility (Fassbender et al, 2015).…”

“…Research in this vein is important for advancing theory and, ultimately, clinical care. For instance, findings from longitudinal research linking SCT to greater internalizing psychopathology and less externalizing psychopathology would shed light on the hypothesis that SCT is best conceptualized as part of the internalizing rather than externalizing spectra of psychopathology, which itself is theoretically important and has implications for etiology, pathophysiology, developmental course, and treatment (Becker & Willcutt, 2018). …”

Family environment moderates the relation of sluggish cognitive tempo to attention‐deficit/hyperactivity disorder inattention and depression

“…As the literature on SCT has advanced, attention has shifted from whether this constellation of symptoms is distinct from ADHD‐IN and depression to a focus on the unique outcomes associated with SCT and how the presence of SCT may influence the presentation and associated impairments among co‐occurring symptoms (Becker & Willcutt, ). Clearly, SCT is robustly associated with both ADHD‐IN and depression (Becker et al, ; Becker, Burns, et al, 2017).…”