Journal of Neuro-Oncology

, Volume 114, Issue 1, pp 71–78 | Cite as

Sluggish cognitive tempo in survivors of pediatric brain tumors

  • Victoria W. Willard
  • Kristina K. Hardy
  • Taryn M. Allen
  • Eugene I. Hwang
  • Sridharan Gururangan
  • Sarah A. Hostetter
  • Melanie J. Bonner
Clinical Study


The presence of neurocognitive late effects in survivors of pediatric brain tumors is well established. However, there remains some debate about how best to conceptualize these deficits. Sluggish cognitive tempo (SCT) is a proposed conceptual framework that has been used to describe a subset of children with ADHD who exhibit a particular profile characterized by lethargy, day dreaming and staring, and poor organization. Previous work has suggested that survivors of leukemia exhibit a similar profile, but it has not yet been examined in survivors of pediatric brain tumors. A sample of 65 survivors of pediatric brain tumors, 25 survivors of leukemia and 50 community controls completed the Child Behavior Checklist, with four items used to measure SCT. Survivors completed additional measures of neurocognitive functioning. Survivors of brain tumors demonstrated significantly greater symptoms of SCT than survivors of leukemia or controls. SCT was associated with attention problems and working memory deficits and the presence of a VP-shunt. Results provided conditional support for the presence of SCT in survivors of brain tumors, with further research needed to determine the clinical utility of the framework.


Pediatric brain tumors Survivorship Sluggish cognitive tempo Late effects Attention problems 


Conflict of interest

The authors have no conflicts of interest or funding to disclose.


