Sluggish cognitive tempo is a dangerous diagnostic idea

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced by extensive drug company affiliations — and always ungoverned by simple common sense, a respect for scientific evidence and an appropriate fear of risky unintended consequences.

Alan Schwartz is a brilliant investigative reporter for the New York Times who has dug deep into the epidemic of attention deficit disorder If anyone in your family has been diagnosed with ADHD, you should definitely Google his revealing series of reports detailing the how’s and why’s of ADHD misdiagnosis and the consequent harms of overmedicating our kids with stimulant drugs.

In a recent Times article, Mr. Schwarz reports on the latest bizarre twist. The very same experts who succeeded in promoting ADHD have now concocted and are promoting a new diagnosis that would be a terrific bonanza for Big Pharma, but terrible for the kids who would be misdiagnosed and over-treated.

Sluggish cognitive tempo (SCT) is a remarkably silly name for an even sillier proposal. Its main characteristics are vaguely described but include some combination daydreaming, lethargy and slow mental processing. Its proponents estimate that SCT afflicts approximately two million children. Not surprisingly, Eli Lilly is already on the case.

The Journal of Abnormal Child Psychology is also taking all this very seriously. SCT is featured in 136 pages of its January issue. Included are claims that the question of its existence “seems to be laid to rest as of this issue” and that SCT is gaining momentum toward recognition as a legitimate disorder.

However ludicrous SCT may seem, the risk it may do great harm is real. Child psychology/psychiatry/pediatrics/family medicine have become fevered fields of diagnostic excess, pharmaceutical company manipulation and careless medication prescription. In just 20 years, rates of ADHD have tripled and autism and childhood bipolar disorder have increased forty-fold.

A prospective study using DSM-IV found that by age 21, 81 percent of kids had already qualified for one diagnosis of mental disorder. DSM-5 recently made things much worse when it turned normal temper tantrums into disruptive mood dysregulation disorder. The last thing our kids need is to be misdiagnosed with sluggish cognitive tempo and bathed in even more stimulant meds.

Alice , trapped in Wonderland, has this instructive conversation with the Cheshire Cat:

Alice: But I don’t want to go among mad people.
The Cat: Oh, you can’t help that. We’re all mad here. I’m mad. You’re mad.
Alice: How do you know I’m mad?
The Cat: You must be. Or you wouldn’t have come here.

Egged on by well meaning (and not so well meaning) experts and by greedy drug companies, we are fast approaching this dystopic wonderland of universal childhood mental illness.

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

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  • guest

    What many of us parents wish is that there were nearly as many experts willing to spend time developing and promoting educational and vocational opportunities for our high-energy, impulsive, creative and distractible boys, as there are experts interested in writing opinion pieces about “the dystopian wonderland of universal childhood mental illness.”

    Children like ours end up with diagnoses and medication because viable alternatives don’t appear to exist for helping them to fit into our increasingly inflexible culture, with its demands for high academic and vocational productivity, consistent focus and unvarying attention to detail. As their childrens’ spirits are crushed by constant negative feedback from teachers with expectations that cannot be met by every single child, every time, increasingly desparate parents turn to what’s available–medication.

    • Deceased MD

      That use to be called psychotherapy. No meds.

      • guest

        Speaking from personal experience, psychotherapy can only do so much to help a kid whose cognitive and behavioral style do not fit into a system with relatively rigid expectations.

  • NewMexicoRam

    I find it helps to get the kids off extra sugars and starches (especially wheat products), increase exercise, and make sure they get at least 9 hours of sleep.

  • JR

    Here’s the summary of people I know on stimulants. I know this is anecdotal… but how can anyone think they are “safe” if beyond me:

    Child One turned violent and chased their siblings with knifes. They were then diagnosed by a Psychiatrist as having “Radical Attachment Disorder” and subjected to years of therapy where they tried to figure out which of his babysitters neglected or tortured him… but none of them did. Off meds he’s fine.

    Child Two turned the oven on and put the dog inside, and then punched her baby sister in the face. She ended up locked in a pysch ward to “detox” at the age of four. Again – she’s fine off meds.

    The adult I know felt that the drugs gave him the confidence to go after a promotion (which he got). However, he increasingly became paranoid and was convinced his boss, his workplace, his co-workers, and his friends were out to get him. He started doing things to retaliate against his neighbor who he was convinced was out to get him because they were “slamming their door loudly on purpose to torture him…” note he never talked to them or his apartment management (even with encouragement from friends) to ask them to be more considerate. At work, he was complaining to HR that he was being targeted because of his “disability” and convinced HR had told everyone about his ADHD and was laughing at him behind his back. I hope he’s off meds now – he moved out of state to get away from everyone out to get him, including his “backstabbing” friends.

    I just can’t believe anyone thinks stimulants are benign.

  • rtpinfla

    Although that seems like a reasonable approach. History tells us that companies like Eli Lilly will fund the research for their new medication or one of their old medications for this new “condition” and-surprise!!- will find that their medication is not only safer than tap water but turns any daydreaming 9 year old into a focused straight A student. The studies will feature some high profile doctors who will receive a nice “honorarium” to have their name put on the article so it will appear legitimate to the general medical community and eventually the media.
    Then watch as Dr. Oz, using information sent to him by Eli Lilly, goes on TV to tell everyone that the SCT “epidemic” is 1) worse than we thought, 2) underdiagnosed by doctors and 3) will not only prevent your kid from getting into Harvard but may very well cause him/her to end up in prison.
    Finally, peek in on an office visit with the harried PCP who, in his 10 minute appointment, tried to convince a concerned parent that a B- grade point average and a detention 3 months ago for passing notes in class doesn’t mean the child needs to be on Eli Liily’s miracle drug. So mom switched doctors to the guy down the street that is more than happy to prescribe this, along with a Z-pak for his headache yesterday that mom knows is a sinus infection.

  • guest

    You are fortunate indeed. Not all parents have access to these resources for their children, depending on their geographic location and their economic status.

  • guest

    Unfortunately, our society offers fewer and fewer opportunities for children or adults who have “dropped out” of the traditional academic track, as the hold that corporate entities have over all of our lives grows increasingly greater, and as mechanization/computerization means that we all spend more and more of our leisure time sitting in front of a computer, either doing clerical work that others used to do for us, or mindless recreation.

  • Deceased MD

    The fundamental problem that everyone reading this should be concerned about is HOW the SCT diagnosis came to be. Big Pharma has now become the child psychiatrist promoting their new absurd condition that does not exist . Every patient, parent, doctor and everyone on the planet should worry about whose in the driver’s seat because Big Pharma is your physician!

  • guest

    And, P.S., if your son continues to be high-energy, impulsive and distractible into his tween years, you may find that there is a dwindling number of educators and schools willing and/or able to accommodate his needs.