Cognitive Disengagement Syndrome vs ADHD - Part IV: Development and Causation
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- čas přidán 30. 06. 2024
- The Other Attention Disorder:
Cognitive Disengagement Syndrome
(formerly Sluggish Cognitive Tempo) versus ADHD
Since 1798, the medical literature on attention disorders has distinguished between at least two kinds, one a disorder of distractibility, lack of sustained attention, and poor inhibition and the other a disorder of low power, arousal, or focus. This second disorder has been largely ignored for nearly two centuries until the mid-1980s when studies of children having ADD without Hyperactivity suggested that an important subset had a relatively distinct pattern of symptoms not central to ADHD. These symptoms included daydreaming, mental fogginess and confusion, staring, slow processing of information, hypoactivity, slow movement, and lethargy, among others. The new pattern was called sluggish cognitive tempo (SCT). Controversy has continued over the past 25 years on the nature of CDS and whether it is a subtype of ADHD or a distinct disorder from it. In this presentation, Dr. Barkley reviews the history of CDS and what is known about it from past research. He also describes the results of his own recent investigations into CDS in children and the only study of CDS in adults that he recently published, all of which suggest that CDS is a distinct disorder from ADHD but one that may overlap with it in nearly half of all cases. Dr. Barkley discusses the differences between CDS in symptoms, executive functioning, comorbidity for other disorders, and psychosocial impairment and what little is known about differential treatment response. He also discusses several different possibilities for explaining the underlying nature of CDS.
All of these findings are summarized in the Report of the Workgroup on Sluggish Cognitive Tempo in the Journal of the American Academy of Child and Adolescent Psychiatry to be found here.
www.jaacap.org/article/S0890-...
Topics Covered in the CDS Lectures:
Part I: Provide a Brief Review of Medical History of CDS and Its Symptoms
Part II: Demographic and Cognitive Differences of CDS from ADHD and Overlap
Part III: Impairments in CDS and Other Distinctions from ADHD
Part IV: Etiologies in CDS and Other Distinctions from ADHD
Part V: The Underlying Nature of CDS vs. ADHD
Part VI: Results of Treatment Research and Its Implications for Management of CDS
Can you please make a leacturw of how a person with adhd and cds/sct looks like or how the symptoms of both conditions show in the same person over the course of their life
Great info. I hope the medical system picks this up and learns to differentiate the two disorders. I was diagnosed with ADHD and think I have CDS. Would love to know for sure. One thing about the mind blanking problem Ive always found that there seems to be a sensation attached to it similar to being really tired and finally being able to go to bed and relax. The zone out is like a reward or buzz in itself which made school hard, realistically more for teachers and parents because I didnt know I did it until I was an adult and people mentioned me blanking out. Its not unpleasant but wreaks havok in life. Ive also noticed the ADHD got a bit better with age, less impulsivity etc but CDS symptoms stayed the same. So happy you are researching this.
By medical system, I mean family doctors, as obviously researchers are part of the medical system too.
Thank you!
I can relate, Brynn!
Same, going to bed zone out always was my best reward, but after days or months or years of doing so, it gets very frustrating.
Yeah, I'm reasonably sure now that I have CDS instead of or in addition to inattentive ADHD. That thing you said about the daydreaming being pleasant is very true. It's wreaked havoc in my adult life as well, but it's so hard to give up because it feels like I'm supposed to mentally tear my thoughts away from their natural, pleasant course, every minute of every day of every year for the rest fo my life.I still have to try, but it feels like I'm being sentenced to some kind of punishment, not getting a cure for my condition.
I know math has always been my best subject. In fact I think the first thing that originally got me flagged for "Sluggish Cognitive Tempo" was the disparity between my ability to solve complex math problems, and my performance on timed math tests.
15:30 Thoughts on CDS potentially being a manifestation of autistic burnout? I am autistic, diagnosed ADHD-IN but it was my CDS symptoms that prompted me to get looked at when I was a young adult. My CDS symptoms are much, much stronger during times of what would clearly meet the criteria of autistic burnout, following months or years of prolonged, unrelenting stress. An interesting phenomenon is that during these periods, stimulant medications (both lisdexamfetamine and methylphenidate) are markedly less effective and I actually subjectively *feel* them less. Last summer, I would have felt 30mg of lisdex strongly, but now that I've entered a period of autistic burnout since the autumn during which my CDS symptoms are overwhelming, I can barely feel it.
