Correlates of Sluggish Cognitive Tempo Among Clinic-Referred Youth: Expanding Awareness of Somatic Symptoms and Stress in the Clinical Picture

Abstract

Using data from a clinically referred sample, we examined the role of sluggish cognitive tempo (SCT) as it relates to internalizing disorders, somatic problems, stress, and processing speed among children evaluated in an outpatient setting. Parent ratings on the Child Behavior Checklist (CBCL) and performance on the child Wechsler Intelligence Scale for Children Processing Speed Index (WISC-V PSI) scores were obtained from 122 pediatric patients (81 boys and 41 girls) between 6:1 and 16:9 years old. Forty to 49% of children were rated as having clinically significant symptoms of SCT, based on fathers’ and mothers’ ratings, respectively. Analysis indicated that children rated as exhibiting SCT by mothers were also rated as having clinically significant problems with internalizing symptoms, somatic problems, stress problems, and processing speed difficulties. Like analysis of mothers’ CBCL ratings, analysis of fathers’ CBCL ratings indicated children exhibiting SCT had clinically significant problems with internalizing symptoms, somatic problems, and stress problems. Unlike analysis of mothers’ results, fathers’ ratings of SCT were not significantly correlated to children’s processing speed scores. Importantly, this study extends understanding of how SCT is related to somatic problems and stress problems while confirming past findings regarding the link between SCT and internalizing problems and, more generally, processing speed. Implications for research, diagnosis, and treatment are discussed.

This is a preview of subscription content, access via your institution.

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  2. Achenbach, T. M., & Rescorla, L. A. (2007). Multicultural supplement to the manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Book  Google Scholar 

  4. Barkley, R. A. (2013). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: Executive functioning, impairment, and comorbidity. Journal of Clinical Child & Adolescent Psychology, 42, 161–173. https://doi.org/10.1080/15374416.2012.734259.

    Article  Google Scholar 

  5. Barkley, R. 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(1), 117–125. https://doi.org/10.1007/s10802-013-9824-y.

    Article  PubMed  Google Scholar 

  6. Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York: Guilford Press.

    Google Scholar 

  7. Barkley, R. A. (2018). Barkley sluggish cognitive tempo scale - Children and adolescents (BSCTS-CA). N.P: Guilford Publications.

    Google Scholar 

  8. Barkley, R. A., DuPaul, G. J., & McMurry, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58(6), 775–789. https://doi.org/10.1037/0022-006X.58.6.775.

    Article  PubMed  Google Scholar 

  9. Bauermeister, J. J., Barkley, R. A., Bauermeister, J. A., Martinez, J. V., & McBurnett, K. (2012). Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: Neuropsychological and psychological correlates. Journal of Abnormal Child Psychology, 40(5), 683–697. https://doi.org/10.1007/s10802-011-9602-7.

    Article  PubMed  Google Scholar 

  10. Becker, S. P. (2013). Topical review: Sluggish cognitive tempo: Research findings and relevance for pediatric psychology. Journal of Pediatric Psychology, 38(10), 1051–1057. https://doi.org/10.1093/jpepsy/jst058.

    Article  PubMed  Google Scholar 

  11. Becker, S. P., Garner, A. A., & Byars, K. C. (2016a). Sluggish cognitive tempo in children referred to a pediatric sleep disorders center: Examining possible overlap with sleep problems and associations with impairment. Journal of Psychiatric Research, 77, 116–124. https://doi.org/10.1016/j.jpsychires.2016.03.005.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Becker, S. P., Leopold, D. R., Burns, G. L., Jarrett, M. A., Langberg, J. M., Marshall, S. A., McBurnett, K., Waschbusch, D. A., & Willcutt, E. G. (2016b). 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(3), 163–178. https://doi.org/10.1016/j.jaac.2015.12.006.

    Article  Google Scholar 

  13. Becker, S. P., Withrow, A. R., Stoppelbein, L., Luebbe, A. M., Fite, P. J., & Greening, L. (2016c). Sluggish cognitive tempo is associated with suicide risk in psychiatrically hospitalized children. Journal of Child Psychology and Psychiatry, 57(12), 1390–1399. https://doi.org/10.1111/jcpp.12580.

    Article  PubMed  Google Scholar 

  14. Becker, S. P., & Langberg, J. M. (2012). Sluggish cognitive tempo among young adolescents with ADHD: Relations to mental health, academic, and social functioning. Journal of Attention Disorders. https://doi.org/10.1177/1087054711435411.

