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problem that appears when they searched their memory what is quite distinct about them is that they are socially withdrawn reticent shy apprehensive and often prone to social anxiety but certainly socially reticent is a very good word for them this is not a word that would ever be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