Thank you for your interest in CCO content. As a guest, please complete the following information fields. These data help ensure our continued delivery of impactful education.
Become a member (or login)? Member benefits include accreditation certificates, downloadable slides, and decision support tools.
Adler LA, et al. J Clin Psychiatry. 2021;82:20m13687.
Sluggish cognitive tempo (SCT) is a cluster of symptoms associated with attention difficulties and is common in attention-deficit/hyperactivity disorder (ADHD). Patients with SCT may have difficulty concentrating and staying alert, feel lethargic frequently, and get confused easily or struggle to process information quickly and accurately. SCT was previously shown to add to the impairment seen in ADHD, but the effect of stimulant medication on SCT symptoms was unknown. This study examined the efficacy of the stimulant lisdexamfetamine (LDX) vs a placebo on SCT symptoms and executive functioning attributes in adults with comorbid ADHD and SCT.
Thirty-eight patients with DSM-5 ADHD and SCT were recruited from 2 academic medical centers and randomized to receive 4 weeks of LDX 30-70 mg/day or placebo before a 2-week washout period and crossover to the other arm for an additional 4 weeks. The Barkley Adult ADHD Rating Scale-IV SCT subscale and the ADHD Rating Scale were used to measure patient outcomes.
LDX improved SCT score ratings compared with placebo on SCT ratings in both treatment periods, but this reached significance only in the first 4-week treatment period (prior to crossover). Patients who received LDX had significantly improved ADHD symptoms, executive functioning, and ratings of functional impairment compared with patients who received the placebo. No interactions were observed between sex, age, race, and ethnicity and the outcome measures.
LDX significantly improved ratings of SCT, ADHD, executive functioning, and impairment in adults with comorbid ADHD and SCT.
SCT when present with ADHD adds to the impairment and leads to difficulty in treatment. This was a randomized clinical trial with placebo comparison that used standardized rating scales and careful diagnosis to characterize the study population. There were not enough patients to examine whether patients with different ADHD subtypes responded differently to LDX.
As a healthcare professional, I have observed symptoms of SCT in my patients but must admit I only heard the terminology of “sluggish cognitive tempo” when I read this study. Healthcare professionals should screen adult patients with ADHD for SCT, and if SCT is observed, an adequate trial of LDX should be done (maximum dose of 70 mg/day for 4 weeks).