  1. 1.
    Robinson KE, Futtesch JF, Champion JE, Andreotti CF, Hipp DW, Bettis A, Barnwell A, Compas BE (2010) A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors. Pediatr Blood Cancer 55:525–531. doi: 10.1002/pbc.22568 PubMedCrossRefGoogle Scholar
  2. 2.
    Maddrey AM, Bergeron JA, Lombardo ER, McDonald NK, Mulne AF, Barenberg PD, Bowers DC (2005) Neuropsychological performance and quality of life of 10 year survivors of childhood medulloblastoma. J Neurooncol 72:245–253. doi: 10.1007/s11060-004-3009-z PubMedCrossRefGoogle Scholar
  3. 3.
    Zebrack BJ, Gurney JG, Oeffinger K, Whitton J, Packer RJ, Mertens A, Turk N, Castleberry R, Dreyer Z, Robison LL, Zeltzer LK (2004) Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivors study. J Clin Oncol 22:999–1006. doi: 10.1200/JCO.2004.06.148 PubMedCrossRefGoogle Scholar
  4. 4.
    Kahalley LS, Conklin HM, Tyc VL, Wilson SJ, Hinds PS, Wu S, Xiong X, Hudson MM (2011) ADHD and secondary ADHD criteria fail to identify many at-risk survivors of pediatric ALL and brain tumor. Pediatr Blood Cancer 57:110–118. doi: 10.1002/pbc.22998 PubMedCrossRefGoogle Scholar
  5. 5.
    Bonner MJ, Hardy KK, Willard VW, Gururangan S (2009) Additional evidence of a nonverbal learning disability in survivors of pediatric brain tumors. Child Health Care 38:49–63. doi: 10.1080/02739610802615849 CrossRefGoogle Scholar
  6. 6.
    Buono LA, Morris MK, Morris RD, Krawiecki N, Norris FH, Foster MA, Copeland DR (1998) Evidence for the syndrome of nonverbal learning disabilities in children with brain tumors. Child Neuropsychol 4:144–157. doi: 10.1076/chin. CrossRefGoogle Scholar
  7. 7.
    Carey ME, Barakat LP, Foley B, Gyato K, Phillips PC (2001) Neuropsychological functioning and social functioning of survivors of pediatric brain tumors: evidence of a nonverbal learning disability. Child Neuropsychol 7:265–272. doi: 0929-7049/01/0704-265 PubMedCrossRefGoogle Scholar
  8. 8.
    Poggi G, Liscio M, Adduci A, Galbiati S, Massimino M, Sommovigo M, Zettin M, Figini E, Castelli E (2005) Psychological and adjustment problems due to acquired brain lesions in childhood: a comparison between post-traumatic patients and brain tumour survivors. Brain Inj 19:777–785. doi: 10.1080/0269905500110132 PubMedCrossRefGoogle Scholar
  9. 9.
    Butler RW, Copeland DR (2002) Attentional processes and their remediation in children treated for cancer: a literature review and the development of a therapeutic approach. J Int Neuropsychol Soc 8:115–124. doi: 10.1017/S1355617702811110 PubMedCrossRefGoogle Scholar
  10. 10.
    Harrington KM, Waldman ID (2010) Evaluating the utility of sluggish cognitive tempo in discriminating among DSM-IV ADHD subtypes. J Abnorm Child Psychol 38:173–184. doi: 10.1007/s10802-009-9355-8 PubMedCrossRefGoogle Scholar
  11. 11.
    Hartman CA, Willcutt EG, Rhee SH, Pennington BF (2004) The relation between sluggish cognitive tempo and DSM-IV ADHD. J Abnorm Child Psychol 32:491–503. doi: 10.1023/B:JACP.0000037779.85211.29 PubMedCrossRefGoogle Scholar
  12. 12.
    McBurnett K, Pfiffner LJ, Frick PJ (2001) Symptom properties as a function of ADHD type: an argument for continued study of sluggish cognitive tempo. J Abnorm Child Psychol 29:207–213. doi: 10.1023/A:1010377530749 PubMedCrossRefGoogle Scholar
  13. 13.
    Carlson CL, Mann M (2002) Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. J Clin Child Adolesc Psychol 31:123–129. doi: 10.1207/153744202753441738 PubMedGoogle Scholar
  14. 14.
    Lee S, Burns GL, Snell J, McBurnett K (in press) Validity of the sluggish cognitive tempo symptom dimension in children: Sluggish cognitive tempo and ADHD-Inattention as distinct symptom dimensions. J Abnorm Child Psychol. doi: 10.1007/s10802-013-9714-3
  15. 15.
    Wåhlstedt C, Bohlin G (2010) DSM-IV-defined inattention and sluggish cognitive tempo: independent and interactive relations to neuropsychological factors and comorbidity. Child Neuropsychol 16:350–365. doi: 10.1080/09297041003671176 PubMedCrossRefGoogle Scholar
  16. 16.
    Barkley RA (2013) Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. J Atten Disord 42:161–173. doi: 10.1080/15374416.2012.734259 Google Scholar
  17. 17.
    Meeske KA, Katz ER, Palmer SN, Burwinkle T, Varni JW (2004) Parent proxy-report health-related quality of life and fatigue in pediatric patients diagnosed with brain tumors and acute lymphoblastic leukemia. Cancer 101:2116–2125. doi: 10.1002/cncr.20609 PubMedCrossRefGoogle Scholar
