Talk:Cognitive disengagement syndrome

What is SCT

This is a very misunderstood condition with very little information compared to "regular" ADHD. It will probably be in the next version of the DSM.—Preceding unsigned comment added by Scuro (talk • contribs) 18:13, 11 December 2006

I never heard of this before seeing it on Wikipedia. Are you aware of any literature published on it? -- Tim D 01:15, 12 December 2006 (UTC)

It is interesting to note what The New York Times [1] says on April 11, 2014 about this alleged disorder, and about a certain Wikipedia editor, Russell Barkley, PhD, whose financial ties to industry are noted on his own Wikipedia page.

The Times says, "Dr. Barkley, who has said that 'S.C.T. is a newly recognized disorder,' also has financial ties to Eli Lilly; he received $118,000 from 2009 to 2012 for consulting and speaking engagements, according to propublica.org. While detailing sluggish cognitive tempo in The Journal of Psychiatric Practice, Dr. Barkley stated that Strattera’s performance on sluggish cognitive tempo symptoms was 'an exciting finding.' [Strattera is sold by Eli Lilly.] Dr. Barkley has also published a symptom checklist for mental health professionals to identify adults with the condition; the forms are available for $131.75 apiece from Guilford Press, which funds some of his research.

"Dr. Barkley, who edits sluggish cognitive tempo’s Wikipedia page, declined a request to discuss his financial interests in the condition’s acceptance."

Please read the article for more information on what looks like disease mongering.

A Psychologist Wikiwonderwhy101 (talk) 02:50, 12 April 2014 (UTC)

So... I saw this complaint and I'm squinting at it. What I have found over the years is that when someone does not have a valid argument against a doctor's reasoning, they will bring up financial ties to pharmaceutical companies. If your arguments against it are limited to the doctor's financial ties to a particular manufacturer, I would respectfully suggest that you may need to find a better argument. Personally, I believe that the personal prestige of being the "discoverer" of a new condition is a more likely and probably stronger incentive; being known as the person who made a significant discovery is a huge incentive for many research doctors.

And, full disclosure, I find the evidence for CDS/CDD/SCT to be significantly less than compelling, personally, at present - to me, however, it's that I don't believe there is enough evidence that this is a distinct cluster of symptoms with a common etiology. There seems to be a "there" there, but it's not enough of a "there" to convince me that the cluster of symptoms called "CDS" is its own mental health condition.

Yet.

KateBergerMpls (talk) 17:01, 3 December 2023 (UTC)

I do not think that they should be conceived of as physically sluggish -- after all there is some correlation between hyperactivity (as measured by DSM-IV criteria) and SCT (eventhough it is not as strong as the correlation with inattentiveness). See eg. Hartman et al. (2004) Journal of Abnormal Child Psychology, Vol. 32, No. 5, October 2004, pp. 491–503. To my knowledge, no study has shown reduced physical activity along with increased SCT. (Of course, they are sluggish compared to the hyperactive ADHD/HI subtype, but not when compared to your 'average' child.)--89.253.76.55 (talk) 12:37, 14 March 2008 (UTC)

There is correlation between SCT and ADHD-IN and between ADHD-IN and ADHD-HI (of course) but not between SCT and ADHD-HI. | J Abnormal Psych, Jan 2014

This is not a new concept or designation. Dr. Russell Barkley in his lecture notes from 2000, speaks with authority on SCT. [2] Download the pdf and go to the second section entitled:"Is inattentive ADHD really another Disorder"? I believe researchers were already aware of this group back at the time of the formation of the DSM3 and that the critera for inattentive in that version match SCT more closely. When each version of the DSM is updated, they make final decisions by committee. Sometimes the best decisions are not made.

SCT does not equal inattentive ADHD. --Scuro 03:23, 12 December 2006 (UTC)

I agree that ADHD-I is likely something very different from ADHD, but I couldn't find his mention of "sluggish cognitive tempo" in those lecture highlights. Does he ever mention it by name? From what I've seen so far, it appears that if anything it could be a subset of ADHD-I -- Tim D 05:20, 12 December 2006 (UTC)

Actually here's a good article that summarizes the current situation concerning SCT. It looks to me that SCT is more of a factor that can help diagnose someone, rather than a diagnosis in itself. Perhaps in the future it will play a part in differentiating between ADHD-I and some other kind of inattention disorder, but at least according to the article cited above, it weighs pretty heavily with what's we see now as ADHD-I. -- Tim D 06:50, 12 December 2006 (UTC)

Sounds like when the next version of the DSM comes out, SCT will either be a separate disorder, or the inattentive subtype will be for "pure" inattentive ADHD (SCT) from birth.

The problem right now is that SCT does not equal inattentive ADHD. You can be SCT and qualify for the inattentive diagnosis but so could an adult ADHDer who formerly was hyperactive. Let me explain, a Hyperactive ADHDer in later life gets their first diagnosis, and they may well get a diagnosis of inattentive ADHD. Why?, a good number of those ADHDers who are hyperactive as children, lose their hyperactivity as adults. Remember, ADHD is a developmental disorder, things change. One of the major things to change is that ADHD kids often lose their hyperactivity but hang on to other ADHD traits. So going back to my example, this adult who formerly would have gotten a diagnosis of hyperactive ADHD, now could have enough inattentive symptoms to get the inattentive diagnosis and may not have enough of the Hyperactive symptoms to qualify for the other two types of ADHD. These former hyperactive ADHDers are very different from SCT's in most ways. THEY ARE NOT THE SAME.

