The objective was to determine the differential validity of a cognitive disengagement syndrome-only (CDS-only) group from ADHD-inattentive presentation-only (IN-only), ADHD-hyperactive-impulsive presentation-only (HI-only), and ADHD-combined presentation (C-only) groups within childhood (ages 5–10) and adolescence (ages 11–16).
Methods:
Parents of a nationally representative sample of 5,525 Spanish youth (ages 5–16, 56.1% boys) completed measures of CDS, ADHD-inattention (IN), and ADHD-hyperactivity/impulsivity (HI) and other measures. Scores greater/less than the top 5% on CDS, IN, and HI were used to create: (1) control, (2) CDS-only, (3) ADHD-IN-only, (4) ADHD-HI-only, (5) ADHD-C-only, (6) CDS + ADHD-IN, (7) CDS + ADHD-HI, and (8) CDS + ADHD-C groups within childhood and adolescence.
Results:
Within childhood, the CDS-only group had higher scores than the three ADHD presentations on anxiety, depression, somatization, daytime sleep-related impairment, nighttime sleep disturbance, social impairment, and peer withdrawal, whereas CDS-only, ADHD-IN-only, and ADHD-HI-only groups did not differ on oppositional defiant disorder (ODD) and academic impairment (ADHD-C-only higher). Within adolescence, the CDS-only group again had higher scores than the three ADHD presentations on somatization and daytime sleep-related impairment but was now lower than the three ADHD presentations on ODD as well as lower on academic impairment than the ADHD-IN-only and ADHD-C-only groups. Within adolescence, the CDS-only group and the three ADHD presentations did not differ on depression, social impairment, or peer withdrawal.
Conclusion:
The CDS-only group had strong differential validity from ADHD-IN-only, ADHD-HI-only, and ADHD-C-only groups within childhood with less striking differences in adolescence. In addition to more studies with adolescents, etiological models with multi-informant longitudinal data are needed to better understand the differences in CDS and ADHD dimensions and their changes across development.
BarkleyR. A. (2012). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology, 121, 978–990. https://doi.org/10.1037/a0023961
2.
BarkleyR. A. (2013). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: Executive functioning, impairment, and comorbidity. Journal of Clinical Child and Adolescent Psychology, 42, 161–173. https://doi.org/10.1080/15374416.2012.734259
3.
BarkleyR. A. (2014). Sluggish cognitive tempo (concentration deficit disorder?): Current status, future directions, and a plea to change the name. Journal of Abnormal Child Psychology, 42, 117–125. https://doi.org/10.1007/s10802-013-9824-y
4.
BaşayÖ.ÇiftçiE.BeckerS. P.BurnsG. L. (2021). Validity of sluggish cognitive tempo in Turkish children and adolescents. Child Psychiatry & Human Development, 52, 191–199. https://doi.org/10.1007/s10578-020-01110-5
5.
BeckerS. P. (2025). Cognitive disengagement syndrome: A construct at the crossroads. American Psychologist. Advance online publication. https://dx-doi-org-s.web.bisu.edu.cn/10.1037/amp0001517
6.
BeckerS. P.BurnsG. L.SmithZ. R.LangbergJ. M. (2020). Sluggish cognitive tempo in adolescents with and without ADHD: Differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains. Journal of Abnormal Child Psychology, 48, 391–406. https://doi.org/10.1007/s10802-019-00603-09
7.
BeckerS. P.EpsteinJ. N.BurnsG. L.MossingK. W.SchmittA. P.FershtmanC. E.VaughnA. J.ZoromskiA. K.PeughJ. L.SimonJ. O.TammL. (2022). Academic functioning in children with and without sluggish cognitive tempo. Journal of School Psychology, 95, 105–120. https://doi.org/10.1016/j.jsp.2022.10.001
8.
BeckerS. P.LeopoldD. R.BurnsG. L.JarrettM. A.LangbergJ. M.MarshallS. A.McBurnettK.WaschbuschD. A.WillcuttE. 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, 163–178. https://doi.org/10.1016/j.jaac.2015.12.006
9.
