A number of symptoms have been associated with ADHD for years. What exactly do they consist of?
However, in the 1970s a third group of symptoms was observed that until now had not received the same consideration as the previous ones, despite the fact that it could be a third independent factor: slow cognitive tempo.
And it is that many authors consider slow cognitive tempo as a modality of inattentive ADHD, while others oppose this possibility and postulate it as a problem of a different nature.
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In this article we will address eight common symptoms of slow cognitive tempo , outlining similarities and differences with ADHD in relation to its clinical expression.
Slow cognitive tempo: what is it?
Despite the fact that slow cognitive tempo was originally conceived as a dimension of ADHD in its inattentive subtype (appearing in one of every three cases of the same), today it is recognized that it can be present not only in this context, but also when hyperactivity predominates as a clinical expression. However, there are cases in which cognitive tempo symptoms occur without evidence of either of the other two, but rather as an independent phenomenon with its own entity.
It is for this reason that many psychologists and psychiatrists consider that it could be a disorder independent of the most well-known forms of ADHD, with the capacity to reduce the quality of life of those who may suffer from it. Despite this, it does not have consolidated diagnostic criteria in the manuals, and the tests for its detection are still scarce or linked to the technologies for the evaluation of ADHD.
Knowledge about the symptoms of slow cognitive tempo is of great interest, as it is a phenomenon that is receiving a growing volume of research and that in the future could be incorporated as a new clinical entity, facilitating the design of therapeutic measures aimed at covering the needs of the affected group and their families.
We proceed to explore the particular way in which this manifests itself. It is necessary to take into account that 60% of children with slow cognitive tempo present symptoms typical of ADHD , so it is possible that it is an independent clinical phenomenon but belonging to the same spectrum.
1. Daydream or be in the clouds
Children with slow cognitive tempo may appear self-absorbed, as if they are thinking about something that captures their full attention, to the point of showing low reactivity to external events or deliberate attempts to claim their interest.
These are children who seem sleepy, as if weighed down by a noticeable lack of energy. That is why they tend to be far from the rhythm of their peers in the content taught in the classroom, which makes them feel behind in all the dynamics that can be used (individual or group). In certain cases it is possible that the child sleeps during classes, or appears in a state of apparent drowsiness that cannot be explained by lack of sleep or fatigue.
2. Habitual confusion
Children with slow cognitive tempo seem confused, as if what is happening outside is breaking down their mental inertia and they have to dedicate a lot of effort to recovering their attentional focus. In many cases, they report being overwhelmed by environments that contain multiple sensory stimuli that struggle for their attention, as if they were difficult for them to process.
This confusion may be the result of some compromise of executive functions, a set of higher-order cognitive domains necessary to initiate an adequate planning process, solve complex problems or become aware of our own mental processes. In large part, these are resources that depend on the structural and/or functional integrity of the profrontal cortex.
3. Stare
One of the most striking behaviors of these children (and which is easily captured by both their parents and their teachers) is that of remaining motionless, staring at an indefinite point and expressionless eyes.
They can remain in this way for a long period of time, making it clear that they are immersed in a thought that is extremely far from what is happening at that moment. It is a behavior from which both inattention and confusion are inferred.
4. Apathy and little commitment to tasks
Children with slow cognitive tempo usually show an evident lack of motivation to get involved in school tasks, which do not represent a sufficient stimulus for them to dedicate their time and effort. They may spend long hours trying to finish their exercises, because they get distracted by other irrelevant issues or do not maintain a sustained effort towards their resolution. That is why, frequently, it can become a moment that they live as aversive.
When the tasks become more demanding, there is a great lack of commitment to acquire the knowledge required for their understanding, which is why academic difficulties often arise. In any case, the standard pedagogical dynamics of educational centers do not open the possibility for these children to take advantage of their cognitive resources without an adequate adaptation of the curriculum.