SCT most likely was just a descriptor that someone researcher came up with so that you wouldn't get the the inattentive ADHDers from birth mixed up with the hyperactive ADHDers who may qualify for that diagnosis later in life. It is not a true designation nor can you diagnosis someone with it. Did that make sense? :)

Yes, it made sense. It's also wrong. :-) 78.144.77.25 (talk) 16:26, 27 April 2014 (UTC)

--Scuro 04:51, 13 December 2006 (UTC)

Right, I understand those things. Although the whole developmental part of ADHD isn't quite clear cut. Adults who grew up with ADHD may not "lose" their hyperactivity, per se; they simply develop skills to better cope with it as they mature. Many maintain their impulsiveness throughout their life, although often to a lesser and controlled degree. The inattention then may become the dominating feature of the disorder. But still, SCT does appear to be something that can be present in anyone with ADHD, but weighs heavily with the primarily inattentive subtype. It's an interesting construct, but I think think that it can be expressed better in this article.

By the way, do you have any resources saying that SCT may show up in the DSM-V? I haven't come across any yet.

-- Tim D 06:31, 14 December 2006 (UTC)

I took another wack at the article. Some of my previous edits were kind of messy. Some information also needed to be changed and some was added. I hope that reads a lot better. Yes, you are right about coping skills. Some ADHDers in adulthood will find more acceptable ways to deal with that hyperactive urge or will choose enviornments to work in that don't require silence and sitting still. Still other ADHDers will lose most or all of their hyperactivity. Some have suggested that the degree to which hyperactivity remains in adulthood , indicates in a general way, the level of ADHD within that individual.

I'm sorry if I haven't made myself clearer about SCT. SCT can not be present in all of those with ADHD. Barkley has stated that all ADHDers who have, or once had, a "wiff" of hyperactivity, should be excluded from this grouping. My guess is that once the Researchers finally started to look just at the charcteristics of inattentive subtype kids, they saw two different types of kids with two different profiles.

I believe Barkley was on the team that came up with designations for ADHD in the DSM3 and DSM4. He most likely will also part of that team for the DSM5. Barkley has stated that he would prefer that inattentive ADHD be kept for pure SCT for the present time. It is big mess now, and he has stated as much in any lecture he gives. He has also stated that he believes that it could be a different disorder in which case it would get it's own designation in the new DSM5. The jury is still out. Is SCT still part of ADHD? They are very different profiles yet I believe they share some impulsive traits. Personally, I believe that SCTers also have some degree of inhibition problems with emotions and some other areas. The two conditions do not share hyperactivity. Most of what I have stated beyond opinion, can be found in the PDF lecture notes of Russell Barkley in SF 2000. The link is in the external link section. --Scuro 03:55, 15 December 2006 (UTC)

There have been a number of new additions and changes since my last post. I believe I have this condition and have had great difficulty finding good information on this disorder. I have shared the best sources in the external link section and have tried to make concise and meaningful posts. I hope that the original posters can see where my motivation is coming from and generally accept the additions and deletions that I have made to make the article better. If you have better or newer info, please add!--Scuro 06:58, 17 December 2006 (UTC)

As of April 14th, 2014, the statement under SCT under History that "As of April 2014, sluggish cognitive tempo is the subject of pharmaceutical company clinical drug trials, including ones by Eli Lilly that proposed that Strattera could be prescribed to treat proposed symptoms of sluggish cognitive tempo.[4]" is false. The NYTimes did not say this nor does the research article in which the results of this study of ADHD children are reported. This study was not a clinical trial and did not recommend that Strattera be prescribed to treat SCT. Even if the article had so stated the company could make no such assertion as their drug is not FDA approved for treating this condition. Moreover, further into this section the editor states that Strattera is the best selling drug for Eli Lilly which is also false. Moreover, in various places in this webpage on SCT the statement is made that SCT researchers such as myself have conflicts of interest when no such conflicts have been demonstrated. Indeed I categorically deny them. My work with Eli Lilly was not funded to promote awareness of SCT and statements to that effect in this page are an utter falsehood. RussellBarkley (talk) 10:47, 15 April 2014 (UTC) — Preceding unsigned comment added by RussellBarkley (talk • contribs) 00:24, 15 April 2014 (UTC)

I have removed the statement from both the History and the Treatment sections of this entry that stated that Eli Lilly has conducted a clinical trial of atomoxetine for determining if its drug can be prescribed for use in SCT. While that statement did appear in the April 2014 NYTimes article as originally sourced here, the claim is mistaken as noted by an investigator on that study in a letter sent to the NYTimes to clarify this matter. So I have left these mistaken assertions in the Controversy section where they might belong rather than in the sections on History and Treatment, where they represent mistaken assertions. That letter from Dr. McBurnett is below:

"Editors, New York Times April 15, 2014 Please consider publishing my letter in an upcoming edition of the Times:

The Times deserves much credit for starting a national discussion on Sluggish Cognitive Tempo (SCT) (“Idea of New Attention Disorder Spurs Research, and Debate,” April 11). I was quoted accurately by Mr. Schwartz, but I would like to add a few clarifications, especially in light of the spirited commentary that resulted. SCT is not being pushed by big pharma or by organized psychiatry for profit motives. Eli Lilly did not design a study to show that atomoxetine (Strattera) reduces SCT, rather, I asked them to include SCT as a secondary outcome in a study of the drug’s effect on dyslexia, after the study design was nearly complete. I regularly conduct clinical trials on contract from pharmaceutical companies, but all of my funding to study SCT has come from NIMH. Most if not all of the research on SCT to date has been published by academic psychologists, who do not have prescribing privileges. Numerous peer-reviewed studies have demonstrated that SCT is highly associated with Inattention symptoms in ADHD, but also that it is a separate symptom group that is independently associated with impairment in daily functioning. This is a necessary but insufficient criterion for being considered a separate disorder. The best evidence for considering SCT to be a “new” (or newly recognized) disorder is Dr. Barkley’s 2012 study published in the Journal of Abnormal Psychology, in which he showed that adults who rated themselves high on SCT but low on ADHD symptoms also reported a broad array of associated problems in relationships, earning power, meeting daily responsibilities, and other domains. Such findings require replication using better methods before it can be determined with confidence that SCT is a separate disorder. However, there are many scientific reasons for studying SCT other than to provide evidence for its inclusion the next DSM. Finally, I think I can speak for most of my colleagues in saying that we do not believe that daydreaming and solitary thought are pathological or that they indicate a need for treatment. We are concerned as to whether excessive daydreaming may represent abnormal brain activity that is detrimental to an individual. My goal is to better understand the largely invisible cognitive difficulties of ADHD and SCT, when these are sufficiently severe as to keep people from achieving their full potential. Sincerely, Keith McBurnett, PhD Professor, Department of Psychiatry University of California, San Francisco"

RussellBarkley (talk) 15:35, 17 April 2014 (UTC)

Causes (citation needed)

I wrote "citation needed" in the sentence of causes, because I wonder in what way it is similar to ADHD when different genes and different regions of the brain are affected. Lova Falk 19:03, 8 April 2007 (UTC)

Treatment

This sentence is not clear: "Roughly one in five responds with a therapeutic decrease in symptoms, while two thirds of this population will show mild benefits."
Do you mean the following:
"Only roughly one in five with SCT responds with a therapeutic decrease in symptoms, while two thirds of the other types of ADHD will show mild benefits." Lova Falk 20:03, 8 April 2007 (UTC)

Learning difficulties?

I edited this sentence: "Those with SCT symptoms show a qualitatively different kind of attention deficit more typical of a true information input and output problem that one sees with a learning disability, than from those who have had a significant history of hyperactivity-impulsivity."
I found this sentence confusing, so I checked the reference: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811
Neither "input and output problem", "learning disability", nor "history" is mentioned in this article. So I removed all those parts and left an abbreviated version of this sentence.
Great source by the way! Lova Falk 14:47, 27 April 2007 (UTC)

Perhaps the sentence could be improved... if that is the main beef. Would you like to do an edit?

I didn't want to read through the initial source again so instead I've inserted another source where the word input and output is used explictly. Simply open up the pdf and search those words. Barkley clearly states that there are input problems with focus and also states that those with ADHD have an output problem eg they have difficulty doing work. As an aside he also states that those with SCT symptoms more frequently have LD's. With regards to the phrase, "those who had a significant history of hyperactivity"...this make reference to the fact one can be hyperactive as a child but show few or no hyperactive symptoms as an adult....thus there are those who ADHD who have a history of hyperactivity and those that don't. --scuro 20:09, 27 April 2007 (UTC)

ADD and SCT

I reverted the edit by "24.6.174.110" that substituted ADD for SCT. There is no consensus (yet?) that ADD = SCT, and therefore the terms cannot simply be substituted. So if articles are referenced in which the treatment of ADD are described, we cannot just write SCT instead. In fact, at least one of the referenced articles says there is a difference between ADD and SCT: "Many ADD children, although not all, appear sluggish, drowsy, spacey, lethargic, and markedly hypoactive. They fit the criteria for having a sluggish cognitive tempo (SCT)." (Italics done by me). In this article, the term ADD is used for "the truly inattentive type of ADHD (not simply the subthreshold combined type)". So apparently, according to Adele Diamond, not all ADD children fit the criteria for SCT. Lova Falk 06:48, 13 June 2007 (UTC)

I can't wait until the DSM-V comes out. Diamond took it upon herself to identify (SCT) as ADD. It makes sense because SCT is a true Attention deficit type disorder BUT Barkley has argued against using the term. SO...we go with what there is and what is currently used.

Officially every type of ADHD is all referred to as AD/HD and then categorized with the different subtypes. SCT as it is currently described would be a homogeneous group with the inattentive ADHD but SCT is not in the DSM4 for now and it is only a discriptive term. The way I would describe some displaying those symptoms would be that they have SCT tendencies or symptoms. The recent edits and deletions have changed the meaning somewhat.--scuro 15:56, 13 June 2007 (UTC)

April 2014 New York Times article on sluggish cognitive tempo

Idea of New Attention Disorder Spurs Research, and Debate by Alan Schwarz, The New York Times, April 11, 2014 --24.97.201.230 (talk) 04:31, 12 April 2014 (UTC)

In this New York Times article, it was disclosed that Russell Barkley of the Medical University of South Carolina, who received $118,000 from 2009 to 2012 from Eli Lilly, edits the sluggish cognitive tempo wikipedia page. --24.97.201.230 (talk) 05:22, 12 April 2014 (UTC)

This is Russell Barkley's wikipedia article: Russell Barkley

These are Russell Barkley's contributions: Special:Contributions/RussellBarkley --24.97.201.230 (talk) 05:25, 12 April 2014 (UTC)

Yes, I've added a {{connected contributor}} note about this, at the top of the page. He is bound by Wikipedia:Conflict of interest, which states in part:

"If either of the following applies to you: [...] 2. you expect to derive monetary or other benefits or considerations from editing Wikipedia (for example, by being an owner, officer, or other stakeholder of an organization; or by having some other form of close financial relationship with a topic you wish to write about),

then you are very strongly discouraged from directly editing Wikipedia in areas where those external relationships could reasonably be said to undermine your ability to remain neutral. If you have a financial connection to a topic – including, but not limited to, as an owner, employee, contractor or other stakeholder – you are advised to refrain from editing affected articles directly."