  15. Becker, S. P., & Langberg, J. M. (2014). Attention deficit/hyperactivity disorder and sluggish cognitive tempo dimensions in relation to executive function in adolescents with ADHD. Child Psychiatry and Human Development, 45(1), 1–11. https://doi.org/10.1007/s10578-013-0372-z.

    Article  PubMed  Google Scholar 

  16. Becker, S. P., Langberg, J. M., Luebbe, A. M., Dvorsky, M. R., & Flannery, A. J. (2014a). Sluggish cognitive tempo is associated with academic functioning and internalizing symptoms in college students with and without attention-deficit/hyperactivity disorder. Journal of Clinical Psychology, 70, 388–403. https://doi.org/10.1002/jclp.22046.

    Article  PubMed  Google Scholar 

  17. Becker, S. P., Luebbe, A. M., Fite, P. J., Stoppelbein, L., & Greening, L. (2014b). Sluggish cognitive tempo in psychiatrically hospitalized children: Factor structure and relations to internalizing symptoms, social problems, and observed behavioral dysregulation. Journal of Abnormal Child Psychology, 42, 49–62. https://doi.org/10.1007/s10802-013-9719-y.

    Article  PubMed  Google Scholar 

  18. Becker, S. P., Burns, G. L., Smith, Z. R., & Langberg, J. 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(3), 391–406. https://doi.org/10.1007/s10802-019-00603-9.

  19. Becker, S. P., Marsh, N. P., Holdaway, A. S., & Tamm, L. (2019). Sluggish cognitive tempo and processing speed in adolescents with ADHD: Do finding vary based on informant task? European Child and Adolescents Psychiatry, online first. https://doi.org/10.1007/s00787-019-01446-x.

  20. Björkenstam, E., Björkenstam, C., Jablonska, B., & Kosidou, K. (2018). Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: A cohort study of 543,650 adolescents and young adults in Sweden. Psychological Medicine, 48, 498–507. https://doi.org/10.1017/S0033291717001933.

    Article  PubMed  Google Scholar 

  21. Burns, G. L., & Becker, S. P. (2019). Sluggish cognitive tempo and ADHD in a nationally representative sample of U.S. children: Differentiation of categorical and dimensional approaches. Journal of Clinical and Adolescent Psychology, online first. https://doi.org/10.1080/15374461-2019,1678165.

  22. Burns, G. L., Becker, S. P., Servera, M., Del Mar Bernad, M., & Garcia-Banda, G. (2017). Sluggish cognitive tempo and attention-deficit/hyperactivity disorder (ADHD) inattention in the home and school contexts: Parent and teacher invariance and cross-setting validity. Psychological Assessment, 29(2), 209–220. https://doi.org/10.1037/pas0000325.

    Article  PubMed  Google Scholar 

  23. Calhoun, S. L., & Mayes, S. D. (2005). Processing speed in children with clinical disorders. Psychology in the Schools, 42(4), 333–343. https://doi.org/10.1002/pits.20067.

    Article  Google Scholar 

  24. Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child & Adolescent Psychology, 31(1), 123. https://doi.org/10.1207/S15374424JCCP3101_14.

    Article  Google Scholar 

  25. Chen, W. J., Faraone, S. V., Biederman, J., & Tsuang, M. T. (1994). Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis. Journal of Consulting and Clinical Psychology, 62(5), 1017–1025. https://doi.org/10.1037/0022-006X.62.5.1017.

    Article  PubMed  Google Scholar 

  26. Combs, M. A., Canu, W. H., Broman-Fulks, J. J., Rocheleau, C. A., & Nierman, D. C. (2012). Perceived stress and ADHD symptoms in adults. Journal of Attention Disorders, online first. https://doi.org/10.1177/1087054712459558.

  27. Condon, E. M. (2018). Chronic stress in children and adolescents: A review of biomarkers for use in pediatric research. Biological Research in Nursing, 20(5), 478–496. https://doi.org/10.1177/1099800418779214.

    Article  Google Scholar 

  28. Cook, N. E., Braaten, E. B., Vuijk, P. J., Lee, B. A., Samkavitz, A. R., Doyle, A. E., & Surman, C. B. H. (2019). Slow processing speed and sluggish cognitive tempo in pediatric attention-deficit/hyperactivity disorder: Evidence for differentiation of functional correlates. Child Psychiatry and Human Development, 50(6), 1049–1057. https://doi.org/10.1007/s10578-019-00904-6.