  18. 18.
    Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQL in pediatric cancer: reliability and validity of the pediatric quality of life inventory. Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module Cancer 94:2090–2106. doi: 10.1002/cncr.10428 Google Scholar
  19. 19.
    Kahalley LS, Conklin HM, Tyc VL, Hudson MM, Wilson SJ, Wu S, Xiong X, Hinds PS (in press) Slower processing speed after treatment for pediatric brain tumor and acute lymphoblastic leukemia. Psychooncology. doi: 10.1002/pon.3255
  20. 20.
    Aukema EJ, Caan MW, Oudhuis N, Majoie CB, Vos FM, Reneman L, Last BF, Grootenhuis MA, Schouten-van Meetersen AY (2009) White matter fractional anisotropy correlates with speed of processing and motor speed in young childhood cancer survivors. Int J Radiat Oncol Biol Phys 74:837–843. doi: 10.1016/j.ijrobp.2008.08.060 PubMedCrossRefGoogle Scholar
  21. 21.
    Mulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, Brown R, Xiong X, Wu S, Gururangan S, Reddick WE (2004) Short-term efficacy of methylphenidate: a randomized, double-blind, placebo-controlled trial among survivors of childhood cancer. J Clin Oncol 22:4795–4803. doi: 10.1200/JCO.2004.04.128 PubMedCrossRefGoogle Scholar
  22. 22.
    Reeves CB, Palmer S, Gross AM, Simonian SJ, Taylor L, Willingham E, Mulhern RK (2007) Brief Report: sluggish cognitive tempo among pediatric survivors of acute lymphoblastic leukemia. J Pediatr Psychol 32:1050–1054. doi: 10.1093/jpepsy/jsm063 PubMedCrossRefGoogle Scholar
  23. 23.
    Ellenberg L, Liu Q, Gioia G, Yasui Y, Packer RJ, Mertens A, Donaldson SS, Stovall M, Kadan-Lottick N, Armstrong G, Robison LL, Zeltzer LK (2009) Neurocognitive status in long-term survivors of childhood CNS malignancies: a report from the childhood cancer survivor study. Neuropsychology 23:705–717. doi: 10.1037/a0016674 PubMedCrossRefGoogle Scholar
  24. 24.
    Butler RW, Haser JK (2006) Neurocognitive effects of treatment for childhood cancer. Dev Disabil Res Rev 12:184–191. doi: 10.1002/mrdd.20110 CrossRefGoogle Scholar
  25. 25.
    Achenbach TM (1991) Manual for the CBCL. University of Vermont, BurlingtonGoogle Scholar
  26. 26.
    Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth & Families, BurlingtonGoogle Scholar
  27. 27.
    Achenbach TM, Rescorla LA (2007) Multicultural supplement to the manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth & Families, BurlingtonGoogle Scholar
  28. 28.
    Wechsler D (2003) Wechsler intelligence scale for children—4th Edition. The Psychological Corporation, San AntonioGoogle Scholar
  29. 29.
    Wechsler D (1997) Wechsler adult intelligence scale—3rd edition. The Psychological Corporation, San AntonioGoogle Scholar
  30. 30.
    Conklin HM, Krull KR, Reddick WE, Pei D, Cheng C, Pui CH (2012) Cognitive outcomes following contemporary treatment without cranial irradiation for childhood acute lymphoblastic leukemia. J Natl Cancer Inst 104:1386–1395. doi: 10.1093/jnci/djs344 PubMedCrossRefGoogle Scholar
  31. 31.
    Jansen NC, Kingma A, Schuitema A, Bouma A, Huisman J, Veerman AJ, Kamps WA (2006) Post-treatment intellectual functioning in children treated for acute lymphoblastic leukaemia (ALL) with chemotherapy-only: a prospective, sibling-controlled study. Eur J Cancer 42:2765–2772. doi: 10.1016/j.ejca.2006.06.014 PubMedCrossRefGoogle Scholar
  32. 32.
    Poggi G, Liscio M, Galbiati S, Adduci A, Massimino M, Gandola L, Spreafico F, Clerici CA, Fossati-Bellanti F, Sommovigo M, Castelli E (2005) Brain tumors in children and adolescents: cognitive and psychological disorders at different ages. Psychooncology 14:386–395. doi: 10.1002/pon.85510.1002/pon.855 PubMedCrossRefGoogle Scholar
  33. 33.
    Duffner PK (2010) Risk factors for cognitive decline in children treated for brain tumors. Eur J Paediatr Neurol 14:106–115. doi: 10.1016/j.ejpn.2009.10.005 PubMedCrossRefGoogle Scholar
  34. 34.
    Hardy KK, Bonner MJ, Willard VW, Watral MA, Gururangan S (2008) Hydrocephalus as a possible additional contributor to cognitive outcome in survivors of pediatric medulloblastoma. Psychooncology 17:1157–1161. doi: 10.1002/pon.1349 PubMedCrossRefGoogle Scholar
  35. 35.
    Becker SP, Luebbe AM, Greening L, Fite PJ, Stoppelbein L (in press) A preliminary investigation of the relation between thyroid functioning and sluggish cognitive tempo in children. J Atten Disord. doi: 10.1177/1087054712466917