BeckerS. P.MossingK. W.ZoromskiA. K.VaughnA. J.EpsteinJ. N.TammL.BurnsG. L. (2020). Assessing sluggish cognitive tempo and ADHD inattention in elementary students: Empirical differentiation, invariance across sex and grade, and measurement precision. Psychological Assessment, 32, 1047–1056. https://doi.org/10.1037/pas0000946
10.
BeckerS. P.VaughnA. J.ZoromskiA. K.BurnsG. L.MikamiA. Y.FredrickJ. W.EpsteinJ. N.PeaughJ. L.TammL. (2024). A multi-method examination of peer functioning in children with and without cognitive disengagement syndrome. Journal of Clinical Child and Adolescent Psychology. Advance online publication. https://doi.org/10.1080/15374416.2024.2301771
11.
BeckerS. P.WillcuttE. G. (2019). Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. European Child & Adolescent Psychiatry, 28(5), 603–613. https://doi.org/10.1007/s00787-018-1136-x
12.
BeckerS. P.WillcuttE. G.LeopoldD. R.FredrickJ. W.SmithZ. R.JacobsonL. A.BurnsG. L.MayesS. D.WaschbuschD. A.FroehlichT. E.McBurnettK.ServeraM.BarkleyR. A. (2023). Report of a Work Group on sluggish cognitive tempo: Key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 62, 629–645. https://doi.org/10.1016/j.jaac.2022.07.821
13.
BelinatiG.MouraM.BeckerS. P.BurnsG. L. (2024). Validity of cognitive disengagement syndrome with mother and father ratings of Brazilian children: Replication of northern hemisphere findings in South America. Child Psychiatry & Human Development. Advance online publication. https://doi.org/10.1007/s10578-024-01789-w
14.
BenjaminiY.HochbergY. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, 57, 289–300.
15.
BurnsG. L.BeckerS. P. (2021). Sluggish cognitive tempo and ADHD symptoms in a nationally representative sample of U.S. children: Differentiation using categorical and dimensional approaches. Journal of Clinical Child and Adolescent Psychology, 50, 267–280. https://doi.org/10.1080/15374416.2019.1678165
16.
BurnsG. L.BeckerS. P. (2022). Convergent and discriminant validity of the Child and Adolescent Behavior Inventory scale scores with well-established psychopathology and academic achievement measures in adolescents with ADHD. Assessment, 29, 1086–1098. https://doi.org/10.1177/10731911211001929
17.
BurnsG. L.BeckerS. P.MontañoJ. J.ServeraM. (2024). Clinical distinction between cognitive disengagement syndrome and ADHD presentations in a nationally representative sample of Spanish children and adolescents. Journal of Child Psychology and Psychiatry, 65(12), 1601–1611. https://doi.1111/jcpp.14005
18.
BurnsG. L.GeiserC.ServeraM.BeckerS. P. (2022). Consistency and source specificity of symptom ratings for Child and Adolescent Behavior Inventory Scales with mother, father, and teacher ratings of Spanish children. Psychological Assessment, 34, 827–837. https://doi.org/10.1037/pas0001148
19.
BurnsG. L.LeeS.ServeraM.McBurnettK.BeckerS. P. (1997–2021). Child and adolescent behavior inventory - parent version 2.0.
20.
BurnsG. L.MontañoJ. J.BeckerS. P.ServeraM. (2025). Cognitive disengagement syndrome symptoms from early childhood to adolescence in a nationally representative Spanish sample. Journal of Clinical Child & Adolescent Psychology, 54, 374–388. https://doi.org/10.1080/15374416.2023.2272944
21.
BurnsG. L.PreszlerJ.AhnachA.ServeraM.BeckerS. P. (2022). Multisource network and latent variable models of sluggish cognitive tempo, ADHD-inattentive, and depressive symptoms with Spanish children: Equivalent findings and recommendations. Research on Child and Adolescent Psychopathology, 50, 881–894. https://doi.org/10.1007/s10802-021-00890-1
22.
