A Comparison of Cognitive Disengagement Syndrome in Children with Major Depression Versus Attention Deficit and Hyperactivity Disorder

Doğa Sevinçok; Tuğçe Canol Özbek; Mutlu Muhammed Özbek

doi:10.58600/eurjther2249

Authors

Doğa Sevinçok Department of Child and Adolescent Psychiatry, Istinye University, Istanbul, Türkiye https://orcid.org/0000-0003-3138-6922
Tuğçe Canol Özbek Department of Child and Adolescent Psychiatry, Kars Harakani State Hospital,Kars, Türkiye https://orcid.org/0000-0002-5314-3086
Mutlu Muhammed Özbek Department of Child and Adolescent Psychiatry, Faculty of Medicine, Yalova University, Yalova, Türkiye https://orcid.org/0000-0002-0928-2820

DOI:

https://doi.org/10.58600/eurjther2249

Keywords:

Cognitive Disengagement Syndrome, Attention Deficit and Hyperactivity Disorder, Major Depression, Children

Abstract

Objective: There is growing evidence that Cognitive Disengagement Syndrome (CDS) is a distinct construct, supported by both empirical research and clinical differentiation. CDS demonstrates a stronger association with the inattentive type of Attention Deficit Hyperactivity Disorder (ADHD-IA), compared to its correlation with hyperactivity/impulsivity symptoms. Several studies have identified a significant positive relationship between CDS and internalizing symptoms such as anxiety and depression. To our knowledge, no study has explored CDS in children with major depression (MD). In the present study, we compared children with MD but without ADHD to children with ADHD but without depression in terms of CDS. We examined whether children with MD would have greater CDS when compared to children with ADHD.

Methods: Thirty-six adolescents with ADHD, and twenty-five adolescents with MD, aged 12 to 18 years old, were administered the Barkley Child Attention Scale (BCAS), Turgay's DSM-IV Based ADHD and Disruptive Behavior Disorders Screening Scale, and the Children’s Depression Rating Scale-Revised (CDRS-R).

Results: The majority of the ADHD and MD groups were boys. The MD group had significantly higher BCAS scores than the ADHD group (U=287.0, p=0.016). In the ADHD group, the severity of BCAS scores was inversely correlated with ADHD-Hyperactivity/impulsivity scores (r=-0.681, p<0.001). In the MD group, there was a significant positive relationship between BCAS and CDRS scores (r= 0.493, p=0.012).

Conclusions: The findings of this study highlight the transdiagnostic relevance of CDS by demonstrating its association with depression, independent of ADHD. This underscores the importance of considering CDS in the assessment and treatment of depression across various clinical contexts.

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References

Burns GL, Becker SP, Geiser C, Leopold DR, Willcutt EG (2020) Are Sluggish Cognitive Tempo, ADHD, and Oppositional Defiant Disorder Trait- or State-Like Constructs from Prekindergarten to Fourth Grade? J Clin Child Adolesc Psychol 49:460-468. https://doi.org/10.1080/15374416.2019.1567348

Becker SP (2021) Systematic Review: Assessment of Sluggish Cognitive Tempo Over the Past Decade. J Am Acad Child Adolesc Psychiatry 60:690-709. https://doi.org/10.1016/j.jaac.2020.10.016

Burns GL, Montano JJ, Becker SP, Servera M (2023) Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample. J Clin Child Adolesc Psychol:1-15. https://doi.org/10.1080/15374416.2023.2272944

Barkley RA (2013) Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. J Clin Child Adolesc Psychol 42:161-173. https://doi.org/10.1080/15374416.2012.734259

Servera M, Saez B, Burns GL, Becker SP (2018) Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. J Abnorm Psychol 127:818-829. https://doi.org/10.1037/abn0000375

Becker SP, Leopold DR, Burns GL, Jarrett MA, Langberg JM, Marshall SA, McBurnett K, Waschbusch DA, Willcutt EG (2016) The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo: A Meta-Analysis and Critical Review. J Am Acad Child Adolesc Psychiatry 55:163-178. https://doi.org/10.1016/j.jaac.2015.12.006

Becker SP, Vaughn AJ, Zoromski AK, Burns GL, Mikami AY, Fredrick JW, Epstein JN, Peugh JL, Tamm L (2024) A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome. J Clin Child Adolesc Psychol:1-16. https://doi.org/10.1080/15374416.2024.2301771

