Monday, May 19, 2014

Sluggish cognitive tempo,  a new diagnosis du jour?

The drug companies may be finding a new profit center, having maxed out their ability to push pills on the more than 6 million American children who have received a diagnosis of A.D.H.D. (attention deficit hyperactivity disorder, which in my son’s case was evaluated by a sane pediatric psychiatrist who wisely said “Chill, he’s just acting like a kid.”) The new syndrome, summarized by Schwartz, is called sluggish cognitive tempo and said to be characterized by lethargy, daydreaming and slow mental processing. It is the subject of the entire January issue of The Journal of Abnormal Child Psychology.
Papers have proposed that a recognition of sluggish cognitive tempo could help resolve some longstanding confusion about A.D.H.D., which despite having hyperactivity in its name includes about two million children who are not hyperactive, merely inattentive. Some researchers propose that about half of those children would be better classified as having sluggish cognitive tempo, with perhaps one million additional children, who do not meet A.D.H.D.’s criteria now, having the new disorder, too.
The syndrome is not well defined, and many researchers refuse to discuss it, or their financial interests in the condition’s acceptance.

The description I find most intriguing and plausible is of a syndrome that involves extreme mind wandering, perhaps of a brain that is chronically in the “default” mode (described in a number of MindBlog posts) and unable to (or unwilling or too lazy to) activate the “attentional” or goal oriented, direct experiential focus, task positive network appropriately.  (Think about the teenagers behind fast-food counters completely unable to do simple addition and subtraction!). The best therapy for this syndrome would seem to be cognitive or behavioral (i.e. "SHAPE UP!"), rather than another pill to pop.

Drug treatments of this or other behavioral syndromes such as depression have the risk of diminishing personal agency and responsibility, as Iarovici notes:
We walk a thinning line between diagnosing illness and teaching our youth to view any emotional upset as pathological. We need a greater focus on building resilience in emerging adults. We need more scientific studies — spanning years, not months — on the risks and benefits of maintenance treatment in emerging adults.

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