Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research

ABSTRACT

Cognitive disengagement syndrome (CDS, previously referred to as sluggish cognitive tempo) is a unique set of symptoms distinct from ADHD inattentive symptoms that appear to be independently associated with neuropsychological and psychosocial outcomes in community and ADHD-specific samples of youth. However, our understanding of CDS in individuals with chronic or complex medical conditions is limited. The current systematic review is the first to summarize the literature on CDS prevalence rates and associations with neurocognitive and functional outcomes in youth with medical conditions, and to discuss areas of future research to guide clinical intervention. We conducted literature searches across four major databases and included studies assessing prevalence estimates, associations with neuropsychological and/or psychosocial functioning, or predictors of CDS in individuals with chronic or complex medical conditions. Twenty-five studies were identified and retained. Fifteen of sixteen studies reported elevations in CDS symptoms, though findings were mixed in studies comparing mean differences to typically developing youth. Seven studies provided inconsistent evidence for CDS being associated with neuropsychological or academic functioning, with six studies demonstrating consistent effects on psychosocial functioning. Finally, nine studies identified biological and sociodemographic factors associated with CDS, though almost all await replication. CDS symptoms are significantly elevated in youth with medical conditions and appear to be particularly linked with psychosocial functioning. Future research is needed to identify prevalence of CDS across a range of medical conditions, examine associations with neuropsychological and psychosocial functioning, and examine whether CDS impacts self-management.

KEYWORDS:

• Adherence/self-management
• attention, hyperactivity, and ADHD
• cognitive disengagement syndrome
• systematic review
• psychosocial functioning

Disclosure statement

No potential conflict of interest was reported by the author(s).

Research data statement

No new data were generated or analyzed in support of this research.

Notes

¹ These items include daydreams, gets lost in own thoughts, spaces or zones out, appears lost in a fog, stares blankly, loses train of thought, difficulty putting thought into words, forgets what was going to say, thinking gets mixed up, easily confused, thinking is slow, easily tired, low level of activity, behavior is slow, drowsy, or sleepy.

Additional information

Funding

When this review was conducted, Stephen Becker was supported by award number [R01MH122415] from the National Institute of Mental Health (NIMH) and award number [R305A200028] from the Institute of Education Sciences, U.S. Department of Education. The content is solely the responsibility of the authors and does not necessarily represent the official views of the IES or the NIH.