by Mary Silva

Stephen Becker, PhD.

Dr. Stephen Becker is putting science behind a controversial group of symptoms known as sluggish cognitive tempo, or SCT. He recently organized an issue of the Journal of Abnormal Child Psychology devoted to SCT, marked by daydreaming, foggy thinking and lethargy. That issue has renewed interest in the condition.

A debate has been going on among psychologists since before Stephen Becker, PhD, was born. Becker, now a clinical psychologist in the Division of Behavioral Medicine and Clinical Psychology, would like to settle it once and for all.

The debate is about sluggish cognitive tempo (SCT), a set of behavioral symptoms characterized by excessive daydreaming, mental fogginess and lethargy. Becker observed it first-hand while working with children during his graduate training and clinical residency.

The kids he worked with all had been diagnosed with ADHD. Yet some of them behaved in unexpected ways.

“When you think about the classic child with ADHD, you think about hyperactivity, running around, impulsiveness,” Becker says. “But these kids were withdrawn, often confused, and even slower in the ways they seemed to process information.”


SCT has been a subject of discussion and controversy for decades. Some psychologists and psychiatrists dismiss it altogether. Some believe it is a subset of symptoms within ADHD. Some think it should be its own disorder. Interest in settling the debate is growing because estimates indicate that SCT affects as many as 2 million children in this country.

Becker is interested because he has seen what SCT can do to a child.

“These symptoms can cause academic and social problems and difficulties with regulating emotion,” he says. “Yet kids who show these SCT behaviors are likely not being identified. They are not the kids blurting out answers or causing disruptions in the classroom.”

But they are kids who face social challenges. Becker’s study of the peer functioning of children with SCT symptoms, published in June 2014 in Psychiatry Research, found that 75 percent of children with high levels of SCT were rated as functionally impaired, compared to just 8 percent of children with low SCT. Becker says despite the prevalence of ADHD – now estimated to affect some 6 million children in the U.S. – there is still much we need to learn, and scientists know far less about SCT.

“We need to understand how these kids differ – and do they differ in meaningful ways?” he says. “We have hunches that they do, but we haven’t compared children with SCT to other children in a rigorous way.”


Becker has undertaken a first-ever study recruiting kids based on the presence or absence of SCT symptoms.

He hopes the study, which is funded by a Trustee Award of the Cincinnati Children’s Research Foundation, will provide pilot data for a larger-scale grant. His team began recruiting in September 2014, and as of March, had enrolled 50 children. Their goal is 100.

The study will look at four groups: children who have developed normally, those with SCT only, those with ADHD only, and those with both. As of this writing, most participants were in the combined or ADHD-only groups, but 10 were in the SCT-only group. Children in this study range in age from 8 to 12 because, says Becker, “It’s a time when kids encounter a lot of challenges, and many are first diagnosed with ADHD.”

Wherever the study of SCT leads, Becker believes a better understanding will help identify how to help children showing SCT behaviors. “We know that when these symptoms are present, they come with impairment – poor emotion regulation, more social withdrawal, more loneliness, and more academic problems,” he says.

The most convincing argument for further study of SCT is the response Becker has received from families. “Parents have emailed me out of the blue,” he says. “I have no idea how they found me, or my research. But I’ve been touched by their response.”

Children's Attention Problem Study.