Willcutt EG, Chhabildas N, Kinnear M, DeFries JC, Olson RK, Leopold DR, Keenan JM, Pennington BF (2014) The internal and external validity of sluggish cognitive tempo and its relation with DSM-IV ADHD. J Abnorm Child Psychol 42:21-35. https://doi.org/10.1007/s10802-013-9800-6

Bauermeister JJ, Barkley RA, Bauermeister JA, Martinez JV, McBurnett K (2012) Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: neuropsychological and psychosocial correlates. J Abnorm Child Psychol 40:683-697. https://doi.org/10.1007/s10802-011-9602-7

Becker SP, Langberg JM (2013) Sluggish cognitive tempo among young adolescents with ADHD: relations to mental health, academic, and social functioning. J Atten Disord 17:681-689. https://doi.org/10.1177/1087054711435411

Burns GL, Preszler J, Ahnach A, Servera M, Becker SP (2022) Multisource Network and Latent Variable Models of Sluggish Cognitive Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children: Equivalent Findings and Recommendations. Res Child Adolesc Psychopathol 50:881-894. https://doi.org/10.1007/s10802-021-00890-1

Penny AM, Waschbusch DA, Klein RM, Corkum P, Eskes G (2009) Developing a measure of sluggish cognitive tempo for children: content validity, factor structure, and reliability. Psychol Assess 21:380-389. https://doi.org/10.1037/a0016600

Bernad Mdel M, Servera M, Becker SP, Burns GL (2016) Sluggish Cognitive Tempo and ADHD Inattention as Predictors of Externalizing, Internalizing, and Impairment Domains: A 2-Year Longitudinal Study. J Abnorm Child Psychol 44:771-785. https://doi.org/10.1007/s10802-015-0066-z

Vu A, Thompson L, Willcutt E, Petrill S (2019) Sluggish cognitive tempo: longitudinal stability and validity. Atten Defic Hyperact Disord 11:463-471. https://doi.org/10.1007/s12402-019-00287-7

Fredrick JW, Langberg JM, Becker SP (2022) Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization. Res Child Adolesc Psychopathol 50:809-822. https://doi.org/10.1007/s10802-022-00923-3

Harrington KM, Waldman ID (2010) Evaluating the utility of sluggish cognitive tempo in discriminating among DSM-IV ADHD subtypes. J Abnorm Child Psychol 38:173-184. https://doi.org/10.1007/s10802-009-9355-8

Araujo Jimenez EA, Jane Ballabriga MC, Bonillo Martin A, Arrufat FJ, Serra Giacobo R (2015) Executive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD. J Atten Disord 19:507-514. https://doi.org/10.1177/1087054713495442

Becker SP, Garner AA, Tamm L, Antonini TN, Epstein JN (2019) Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal, Peer Ignoring, and Low Engagement. J Clin Child Adolesc Psychol 48:228-237. https://doi.org/10.1080/15374416.2017.1286595

Flannery AJ, Luebbe AM, Becker SP (2017) Sluggish Cognitive Tempo is Associated With Poorer Study Skills, More Executive Functioning Deficits, and Greater Impairment in College Students. J Clin Psychol 73:1091-1113. https://doi.org/10.1002/jclp.22406

Becker SP, Burns GL, Garner AA, Jarrett MA, Luebbe AM, Epstein JN, Willcutt EG (2018) Sluggish cognitive tempo in adults: Psychometric validation of the Adult Concentration Inventory. Psychol Assess 30:296-310. https://doi.org/10.1037/pas0000476

Becker SP, McQuade JD (2020) Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity during Social and Cognitive Stressor Tasks. J Abnorm Child Psychol 48:923-933. https://doi.org/10.1007/s10802-020-00651-6

Fredrick JW, Becker SP (2021) Sluggish Cognitive Tempo Symptoms, But Not ADHD or Internalizing Symptoms, Are Uniquely Related to Self-Reported Mind-Wandering in Adolescents With ADHD. J Atten Disord 25:1605-1611. https://doi.org/10.1177/1087054720923091

Shelton CR, Addison WE, Hartung CM (2019) ADHD and SCT Symptomatology in Relation to College Students' Use of Self-Regulated Learning Strategies. J Atten Disord 23:1719-1728. https://doi.org/10.1177/1087054717691134

