Editorial: Neural Correlates of Sluggish Cognitive Tempo: Biological Evidence of a Distinct Clinical Entity?
Editorial: Neural Correlates of Sluggish Cognitive Tempo: Biological Evidence of a Distinct Clinical Entity?
复制标题
社论：认知节奏缓慢的神经相关性：独特临床实体的生物学证据？
DOI：
10.1016/j.jaac.2018.08.015
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发表时间：
2019
影响因子：
13.3
通讯作者：
Posner,Jonathan
中科院分区：
文献类型：
--
作者：
Sussman,TamaraJ;Posner,Jonathan
Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder encompassing a wide array of clinical presentations, levels of impairment, etiologies, and neurobiological correlates. Despite this well-known heterogeneity, most research into the pathophysiology of ADHD has relied on comparisons between typically developing youth and those with the disorder (or perhaps further stratifying by DSM-defined ADHD subtypes). Although informative, this approach assumes a level of pathophysiologic homogeneity that belies the large and growing body of literature underscoring diverse neurobiological and neuropsychological profiles subsumed under the umbrella of this complex syndrome. 1 For example, deficits in executive functions are characteristic of ADHD, yet meta-analysis suggests that these deficits are neither necessary nor sufficient to define all cases2 and that substantial overlaps in levels of executive functioning exist between children with ADHD and their typically developing peers. 1 Likewise, neuroimaging research points to distinct neural circuits underlying different clinical presentations of ADHD, suggesting that, within the diagnosis of ADHD, the neural circuits that are most salient to the disorder can differ from one child to the next. 3 Refining our understanding of ADHD subtypes not only on the basis of symptoms, but also by incorporating neurobiology, physiology, and neurocognitive profiles, could help propel the field toward greater specificity in diagnosis and treatment.Sluggish cognitive tempo (SCT) provides a candidate phenotype that could help define a clinical entity that in current practice is commonly subsumed under ADHD. SCT symptoms are often observed in children with ADHD, 4–6 yet despite this co-occurrence, a growing body of research suggests that SCT symptoms, such as seeming to be “in a fog,” daydreaming, and being sleepy or lethargic, might be distinct from those of ADHD. 7, 8 Furthermore, SCT symptoms are stable over time7 and are independently associated with social impairment, lower self-esteem, and difficulties with emotion regulation. 8 Currently, the SCT construct lacks a definition sufficiently well agreed upon to constitute a diagnosis. For example, there is no consensus on a symptom set for SCT, although a meta-analysis has pointed to 13 items that could provide a starting point. 7 Furthermore, only a few studies have examined biological factors related to SCT. Improving our understanding of the biological underpinnings of SCT could provide additional evidence to help determine whether the construct warrants consideration as a distinct clinical entity or diagnosis.
