TY - JOUR
T1 - The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo
T2 - A Meta-Analysis and Critical Review
AU - Becker, Stephen P.
AU - Leopold, Daniel R.
AU - Burns, G. Leonard
AU - Jarrett, Matthew A.
AU - Langberg, Joshua M.
AU - Marshall, Stephen A.
AU - McBurnett, Keith
AU - Waschbusch, Daniel A.
AU - Willcutt, Erik G.
N1 - Funding Information:
Dr. Becker is supported by award number K23MH108603 from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).
Funding Information:
Disclosure: Dr. Becker has received research support from the National Institute of Mental Health (NIMH), the Cincinnati Children’s Research Foundation (CCRF), the Ohio Department of Mental Health (ODMH), and a Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) Young Scientist Research Fund Award. Dr. Jarrett has received research support from the National Institutes of Health (NIH), the University of Alabama Department of Psychology, the University of Alabama Research Grants Committee, a University of Alabama College of Arts and Sciences Research, Scholarship, and Creative Activity (CARSCA) Award. He has received an article honorarium from Guilford Press. Dr. Langberg has received research support from NIH and the Institute of Education Sciences (IES). He has received book honoraria from the National Association for School Psychologists (NASP). Dr. McBurnett has received research support from IES and Shire. He has received presentation honoraria from Sunovion. Dr. Waschbusch has received research support from NIH, Children’s Miracle Network, and the Department of Psychiatry at Hershey Medical Center. He has received book chapter honoraria from Oxford University Press and Guilford Press and editorial stipends from Springer. Dr. Willcutt has received research support from NIH and the Manton Foundation. He has received book honoraria from Guilford Press and Springer, and presentation honoraria from Florida State University, the University of California San Diego, and Georgia State University. Mr. Marshall has received research support from the Ohio University Graduate Named Fellowship award and the Ohio University Student Enhancement Award. Dr. Burns and Mr. Leopold report no biomedical financial interests or potential conflicts of interest.
Publisher Copyright:
© 2016 American Academy of Child and Adolescent Psychiatry.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objective To conduct the first meta-analysis evaluating the internal and external validity of the sluggish cognitive tempo (SCT) construct as related to or distinct from attention-deficit/hyperactivity disorder (ADHD) and as associated with functional impairment and neuropsychological functioning. Method Electronic databases were searched through September 2015 for studies examining the factor structure and/or correlates of SCT in children or adults. The search procedures identified 73 papers. The core SCT behaviors included across studies, as well as factor loadings and reliability estimates, were reviewed to evaluate internal validity. Pooled correlation effect sizes using random effects models were used to evaluate SCT in relation to external validity domains (i.e., demographics, other psychopathologies, functional impairment, and neuropsychological functioning). Results Strong support was found for the internal validity of the SCT construct. Specifically, across factor analytic studies including more than 19,000 individuals, 13 SCT items loaded consistently on an SCT factor as opposed to an ADHD factor. Findings also support the reliability (i.e., internal consistency, test-retest reliability, interrater reliability) of SCT. In terms of external validity, there is some indication that SCT may increase with age (r = 0.11) and be associated with lower socioeconomic status (r = 0.10). Modest (potentially negligible) support was found for SCT symptoms being higher in males than females in children (r = 0.05) but not in adults. SCT is more strongly associated with ADHD inattention (r = 0.63 in children, r = 0.72 in adults) than with ADHD hyperactivity-impulsivity (r = 0.32 in children, r = 0.46 in adults), and it likewise appears that SCT is more strongly associated with internalizing symptoms than with externalizing symptoms. SCT is associated with significant global, social, and academic impairment (r = 0.38-0.44). Effects for neuropsychological functioning are mixed, although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits. Conclusion This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is currently not enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research.
AB - Objective To conduct the first meta-analysis evaluating the internal and external validity of the sluggish cognitive tempo (SCT) construct as related to or distinct from attention-deficit/hyperactivity disorder (ADHD) and as associated with functional impairment and neuropsychological functioning. Method Electronic databases were searched through September 2015 for studies examining the factor structure and/or correlates of SCT in children or adults. The search procedures identified 73 papers. The core SCT behaviors included across studies, as well as factor loadings and reliability estimates, were reviewed to evaluate internal validity. Pooled correlation effect sizes using random effects models were used to evaluate SCT in relation to external validity domains (i.e., demographics, other psychopathologies, functional impairment, and neuropsychological functioning). Results Strong support was found for the internal validity of the SCT construct. Specifically, across factor analytic studies including more than 19,000 individuals, 13 SCT items loaded consistently on an SCT factor as opposed to an ADHD factor. Findings also support the reliability (i.e., internal consistency, test-retest reliability, interrater reliability) of SCT. In terms of external validity, there is some indication that SCT may increase with age (r = 0.11) and be associated with lower socioeconomic status (r = 0.10). Modest (potentially negligible) support was found for SCT symptoms being higher in males than females in children (r = 0.05) but not in adults. SCT is more strongly associated with ADHD inattention (r = 0.63 in children, r = 0.72 in adults) than with ADHD hyperactivity-impulsivity (r = 0.32 in children, r = 0.46 in adults), and it likewise appears that SCT is more strongly associated with internalizing symptoms than with externalizing symptoms. SCT is associated with significant global, social, and academic impairment (r = 0.38-0.44). Effects for neuropsychological functioning are mixed, although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits. Conclusion This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is currently not enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research.
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U2 - 10.1016/j.jaac.2015.12.006
DO - 10.1016/j.jaac.2015.12.006
M3 - Review article
C2 - 26903250
AN - SCOPUS:84960392291
SN - 0890-8567
VL - 55
SP - 163
EP - 178
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
IS - 3
ER -