Superm401 - Talk 02:37, 13 April 2014 (UTC)

The discussion on this conflict of interest can be found here. Lova Falk talk 17:58, 13 April 2014 (UTC)

The current web page for SCT has been updated recently by someone to include false statements about me and my association with the Eli Lilly company. The section on Controversy now reads: "Adding to the controversy are potential finance-related conflicts of interest among the condition's proponents, including the funding of several prominent SCT researchers' work by global pharmaceutical company Eli Lilly and, in the case of Barkley, direct payment from that company for promoting professional and public awareness of sluggish cognitive tempo. According to the New York Times, "Dr. Barkley, who has said that 'SCT is a newly recognized disorder'...received $118,000 from 2009 to 2012 for consulting and speaking engagements" related to the phenomenon." This is a completely false statement. I have never received any payment from Eli Lilly for speaking about SCT nor has my past income from this company been "related to the phenomenon." Neither this editor or the NY Times have any evidence that this has been the case. You have also stated that the Eli Lilly company has funded a clinical trial of their drug for SCT, which is also false. Eli Lilly funded an investigator who proposed to study the effects of atomoxetine on childrn with ADHD. Only secondarily did they study their drug for its effects on SCT symptoms. In that study only children with ADHD and those having both ADHD and reading disorders were included. They assessed SCT symptoms as a secondary measure. This does not constitute a clinical trial for SCT as they children were not selected for that condition. Such a study would never permit Lilly to market their drug for SCT. Clearly the writer does not understand the nature of a clinical trial or primary vs. secondary measures or what the FDA requires as evidence to permit promotion of a drug for a mental condition. That company is not able to directly benefit from any findings on SCT as their drug is not FDA approved for any such condition and they are forbidden from making any promotional statements about their drug for any condition for which they have not received FDA approval. That would be off-label promotion which is forbidden by the FDA. Again the writer appears to be uninformed about the nature of FDA restrictions on drug promotion. RussellBarkley (talk) 10:55, 15 April 2014 (UTC) — Preceding unsigned comment added by RussellBarkley (talk • contribs) 00:05, 15 April 2014 (UTC)

I added the "Controversy" section, and in light of your last post here, have just now edited it to more closely reflect the tone of the NY Times piece referenced, which is, as far as we among the NY Times readership know, an accurately reported, as-of-yet unretracted article. If you feel that the actual reporting was in error, I believe you'll have to take it up with that publication. Any further insight or advice here from Wikipedia moderators is more than welcome. With regard to the rest of your post, i.e. the part addressing the "Treatment" section of the Wikipedia article, I haven't been involved with that section, so I can't comment. — Preceding unsigned comment added by 69.171.176.241 (talk) 00:57, 15 April 2014 (UTC)

I take issue with how extensive the controversy section is right now. I mean, we have devoted an entire section to a single source. That doesn't seem to be inline with our policies on due weight. Here are some suggestions:

• The five-sentence quote from Dr. Frances can be summarized.
• I also wouldn't call this "significant" skepticism (again, it's only one article).
• The long quote from Dr. Lee can also be summarized in prose.

As for resolving the claimed inaccuracies from the NYT article, I'll be inviting an administrator to evaluate the situation here to see what we can do. RussellBarkley, I'll ask you to refrain from making warnings or references to possible legal action as we continue here. These are considered legal threats and make resolving these issues on Wikipedia more difficult. I, JethroBT ^{drop me a line} 01:47, 15 April 2014 (UTC)

I have edited the controversy section to reduce it's length and remove any unsourceable claims. I think the section's current length is appropriate given that although the two quotes provided are from the same NYT article, they represent two viewpoints from two independent and respected leaders in the field. As well, while it appears on good faith that there is no direct link from the Dr. Barkley's funding to his research on SCT (as per Dr. Barkley), it is common practice in the medical community to cite any external funds received as "potential conflicts of interest," and should certainly be mentioned here. — Preceding unsigned comment added by 173.69.2.136 (talk) 15:18, 15 April 2014 (UTC)

Thank you. I shall do so. The intent was to merely alert you to false statements that had been inserted about me into this entry on SCT. You are wise not to place so much emphasis on a single source and if you do be sure to state it accurately. Moreover, using a content entry to permit criticism of an investigator is also not consistent with your usual activities. The content stands or falls on the basis of citations provided for that content to other, in this case, scientific publications and subsequent editors are free to correct such content that is inaccurate RussellBarkley (talk) 10:55, 15 April 2014 (UTC)

Thanks, 173.69.2.136, for reverting the total deletion of the 'Controversy' section and focusing it. What very much needs to be there for now is still there. I'm guessing that some further streamlining and possible expansion of the section will be forthcoming, as additional sources and discussions about a subject with very deep medical, social and cultural implications inevitably become much more available. From the last 24 hours:

• http://www.chicagoreader.com/Bleader/archives/2014/04/14/could-a-cure-for-sluggish-cognitive-tempo-be-around-the-corner
• http://www.sfgate.com/technology/businessinsider/article/Doctors-Are-Talking-About-Creating-A-New-5402287.php (contains a far more strongly worded position from Dr. Frances)
• http://www.theguardian.com/society/shortcuts/2014/apr/15/sluggish-cognitive-tempo-new-disorder-rival-adhd (refers to this talk page) — Preceding unsigned comment added by Fetald (talk • contribs) 00:49, 16 April 2014 (UTC)

