Cognitive Disengagement Syndrome (CDS) Lecture by Russ Markley

Introduction

• Russ Markley discusses a relatively new attention disorder: Cognitive Disengagement Syndrome (CDS).
• Previously known as Sluggish Cognitive Tempo (SCT).
• Recently changed by a work group of experts in Oct 2022.
• CDS is distinct from ADHD but can overlap.

Cognitive Disengagement Syndrome (CDS)

Characteristics

• Mental Confusion: Individuals appear cognitively confused.
• Staring/Daydreaming: Often have a spacey look, disconnected from external events.
• Drowsy Appearance: Sometimes appear sleepy or in a mental fog.
• Low Motor Activity: Sluggish responses, passivity, or withdrawal.
• Episodic Nature: Symptoms appear during disengagement periods; normal activity otherwise.
• Hypoactive Response: Unlike ADHD's hyperactivity, CDS is characterized by hypoactivity.

Historical Background

• Early Descriptions: Dates back to descriptions by Heinrich Hoffman in the 1800s and Alexander Creighton in the late 1700s.
• 1980s Research: Started distinguishing between ADHD (formerly ADD) with and without hyperactivity.
• Recent Studies: Increased interest and research in the last 15 years.
• Review Publication: Recent review published in the Journal of the American Academy of Child and Adolescent Psychiatry.

CDS and DSM Classification

• Not In DSM: Currently not a recognized diagnosis in the DSM.
• Inappropriate Classification: Often misclassified as inattentive ADHD.
• Presentations in DSM-5: Three ADHD presentations — hyperactive, inattentive, combined.
• Misdiagnosis Issue: CDS is often forced into the inattentive presentation.

Differential Diagnosis

• Combined Presentation Decline: Inattentive presentation emerging as hyperactive symptoms wane with age.
• Sub-Threshold Presentation: Mild combined presentation missing full criteria.
• Distinct from ADHD: 30-50% of those diagnosed as inattentive ADHD actually have CDS.

Identifying a New Disorder

• Criteria: Symptoms coherence, comorbidity patterns, demographic differences, cognitive deficits, impairment patterns, developmental course, etiologies, family history, biological correlates, treatment response.
• CDS vs. ADHD Symptoms: Distinct dimensions — cognitive and motor.

Symptoms

• Daydreams, easily confused, trouble staying alert, spacey appearance, mental fog, stares a lot, lethargic, underactive, slow-moving
• Some symptoms overlap with ADHD but are mostly distinct.
• Steve Becker’s Review: 16 symptoms identified.

Symptom Dimensions

• Coherence: CDS symptoms form a coherent dimension separate from ADHD.
• Correlation: Moderate correlation with ADHD inattention, no or negative correlation with ADHD hyperactivity.
• Stability: Symptom stability increases with age.
• Distinct Symptoms: Separate from symptoms of other disorders like anxiety, depression, etc.

Network Analysis

• Depression vs. CDS: Symptoms of depression and CDS form distinct networks, confirming they are separate conditions.

Further Research Areas

• Distinguishing CDS from other medical, physical, and psychological conditions.
• Future Lectures: Upcoming discussions on cognitive differences between CDS and ADHD.

References

• Medical textbooks, research articles, and reviews from the late 1700s through recent studies.
• Key Publications: Available in the Journal of the American Academy of Child and Adolescent Psychiatry website.