14:00 The point on slow waves explains a lot as well, as I often feel like parts of my brain are asleep while I'm actually awake. Within a few seconds of "letting go" and giving in to the relentless urge to daydream, my startle response is markedly increased. I've had some small myoclonic jerks while awake but daydreaming as well. MRI, fMRI and sleep study have found no problems in terms of neurodegenerative disorders.
I was also thinking it sounds like undiagnosed autism
Amazing the brain scans... blanking out always felt like silence in the front of my brain just like the scans, like brain freeze from cold food but without the pain and cold sensation. How weird.
This looks like a description of social trauma effects on the brain.
What’s so weird is I’m really good at math, but everything else tracks especially reading comprehension. Lowest score on my act.
Wonder how good I would be at math without this 😅
Thank you for your work ❤️
My pleasure. Glad to be of help while retiring. Thanks for watching.
@@russellbarkleyphd2023 😍🤯
What part of the posterior of the brain does EEG show abnormal activity in CDS? I have slowing in the temporal lobes with intermittent spiking and the doctor didn’t seem to know what it was, their system attributes it as my brain has a 90% probability that it is functioning as if it had a traumatic brain injury. I have no history of a head injury and I started speaking a little late so I’m sure it’s developmental, not injury.
Thank you so much for this info! I'm sharing it all with my dad who thinks I'm conductually impaired lol. I'm 32 but only got properly diagnosed two years ago. Also I'm wondering, have you ever found a relation or has it been investigated any comorbidity between CDS and Alpha 1 antitrypsin deficency? Because I'm ADHD inattentive and CDS resonates a lot with me, but I also have alpha1 which is a deficiency of an enzyme which regulates lung protection and inflammatory response of the body, and I've always been quite bad at sports, I have a really low blood pressure, and well I do have other inflammatory disorders but ADHD/CDS is a big one in the mind.
If EEG's are used for research and can see a difference in the brain, why cant it be used in part to identify the disorders while diagnosing and why Dr's say EEG's can't see anything to help with diagnosing?
The studies are comparing groups and averaging all the group data together to see small differences in the mean EEGs. A clinician is just looking at one individual and so the slight differences are not obvious ones.
I've just recieved my ASD diagnosis at age 30, but I have additional symptomatology that is leading me towards an ADHD assessment as well.
Having watched your series on CDS I'm beginning to see somewhat of an overlap in my presentation of symptoms. Specifically, mindblanking and rummination.
I've shown symptoms of ASD and ADHD throughout my life (predominantly the inattentive side), but I had a traumatic head injury after being hit by a bus when I was 14 (right frontal lobe).
It is quite clear to me that I have inherited some of my neurodivergeant traits from my Father (who I believe to have undiagnosed ADHD and ASD, which has developed into Antisocial Behaviour Disorder).
Is there any research on the potential link between preexisting neurodivergeant conditions (ASD/ADHD) and the development of CDS in response to traumatic brain injuries?
Not to my knowledge but CDS is a very new field of study. Maybe someone will eventually look at that association with TBI
it's funny how our lives are so similar in different parts of the words except my accident was crashing with a bike.
very interesting story my friend
I definitely have it
😅 There's at least some overlap there with my hesitance on "consequences" in another video on yours. "Projection" comes to mind, but that's a little different perhaps than just a bit of inherent bias against.
If one with CDS has a lower resting heart rate due to chronic inattention to outside stimuli, then it stands to reason their heart rate may have to go up more just to get up to the needed working speed for the situation. Also, it may be a bigger surprise if one was not attentive, and thus may increase heart rate more than in others. Also, if you are not attentive, you may need a little time after your heart rate increases in order to just identify what the stimuli even is.
Do we know if it correlates with a acetylcholine deficiency or dysfunction?
No, we don't. No one studied it yet.
I haven't seen the HRV study out of China but I would assume the findings were the opposite. A high HRV means a person is more relaxed (parasympathetic activation). Are you sure the finding wasn't a LOWER resting HRV and a larger DECREASE in HRV in response to the warning stimuli? This would be more consistent with higher stress/anxiety. HRV findings are often misinterpreted as it sounds similar to HR. However, they are negatively correlated.
