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But interestingly 30% to 50% of the children
who are now called inattentive type probably have a different disorder
and researchers have called them SCT (Sluggish Cognitive Tempo)
it's about 30% to 50% of all inattentive type children
and we now believe this is a qualitatively unique disorder
the debate now is whether this is a separate type of ADHD
a point with which I disagree or
is it a qualitatively separate disorder a point with which I agree
why would I view this as a different disorder
first of all the symptoms are the opposite of ADHD
but you won't see them anywhere in the DSM
but these are the most compelling symptoms that go with SCT
but because these children also have an attention problem
there is no place else to put them
because ADHD is the only attention disorder in the DSM
so they get dropped into ADHD
even though they have no symptoms in common with it
these individuals have a problem with processing information
which ADHD children do not have
these children have trouble with focused attention
choosing what important from what's not
ADHD children do not their problem is and persistence
these people may have a long-term memory storage problem
or it could just be the same attention problem
that appears when they searched their memory
what is quite distinct about them is that they are socially withdrawn
reticent shy apprehensive
and often prone to social anxiety
but certainly socially reticent is a very good word for them
this is not a word that would ever be applied to an ADHD child
most importantly and tellingly they do not have an inhibition disorder
and inhibition is the heart of ADHD
and therefore they do not have a self-regulation disorder
and ADHD is a self regulation disorder
and these individuals do not have the executive deficits
that I just listed for you that go with ADHD
for those reasons alone
you could argue that this is a distinct disorder
but there are others
there is a very low rate of oppositional and conduct disorder
associated with this type of child
ODD and CD are much more common in ADHD children
these children have more anxiety problems
ADHD children while 1 in 4 may have anxiety
it's far higher in this group
we're not sure if depression goes with this group
both groups have about a 20% to 25% risk of depression
but it doesn't distinguish the two disorders
when we interview families of these children
their parents are concerned only about school
nothing else
these are good kids not disruptive outside of school
they even have a few friends not as many as other children
but more than ADHD children will ever have
so the big concern is let's get that school work done
and the mistakes they're making in school
you interview the parent of an ADHD child they're worried about everything
peer relationships family functioning
community behavior
not to mention what happens as the teen gets older
and starts driving and having a job
and managing money and becoming sexually active
SCT families don't worry about any of that stuff
ADHD families worry and well they should
(audience laughter)
these children mainly have trouble with the accuracy of school work
they get all the work done and half of its wrong
ADHD children don't do any work (audience laughter)
so the difference
SCT is an accuracy disorder ADHD is a productivity disorder
that is a qualitative difference another one is that these children
may be more prone to math disorders but we're not sure about that
these children come from quite different families
families with the same kinds of problems
higher rates of anxiety
higher rates of learning problems in school
thats about it
children with ADHD come from families with a lot more ADHD
a lot more school failure a lot more anti-social behaviour
alcoholism depression and drug abuse
these children do not
when we look at the treatments that work for these children
and this has not been very well studied by the way
but even here differences appear
the medications for ADHD don't work very well for these children
they don't hurt them you can try them
the lowest doses are the best they just don't help them
in fact in our study only 1 in 5 children was kept on
their medication after the trial in ADHD its 92%
these children are the best responders to social skills training
but no surprise social skills training was invented
40 years ago for shy people
and we know it works best for shy people
not for aggressive people
and so these children actually do very well in social skills training
ADHD children do not do well at all in social skills training
if they do it needs to be done
in the school environment with the children they go to school with
not in a summer camp
and certainly not in some Saturday morning clinic
with other children they will never see again
the rest of their life
if you're doing that you're probably wasting your money
so if they benefit it's because they benefit by the teachers
and others doing the training outside of the clinic environment
in the natural setting where the social problems arise
and even then it's not so much the skill training
as prompting and cueing and rewarding the occurrence of the skill
now do be aware
that research now shows that 1 in 4 children
put in a social skills group will be made worse by the group
this is known as deviancy training and it happens to occur because
the more aggressive children in any peer group
will train up the less aggressive children
to become more aggressive if only in self-defence
it happens every kindergarten year to normal children as well
so clinicians need to be careful because there are side effects
to social interventions
25% of ADHD children get worse by being in a social skills group
and we wish to avoid that
now the MTA study has found
that anxiety is the best predictor of response to the behavioral interventions
we could argue therefore that SCT children are probably the
best responders to behavior modification even better than ADHD children are
we know the cognitive therapy
which is teaching children to talk to themselves
fails for ADHD
we know why now because the minds voice is not developing on time
and in order for talking to yourself to have any success
you must have a normally developing internal speech
and they don't at least not until adulthood
and then some cognitive training does help as a supplement to medication
but in childhood cognitive training doesn't help ADHD
but this isn't ADHD so shouldn't we revisit this
and do cognitive training for SCT
no one has done it
there's a dissertation you know somebody who wants a dissertation
I just gave you one (audience laughter)
what about medication
well we don't know
we know the stimulants aren't particularly wonderful for them
they don't hurt them but they don't help them all that much
what else might work
well I don't know honestly but let me conjecture
if I were writing a grant tomorrow I might speculate
that Strattera (Atomoxetine) might work for these children
only because these are more anxious children
and Strattera treats anxiety when it's coexists with ADHD
so maybe Atomoxetine might have a shot at this disorder
we don't know nobody's done it
another drug that might be interesting is Provigil (Modafinil)
Modafinil is an anti narcoleptic
and it does seem to help people with ADHD it might help this group even more
because you remember those symptoms I showed you two slides ago
does that sound a little narcoleptic to you
lethargic slow-moving
drowsy staring inattentive
Humph maybe a brain stem drug might help you
again all speculative we don't know
by the way that is all we do know on SCT
so please don't ask me anymore questions about it
because you now know everything I know
what I do want you to know as a family is to understand that's not ADHD
ADHD is quite different from that
and so if you happen to have an SCT child or you know someone who does
please don't tell them to read the books on ADHD
they will be sadly misinformed
they will be told of all kinds of risks and all kinds of treatments
which as far as we know have little if any application
to these children
there is no book for parents on SCT not yet
nor should there be we don't know enough
but researchers are now studying these children
the very first psychological treatments for SCT
were published about a year ago
at the University of California at San Francisco
and so we're now beginning to see more and more research
on SCT children as distinct from ADHD children
but what I would want a family of an SCT child to understand
is that this is not ADHD
so what you should be worried about are not the things
families with ADHD children should be worried about
it's pretty much going to be a school-based issue
and the treatments that don't work for those kids
might well work for your child
and the treatment that do work for those kids
such as medication might not be so great for your child
no harm but not necessarily so great