Neurocognition in children with cognitive disengagement syndrome: accurate but slow

ABSTRACT

Cognitive disengagement syndrome (CDS), previously termed sluggish cognitive tempo (SCT), is characterized by excessive daydreaming, mental confusion, and slowed behavior or thinking. Prior research has found inconsistent relations between CDS and neurocognition, though most studies have used small or ADHD-defined samples, non-optimal measures of CDS, and/or examined limited neurocognitive domains. Accordingly, this study examined the association of parent- and teacher-reported CDS symptoms using a comprehensive neurocognitive battery in a sample of 263 children (aged 8–12) selected with a range of CDS symptomatology. Parents and teachers provided ratings of CDS and ADHD inattentive (ADHD-IN) symptoms. Path analyses were conducted to examine CDS and ADHD-IN as unique predictors of neurocognitive functioning after covarying for age, sex, and family income. CDS symptoms were uniquely associated with slower performance across a range of cognitive domains, including verbal inhibition, rapid naming/reading, planning, divided attention, and set shifting. In contrast, ADHD-IN symptoms were uniquely associated with poorer performance on a Go/NoGo task (inhibition/distractibility), visual scanning and discrimination, and interference control. Findings from the current study, amongst the first to recruit children based on levels of CDS symptomatology, provide the strongest evidence to date that the neurocognitive phenotype of CDS is characterized by slowed cognitive processing, and add to its validity as a separate syndrome from ADHD. If replicated, these findings have implications for assessment, treatment, and school accommodations for CDS. Neuroimaging studies exploring the neurobiological basis of CDS are also needed.

KEYWORDS:

• ADHD
• sluggish cognitive tempo
• executive functions
• neuropsychology
• processing speed

Acknowledgments

We are grateful to the many families and teachers involved in this project and for the support of research staff, in particular Amanda Withrow, Dana Schindler, and Josalyn Foster.

Author contributions

All authors contributed to the study conception and design. Data analyses were performed by L.T., S.B., and J.P., with consultation from S.O. and M.K. on the working memory tasks. The first draft of the manuscript was written by L.T. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

The authors declare they have no financial interests; however, Michael Kofler/Florida State University was awarded a patent for a neurocognitive intervention that targets central executive working memory. This intervention was not used in the current study, and there are no current licensing, financial, or other conflicts to report.

Availability of data and material

Data are available from the corresponding author upon reasonable request and after establishing a Data Use Agreement.

Informed consent

Written informed consent, including publishing their de-identified data, was obtained from legal guardians.

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/09297049.2023.2185215

Notes

¹ As medications may impact neurocognitive performance, all participants taking a stimulant medication had a 24-hour washout.

Additional information

Funding

This research was supported by grant number K23MH108603 from the National Institute of Mental Health (NIMH) and a Trustee Award from Cincinnati Children’s Research Foundation (CCRF). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the CCRF