Here is another article that just appeared on the web if you wish to reference it as well. http://psychcentral.com/blog/archives/2014/04/16/does-sluggish-cognitive-tempo-sct-exist/ RussellBarkley (talk) 15:46, 17 April 2014 (UTC)

Russell Barkley-- the source for the Eli Lilly connection claims is the New York Times! --24.97.201.230 (talk) 23:23, 17 April 2014 (UTC)

Idea of New Attention Disorder Spurs Research, and Debate by Alan Schwarz, The New York Times, April 11, 2014 says the following about Barkley:

• The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”
• Dr. Barkley, who has said that “S.C.T. is a newly recognized disorder,” also has financial ties to Eli Lilly; he received $118,000 from 2009 to 2012 for consulting and speaking engagements, according to propublica.org. While detailing sluggish cognitive tempo in The Journal of Psychiatric Practice, Dr. Barkley stated that Strattera’s performance on sluggish cognitive tempo symptoms was “an exciting finding.” Dr. Barkley has also published a symptom checklist for mental health professionals to identify adults with the condition; the forms are available for $131.75 apiece from Guilford Press, which funds some of his research.
• Dr. Barkley, who edits sluggish cognitive tempo’s Wikipedia page, declined a request to discuss his financial interests in the condition’s acceptance. --24.97.201.230 (talk) 23:23, 17 April 2014 (UTC)

Strattera claims

RussellBarkley has been removing statements from the Schwartz NYT piece, which describe a clinical trial of a drug called Straterra done by a Dr. McBurnett and funded/overseen by Eli Lilly. The study's purpose, according to the article, was to test whether symptoms of SCT could be treated with this drug. RussellBarkley, can I ask why you are removing this material? Furthermore, I'd ask that whenever you are going to make substantial changes to the article, that you bring them up on the talk page before they are made. I, JethroBT ^{drop me a line} 15:36, 17 April 2014 (UTC)

OK. I am still here on the page but as my comments above indicate these claims about Eli Lilly doing a clinical trial are mistaken as shown in a letter to the NYTimes by one of the investigators on that study so it seemed best to leave the assertion of the NyTimes on that matter under the Controversy section instead of repeating it twice more under the History and Treatment sections. Does that make sense? Or should the mistaken assertions be left in those locations? I have placed the letter from Dr. McBurnett here to show that the assertion by the NYTimes was a misrepresentation of that study. Should that clarification be made here or not? RussellBarkley (talk) 15:44, 17 April 2014 (UTC)

Thanks for the clarifications. I agree that it is excessive to have the claim repeated in multiple places. I think it probably should go under the Treatments section for now though (because the claim is about the treatment of SCT symptoms). You mentioned a letter from Dr. McBurnett, but I do not see it in the article or on this talk page. Could you point me to where you have placed it? I, JethroBT ^{drop me a line} 16:02, 17 April 2014 (UTC)

The letter is above under What is SCT explaining why I deleted that first assertion but here it is again:

Letter to the NYT Editors from Dr. McBurnett; collapsing for length

"Editors, New York Times April 15, 2014 Please consider publishing my letter in an upcoming edition of the Times: The Times deserves much credit for starting a national discussion on Sluggish Cognitive Tempo (SCT) (“Idea of New Attention Disorder Spurs Research, and Debate,” April 11). I was quoted accurately by Mr. Schwartz, but I would like to add a few clarifications, especially in light of the spirited commentary that resulted. SCT is not being pushed by big pharma or by organized psychiatry for profit motives. Eli Lilly did not design a study to show that atomoxetine (Strattera) reduces SCT, rather, I asked them to include SCT as a secondary outcome in a study of the drug’s effect on dyslexia, after the study design was nearly complete. I regularly conduct clinical trials on contract from pharmaceutical companies, but all of my funding to study SCT has come from NIMH. Most if not all of the research on SCT to date has been published by academic psychologists, who do not have prescribing privileges. Numerous peer-reviewed studies have demonstrated that SCT is highly associated with Inattention symptoms in ADHD, but also that it is a separate symptom group that is independently associated with impairment in daily functioning. This is a necessary but insufficient criterion for being considered a separate disorder. The best evidence for considering SCT to be a “new” (or newly recognized) disorder is Dr. Barkley’s 2012 study published in the Journal of Abnormal Psychology, in which he showed that adults who rated themselves high on SCT but low on ADHD symptoms also reported a broad array of associated problems in relationships, earning power, meeting daily responsibilities, and other domains. Such findings require replication using better methods before it can be determined with confidence that SCT is a separate disorder. However, there are many scientific reasons for studying SCT other than to provide evidence for its inclusion the next DSM. Finally, I think I can speak for most of my colleagues in saying that we do not believe that daydreaming and solitary thought are pathological or that they indicate a need for treatment. We are concerned as to whether excessive daydreaming may represent abnormal brain activity that is detrimental to an individual. My goal is to better understand the largely invisible cognitive difficulties of ADHD and SCT, when these are sufficiently severe as to keep people from achieving their full potential. Sincerely, Keith McBurnett, PhD Professor, Department of Psychiatry University of California, San Francisco"

RussellBarkley (talk) 16:04, 17 April 2014 (UTC)

Thanks for providing the letter contents. There are further complications though, because this letter to the editor has not actually been published anywhere; we can't direct readers to this talk page as a source for this letter. We do allow self-published sources from experts in limited circumstances, however, and I think it would be fair to use this information to say that the claims from the NYT are contested. Is it possible that Dr. McBurnett can publish this letter online, such as on a blog or other website that is clearly maintained by him? I, JethroBT ^{drop me a line} 17:00, 17 April 2014 (UTC)

Scope of controversy

Looking for some input here before editing in hopes of avoiding, you know, fireworks. In the spirit not of mere contrarianism, but of thorough acknowledgement of the pretty fascinating professional debate that's already out there, I believe there's improvement that can made to the "Controversy" section. RussellBarkley's link to the psychcentral.com blog piece above (added to my short link list in the "April 2014 New York Times article on sluggish cognitive tempo" section) is well taken; that piece offers a legitimate criticism of NYT's (and other news outlets') arguably sloppy equating of a "new" disorder with the "newly recognized disorder" that Dr. Barkley was quoted as terming SCT — not quite a point that's at the very heart of the debate, but certainly fair enough.