Nelson JM, Lovett BJ (2023) Sluggish Cognitive Tempo (SCT), Comorbid Psychopathology, and Functional Impairment in College Students: The Clinical Utility of SCT Subfactors. J Atten Disord 27:313-323. https://doi.org/10.1177/10870547221142458

Meinzer MC, Pettit JW, Viswesvaran C (2014) The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev 34:595-607. https://doi.org/10.1016/j.cpr.2014.10.002

Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127:462-470. https://doi.org/10.1542/peds.2010-0165

Bernad Mdel M, Servera M, Grases G, Collado S, Burns GL (2014) A cross-sectional and longitudinal investigation of the external correlates of sluggish cognitive tempo and ADHD-inattention symptoms dimensions. J Abnorm Child Psychol 42:1225-1236. https://doi.org/10.1007/s10802-014-9866-9

American Psychiatric Association (2013) The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Press

Firat S, Unsel Bolat G, Gul H, Baytunca MB, Kardas B, Aysev A, Ercan ES (2018) Barkley Child Attention Scale validity and reliability study. Dusunen Adam: The Journal of Psychiatry and Neurological Sciences 31:284-293. https://doi.org/10.5350/dajpn2018310306

Bolat H, Ercan ES, Unsel-Bolat G, Tahillioglu A, Yazici KU, Bacanli A, Pariltay E, Aygunes Jafari D, Kosova B, Ozgul S, Rohde LA, Akin H (2020) DRD4 genotyping may differentiate symptoms of attention-deficit/hyperactivity disorder and sluggish cognitive tempo. Braz J Psychiatry 42:630-637. https://doi.org/10.1590/1516-4446-2019-0630

Kilicoglu AG, Zadehgan Afshord T, Derin S, Ertas E, Coskun P, Aktas S, Guler EM (2023) Comparison of Possible Changes in Oxidative Stress, DNA Damage, and Inflammatory Markers in Children/Adolescents Diagnosed with Sluggish Cognitive Tempo and Children/Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 33:325-331. https://doi.org/10.1089/cap.2022.0081

Turgay A (1994) Disruptive behavior disorders child and adolescent screening and rating scales for children, adolescents, parents and teachers. West Blomfield, MI: Integrative Therapy Institute Publication,

Ercan ES, Amado S, Somer O, Çikoǧlu S (2001) Development of a test battery for the assessment of attention deficit hyperactivity disorder [in Turkish]. Cocuk ve Genclik Ruh Sagli{dotless}ǧi{dotless} Dergisi (Turkish Journal of Child and Adolescent Mental Health) 8:132-144

Poznanski EO, Mokros HB, Western Psychological S (1996) Children's depression rating scale, revised (CDRS-R). Western Psychological Services, Los Angeles, Calif.

Güney S, Baykara H, Emiroğlu N (2018) Psychometric properties of the Turkish adaptation of the Children's Depression Rating Scale: revised in Turkish adolescents. Anatolian Journal of Psychiatry. https://doi.org/10.5455/apd.292666

Becker SP, Marshall SA, McBurnett K (2014) Sluggish cognitive tempo in abnormal child psychology: an historical overview and introduction to the special section. J Abnorm Child Psychol 42:1-6. https://doi.org/10.1007/s10802-013-9825-x

Lee S, Burns GL, Snell J, McBurnett K (2014) Validity of the sluggish cognitive tempo symptom dimension in children: sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. J Abnorm Child Psychol 42:7-19. https://doi.org/10.1007/s10802-013-9714-3

McBurnett K, Villodas M, Burns GL, Hinshaw SP, Beaulieu A, Pfiffner LJ (2014) Structure and validity of sluggish cognitive tempo using an expanded item pool in children with attention-deficit/hyperactivity disorder. J Abnorm Child Psychol 42:37-48. https://doi.org/10.1007/s10802-013-9801-5

Sevincok D, Ozbay HC, Ozbek MM, Tunagur MT, Aksu H (2020) ADHD symptoms in relation to internalizing and externalizing symptoms in children: the mediating role of sluggish cognitive tempo. Nord J Psychiatry 74:265-272. https://doi.org/10.1080/08039488.2019.1697746