Finally, this apathy also translates into an apparent lack of enthusiasm, which can lead to a certain lack of sources of leisure or recreation. It is difficult to find an activity that stimulates their motivation, which ends up producing a lack of reasons to feel satisfaction for the skills or abilities.
5. Motor slowness
Children with slow cognitive tempo may show some psychomotor retardation, which is expressed in the form of slow movements or coordination difficulties (in severe cases), and which becomes evident during play with peers or in physical education sessions. More demanding. They are sometimes described as clumsy, noting that they cannot keep up with the group, both in tasks that require physical effort and in those that require intellectual effort.
Such slowness cannot be explained by tiredness or fatigue, nor is it associated with sleep problems, poor nutrition or brain alteration (ataxia, for example). The diagnosis of slow cognitive tempo allows the articulation of specific therapeutic pedagogy programs, which will result in a more adequate adaptation to the school context and in the prevention of emotional disorders that have often been identified in this group.
6. Slow information processing
The studies that have been designed in order to explore the cognitive profile of children with slow cognitive tempo show the existence of a variable affectation in the speed of information processing, attention and metacognitive-type skills. These are higher order processes linked to the activity of the prefrontal cortex , and have been considered as constitutive elements of human executive functions.
Information processing speed describes the ability to manage environmental demands, and to allocate mental resources to optimize the way we deal with them. In the case of children with slow cognitive tempo, there is an overflow in cognitive processes when stimuli become complex or different sources of information are presented competing simultaneously for attention.
Precisely with regard to attention, it has been described that these children have problems directing the focus of consciousness towards a specific stimulus for long periods of time (sustained attention). Although it is natural that after a certain moment there is a decline in vigilance tasks, in these children that peak of resistance comes much earlier than expected, eroding their ability to remain oriented and aware of what is happening around them. This alteration is common to both slow cognitive tempo and inattentive ADHD.
Additionally, problems have been pointed out in selecting the relevant information from the environment and ignoring the accessory (search for a stimulus in a space in which it coexists with a series of distractors). In this case, the neural structures involved would be the parietal cortex, the precentral gyrus, the frontal oculomotor cortex, the superior colliculi, and the thalamus. This alteration of attention is distinctive of slow cognitive tempo.
7. Internalizing symptoms
Internalizing symptoms are common in children with slow cognitive tempo. They are opposed to externalizers, typical of ADHD with a hyperactive predominance (disruptive behaviors, interruptions, motor restlessness or tantrums). Major depression is the most common comorbid disorder, and the one that can also contribute most strongly to slowing of motor skills and thinking. It can be difficult to detect.
Altered self-image, shyness, poor self-esteem, and social isolation can also occur; as a result of the difficulty in interacting with others and comparison processes regarding performance in school tasks (academic failure and rejection are the two most disabling fears in late childhood and early adolescence). These symptoms are one of the most relevant differential elements regarding slow cognitive tempo and ADHD.
8. Need for more time than others and academic errors
Children with slow cognitive tempo require activity planning in which the time allowed for their completion is increased. On the other hand, the difficulty cited in the attentional processes can lead to the commission of more errors in the tasks, as well as oversights that lead to the commission of spelling mistakes or mathematical calculations.
The diagnosis of slow cognitive tempo usually occurs much later than that of ADHD, so the difficulties of these children are often detected with a notable delay. The exact clinical definition of this neurodevelopmental disorder will require more studies in the future, but it is expected that it will improve its identification and reduce the impact on the quality of life of those who suffer from it.
Bibliographic references
- Servera, M., Sáez, B., Burns, G.L. y Becker, S.P. (2018). Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. Journal of abnormal Psychology, 127(8), 818-829.
- Tirapu-Ustarroz, J., Ruiz-Garcia, BM, Luna-Lario, P. Hernaez-Goñi, P. (2015). Sluggish cognitive tempo: an updated review. Journal of Neurology, 61(7), 323-331.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.