  36. 36.
    Merchant TE, Conklin HM, Wu S, Lustig RH, Xiong X (2009) Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation of cognitive, endocrine, and hearing deficits. J Clin Oncol 27:3691–3697. doi: 10.1200/JCO.2008.21.2738 PubMedCrossRefGoogle Scholar
  37. 37.
    Sobol G, Musioł K, Kalina M, Kalina-Faska B, Mizia-Malarz A, Ficek K, Mandera M, Woś H, Małecka-Tendera E (2012) The evaluation of function and the ultrasonographic picture of thyroid in children treated for medulloblastoma. Childs Nerv Syst 28:399–404. doi: 10.1007/s00381-011-1625-4 PubMedCrossRefGoogle Scholar
  38. 38.
    Levisohn L, Cronin-Golomb A, Schmahmann JD (2000) Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain 123:1041–1050. doi: 10.1093/brain/123.5.1041 PubMedCrossRefGoogle Scholar
  39. 39.
    Garner AA, Marceaux JC, Mrug S, Patterson C, Hodgens B (2010) Dimensions and correlates of attention deficit/hyperactivity disorder and sluggish cognitive tempo. J Abnorm Child Psychol 38:1097–1107. doi: 10.1007/s10802-010-9436-8 PubMedCrossRefGoogle Scholar
  40. 40.
    Ivanenko A, Tauman RG, Gozal D (2003) Modafinil in the treatment of excessive daytime sleepiness in children. Sleep Med 4:579–582. doi: 10.1016/S1389-9457(03)00162-X PubMedCrossRefGoogle Scholar
  41. 41.
    Kumar R (2008) Approved and investigational uses of modafinil: an evidence-based review. Drugs 68:1803–1839. doi: 0012-6667/08/0013-1803 PubMedCrossRefGoogle Scholar
  42. 42.
    Kahbazi M, Ghoreishi A, Rahiminejad F, Mohammadi MR, Kamalipour A, Akhondzadeh S (2009) A randomized, double-blind and placebo-controlled trial of modafinil in children and adolescents with attention deficit and hyperactivity disorder. Psychiatry Res 168:234–237. doi: 10.1016/j.psychres.2008.06.024 PubMedCrossRefGoogle Scholar
  43. 43.
    Amiri S, Mohammadi MR, Mohammadi M, Nouroozinejad GH, Kahbazi M, Akhondzadeh S (2008) Modafinil as a treatment for attention-deficit/hyperactivity disorder in children and adolescents: a double blind, randomized clinical trial. Prog Neuropsychopharmacol Biol Psychiatry 32:145–149. doi: 10.1016/j.pnpbp.2007.07.025 PubMedCrossRefGoogle Scholar
  44. 44.
    Biederman J, Pliszka SR (2008) Modafinil improves symptoms of attention-deficit/hyperactivity disorder across subtypes in children and adolescents. J Pediatr 152:394–399. doi: 10.1016/j.jpeds.2007.07.052 PubMedCrossRefGoogle Scholar
  45. 45.
    Lundorff LE, Jønsson BH, Sjøgren P (2009) Modafinil for attentional and psychomotor dysfunction in advanced cancer: a double-blind, randomised, cross-over trial. Palliat Med 23:731–738. doi: 10.1177/0269216309106872 PubMedCrossRefGoogle Scholar
  46. 46.
    Penny A, Waschbusch DA, Klein RM, Corkum P, Eskes G (2009) Developing a measure of sluggish cognitive tempo for children: content validity, factor structure, and reliability. Psychol Assess 21:380–389. doi: 10.1037/a0016600 PubMedCrossRefGoogle Scholar
  47. 47.
    Pfiffner LJ, Yee Mikami A, Huang-Pollock C, Easterlin B, Zalecki C, McBurnett K (2007) A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. J Am Acad Child Adolesc Psychiatry 46:1041–1050. doi: 10.1097/chi.0b013e318064675f PubMedCrossRefGoogle Scholar
  48. 48.
    Jacobson LA, Murphy-Bowman SC, Pritchard AE, Tart-Zelvin A, Zabel TA, Mahone EM (2012) Factor structure of a sluggish cognitive tempo scale in clinically-referred children. J Abnorm Child Psychol 40:1327–1337. doi: 10.1007/s10802-012-9643-6 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Victoria W. Willard
    • 1
    • 6
  • Kristina K. Hardy
    • 2
  • Taryn M. Allen
    • 1
  • Eugene I. Hwang
    • 3
  • Sridharan Gururangan
    • 4
  • Sarah A. Hostetter
    • 2
  • Melanie J. Bonner
    • 1
    • 5
  1. 1.Department of Psychology and NeuroscienceDuke UniversityDurhamUSA
  2. 2.Center for Neuroscience and Behavioral MedicineChildren’s National Medical CenterWashingtonUSA
  3. 3.Brain Tumor Institute and Center for Cancer and Blood DisordersChildren’s National Medical CenterWashingtonUSA
  4. 4.Preston Robert Tisch Brain Tumor Center and Departments of Pediatrics and SurgeryDuke University Medical CenterDurhamUSA
  5. 5.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  6. 6.Department of PsychologySt Jude Children’s Research HospitalMemphisUSA

Personalised recommendations