    Article  PubMed  Google Scholar 

  29. Coplan, R. J., Hughes, K., Bosacki, S., & Rose-Krasnor, L. (2011). Is silence golden? Elementary teachers’ strategies and beliefs regarding hypothetical shy/quiet and exuberant/talkative children. Journal of Educational Psychology, 103(4), 939–951. https://doi.org/10.1037/a0024551.

  30. Cortes, J. F., Servera, M., Becker, G., & Burns, G. L. (2014). External validity of ADHD inattention and sluggish cognitive tempo dimensions in Spanish children with ADHD. Journal of Attention Disorders, online first. https://doi.org/10.1177/1087054714548033.

  31. Del Mar Bernad, M., Servera, M., Becker, S. P., & Burns, G. L. (2016). Sluggish cognitive tempo and ADHD inattention as predictors of externalizing, internalizing, and impairment domains: A 2-year longitudinal study. Journal of Abnormal Child Psychology, 44(4), 771–785. https://doi.org/10.1007/s10802-015-0066-z.

    Article  PubMed Central  Google Scholar 

  32. Desman, C., Petermann, F., & Hampel, P. (2008). Deficit in the response inhibition in children with attention deficit/hyperactivity disorder (ADHD): Impact of motivation? Child Neuropsychology, 14(6), 483–503. https://doi.org/10.1080/09297040701625831.

    Article  PubMed  Google Scholar 

  33. Donaldson, D., Prinstein, M. J., & Danovsky, M. (2000). Patterns of children’s coping with life stress: Implications for clinicians. Journal of Orthopsychiatry, 70(3), 351–359. https://doi.org/10.1037/h0087689.

    Article  Google Scholar 

  34. Dvorsky, M. R., Becker, S. P., Tamm, L., & Willoughby, M. T. (2019). Testing the longitudinal structure and change in sluggish cognitive tempo and inattentive behaviors from early through middle childhood. Assessment, online first. https://doi.org/10.1177/107319111987224.

  35. Edelbrock, C., & Costello, A. J. (1988). Convergence between statistically derived behavior problem syndromes and child psychiatric diagnoses. Journal of Abnormal Child Psychology, 16, 219–231. https://doi.org/10.1007/BF00913597.

    Article  PubMed  Google Scholar 

  36. Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38(8), 1097–1107. https://doi.org/10.1007/s10801-010-9436-8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Fassbender, C., Krafft, C. E., & Schweitzer, J. B. (2015). Differentiating SCT and inattentive symptoms in ADHD using fMRI measures of cognitive control. NeuroImage: Clinical, 8, 390–397. https://doi.org/10.1016/j.nicl.2015.05.007.

    Article  Google Scholar 

  38. Flanagan, D. P., & Alfonso, V. C. (2017). Essentials of WISC-V assessment (1st ed.). Hoboken: Wiley.

    Google Scholar 

  39. Fredrick, J. W., Kofler, M. J., Jarrett, M. A., Burns, G. L., Luebbe, A. M., Garner, A. A., Harmon, S. L., & Becker, S. P. (2020). Sluggish cognitive tempo and ADHD symptoms in relation to task- unrelated thought: Examining unique links with mind-wandering and rumination. Journal of Psychiatric Research, 123, 95–101. https://doi.org/10.1016/j.jpsychires.2020.01.016.

    Article  PubMed  Google Scholar 

  40. Hartman, C. A., Rommelse, N., van der Klugt, C. L., Wanders, R. B. K., & Timmerman, M. E. (2019). Stress exposure and the course of ADHD from childhood to young adulthood: Comorbid severe emotion dysregulation or mood and anxiety problems. Journal of Clinical Medicine, 8(11), 1824. https://doi.org/10.3390/jcm8111824.

    Article  PubMed Central  Google Scholar 

  41. Hudziak, J. J., Copeland, W., Stanger, C., & Wadsworth, M. (2004). Screening for DSM-IV externalizing disorders with the Child Behavior Checklist: A receiver-operating characteristic analysis. Journal of Child Psychology and Psychiatry, 45(7), 1299–1307. https://doi.org/10.1111/j.1469-7610.2004.00314.x.

    Article  PubMed  Google Scholar 

  42. Humhereys, K. L., Watts, E. L., Dennis, E. L., King, L. S., Thompson, P. M., & Gotlib, I. A. (2019). Stressful life events: ADHD symptoms and brain structures. Journal of Child and Adolescent Psychology, 47(3), 421–432. https://doi.org/10.1007/s10802-018-0443-5.

