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When I first heard of the proposed new childhood diagnosis of "Sluggish cognitive Tempo Disorder," I thought it was an April Fools Day joke and I wrote a Psychology Today blog asking this question. New York Times reporter Alan Schwarz soon disillusioned me. The proponents of the new disorder were some very serious people, he assured me, and this purported new disorder is no joke.
Is Sluggish Cgognitve Tempo Disorder a Joke?
In today's Daily Beast a pediatrician who writes under the name Russell Saunders wonders the same thing. Is this a joke? Taking a similar tongue-in-cheek approach as I did to this purported new "disorder", Suanders admits that he himself has the disorder, though up until now, he simply considered himself "scatter-brained," not mentally ill. As a kid he often turned in his assignments late, and even today he tends to forget about doing his paperwork on time.
Suanders concludes that not every deviation from normal childhood is a mental disorder, though many doctors and parents prefer it to be so. He says: some kids are prone to letting their minds wander and daydreaming. Sometimes that gets them into trouble. That doesn’t mean we should be calling it a disorder, or trying to medicate it away."
Disease Mongering
An even more skeptical article appeared in Slate Magazine about a week ago. The author writes that this new "disorder" sounds "like an Onion-style parody." But, the article continues, it also "sounds like a classic case of 'disease mongering': blurring normality with sickness to boost drug companies’ bottom lines." The author of this article, Peter Aldous, sees a more sinister side of this diagnosis, just as Alan Schwarz hinted in his New York Times article and in his reply to my blog. Aldous writes that the main cheerleader for this new diagnosis, Russell Barkley has received more than $100,000 in speaking and consulting fees from pharmaceutical giant Eli Lilly, which has a drug waiting in the wings that might be used to treat SCT."
Aldous wonders what disease mongering really is, but he is fairly certain that he has identified one with Sluggish Cognitive Tempo Disorder (SCT). "Disease mongering is a tough concept to define—but if it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck. What we have here seems to be a duck egg. SCT has yet to hatch as a distinct disorder, but if it does, there’s the clear potential for drug companies’ marketing departments to expand its boundaries to encompass people who are not really sick."
Barkley is also suggesting a new name for the disorder, feeling that "sluggish" might be offensive to some parents and children. He has proposed "concentration deficit disorder, arguing that labeling kids as 'sluggish' is harmful." Maybe so, but the proposed name change also reinforces the idea that SCT is a disorder, rather than a bunch of symptoms that 'normal' people may exhibit to a lesser degree."
Althous believes that "Barkley's findings raise a red flag for some mental health experts, who fear that we’re in danger of pathologizing normal mental variation. 'You’ve got to be very careful here,' says Jerome Wakefield of New York University, who studies the validity of psychiatric diagnoses. “This is the kind of disorder that parents will see in their kids—whether they have it or not.”
The Role of Pharma in Disease Mongering
For a newly coined disease to take off and truly flourish in the marketplace, having the support of a pharmaceutical company helps. Sure enough, continues Althous, "That turns the spotlight on Eli Lilly, which last year published a clinical trial showing that its ADHD drug atomoxetine, marketed as Strattera, reduced SCT symptoms. The trial was designed to see if the drug helps children with both ADHD and dyslexia, and the SCT checklist was just one of several tests used to monitor how they were doing. Lilly included it at the request of an academic psychiatrist on the team, Keith McBurnett of the University of California, San Francisco. Still, when the trial was written up, the company wasn’t shy about trumpeting its finding: “This is the first study to report significant effects of any medication on SCT,” the paper concluded.
What is Strattera?
Atomoxetine (brand name Strattera) is a non-stimulant form of medication used for children with attention and focusing problems. There are certain side effects of atomoxetine that parents should be aware of. According to the health information website Medline Plus,a service of the National Institute of Health, the following warnings should be noted when a child takes Strattera.
"Studies have shown that children and teenagers with attention-deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) who take atomoxetine are more likely to think about killing themselves than children and teenagers with ADHD who do not take atomoxetine.
While your child is taking atomoxetine, you should watch his or her behavior very carefully, especially at the beginning of treatment and any time his or her dose is increased or decreased. Your child may develop serious symptoms very suddenly, so it is important to pay attention to his or her behavior every day. Ask other people who spend a lot of time with your child, such as brothers, sisters, and teachers to tell you if they notice changes in your child's behavior."
What Should Parents do to help a Daydreaming child?
To answer the question I ask in the title of this article, parents have two options if they want to help their scatterbrained day-dreamy kids. They can take their child to a doctor who buys into the notion that daydreaming is a disorder that requires medication; or they can do what my own parents did in the days before kids were medicated for being a little dreamy: allow their child to be daydreamy and scatterbrained and assume that when the child becomes truly interested in something, her focus will improve in time.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of Why French Kids don't have ADHD, and a forthcoming book: A Disease Called Childhood.
