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"Sluggish Cognitive Tempo" Is the New Kid on the Attention-Disorder Block — Physician’s First Watch

Medical News |
April 14, 2014

"Sluggish Cognitive Tempo" Is the New Kid on the Attention-Disorder Block

By Joe Elia

An emerging diagnosis, not yet in the DSM, seems poised to enter the family of attention disorders. Called "sluggish cognitive tempo," it's reported in the New York Times to be a seemingly ill-defined target for ADHD-related drugs.

Characterized by lethargy, daydreaming, and slow mental processing, SCT is estimated to affect some 2 million children (roughly 6 million have ADHD). One researcher with strong ties to an ADHD drug maker says that SCT "has become the new attention disorder," according to the Times. Others aren't so sure. One expert warned: "We haven't even agreed on the symptom list — that's how early we are in the process."

Asked to comment, Peter Roy-Byrne, editor-in-chief of NEJM Journal Watch Psychiatry, expressed concern that SCT "will be used as a convenient easy diagnosis in lieu of evaluating things more carefully, especially from a psychological and behavioral perspective."

Reader Comments (13)

Addison Hay, MD Physician, Family Medicine/General Practice

Sounds like a classic case of a drug looking for a diagnosis instead of a diagnosis looking for a drug.

Michael Groome PhD Other Healthcare Professional, Other, Private Psychology Practice

I have my moments too, but am I diagnosable? I await a clearer list of symptoms before we can talk about a diagnostic category.

Phyllis du Mont, PhD, NP, Professor Other Healthcare Professional, University

Dear heavens! Within limits, mere differences in temperament, style, gifts and talents are not diseases. Medications are not uniformly benign. How could any sort of risk benefit ratio be assessed? Sleep hygiene, ruling out medical issues, encouraging a balance of rest, sleep and activity, matching learning style to the educational environment, all make sense, But a pharmacological solution? Spare us.

L.M. Colasanti, MA Other, Epidemiology/Statistics, Community College of Vermont

That children and youth experiencing significant difficulties ought to receive treatment is a given. But there are questions raised by the seemingly endless extension of the list of psychiatric disorders with which these young ones are being diagnosed that deserve greater scrutiny. This is nowhere more important than in the realm of emotional and behavioral disorders, for which the standard of treatment is, and has been for quite some time, psychotropic medication.

Prevalence estimates of anytime psychiatric disorders in the general population are as high as 61%, and of those disorders requiring treatment among children and youth in the U.S, the estimates hover around 20%. The most common among by far among children and youth are the various permutations of ADHD. In a statistical brief of “The Five Most Costly Children's Conditions, 2011,” the Agency for Healthcare Research and Quality [AHRQ] noted that “[o]f the five most costly conditions for children, mental disorders affected the fewest children but had the highest average expense per child,” as well as the highest cost overall, totaling $13.8 billion, up from $8.9 billion in 2006, an increase of more than 55%. It should also be noted that nearly half [48.4%] of that total was paid by Medicaid. Add to that this curious fact: Among all other DSM-identified disorders afflicting children and youth {anxiety, conduct disorders, etc.} insurance coverage is not correlated with diagnosis, but a diagnosis of ADHD is twice as likely among children and youth with insurance, including Medicaid.

Of course, the underlying problem here is not limited to children and youth. According to BCC research out of Wellesley, MA, the annual global market for drugs used to treat mental disorders was at $70.1 billion in 2012, with a five-year compound annual growth rate of 2.3%. ...

J Ross Hester, PA-CH Other Healthcare Professional, Psychiatry, Edcom Associates Holistic Health

This sounds suspiciously like "ADD- Inattentive Type" the descriptive diagnosis used for those with the other symptomds of Attention Deficit Disorder, but without hyperactivity. Just as the condition in females has classically been diagnosed less because of their tendency to be less physically aggressive, I suspect so-called SCT will be reserved for those weathy or well enough insured to come to the attention of providers and Big Pharma.

Jussi Sipilä Physician, Neurology

This despairs me. Please tell me this is a late April Fool's, please.

The scientific reasoning behind this is closing in on the level homeopaths operate on. Makes me wish it's just pure greed after all.

And no, this has nothing to do with Alzheimer's. Although the logic behind seems a manifestation of a cognitive dysfunction.

Margaret Lipton CNM ARNP Other Healthcare Professional, Obstetrics/Gynecology

Actually, sluggish cognitive tempo sounds a lot like chronic Vit D deficiency. What's next, rickets?

TRACY KOLENCHUK Other, Other, Healthicine.org

A diagnosis that gives no indication of cause is a diagnosis for disaster, unless you are trying to make money treating 'symptoms' with no regard for the health of the patient.

Cristina Kamin Ph.D J.D., LLM, MD Physician, Neurology, Research Facility

In the words of Marcia Angell, author of the New York Review of Books article "The Illusion of Psychiatry" (July 14, 2011) "It is getting harder and harder to be normal." haha what a scam

Jon Wilcox FRNZCGP Physician, Family Medicine/General Practice, Auckland

The brain fog (of CFS for example) is real, and patients struggle to receive acknowledgement. It also fluctuates, so labels may obviously be difficult. For all the CFS patients with brain fog (immune mediated recurring sub-clinical encephalopathy) there are heaps of us "normal" people who fall into the grey zone. We need to recognise this rather than just telling our clients to just "take a holiday" or "change your job". It is easy to criticise the DSM but surely SCT is a somewhat better label than brain fog ?

KAREN WILLIAMS Other Healthcare Professional, Pharmacology/Pharmacy, HealthPartners Pharmacy

More evidence that psychiatry has been seduced by the drug companies. This is ridiculous. Maybe someone should consider that the kids just need more sleep?!?

Kathryn Raines, MSN, NP Other Healthcare Professional, Family Medicine/General Practice, MCHS-Oakridge

interesting article---how about in adults---could this be a precursor to Alzheimer's?

Maarten Vasbinder MD Physician, Family Medicine/General Practice, Moraira Spain

At the moment we are working on another diagnosis for DSM: "Dollar sign thinking in the environment of psychiatrists and psychologists". People who suffer of this attention disorder (extreme attention to non-existing but money producing diseases), can be very dangerous.

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