Restricted accessResearch articleFirst published online 2025-5
The Relationship Between Cognitive Disengagement Syndrome in Children and Cognitive Disengagement Syndrome,Depression,and Anxiety Levels in Their Parents
This study aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) symptoms in children/adolescents and their parents within the Turkish population, examining the association with co-occurring ADHD symptoms, peer/social relationships, and total difficulties.
Method:
The study included 229 parents aged 18 to 50 with children aged 6 to 18 from the staff of Karabuk Training and Research Hospital. Data collection occurred from April to September 2022. Participants completed various scales, including the Adult Concentration Inventory (ACI), Adult ADHD Self-Report Scale (ASRS), Depression Anxiety Stress Scale-21 (DASS-21), Conners’ Parent Rating Scale-Revised Short Form (CPRS-R), Strengths and Difficulties Questionnaire (SDQ), and Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT).
Results:
A positive correlation was found between CDS symptoms in children/adolescents and their parents. CDS symptoms in children were also associated with significant comorbidities, such as ADHD, oppositional defiance, peer problems, and internalization problems. In parents, CDS was observed to be associated with levels of depression, anxiety, and stress.
Conclusion:
The study highlights the strong relationship between CDS symptoms in children and their parents, suggesting potential genetic and environmental factors. CDS is associated with significant mental health comorbidities across all age groups. The findings underscore the need for interventions to support the mental health of both children and parents with CDS. Further research is needed to elucidate the impact and etiology of CDS on family dynamics and mental health.
ArbeauK. A.CoplanR. J.WeeksM. (2010). Shyness, teacher child relationships, and socio-emotional adjustment in grade 1. International Journal of Behavioral Development, 34(3), 259–269.
2.
BarkleyR. A. (2012). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology, 121(4), 978–990.
3.
BarkleyR. A. (2013). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: Executive functioning, impairment and comorbidity. Journal of Clinical Child & Adolescent Psychology, 42(2), 161–173. https://doi.org/10.1080/15374416.2012.734259
4.
BarkleyR. 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.
5.
BarkleyR. A. (Ed.) (2015). Concentration deficit disorder (sluggish cognitive tempo). In Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 267–313). New York, NY: Guilford Press.
6.
BeckerS. P. (2013). Topical review: Sluggish cognitive tempo: Research findings and relevance for pediatric psychology. Journal of Pediatric Psychology, 38(10), 1051–1057.
7.
BeckerS. P. (2021). Sluggish cognitive tempo and peer functioning in school-aged children: A six-month longitudinal study. Psychiatry Research, 17(1–2), 72–78.
8.
BeckerS. P.BarkleyR. A. (2018). Sluggish cognitive tempo. In T. Banaschewski, D. Coghill & A. Zuddas (Eds.), Oxford textbook of attention deficit hyperactivity disorder (pp. 147–153). Oxford University Press.
9.
BeckerS. P.BurnsG. L.GarnerA. A.JarrettM. A.LuebbeA. M.EpsteinJ. N.WillcuttE. G. (2018). Sluggish cognitive tempo in adults: Psychometric validation of the adult concentration inventory. Psychological Assessment, 30(3), 296–310.
10.
BeckerS. P.LangbergJ. M. (2012). Sluggish cognitive tempo among young adolescents with ADHD: Relations to mental health, academic, and social functioning. Journal of Attention Disorders, 17(8), 681–689. Advance online publication. https://doi.org/10.1177/1087054711435411
11.
BeckerS. P.LangbergJ. M. (2014). Attention-deficit/hyperactivity disorder and sluggish cognitive tempo dimensions in relation to executive functioning in adolescents with ADHD. Child Psychiatry and Human Development, 45(1), 1–11.
12.
BeckerS. P.LeopoldD. R.BurnsG. L.JarrettM. A.LangbergJ. M.MarshallS. A.McBurnettK.WaschbuschD. A.WillcuttE. G. (2016). The internal, external, and diagnostic validity of sluggish cognitive tempo: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 55(3), 163–178.
13.
BeckerS. P.LuebbeA. M.FiteP. J.StoppelbeinL.GreeningL. (2014). 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(1), 49–62. https://doi.org/10.1007/s10802- 013-9719
14.
BeckerS. P.MarshallS. A.McBurnettK. (2014). Sluggish cognitive tempo in abnormal child psychology: An historical overview and introduction to the special section. Journal of Abnormal Child Psychology, 42(1), 1–6.
15.
BeckerS. P.WillcuttE. G.LeopoldD. R.FredrickJ. W.SmithZ. R.JacobsonL. A.BurnsG. L.MayesS. D.WaschbuschD. A.FroehlichT. E.McBurnettK.ServeraM.BarkleyR. A. (2023). Report of a work group on sluggish cognitive tempo: Key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 629–645.
16.
BurnsG. L.BeckerS. P. (2021). Sluggish cognitive tempo and ADHD symptoms in a nationally representative sample of U.S. Children: Differentiation using categorical and dimensional approaches. Journal of Clinical Child & Adolescent Psychology, 50(2), 267–280. https://doi.org/10.1080/15374416.2019.16781652021.