So, what is at the heart of the debate?

In addition to the NYT-sourced quotes I included in the original "Controversy" draft, there exist more (and stronger) cases publicly made against the recognition of SCT as a potentially pharmaceutically treatable disorder:

• Dr. Allen Frances (already included in this section) gets even more candid with his opinions in a Psychology Today blog article, beginning with "'Sluggish Cognitive Tempo' may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered..." and going on to say, "The very same experts who succeeded in promoting ADHD have now concocted and are promoting a new diagnosis that would be a terrific bonanza for pharmaceuticals, but terrible for the kids who would be misdiagnosed and over-treated." [3]

• On the same website, Dr. Lois Holzman weighs in, beginning with, "A friend from South Africa contacted me today to see if I had read the article about a new diagnosis, sluggish cognitive tempo. I hadn’t. My first thought was that she must be referring to some parody of diagnosis in The Onion." Holzman then moves on: "...It seems to me that it’s time to stop identifying [SCT researchers cited in the NYT article] as 'experts in mental health.' They have nothing whatsoever to do with health. Thir [sic] business is illness. They’re illness makers. What they do is create illness—not merely mental (whatever that is supposed to mean) but social, cultural, political and ethical illness...What are we doing to our children—and, consequently, to everyone? How have we let an illness model transform what childhood—and, consequently, family life is? How has understanding “what’s going on with these kids” (if, indeed, anything is going on with them) become identical to diagnosing them as sick?...I fear that without addressing and transforming the pervasive and more pernicious diagnostic way of seeing the world that we’ve all been socialized to—we’ll soon have to daydream in secret, until we no longer have anything to daydream about." [4]

• Clinical psychologist Bruce E. Levine has just written a long-form piece outlining what he sees as a now deeply corrupt alliance among researchers and pharmaceutical giants, going so far as to say, "But while politically astute establishment psychiatrists such as [National Institute of Mental Health Director Thomas R.] Insel, Frances and others are calling for reform, the institution of psychiatry may well be so damaged by a generation of drug company corruption that it cannot be reformed in any meaningful way." I'm including that quote here just for context. Later, however, Levine says, "While psychiatrists have grabbed the big money from drug companies, a few thought leader psychologists are picking up Big Pharma loose change..." and follows the statement with a single example: a description of Dr. Barkley's financial connection to Eli Lilly, as reported by NYT. [5]

The goal here, I remind, is not to blanket the "Controversy" section with a mish-mash of angry criticism of SCT or its researchers. It's to get across the real gist of the debate, i.e. the uncommonly elemental, ground-level nature of the disagreements about SCT's significance to society — particularly the development of a youth demographic who will indisputably be affected strongly, for better or worse, by decisions made now on medical, scientific, political, economic, cultural, and even philosophical levels. As has long been the case with ADHD, even a cursory look through the dissenting opinions that now exist with regard to SCT is enough to show a reader the severity of polarization here, and yes, the high emotion now being expressed, even—strikingly—by prominent, vetted professionals with "something to lose." I believe some of this needs to be reflected in the section. Thoughts? Fetald (talk) 20:36, 17 April 2014 (UTC)

User 24.97.201.230 has already relocated his/her latest comment from this space to the intended NYT article section above, but I've kept this portion of it here:

Idea of New Attention Disorder Spurs Research, and Debate by Alan Schwarz, The New York Times, April 11, 2014 says the following about Barkley:

[...]

• The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.” --24.97.201.230 (talk) 23:23, 17 April 2014 (UTC)

Thanks for the reminder that Dr. Barkley has, it appears, repeatedly referred to SCT as a "new" disorder — an idea contrary, by the way, to the opposite idea (i.e., SCT is not new) being argued in a sizable portion of the psychcentral.com blog item [6] that he himself added to my little suggested-reading list from earlier in this section. Presumably, he suggested this article for other reasons (e.g. the included statements about non-Big-Pharma-funded SCT research) but I'm not sure. Anyway, this blog item, taken along with the above NYT-sourced Barkley quote does rather undercut what I was implying in my last comments, i.e. that to be fair, Barkley has been, perhaps in the interest of historical accuracy, conscientiously limiting his description of SCT to that of a "newly recognized disorder" — something that's apparently not the case. Fetald (talk) 01:53, 18 April 2014 (UTC)

Relation to Dysexecutive Syndrome

Revised this section as noted. As I further explore references, I am concerned that a good part of this article is written in a biased manner, ie towards SCT being a distinct disorder, as opposed to the current (and recent, with the new DSM-V making no mention of it) scientific consensus that it is not a distinct disorder, as noted in the ongoing controversy section.

In regards to this dysexecutive section, I am not sure that it should exist. This section (prior to my edit) could be paraphrased as follows: "this paper (Diamond) says ADHD-I and SCT both have problems with EF. this paper (Barkley) says SCT does not have problems with EF. therefore, SCT is likely different from ADHD-I." In fact, as I alluded to in the edit, Diamond's paper actually simply assumes there is overlap between ADHD-I and SCT, but does not evaluate any proposed symptoms of SCT, and only mentions it in passing. It is hard to construe that she is actually claiming that those with SCT symptoms have problems with EF (again, since no SCT symptoms were evaluated). Since the Barkley paper, and the section as it reads now, simply states that those with SCT don't have problems with EF, I'm not sure why this is worth mentioning. (Other than to add a sense of scientific validity [via length] to the overall article.)

