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How Do You Help a Sluggish Child?

The controversial diagnosis of Sluggish Cognitive Tempo.

Key points

  • Problems with attention problems, mind-wandering, and energy have led to the controversial construct Sluggish Cognitive Tempo (SCT). 
  • There is debate as to whether this condition is part of ADHD or a distinct diagnosis.
  • No medications are currently approved to treat SCT. Potentially relevant drugs may include Strattera, Ritalin, and antidepressants.

Some children daydream much more than others. They take in information slowly, get sleepy when bored and act withdrawn. They may be sad and anxious but usually aren’t disruptive. Do they need medication?

Heung Soon/Pixabay
Source: Heung Soon/Pixabay

In a 1986 study that tested a rating scale used by teachers to identify students with behavior problems, one problem was defined as “sluggish tempo.” At the time, ADHD researchers were debating whether two kinds of ADHD, called predominantly hyperactive/impulsive and predominantly inattentive, were, in fact, separate conditions. Of the six million U.S. children who have been diagnosed with ADHD, according to the CDC, about two million fall into the inattentive group.

The clinical psychologist Russell Barkley of Virginia Commonwealth University Medical Center concluded that the predominantly inattentive group actually suffered from a distinct illness. It now goes by the name Sluggish Cognitive Tempo (SCT).

In 2014, the Journal of Abnormal Child Psychology devoted a special issue to SCT, though the idea that it might be a separate illness remains controversial.

SCT is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a recognized list of psychiatric diagnoses. But a psychiatrist or psychologist may diagnose SCT based on symptoms. People with SCT may stare blankly into space, lose their train of thought and have trouble expressing themselves or forget what they were thinking or about to say.

While people with ADHD can do well when they are in a “high-load” demanding situation that doesn’t leave room for distraction, people with SCT would not.

The term SCT has caught on among people with attention issues. A Reddit group for SCT has 4,400 members, many of them adults who think they may have had this problem beginning in childhood.

How Is SCT Treated?

There is no standard treatment plan or research comparing medications or therapy on this group. A 2013 study of Strattera (atomoxetine), a non-stimulant prescribed for ADHD, was the first to report a drug having a positive effect on SCT, but a 2017 study found that it wasn’t especially helpful for SCT symptoms.

A doctor might also prescribe Ritalin (methylphenidate hydrochloride), a standard ADHD drug. A drug called Luvox (fluvoxamine), an antidepressant used to treat social anxiety or obsessive-compulsive behavior, may be prescribed as well. Anti-depressants and therapy may help address sadness and anxiety.

A new non-stimulant medication called Qelbree has been approved for children with ADHD, which may be helpful although it carries the risk of triggering thoughts of suicide.

A 2020 case study described a boy whose parents brought him to a clinic when he was five years and six months old. He learned to read and write on time, and when he was seven his teacher “reported that he used to move very slowly, look at something for a long time with empty eyes, [and] daydream, but academically did not have problems.” He eventually was treated with Ritalin. When that didn’t help his sluggishness, by the time he was almost ten he received Strattera for seven months and improved.

Every medication carries the risk of side effects. It’s important, of course, to check whether sluggishness is caused by lack of sleep or sleep apnea, a condition in which your sleep is disrupted, or another learning disorder or neurological problem.

A version of this story appears at Your Care Everywhere.