17.
BurnsG. L.ServeraM.BernadM. D. M.CarrilloJ. M.CardoE. (2013). Distinctions between sluggish cognitive tempo, ADHD-IN, and depression symptom dimensions in Spanish first-grade children. Journal of Clinical Child & Adolescent Psychology, 42(6), 796–808.
Camprodon-RosanasE.Ribas-FitóN.Batlle-VilaS.PersaventoC.Alvarez-PedrerolM.SunyerJ.FornsJ. (2017). Sluggish cognitive tempo: Sociodemographic, behavioral, and clinical characteristics in a population of Catalan school children. Journal of Attention Disorders, 21(8), 632–641.
20.
Cano-CrespoA.Moreno-GarcíaI.ServeraM.Morales-OrtizM. (2024). Emotional regulation problems in cognitive disengagement syndrome (formerly sluggish cognitive tempo), attention deficit and hyperactivity disorder, anxiety and depression. Spanish Journal of Psychology, 27, e20.
21.
ConnersC. K. (1997). Conners’ rating scales-revised. Instruments for use with children and adolescents. MHS.
22.
DoğanS.ÖncüB.Varol SaraçoğluG.KüçükgöncüS. (2009). Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS-v1.1): The validity and reliability of the Turkish version. Anatolian Journal of Psychiatry, 10(2), 77–87.
23.
DurukanI.ErdemM.TufanA. E.CöngöloğluA.YorbıkO. ̈.Ve TürkbayT. (2008). Depression and anxiety levels and coping strategies used by mothers of children with ADHD: A preliminary study. Anatolian Journal of Psychiatry, 9, 217–223.
24.
FantiK. A.HenrichC. C. (2010). Trajectories of pure and cooccurring internalizing and externalizing problems from age 2 to age 12: Findings from the National Institute of Child Health and Human Development Study of Early Child Care. Developmental Psychology, 46(5), 1159–1175.
25.
FerrettiN. M.KingS. L.HiltonD. C.RondonA. T.JarrettM. A. (2019). Social functioning in youth with attention-deficit/hyperactivity disorder and sluggish cognitive tempo. Yale Journal of Biology and Medicine, 92(1), 29–35. https://www.ncbi.nlm.nih.gov/pubmed/30923471
26.
FlanneryA. J.BeckerS. P.LuebbeA. M. (2016). Does emotion dysregulation mediate the association between sluggish cognitive tempo and college students’ social impairment?Journal of Attention Disorders, 20(9), 802–812. https://doi.org/10.1177/1087054714527794
27.
FlanneryA. J.LuebbeA. M.BeckerS. P. (2017). Sluggish cognitive tempo is associated with poorer study skills, more executive functioning deficits, and greater impairment in college students. Journal of Clinical Psychology, 73(9), 1091–1113. https://doi.org/10.1002/jclp.22406
28.
FredrickJ. W.LuebbeA. M.ManciniK. J.BurnsG. L.EpsteinJ. N.GarnerA. A.JarrettM. A.BeckerS. P. (2019). Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression. Journal of Clinical Psychology, 75(1), 221–237.
29.
GoodmanR. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.
30.
GrahamD. M.CrockerN.DeweeseB. N.RoeschS. C.ColesC. D.KableJ. A.MayP. A.KalbergW. O.SowellE. R.JonesK. L.RileyE. P.MattsonS. N. (2013). Prenatal alcohol exposure, attention-deficit/hyperactivity disorder, and sluggish cognitive tempo. Alcoholism Clinical and Experimental Research, 37(Suppl 1), E338–E346.
31.
GümüştaşF.YulafY. (2019). Effects of parents’ attachment styles and attention deficit symptoms on social responsiveness in children with ADHD. Anatolian Journal of Psychiatry, 20(6), 651–658.
32.
GüvenirT.ÖzbekA.BaykaraB.ArkarH.ŞentürkB.İncekaşS. (2008). Psychometric properties of the Turkish adaptation of the Strengths and Difficulties Questionnaire (SDQ), Journal of Child and Adolescent Mental Health, 15(1), 65–74.
33.
HenryJ. D.CrawfordJ. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239.
34.
KamradtJ. M.MomanyA. M.NikolasM. A. (2018). Sluggish cognitive tempo symptoms contribute to heterogeneity in adult attention-deficit hyperactivity disorder. Journal of Psychopathology and Behavioral Assessment, 40(2), 206–223. https://doi.org/10.1007/s10862-017-9631-9
KarakayaÖ. (2021). Adaptation, Validity, and Reliability Study of the Adult Concentration Inventory into Turkish [Doctoral dissertation, Ankara Yıldırım Beyazıt University Faculty of Medicine].
37.
KesslerR. C.AdlerL.AmesM.DemlerO.FaraoneS.HiripiE.HowesM. J.JinR.SecnikK.SpencerT.UstunT. B.WaltersE. E. (2005). The World Health Organization adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.
38.
KumarK.SharmaR.SainiL.ShahR.SharmaA.MehraA. (2022). Personification of stress, depression, anxiety, and quality of life, among parents of attention deficit hyperkinetic disorder children. Indian Journal of Social Psychiatry, 38(2), 137–142.