Quote from Diamond source (p4), only mention of SCT in entire 12 page paper, and only to state that she is not talking about SCT.

"In this article, I focus on individuals with ADD (those who meet the criteria for inattentive-type ADHD and who are not hyperactive, excluding those with significant hyperactivity even if subthreshold for a combined-type diagnosis according to current DSM criteria). There is considerable overlap between what I am calling 'ADD' and what others have called 'slow cognitive tempo' (SCT; e.g., Milich et al., 2001), but SCT includes additional features that characterize only a subset of children with ADD."

Should this section disappear? — Preceding unsigned comment added by 173.69.2.136 (talk) 04:28, 18 April 2014 (UTC)

Article Reorganization

As I further reference check and find less and less evidence that anyone besides a few believe that this is a distinct disorder, I propose that the page be newly reorganized. Rather than "disorder: causes, treatment, prognosis, controversy", I think it should take the form of "proposed disorder: brief description, arguments for being a distinct disorder, arguments against being a distinct disorder".

The current article organization itself lends credence to the very disputed claim of a distinct disorder. As well, the current cause/treatment/prognosis sections talk less about these issues in relation to SCT, and instead, simply use them to contrast what is known about SCT with what is known about ADHD.

Any thoughts before I have at it? — Preceding unsigned comment added by 173.69.2.136 (talk) 04:59, 18 April 2014 (UTC)

Agreed that the current organization lends credence not supported by the content. I say have at it. If the meatier stuff is out there to support a return to the current scheme, then let it build legitimately. Fetald (talk) 18:47, 18 April 2014 (UTC)

Started reorganization process by clearly delineating proposed differences in SCT v. ADHD. Next, plan to reorganize most of current article into section 'arguments for being a distinct disorder', followed by section 'arguments against.' 'For' will hopefully have most of the well thought out literature already presented, 'against' will hopefully have both mention of recent events and other experts weighing in, as well as critical review of literature presented in the 'for' section. — Preceding unsigned comment added by Clraiyt (talk • contribs) 04:59, 22 April 2014 (UTC)

Neutrality and Factual accuracy dispute from December 2015?

Yeah, this is something that's been allowed to continue for close to a year now.

Just WHAT are these disputes supposed to be composed of?? WHAT are the factual inaccuracies which have been noted? How exactly is this article supposed to be improved, when whoever logged the complaint doesn't deem it FIT to reveal his or hers suggestions or concerns?

I'd like to improve the quality of this article, but I have NO IDEA where to begin...! So, whoever you are, contrarian guy, stand up and reveal yourself! WHAT do you want, anyway?! — Preceding unsigned comment added by 79.138.33.214 (talk) 08:36, 2 October 2016 (UTC)

I fully agree with you, I couldn't find out either what exactly is considered inaccurate or critized because none of these people wrote sth. on the talk page. My suggestion now would be to keep it for a month or so that people can comment on the issue. But then delete it if, nothing changes.--Trantüte (talk) 22:29, 13 March 2017 (UTC)

Done. Trantüte (talk) 14:13, 18 April 2017 (UTC)

Concentration Deficit Disorder

Hello all,

You're welcome from me adding the term Concentration Deficit Disorder to the page.

I am convinced that there is truth to the existence of this disorder based on my own experiences while growing up. The description of the disorder and what I remember is too similar to be a coincidence. I was diagnosed with ADD (predominately Inattentive) and Asperger's plus a mood disorder (major depression most likely). It has always irked me that the diagnosis did not fully encompass what I experienced from a subjective perspective.

Although I am in no way a licensed medical professional, my intuition tells me this much. If CDD can be proven to exist, then there must also be some kind of connection between it and both autism spectrum disorders and schizoid personality disorder, hidden or otherwise. There could also be a link between CDD and PTSD. Finally, I suspect that my own condition was initially caused by a bad case of rotovirus, which in turn negatively impacted my body's microbiome.

TL;DR I believe the people who are making this page are on the right path. Keep researching!

NAStrahl (talk) 21:49, 2 December 2016 (UTC)

Transportation Theory

Hello again,

I have recently discerned and hypothesize that there is a connection between SCT/CDD and the processes described in this article:

https://en.wikipedia.org/wiki/Transportation_theory_(psychology)

NAStrahl (talk) 01:45, 21 September 2017 (UTC)

Depression and SCT

How much research has been done to distinguish SCT from depression? Specifically, how much evidence exists for the existence of SCT independently of a depression disorder, given the very clear overlap between the lethargy and anhedonia present in the latter? This would be useful to add to the article given that this disorder is ultimately speculative and not established at this time. 65.79.146.140 (talk) 18:57, 21 July 2023 (UTC)

Requested move 12 August 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Moved. History6042 (talk) 12:02, 9 September 2023 (UTC)

---

(non-admin closure)

Sluggish cognitive tempo → Cognitive disengagement syndrome – The article that introduced the name "cognitive disengagement syndrome" announced it as a consensus change in terminology of an international work group that convened in 2021. [7] Since then, "cognitive disengagement syndrome" has been seeing adoption as a replacement in the literature. 130.126.255.178 (talk) 18:26, 12 August 2023 (UTC)— Relisting. estar8806 (talk) ★ 15:10, 22 August 2023 (UTC)— Relisting. —usernamekiran (talk) 08:40, 30 August 2023 (UTC)

