Attention-deficit/hyperactivity disorder is one of the most common neurological disorders in the world. In 2016, the World Health Organization estimated that people with persistent ADHD symptoms made up almost 3% of the global population.1
And yet, not everyone who has difficulty concentrating fits neatly into the mold of ADHD, predominantly inattentive presentation. Instead, they may have cognitive disengagement syndrome (aka sluggish cognitive tempo) — and may not even know it.
Too long; didn't read
- Cognitive disengagement syndrome (CDS) is a little-known neurological condition related to ADHD.
- CDS and the inattentive presentation of ADHD are similar, but have a few key differences.
- CDS isn't an official diagnosis, but you can still seek treatment targeting its symptoms.
What is sluggish cognitive tempo (SCT)?
Cognitive disengagement syndrome (CDS), previously known as sluggish cognitive tempo (SCT), is a designation for people who experience one or more symptoms comprising either a previously unknown subtype of ADHD or a separate but related disorder.
Symptoms of sluggish cognitive tempo:
- Difficulty processing spoken information
- Struggling to put thoughts into words
- Looking tired
- Spacing out
- Inconsistent alertness
- Taking longer than others to finish work
- Making mistakes on work
How is cognitive disengagement syndrome different from ADHD?
ADHD and CDS are often lumped together because both are classified as "attention disorders." However, attention and concentration are distinct issues, and therefore, inattention and difficulty concentrating also differ.
Think of it this way: if you have ADHD, you can theoretically start focused but become distracted. By contrast, those with cognitive disengagement syndrome find it almost impossible to concentrate in the first place.
Why are people with cognitive disengagement syndrome misdiagnosed with ADHD?
Healthcare professionals may mistake your behaviors and tendencies as symptoms of ADHD because CDS isn't yet common knowledge. Also, many apparent symptoms of ADHD are CDS symptoms in disguise. For example, you might look like you're lost in thought when you're not thinking at all or make mistakes that aren't careless.
Can you have sluggish cognitive tempo and ADHD?
Although ADHD and CDS may be separate disorders, many people exhibit symptoms of both, like if you're talkative but have trouble putting your thoughts into words. That's why it's so important to find a way to treat symptoms of both conditions, not just one or the other.
Is SCT a diagnosis?
Although sluggish cognitive tempo has been studied for almost four decades by disorder experts, sluggish cognitive tempo (or CDS) isn't officially recognized in the DSM. The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is a handbook considered the gold standard for healthcare professionals in mental disorders.
For that reason, general-practice physicians are unlikely to hear of it and may doubt the legitimacy of a condition unlisted in the DSM.
How to manage sluggish cognitive tempo
CDS/SCT is not yet DSM-recognized, and official guidelines for diagnosis are not established, so there's no standard treatment program for it. But, if you track your symptoms and share them with your physician or psychiatrist, they may agree with your self-diagnosis, enabling them to tailor your treatment to your specific needs.
For example, one study suggests that the central nervous system stimulant Vyvanse may be particularly effective at targeting CDS symptoms.2 Keep in mind that the maker of Vyvanse commissioned the study.
More and more information about CDS is constantly coming out. Try setting up an alert on Google or Google Scholar for the search term "cognitive disengagement syndrome." That way, you'll get all the new research. For example, this chapter by Russell Barkley, widely regarded as one of the top experts on CDS, is a great resource.
1 ADHD Attention Deficit and Hyperactivity Disorders | The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Survey (2016)
2 Journal of Clinical Psychiatry | A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHD (2021)