Sluggish Cognitive Tempo Symptoms Contribute to Heterogeneity in Adult Attention-Deficit Hyperactivity Disorder

Abstract

Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in over 50% of cases, although its associated symptom profiles, comorbid problems, and neuropsychological deficits change substantially across development. Sluggish cognitive tempo (SCT) symptoms may contribute to associations between ADHD and comorbid problems and may partially explain the substantial heterogeneity observed in its correlates. 349 adults aged 18–38 years (M = 23.2, SD = 4.5, 54.7% male, 61.03% with ADHD) completed a multi-informant diagnostic procedure and a comprehensive neuropsychological battery. Adults with ADHD (n = 213) were retained for analyses. Latent class analyses (LCA) revealed three profiles of SCT symptoms among those with ADHD, which we classified as minimal, moderate, or severe SCT. Multiple analysis of covariance (MANCOVA) revealed significant differences among these profiles, which remained when controlling for persistence of ADHD symptoms and sex. In general, adults with ADHD combined with SCT symptoms (moderate and severe) had significantly more symptoms of anxiety, depression, and persistent inattention, and had more severe professional and relational impairment compared to ADHD adults without SCT. Compared to those with moderate or minimal SCT symptoms, the severe SCT group had the most symptoms of depression and internalizing disorders, and the most impairment in the domain of daily responsibility. No significant differences based on externalizing symptoms emerged when controlling for sex and persistence of inattention symptoms, suggesting the moderate and severe SCT groups do not simply reflect more symptoms. Moreover, follow-up mediation analyses revealed that SCT might at least partially explain the heterogeneity in ADHD. Findings have implications for refinement of etiological conceptualization, assessment methods, and intervention strategies.

The Relationship between Sluggish Cognitive Tempo, Self-esteem, and Attention-deficit Hyperactivity Disorder among University Students

“…This result is consistent with the findings related to hypothesis 2 that there is a significant correlation (0.63) between SCT and ADHD, and a significant correlation (0.25) can be found between self-esteem and ADHD. It is also consistent with the findings that mediation follow-up analyses revealed that SCT may at least partially explain the heterogeneity in ADHD (Kamradt Momany, and Nikolas, 2018). The higher levels of SCT also predicted higher levels of anxiety, depression, academic, and social weakness (Bernad, Servera, Becker, and Burns, 2016).…”

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

“…Further, given not only small effects, but also the nonsignificant moderation for positive emotional climate on the association of SCT to ADHD‐IN, several other nonfamilial (e.g., peers relationships) or nonenvironmental factors (e.g., biology) might be considered in future research examining potential moderating influences on the relations of SCT with ADHD‐IN and depression. Finally, we assumed that stronger associations of SCT with depression and ADHD‐IN would worsen impairment given preliminary research showing that adults with ADHD combined with SCT symptoms have more impairment compared to adults with fewer SCT symptoms (Kamradt et al, ). Although beyond the scope of the present paper, testing the three‐way interaction of family environment, SCT, and co‐occurring symptomatology as predictors of specific domains of functional impairment would be a needed and exciting next step.…”

“…SCT symptoms are also strongly related to, yet empirically distinct from, depression in adults (Becker, Burns, et al, 2017). In fact, some studies find stronger associations between SCT and internalizing symptoms (particularly depression) than between SCT and ADHD‐IN and internalizing symptoms (Becker, Langberg, et al, 2014; Kamradt, Momany, & Nikolas, ).…”

“…The relation between SCT and depressive symptoms may be strengthened in an environment with infrequent modeling and reinforcement of PA. Researchers contend that SCT and depression may have shared core aspects, such as underactivity and drowsiness that may explain the substantial overlap between these symptom domains (Becker, Luebbe, Fite, Stoppelbein, & Greening, ; Kamradt et al, ). Therefore, an individual's tendency toward these behaviors may exacerbate depressive symptomatology in an environment that does not specifically socialize and encourage PA.…”

Sluggish cognitive tempo and personality: Links to BIS/BAS sensitivity and the five factor model

“…For instance, it has been shown that SCT is not best included as part of a general disruptive behavior factor (Lee et al, 2016). Rather, SCT is more strongly associated with internalizing symptoms than with externalizing behaviors (Becker et al, 2016), and SCT symptoms are associated with increased anxiety/depressive symptoms in adults (Becker, Burns, et al, 2018; Becker, Langberg, et al, 2014; Kamradt et al, 2017; Leikauf & Solanto, 2017; Wood, Lewandowski, et al, 2017). Studies of adults, primarily conducted in college students, have also found SCT symptoms to be associated with increased social withdrawal/isolation and loneliness, lower self-esteem, greater emotion dysregulation, suicide risk, and poorer sleep quality (Barkley, 2012; Becker, Burns, et al, 2018; Becker, Holdaway, et al, 2018; Becker, Luebbe, et al, 2014; Flannery, Becker, et al, 2016; Jarrett et al, 2017).…”