Yet now some powerful figures in
mental health are claiming to have identified a new disorder that could
vastly expand the ranks of young people treated for attention problems.
Called sluggish cognitive tempo, the condition is said to be
characterized by lethargy, daydreaming and slow mental processing. By
some researchers’ estimates, it is present in perhaps two million
children.
Experts pushing for more research into sluggish
cognitive tempo say it is gaining momentum toward recognition as a
legitimate disorder — and, as such, a candidate for pharmacological
treatment. Some of the condition’s researchers have helped Eli Lilly
investigate how its flagship A.D.H.D. drug might treat it.
The Selling of Attention Deficit DisorderDEC. 14, 2013
The
Journal of Abnormal Child Psychology devoted 136 pages of its January
issue to papers describing the illness, with the lead paper claiming
that the question of its existence “seems to be laid to rest as of this
issue.” The psychologist Russell Barkley of the Medical University of
South Carolina, for 30 years one of A.D.H.D.’s most influential and
visible proponents, has claimed in research papers and lectures that
sluggish cognitive tempo “has become the new attention disorder.”
In
an interview, Keith McBurnett, a professor of psychiatry at the
University of California, San Francisco, and co-author of several papers
on sluggish cognitive tempo, said: “When you start talking about things
like daydreaming, mind-wandering, those types of behaviors, someone who
has a son or daughter who does this excessively says, ‘I know about
this from my own experience.’ They know what you’re talking about.”
Yet
some experts, including Dr. McBurnett and some members of the journal’s
editorial board, say that there is no consensus on the new disorder’s
specific symptoms, let alone scientific validity. They warn that the
concept’s promotion without vastly more scientific rigor could expose
children to unwarranted diagnoses and prescription medications —
problems that A.D.H.D. already faces.
“We’re seeing a fad in
evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years
or so, this is the beginning of another,” said Dr. Allen Frances, an
emeritus professor of psychiatry at Duke University. “This is a public
health experiment on millions of kids.”
Though the concept of
sluggish cognitive tempo, or S.C.T., has been researched sporadically
since the 1980s, it has never been recognized in the Diagnostic and
Statistical Manual of Mental Disorders, which codifies conditions
recognized by the American Psychiatric Association. The editor in chief
of The Journal of Abnormal Child Psychology, Charlotte Johnston, said in
an email that recent renewed interest in the condition is what led the
journal to devote most of one issue to “highlight areas in which further
study is needed.”
Dr. Barkley declined repeated requests for
interviews about his work and statements regarding sluggish cognitive
tempo. Several of the field’s other key researchers, Stephen P. Becker
of Cincinnati Children’s Hospital Medical Center, Benjamin B. Lahey of
the University of Chicago and Stephen A. Marshall of Ohio University,
also declined to comment on their work.
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.
“These
children are not the ones giving adults much trouble, so they’re easy
to miss,” Dr. McBurnett said. “They’re the daydreamy ones, the ones with
work that’s not turned in, leaving names off of papers or skipping
questions, things like that, that impinge on grades or performance. So
anything we can do to understand what’s going on with these kids is a
good thing.”
But Dr. McBurnett added that sluggish cognitive
tempo remained many years from any scientific consensus: “We haven’t
even agreed on the symptom list — that’s how early on we are in the
process.”
Steve S. Lee, an associate professor of psychology at
the University of California, Los Angeles, who serves on the editorial
board of The Journal of Abnormal Child Psychology, said in an interview
that he was conflicted over the journal’s emphasis on sluggish cognitive
tempo. He expressed concern that A.D.H.D. had already grown to
encompass too many children with common youthful behavior, or whose
problems are derived not from a neurological disorder but from
inadequate sleep, a different learning disability or other sources.
About
two-thirds of children with an A.D.H.D. diagnosis take daily medication
such as Adderall or Concerta, which often quells severe impulsiveness
and inattention but also carries risks for insomnia, appetite
suppression and, among teenagers and adults, abuse or addiction.
Dr.
McBurnett recently conducted a clinical trial funded and overseen by
Eli Lilly that investigated whether proposed symptoms of sluggish
cognitive tempo could be treated with Strattera, the company’s primary
A.D.H.D. drug. (One of Strattera’s selling points is that it is not a
stimulant like Adderall and Concerta, medications more susceptible to
abuse.) His study, published in The Journal of Child and Adolescent
Psychopharmacology, concluded, “This is the first study to report
significant effects of any medication on S.C.T.”
An Eli Lilly
spokeswoman said in an email, “Sluggish cognitive tempo is one of many
conditions that Lilly scientists continue to study to help satisfy unmet
medical needs around the world.”
Representatives of the drug
companies that make the best-selling medications for A.D.H.D. — Shire
(extended-release Adderall and Vyvanse), Novartis (Focalin) and Janssen
(Concerta) — said they are not currently conducting research into
sluggish cognitive tempo. However, because the new condition shares so
many symptoms with A.D.H.D., these products might easily be repositioned
to serve the new market.
Dr. Barkley, who has said that “S.C.T.
is a newly recognized disorder,” also has financial ties to Eli Lilly;
he received $118,000 from 2009 to 2012 for consulting and speaking
engagements, according to propublica.org. While detailing sluggish
cognitive tempo in The Journal of Psychiatric Practice, Dr. Barkley
stated that Strattera’s performance on sluggish cognitive tempo symptoms
was “an exciting finding.” Dr. Barkley has also published a symptom
checklist for mental health professionals to identify adults with the
condition; the forms are available for $131.75 apiece from Guilford
Press, which funds some of his research.
Dr. Barkley, who edits
sluggish cognitive tempo’s Wikipedia page, declined a request to discuss
his financial interests in the condition’s acceptance.
“I have
no doubt there are kids who meet the criteria for this thing, but
nothing is more irrelevant,” Dr. Frances said. “The enthusiasts here are
thinking of missed patients. What about the mislabeled kids who are
called patients when there’s nothing wrong with them? They are not
considering what is happening in the real world.”
