Comment on Eme, R. (2011) Sluggish cognitive tempo
By Joseph A. Buckhalt
Sluggish cognitive tempo is a relatively recent construct that is considered by Robert Eme (2011) to be a "possible new attention disorder." I agree that every ADHD evaluation should include assessment of the behaviors that are listed as criteria for the construct. But I doubt that the cluster of symptoms qualifies as a new diagnostic entity. Those who manifest these symptoms should be referred for an evaluation by a pediatric sleep specialist or a psychologist who has been trained to evaluate children's sleep. Two possibilities are these: a child may be one of the 3-5% of children who have a clinically diagnosable sleep disorder, including sleep apnea; or the child may be free of clinical disorder, but has poor sleep due to a multitude of factors, including insufficient parental monitoring, asthma and allergies, overweight/ obesity, or inadequate sleep environment. These problems may be explored by conducting an interview combined with one of several established self-report instruments. Depending on the results, parents and children can keep a sleep diary for a period of time and clinicians can employ actigraphy, which involves wearing an activity monitor during sleep to determine definitively the time it takes to fall asleep (sleep latency), the time actually sleeping compared with time in bed, and the regularity of sleep and wake times. Should further evaluation be called for, referral should be made to a sleep center for polysomnography, which is essential for diagnosis of many disorders. Polysomnography is the only method thus far that can determine sleep stages, oxygen saturation rates, and other parameters that aid diagnosis of the most serious problems. Interventions include CPAP devices, oral appliances, surgery (tonsillectomy/adenoidectomy), behavior therapy, and consultation with parents and child for better sleep habits and sleep environment.
Children's sleep has received increased attention recently by clinicians and researchers. Reviews of literature on diagnosis and treatments for sleep disorders are available (e.g. Mindell & Owens, 1999), as are reviews of studies showing relations between sleep in healthy children and problems in academic performance and behavior (Buckhalt, Wolfson, & El-Sheikh, 2009; Sadeh, 2007).
After ruling out sleep problems, I wonder if there will be children remaining in sufficient numbers to warrant a diagnostic category of sluggish cognitive tempo. After all, it seems obvious and parsimonious that children who are - to use the Penny et al. (2009) subscale names - slow, sleepy, and prone to daydreaming, may in fact "only" be in need of more sleep. Sleep insufficiency is very prevalent among children and adolescents in the U.S. and elsewhere, and may very well account for some significant portion of manifest academic, behavioral, and emotional problems.
Buckhalt, J. A., Wolfson, A., & El-Sheikh, M. (2009). Children's sleep and school psychology practice. School Psychology Quarterly, 24, 60–69.
Eme, R. (2011). Sluggish cognitive tempo. The School Psychologist, 65, 7-9.
Mindell, J. A., & Owens, J. A. (2009). A clinical guide to pediatric sleep: Diagnosis and management of sleep problems. New York: Lippincott, Williams, & Wilkins.
Penny, A., Waschbusch, D., Klein, R., Corkum, P., & Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: Content validity, factor structure, and reliability. Psychological Assessment, 21, 380-389.
Sadeh, A. (2007). Consequences of sleep loss or sleep disruption in children. Sleep Medicine Reviews, 2, 513–520.