We all know that child in the classroom. They do not disrupt the lesson, they stay in their seat, and they do not disturb their friends. But somehow, they are “not there.” They stare out the window, react late when their name is called, and starting a homework assignment is like climbing a small mountain for them. They begin, but progress slowly. They tire easily. Often, they are perceived as unwilling. However, sometimes the issue is not willingness, but the speed of the mind.
This picture is often gathered under one heading: Attention Deficit Hyperactivity Disorder (ADHD). However, in recent years, a more subtle distinction has been discussed in psychology literature: Cognitive Disengagement Syndrome (CDS).
This concept, referred to for a long time in the literature as Sluggish Cognitive Tempo (SCT), indicates that we need to rethink attention problems.
What Is Cognitive Disengagement Syndrome?
Cognitive Disengagement Syndrome is a pattern defined by symptoms such as daydreaming, mental cloudiness, vacant stares, slow thinking, low energy, and easy fatigability. Community-based research has reported that these symptoms can be seen at a rate of approximately 11% (Barkley, 2014). This rate suggests that Cognitive Disengagement Syndrome is not a rare condition; however, it also suggests that it may often go unnoticed and be evaluated under the heading of “inattentiveness.”
The Difference Between Cognitive Disengagement Syndrome And ADHD
When ADHD is mentioned, impulsivity, hyperactivity, and difficulty with inhibition usually come to mind. Neuropsychological studies associate ADHD more with response inhibition and reaction time variability.
In CDS, the picture is different. Research shows difficulties in the areas of selective and sustained attention, memory processes, and cognitive alertness (Becker & Barkley, 2018). Interestingly, the slowness observed in these individuals is not always a decrease in psychomotor speed. The problem is often related to cognitive tempo and the level of mental alertness rather than motor speed. In other words, these children are not necessarily individuals who walk slowly, write late, or have weak reflexes.
The primary difference usually emerges in mental processes. They hear the question, but it takes them a bit longer to process the meaning and organize an answer. They may delay in gathering their thoughts while explaining a subject they know. They appear sluggish from the outside not because their bodies move slowly, but because their mental tempo is low. It is as if they are in a light sleep or a daze throughout the day.
Another significant difference appears in the emotional profile. CDS symptoms are strongly associated with internalizing problems such as anxiety, depression, and social withdrawal (Becker et al., 2016). Conversely, they do not show a significant relationship with oppositional-defiant or conduct problems (Barkley, 2014). This is clinically important; because these children may be overlooked since they generally “do not cause trouble.”
Academic Functioning And Risk
Research shows that CDS symptoms can be related to low academic performance, particularly in mathematics and writing skills (Becker et al., 2016). A striking finding is this: while hyperactivity symptoms are not always linked to academic success, CDS and inattentiveness symptoms can be independently associated with lower academic performance (Barkley, 2014).
This distinction is important in educational settings. A child who is quiet and compliant may still struggle significantly, yet their difficulties may remain invisible compared to more disruptive behavioral patterns.
Parts Of The Same Disorder?
Current literature suggests that the relationship between CDS and ADHD may not represent subtypes of a single disorder, but rather two separate yet frequently co-occurring constructs (Becker et al., 2016).
However, a significant limitation exists here. A large portion of studies on this subject has been conducted using ADHD samples. This does not yet clarify whether CDS is a completely independent construct. Furthermore, CDS is not currently an independent diagnosis. Therefore, it is ethically important to avoid labeling or definitive approaches in clinical evaluation.
Attention problems are not one-dimensional. Not every instance of daydreaming means ADHD, and not every slowness is an indicator of cognitive inadequacy. The concept of Sluggish Cognitive Tempo — now referred to as Cognitive Disengagement Syndrome — reminds us that we must evaluate attention problems with greater nuance.
References
• Bolat, G. Ü., Bolat, H., Özgül, S., Süren, S., Bacanlı, A., Tahıllıoğlu, H. A., … & Ercan, E. S. (2020). Sluggish cognitive tempo and attention deficit hyperactivity disorder: Similarities and differences. Turkish Journal of Child and Adolescent Mental Health.
• Binici, N. C., & Kutlu, A. (2018). Clinical characteristics of sluggish cognitive tempo accompanying attention deficit hyperactivity disorder. Journal of Contemporary Medicine, 8(3), 245-250.
• Gümüş, Ü. (2021). Investigation of sluggish cognitive tempo symptoms in children with obesity.
• Becker, S. P., & Barkley, R. A. (2018). Sluggish cognitive tempo. Oxford Textbook of Attention Deficit Hyperactivity Disorder, 13, 147-153.
• Becker, S. P., Leopold, D. R., Burns, G. L., Jarrett, M. A., Langberg, J. M., Marshall, S. A., … & Willcutt, E. G. (2016). The internal, external, and diagnostic validity of sluggish cognitive tempo: A meta-analysis and critical review. Journal of the American Academy of Child & Adolescent Psychiatry, 55(3), 163-178.