BurnsG. L.ServeraM.BeckerS. P. (2021). Psychometric properties and normative information on the Child and Adolescent Behavior Inventory with ratings for Spanish children from parents and teachers. Psicothema, 33, 139–145. https://doi.10.7334/psicothema2020.267
23.
CicchettiD.RogoschF. A. (1996). Equfinality and multifinality in developmental psychopathology. Development and Psychopathology, 8, 597–600.
24.
ForrestC. B.MeltzerL. J.MarcusC. L.de la MotteA.KratchmanA.BuysseD. J.PilkonisP. A.BeckerB. D.BevansK. B. (2018). Development and validation of the PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks. Sleep, 41, zsy054. https://doi.org/10.1093/sleep/zsy054
25.
FredrickJ. W.BeckerS. P. (2023). Sluggish cognitive tempo (cognitive disengagement syndrome) and academic functioning: A systematic review and agenda for future research. Clinical Child and Family Psychology Review, 26, 82–120. https://doi.org/10.1007/s10567-022-00411-6
26.
FredrickJ. W.YeamanK. M.YuX.LandbergJ. M.BeckerS. P. (2022). A multi-method examination of sluggish cognitive tempo in relation to adolescence sleep, daytime sleepiness, and circadian preference. Journal of Child Psychology and Psychiatry, 63, 1658–1667. https://doi.org/10.1111/jcpp.13568
27.
JungS.LeeS.BurnsG. L.BeckerS. P. (2021). Internal and external validity of self-report and parent-report measures of sluggish cognitive tempo in South Korean adolescents. Journal of Psychopathology and Behavioral Assessment, 43, 355–366. https://doi.org/10.1007/s10862-020-09821-8
28.
LandbergJ. M.BeckerS. P.DvorskyM. R. (2014). The association between sluggish cognitive tempo and academic functioning in youth with attention-deficit/hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 42, 91–103. https://doi.org/10.1007/s108002-013-9722-3
29.
LeeS.-Y.BurnsG. L.SnellJ.McBurnettK. (2014). Validity of the sluggish cognitive tempo dimension in children: Sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42, 7–19. https://doi.org/10.1007/s10802-013-9714-3
O’HareK.WhiteN.HardingR.GallandB.SellbomM.ShineB.SchaughencyE. (2021). Sluggish cognitive tempo and daytime sleepiness mediate relationships between sleep and academic performance. Journal of Developmental & Behavioral Pediatrics, 42(8), 637–647.
33.
Sadeghi-BahmaniD.MohammadianY.GhasemiM.BahmaniL. S.PiriN.BrühlA. B.BeckerS. P.BurnsG. L.BrandS. (2022). Sluggish cognitive tempo among Iranian children and adolescents: A validation study of the Farsi Child and Adolescent Behavior Inventory (CABI)–Parent Version. Journal of Clinical Medicine, 11, 6346. https://doi.org/10.3390/jcm11216346
34.
SáezB.ServeraM.BeckerS. P.BurnsG. L. (2019). Optimal items for assessing sluggish cognitive tempo in children across mother, father, and teacher ratings. Journal of Clinical Child and Adolescent Psychology, 48, 825–839. https://doi.org/10.1080/15374416.2017.1416619
35.
ServeraM.SáezB.BurnsG. L.BeckerS. P. (2018). Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. Journal of Abnormal Psychoogyl, 127, 818–829. https://doi.org/10.1037/abn0000375
36.
YucensB.BasayO.BuberA.TumkayaS.BasayB. K.ErdenB.BeckerS. P.BurnsG. L. (2024). Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems. Journal of Clinical Psychology, 80(7), 1515–1527. https://10.1002/jclp.23678
37.
WalkerL. S.GarberJ. (2018). Manual for the Children’s Somatic Symptoms Inventory (CSSI). AAP.
38.
WillcuttE. G.ChhabildasN.KinnearM.DeFriesJ. C.OlsonR. K.LeopoldD. R.KeenanJ. M.PenningtonB. F. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM–IV ADHD. Journal of Abnormal Child Psychology, 42, 21–35. https://doi.org/10.1007/s10802-013-9800-6
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