I doubled checked the study and higher SCT symptoms were associated with higher HRV at baseline as I initially reported but the analysis they did was unusual and you might want to have a look at it as that might be the problem with interpreting the results here. They also found more change between baseline and warning signal being linked to SCT. here is the link to the study: doi.org/10.1007/s00787-019-01353-1. In any case, the authors suggest that SCT symptoms seem to be linked to responses that are more typical of those associated with internalizing symptoms. Thanks for watching.
@@russellbarkleyphd2023 Thanks for looking into it and responding. I looked at the abstract (I no longer have full access to university libraries unfortunately). I guess I can see now how it could possibly make sense that those with SCT/CDS have issues of being UNDER-aroused at baseline (high HRV means high parasympathetic NS activity). I don't fully understand what they meant by "SCT symptoms were also positively associated with a change in SD2 nu between the resting and warning signal conditions." If this means that they had a decrease in HRV in response to the warning signal, it seems to me it would suggest that their nervous systems are responding "sluggishly" to the potential threat (if this is what "warning signal condition" is referring to). Perhaps ADHD is more of an under activation of the sympathetic NS whereas SCT/CDS is more due to over-activation of the parasympathetic NS? That could make a lot of sense. But the conclusion that it's consistent with internalizing symptoms doesn't make sense with what I'm suggesting as the research suggests those with depression, GAD, PTSD, stress, etc, have either an over-active SNS but more commonly, an underactive PSN as measured by lower HRV. I just want to say thanks again for producing these videos. I'm a clinical/neuropsychologist that does a lot of ADHD evaluations and your work (newsletter, YT videos, books, etc.) has been my go-to to keep me up to date on this.
So if the term "mind wandering" is being linked to ADHD and "daydreaming" to CDS, then want is the difference between mind wandering and daydreaming according to this usage?
See my latest video on this topic posted to my channel just this week. It explains the differences among them. Be well.
I think I perhaps know what study we need to do. 🤔 We need to ask permission to follow people with ADHD who has a sex change/affirmation/transformation. Do this effect their ADHD/ADD? And how? 🤔
I'm interested in how many people with CDS may identify as ACE, I'm definitely feeling a lean towards that!
But you say ADHD gives higer likelyhood of ODD, but CDS gives lower. 🤔 But people with both have it.. worse? Should it not lower the likelihood to have both? At least if you look at it like math 🙂
In this specific area it indeed seems like there should be some masking going on, but I assume he meant overall having both conditions results in greater impairment.
So if different parts of the brain are affected, should it still be treated with adderall? Popular myth is Adderall stimulates frontal lobe, but that isn’t the problem in CDS?
No, not if it occurs alone. Adderall or Vyvanse might help if ADHD is also a comorbid disorder. Adderall affects more than just the frontal lobes and increases activity in reward centers making external events more rewarding to engage. Thanks for writing.
@@russellbarkleyphd2023 How should CDS be treated? My gf has this off-label “add severe inattentive with lethargy” diagnosis. Her NP has her on Adderall, and the adderall increases her morning rage if she doesn’t take it immediately upon waking. Do you know any practitioners in Kansas City on the cutting edge of this science? Thanks!
Ah ha, your video on treatment is here: czcams.com/video/rei8EMni1zI/video.html
Well i have This and i am on Vyvanse because it helps with motivation, fatigue etc…
Hopefully cogfog along wrong
(quick slightly lazy comment:)
💌:This is so lovely Mr R. Barkley.
I will watch all of your new videos i REALLY REALLY believe they will be helpful eventho i maybe watched/read a LOT books/lectures on websites/presentations/ADHD report :D Thank you so much this is such a amazing idea, and if you even maybe keep a Eye on some things happening or make sense of some major research or what your collegues are up to (you must have amazing connections and might surely be invited but also interessted to go see some presentation of research summarized.) This comment might not be as good as i will comment in the future but know that I WILL watch every single video to hopefully get every nugget of gold I can find to hope to get myself out of this to the best finetuned medication combination/self-eduction about ADHD and maybe even SCT or other things. Thank you very very much!! You have such a amazing way to present i always found it waaaaay easyer to enjoy/pay attention/not have discomfort while i was lerning from u as opposed to more boring lectures form som expterts (but there are some that are also great and i try to diversify my information and i have!) thanksdoctrophy-yellow-smiling🤩😍🤩🥰🥳🥳🥳🤯🤯🤯🤯🤯🤯🤯🤯🤯🤓💘💝💖💗💓💞💕💟❣❤🔥💯🤍