    Article  Google Scholar 

  43. Humphreys, K. L., & Zeanah, C. H. (2015). Deviations from the expectable environment in early childhood and emerging psychopathology. Neuropsychopharmacology, 40(1), 154–170. https://doi.org/10.1038/npp.2014.165.

    Article  PubMed  Google Scholar 

  44. Jacobson, L. A., Geist, M., & Mahone, E. M. (2018). Sluggish cognitive tempo, processing speed, and internalizing symptoms: The moderating effect of age. Journal of Abnormal Child Psychology, 46(1), 127–135. https://doi.org/10.1007/s10802-017-0281-x.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Juster, R., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 35, 2–16.

    Article  Google Scholar 

  46. Kofler, M. J., Irwin, L. N., Sarver, D. E., Fosco, W. D., Miller, C. E., Spiegel, J. A., & Becker, S. P. (2019). What cognitive processes are “sluggish” in sluggish cognitive tempo? Journal of Consulting and Clinical Psychology, 87(11), 1020–1042. https://doi.org/10.1037/ccp0000446.

    Article  Google Scholar 

  47. Lahey, B. B., Schaughency, E. A., Hynd, G. W., Carlson, C. L., & Nieves, N. (1987). Attention deficit disorder with and without hyperactivity: Comparison of behavioral characteristics of clinical referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 26(5), 718–723. https://doi.org/10.1097/00004583-198709000-00017.

    Article  PubMed  Google Scholar 

  48. Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  49. Lee, S. Y., Burns, G., & Becker, S. P. (2017). Can sluggish cognitive tempo be distinguished from ADHD-inattentive in very young children? Evidence from a sample of Korean preschool children. Journal of Attention Disorders, 21(8), 623–637. https://doi.org/10.1177/1087054716680077.

    Article  PubMed  Google Scholar 

  50. Lee, S. Y., Burns, G. L., Snell, J., & McBurnett, K. (2014). Validity of the sluggish cognitive tempo symptom dimension ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42(1), 7–19.

    Article  Google Scholar 

  51. Leikauf, J. E., & Solanto, M. V. (2017). Sluggish cognitive tempo, internalizing symptoms, and executive functioning in adults with ADHD. Journal of Attention Disorders, 21(8), 701–711. https://doi.org/10.1177/1087054716682337.

    Article  PubMed  Google Scholar 

  52. Leopold, D. R., Christopher, M. E., Burns, G. L., Becker, S. P., Olson, R. K., & Willcutt, E. G. (2016). Attention-deficit/hyperactivity disorder and sluggish cognitive tempo throughout childhood: Temporal invariance and stability from preschool through ninth grade. The Journal of Child Psychology and Psychiatry, 57(9), 1066–1074. https://doi.org/10.1111/jcpp.12505.

  53. Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.

    Google Scholar 

  54. Luby, J., Belden, A., Botteron, K., Marrus, N., Harms, M., Babb, C., Nishimo, & Barch, D. (2013). The effects of poverty on childhood brain development: The mediating effect of caregiving and stressful life events. JAMA Pediatrics, 167(12), 1135–1142. https://doi.org/10.1001/jamapediatrics.2013.3139.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Maddux, J. E., & Winstead, B. A. (Eds.). (2019). Psychopathology: Foundations for a contemporary understanding (5th ed.). New York: Routledge.

    Google Scholar 

  56. Malas, N., Donohue, L., Cook, R. J., Leber, S. M., & Kullgren, K. A. (2017). Pediatric somatic symptom and related disorders: Primary care provider perspectives. Clinical Pediatrics, 57(4), 377–388. https://doi.org/10.1177/0009922817727467.

  57. Marshall, S. A., Evans, S. W., Eiraldi, R. B., Becker, S. P., & Power, T. J. (2014). Social and academic impairment in youth with ADHD, predominantly inattentive type and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 42, 77–90. https://doi.org/10.1007/s10802-013-9758-4.

    Article  PubMed  Google Scholar 

  58. McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: An argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213.

    Article  Google Scholar 

  59. Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8(4), 463–488. https://doi.org/10.1093/clipsy/8.4.463.

    Article  Google Scholar 

  60. Mueller, A. K., Koerts, J., Groen, Y., Lange, K. W., & Tucha, O. (2014). Sluggish cognitive tempo and its neurocognitive, social and emotive correlates: A systematic review of the current literature. Journal of Molecular Psychiatry, 2(5), 1–13. https://doi.org/10.1186/2049-9256-2-5.

