Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches

A nationally representative sample of U.S. children was used to determine the empirical and clinical differentiation of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptoms using both categorical and dimensional approaches. Mothers of children (N = 2,056, M± SD age = 8.49 ± 2.15 years, 49.3% girls) completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, sleep difficulties, daily life executive functioning, conflicted shyness, friendship difficulties, and social and academic impairment. Scores greater than the top 5% on SCT and ADHD measures were used to create SCT-only (n = 53, 2.58%), ADHD-only (n = 93, 4.52%), SCT+ADHD (n = 49, 2.38%), and comparison (n = 1,861, 90.52%) groups. Fifty-two percent of the SCT group did not qualify for the ADHD group, whereas 65% of the ADHD group did not qualify for the SCT group. The SCT-only group had higher levels of anxiety, depression, conflicted shyness, and sleep difficulties than the ADHD-only group. In contrast, the ADHD-only group had greater executive functioning deficits and higher ODD than the SCT-only group. SCT-only and ADHD-only groups showed similar levels of friendship, social, and academic impairment. Similar findings emerged when using structural regression analyses to determine the unique clinical correlates of SCT and ADHD dimensions. This is only the second study to examine the distinction of clinically-elevated SCT from ADHD in a national sample of children and extends previous findings to a broader array of functional outcomes. Normative information on the SCT scale also provides a validated rating scale to advance research and clinical care.