39.
LeeS.BurnsG. L.SnellJ.McBurnettK. (2014). Validity of the sluggish cognitive tempo symptom dimension in children: Sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42(1), 7–19.
40.
LeikaufJ. E.SolantoM. V. (2017). Sluggish cognitive tempo, internalizing symptoms, and executive function in adults with ADHD. Journal of Attention Disorders, 21(8), 701–711. https://doi.org/10.1177/1087054716682337
41.
LeopoldD. R.ChristopherM. E.BurnsG. L.BeckerS. P.OlsonR. K.WillcuttE. G. (2016). Attention-deficit/hyperactivity disorder and sluggish cognitive tempo throughout childhood: Temporal invariance and stability from preschool through ninth grade. Journal of Child Psychology and Psychiatry, 57(9), 1066–1074.
42.
LovibondP. F.LovibondS. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343.
43.
MarshallS. A.EvansS. W.EiraldiR. B.BeckerS. P.PowerT. J. (2014). Social and academic impairment in youth with ADHD, predominately inattentive type and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 42(1), 77–90.
44.
MayesS. D.BangertL.KallusR.FoscoW.CalhounS. L.WaschbuschD. A. (2023). Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children. Clinical Child Psychology and Psychiatry, 28(2), 610–622. https://doi.org/10.1177/13591045221110730
45.
MichielsenM.ComijsH. C.SemeijnE. J.BeekmanA. T.DeegD. J.Sandra KooijJ. J. (2013). The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: A longitudinal study. Journal of Affective Disorders, 148(2–3), 220–227.
46.
MoruzziS.RijsdijkF.BattagliaM. (2014). A twin study of the relationships among inattention, hyperactivity/ impulsivity and sluggish cognitive tempo problems. Journal of Abnormal Child Psychology, 42(1), 63–75.
47.
ÖğütlüH.KaşakM.DoğanU.AtasoyS.McnicholasF. (2023). Psychometric properties of the Turkish version of the child and adolescent behavior inventory sluggish cognitive tempo scale (CABI-SCT) in children and adolescents. Clinical Child Psychology and Psychiatry, 28(4), 1580–1594.
48.
SarıçamH. (2018). The psychometric properties of Turkish version of depression anxiety stress scale-21 (DASS-21) in health control and clinical samples.
49.
SaxbeC.BarkleyR. A. (2014). The second attention disorder? Sluggish cognitive tempo vs. Attention-deficit/hyperactivity disorder: Update for clinicians. Journal of Psychiatric Practice, 20(1), 38–49.
50.
SchlarbA.StarckM.GrünwaldJ. (2016). Occurrence of ADHD in parents of ADHD children in a clinical sample. Neuropsychiatric Disease and Treatment, 12, 581–588.
51.
SevincokD.OzaydinY.OzgurB. G.OzbekM. M.AksuH.SevincokL. (2024). The relationship between parental obsessive-compulsive disorder and children’s cognitive disengagement syndrome (Sluggish cognitive tempo). Clinical Child Psychology and Psychiatry, 29(4), 1448–1461.
52.
SmithJ. N.SuhrJ. A. (2021). Sluggish cognitive tempo factors in emerging adults: Symptomatic and neuropsychological correlates. Developmental Neuropsychology, 46(3), 169–183.
53.
SolantoM. V.Pope-BoydS. A.TryonW. W.StepakB. (2009). Social functioning in predominantly inattentive and combined subtypes of children with ADHD. Journal of Attention Disorders, 13(1), 27–35. https://doi.org/10.1177/1087054708320403
54.
TzangR. F.ChangY. C.LiuS. I. (2009). The assosiation between children’ s ADHD subtype and parenting stress and parental symptoms. International Journal of Psychiatry in Clinical Practice, 13(4), 318–325.
55.
WienerJ.BiondicD.GrimbosT.HerbertM. (2016). Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 44(3), 561–574.
56.
XiaW.ShenL.ZhangJ. (2015). Comorbid anxiety and depression in school-aged children with attention deficit hyperactivity disorder (ADHD) and selfreported symptoms of ADHD, anxiety, and depression among parents of school-aged children with and without ADHD. Shanghai Archives of Psychiatry, 27(6), 356–367.
57.
YehC. B.GauS. S.KesslerR. C.WuY. Y. (2008). Psychometric properties of the Chinese version of the adult ADHD self-report scale. International Journal of Methods in Psychiatric Research, 17(1), 45–54.
58.
YıldırımA.BoysanM.KefeliM. C. (2018). Psychometric properties of the Turkish version of the depression anxiety stress scale-21 (DASS-21). British Journal of Guidance & Counselling, 46(5), 582–595.
59.
Yılmaz OHakanBArslanA. (2017). The validity and reliability of the Turkish short form of the Depression Anxiety Stress Scale (DASS 21). Journal of Financial, Economic and Social Research, 2(2), 78–91.
60.
YılmazY.Uzun CicekA. (2024). Cognitive disengagement syndrome in mothers of children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 28(9), 1267–1274.