    Article  Google Scholar 

  61. Oster, C., Ramklint, M., Meyer, J., & Isaksson, J. (2020). How do adolescents with ADHD perceive and experience stress? An interview study. Nordic Journal of Psychiatry, 74(2), 123–130. https://doi.org/10.1080/08039488.2019.1677771.

    Article  PubMed  Google Scholar 

  62. Pagliaccio, D., Luby, J. L., Bogdan, R., Agrawal, A., Gaffrey, M. S., Belden, A. C., Botteron, K. N., Harms, M. P., & Barch, D. M. (2013). Stress-system genes and life stress predict cortisol levels and amygdala and hippocampal volumes in children. Neuropsychopharmacology, 39(5), 1245–1253. https://doi.org/10.1038/npp.2013.327.

    Article  PubMed  Google Scholar 

  63. Penny, A. M., Waschbusch, D. A., Klein, R. M., Corkum, P., & Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: Content validity, factor structure, and reliability. Psychological Assessment, 21(3), 380–389. https://doi.org/10.1037/a0016600.

    Article  PubMed  Google Scholar 

  64. Piccolo, L. R., & Noble, K. G. (2017). Perceived stress is associated with smaller hippocampal volume in adolescence. Pediatric Imaging, Neuro2cognition, and Genetics Study, 55(5), e13025. https://doi.org/10.1111/psyp.13025.

  65. Selye, H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138(3479), 32.

    Article  Google Scholar 

  66. Selye, H. (1978). The stress of life. N.Y: McGraw Hill.

  67. Servera, M., Sáez, B., Burns, G. L., & Becker, S. P. (2018). Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. Journal of Abnormal Psychology, 127(8), 818–829. https://doi.org/10.1037/abn0000375.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Smith, Z. R., & Langberg, J. M. (2017). Predicting academic impairment and internalizing psychopathology using a multidimensional framework of sluggish cognitive tempo with parent- and adolescent reports. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-017-1003-1.

  69. Sorrell, A. E., & Canu, W. H. (2018). Sluggish cognitive tempo and temporal processing: An exploratory examination of association using a novel measure. The ADHD Report, 26(7), 7–12. https://doi.org/10.1521/adhd.2018.26.7.7.

    Article  Google Scholar 

  70. Tamm, L., Brenner, S. B., Bamberger, M. E., & Becker, S. P. (2019). Are sluggish cognitive tempo symptoms associated with executive functions in preschoolers? Child Neuropsychology, 24(1), 82–105. https://doi.org/10.1080/09297049.2016.1225707.

    Article  Google Scholar 

  71. Todd, R. D., Rasmussen, E. R., Wood, C., Levy, F., & Hay, D. A. (2004). Should sluggish cognitive tempo symptoms be included in the diagnosis of attention deficit/hyperactivity disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 588–597.

    Article  Google Scholar 

  72. Wechsler, D., Raiford, S. E., & Holdnack, J. A. (2014). WISC-V technical and interpretive manual (Fifth ed.pp. 55–186). Bloomington: Pearson Education Inc.

    Google Scholar 

  73. Weiler, M. D., Bernstein, J. H., Bellinger, D. C., & Waber, D. P. (2000). Processing speed in children with attention deficit/hyperactivity disorder, inattentive type. Child Neuropsychology, 6(3), 218–234.

    Article  Google Scholar 

  74. Willard, V. W., Hardy, K. K., Allen, T. M., Hwang, E. L., Grurangan, S., Hostettler, S. A., & Bonner, M. J. (2013). Sluggish cognitive tempo in survivors of pediatric brain tumor. Journal of Neurooncology, 114, 71–78. https://doi.org/10.1007/s1060-013-1149-8.

  75. Willcutt, E. G., Chhabildas, N., Kinnear, M., DeFries, J. C., Olson, R. K., Leopold, D. R., et al. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM-IV ADHD. Journal of Abnormal Child Psychology, 42(1), 21–35. https://doi.org/10.1007/s10802-013-9800-6.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to P. Douglas Callan.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Callan, P.D., Shepler, D.K., Justice, M.D. et al. Correlates of Sluggish Cognitive Tempo Among Clinic-Referred Youth: Expanding Awareness of Somatic Symptoms and Stress in the Clinical Picture. J Pediatr Neuropsychol 6, 143–158 (2020). https://doi.org/10.1007/s40817-020-00083-6

Download citation

Keywords

  • Sluggish cognitive tempo
  • Internalizing disorders
  • Processing speed
  • Somatic problems
  • CBCL