• If done, please use sentence case (Cognitive disengagement syndrome). —⁠ ⁠BarrelProof (talk) 00:33, 13 August 2023 (UTC)
• Agree with BarrelProof that it should not be capped. But it also feels too soon; not sure. Dicklyon (talk) 05:15, 16 August 2023 (UTC)

I fully support this change. The aspect of "tempo" connotes retardation and is not relevant to the phenotype, which is rather a disorder of attention and fatigue. "SCT" patients do not feel represented by the label, which limits its ability to make traction as a diagnosis. First sentence should read, "Cognitive disengagement syndrome or sluggish cognitive tempo..." and then default to the former term throughout. Dogeatgod888 (talk) 16:22, 16 August 2023 (UTC)

I agree. It should be "Cognitive disengagement syndrome" first. 87.104.32.202 (talk) 15:19, 17 August 2023 (UTC)

While I agree with the name-change, I think the article starts out with a too strong statement about CDS being different from ADHD. Not everyone agrees with that. 87.104.32.202 (talk) 15:22, 17 August 2023 (UTC)

While not everyone agrees that CDS is different from ADHD, it has a separate set of symptoms from ADHD. Including that CDS is distinct from ADHD clearly highlights this which demonstrates the importance for the condition to be recognised. 61.68.158.49 (talk) 02:58, 2 September 2023 (UTC)

• agree with BarrelProof--Ozzie10aaaa (talk) 12:35, 1 September 2023 (UTC)

Relisting comment- requesting more policy and evidence based comments--estar8806 (talk) ★ 15:10, 22 August 2023 (UTC)

Note: WikiProject Psychology has been notified of this discussion. —usernamekiran (talk) 08:39, 30 August 2023 (UTC)

Note: WikiProject Medicine has been notified of this discussion. —usernamekiran (talk) 08:39, 30 August 2023 (UTC)

Note: WikiProject Autism has been notified of this discussion. —usernamekiran (talk) 08:39, 30 August 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

ICD-10 or blue book

Similarly, ICD-10, the medical diagnostic manual, has no diagnosis code for SCT. (my emphasis) Probably splitting hairs but... ICD-10 is not a diagnostic manual. It's a classification system used to generate statistical data. Are we instead referring to The ICD-10 Classification of Mental and Behavioural Disorders, Clinical descriptions and diagnostic guidelines here? Whilst both use the same codes; ICD-10's Chapter V only has glossary terms, it's the blue book that has the diagnostic criteria. I feel that if we are referring to the blue book, it's worth clarifying as such—even if that's just a wikilink to Medical classification#Derived classifications. Little pob (talk) 15:17, 12 September 2023 (UTC)

"It has reached the threshold of evidence and recognition as a distinct syndrome." - undue weight?

From the lede: "It has reached the threshold of evidence and recognition as a distinct syndrome."

The source here passes the verifiability check, and the sentence does not appear to be WP:ORIGINALRESEARCH, however I do think it's on the precipice of WP:UNDUE to base such a claim off a single source. If we cannot find additional sources I would be in favor of rewording it to something along the lines of "It has reached the threshold of evidence and recognition as a distinct syndrome according to the Journal of the American Academy of Child and Adolescent Psychiatry". Tdmurlock (talk) 21:37, 19 February 2024 (UTC)

Pinging the user who made the edit: @Димитрий Улянов Иванов Tdmurlock (talk) 21:43, 19 February 2024 (UTC)

Thanks for writing. I disagree as it is an international scientific consensus which also reviews the established scientific literature findings attesting their conclusion; thus I don't think that violates WP:UNDUE, at least from my understanding (I may be wrong). In fact, it was concluded: "To experts in the field, it is evident that CDS has reached the threshold of recognition as a distinct syndrome. Still, there is much more work to be done in further clarifying its nature, etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Many directions remain ripe for future study. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding of CDS and to improve the lives of individuals with this unique syndrome." Димитрий Улянов Иванов (talk) 22:10, 19 February 2024 (UTC)

References

Thyroid causing similar symptoms

Hello, @Димитрий Улянов Иванов:, in this edit you removed

Other medical conditions, such as thyroid problems, may cause the same symptoms.

But, if I'm reading this correctly, that sentence isn't saying they're the same or that thyroid problems can cause SGT/CDS, I read it as they have similar symptoms and thus should be considered in a differential diagnosis. Am I reading that wrong or should that remain, perhaps just rephrased? Kimen8 (talk) 12:27, 4 April 2024 (UTC)

Hi, your understanding is perfectly correct. The consensus statement shows that CDS does form unique symptom dimensions that do not overlap completely with any other condition, from my understanding at least. For example, some, but not all, of its inattention symptoms may overlap with ADHD.

So I think it should be rephrased; how about to say that its symptoms partially overlap with other conditions (e.g., ADHD, depression, anxiety etc), although it is itself a distinct construct/syndrome? Sorry for my misreading and thanks for checking on that issue. Димитрий Улянов Иванов (talk) 12:59, 4 April 2024 (UTC)

Something like that. My go at it would be more like (replace CDS/SGT with whatever you're calling it in the article):

Although some symptoms (e.g., ADHD, depression, anxiety) of a thyroid disorder are shared with CDS/SGT, they are distinct conditions and are managed differently.

This captures that (1) they may appear superficially similar, but (2) are not the same, and (3) treatment differs.

Kimen8 (talk) 13:05, 4 April 2024 (UTC)

I agree, Very good. Димитрий Улянов Иванов (talk) 13:09, 4 April 2024 (UTC)