Burns GL, Servera M, Bernad Mdel M, Carrillo JM, Cardo E (2013) Distinctions between sluggish cognitive tempo, ADHD-IN, and depression symptom dimensions in Spanish first-grade children. J Clin Child Adolesc Psychol 42:796-808. https://doi.org/10.1080/15374416.2013.838771

Carlson CL, Mann M (2002) Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. J Clin Child Adolesc Psychol 31:123-129. https://doi.org/10.1207/S15374424JCCP3101_14

Cole DA, Dukewich TL, Roeder K, Sinclair KR, McMillan J, Will E, Bilsky SA, Martin NC, Felton JW (2014) Linking peer victimization to the development of depressive self-schemas in children and adolescents. J Abnorm Child Psychol 42:149-160. https://doi.org/10.1007/s10802-013-9769-1

Sinclair SJ, Siefert CJ, Slavin-Mulford JM, Stein MB, Renna M, Blais MA (2012) Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of U.S. adults. Eval Health Prof 35:259-279. https://doi.org/10.1177/0163278711424282

Camprodon-Rosanas E, Ribas-Fito N, Batlle-Vila S, Persavento C, Alvarez-Pedrerol M, Sunyer J, Forns J (2017) Sluggish Cognitive Tempo: Sociodemographic, Behavioral, and Clinical Characteristics in a Population of Catalan School Children. J Atten Disord 21:632-641. https://doi.org/10.1177/1087054716652477

Lee S, Burns GL, Becker SP (2017) Can Sluggish Cognitive Tempo Be Distinguished From ADHD Inattention in Very Young Children? Evidence From a Sample of Korean Preschool Children. J Atten Disord 21:623-631. https://doi.org/10.1177/1087054716680077

Rondon AT, Hilton DC, Jarrett MA, Ollendick TH (2020) Sleep, Internalizing Problems, and Social Withdrawal: Unique Associations in Clinic-Referred Youth With Elevated Sluggish Cognitive Tempo Symptoms. J Atten Disord 24:524-534. https://doi.org/10.1177/1087054718756197

Saez B, Servera M, Becker SP, Burns GL (2019) Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings. J Clin Child Adolesc Psychol 48:825-839. https://doi.org/10.1080/15374416.2017.1416619

Fenollar Cortes J, Servera M, Becker SP, Burns GL (2017) External Validity of ADHD Inattention and Sluggish Cognitive Tempo Dimensions in Spanish Children With ADHD. J Atten Disord 21:655-666. https://doi.org/10.1177/1087054714548033

Jacobson LA, Murphy-Bowman SC, Pritchard AE, Tart-Zelvin A, Zabel TA, Mahone EM (2012) Factor structure of a sluggish cognitive tempo scale in clinically-referred children. J Abnorm Child Psychol 40:1327-1337. https://doi.org/10.1007/s10802-012-9643-6

Brewe AM, Simmons GL, Capriola-Hall NN, White SW (2020) Sluggish cognitive tempo: An examination of clinical correlates for adults with autism. Autism 24:1373-1383. https://doi.org/10.1177/1362361319900422

Duncan A, Tamm L, Birnschein AM, Becker SP (2019) Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder. Autism 23:1354-1362. https://doi.org/10.1177/1362361318811329

Mayes SD, Calhoun SL, Waschbusch DA (2021) Relationship between sluggish cognitive tempo and sleep, psychological, somatic, and cognitive problems and impairment in children with autism and children with ADHD. Clin Child Psychol Psychiatry 26:518-530. https://doi.org/10.1177/1359104520978459

Musicaro RM, Ford J, Suvak MK, Sposato A, Andersen S (2020) Sluggish cognitive tempo and exposure to interpersonal trauma in children. Anxiety Stress Coping 33:100-114. https://doi.org/10.1080/10615806.2019.1695124

Silverman WK, Ollendick TH (2005) Evidence-based assessment of anxiety and its disorders in children and adolescents. J Clin Child Adolesc Psychol 34:380-411. https://doi.org/10.1207/s15374424jccp3403_2

Gozpinar N, Cakiroglu S, Gormez V (2023) Sluggish Cognitive Tempo Self Report Scale (SCT-SR): Development and Initial Validation Study. J Atten Disord 27:510-520. https://doi.org/10.1177/10870547231153879

Al. O (2023) Chat GBT. https://chat.openai.com/chat. https://chat.openai.com/chat. Accessed Date 25 July 2024