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Is ‘sluggish cognitive tempo’ a valid new childhood disorder?

Sociology influences medicine more than we like to admit. One only needs to look at the history of psychiatric disorders – a term used broadly here to incorporate developmental disorders – to see how “normal…

Sluggish cognitive tempo is used to describe kids whose attentional deficits are due to low levels of mental energy. Alec Couros/Flickr, CC BY-NC-SA

Sociology influences medicine more than we like to admit. One only needs to look at the history of psychiatric disorders – a term used broadly here to incorporate developmental disorders – to see how “normal” in one era is often deemed “abnormal” in another. And how the dividing line between these two ends is often wafer thin.

Research advances are certainly key to what we claim as being a disorder, but political and social influences also play their part.

Autism is an excellent case in point; the cutoff for “abnormal” has shifted from recognising severely affected individuals only (30 years ago) to a more moderate position (20 years ago) and now to a point somewhere in between (today).

Variations aren’t just seen over time, but also between geographical locations. The proportion of children receiving a particular diagnosis can vary dramatically between states, for instance. Without question, the social and political influences of different jurisdictions are major drivers of this variation.

That’s not to say that people receiving these diagnoses don’t warrant assistance from health professions – they clearly do – but rather that our decisions about normal and abnormal are not as objective as we pretend.

Enter ‘sluggish cognitive tempo’

Consider the case of a possible new developmental disorder called sluggish cognitive tempo, identified by US researchers and discussed at length in a recent New York Times article.

The disorder is characterised by behavioural symptoms such as drowsiness, daydreaming, mental confusion, physical lethargy and apathy, and appears to be an offshoot of attention deficit/hyperactivity disorder (ADHD).

Whereas some children may have attentional deficits because of hyperactivity (the child who is “bouncing off the walls”), sluggish cognitive tempo is used to describe kids whose attentional deficits are due to low levels of mental energy.

The case for sluggish cognitive tempo representing a new disorder has been gathering pace over the past five years, so much so that the Journal of Abnormal Child Psychology dedicated most of its January issue to research related to the subject.

Indeed, in the issue, the journal claimed to have “laid to rest” any questions over the existence of the disorder, and that the cluster of symptoms is well on the way to being recognised as a legitimate disorder.

Cause for controversy

Sluggish cognitive tempo stands in contrast to attentional deficits because of hyperactivity. Alec Couros/Flickr, CC BY-NC-SA

Still, the proposal for sluggish cognitive tempo to be recognised as a disorder has been met with derision from many within the scientific community.

Allen Frances, a former chair of the task force that delivered a previous revision of the Diagnostic and Statistical Manual (the so-called psychiatrist’s bible), has been among the most vocal critics.

In a recent article No Child Left Undiagnosed, he wrote:

‘Sluggish Cognitive Tempo’ is a remarkably silly name for an even sillier proposal…[It] may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

These are fighting words, and there’s no hint of a backdown.

I am more circumspect than Dr Frances in my evaluation of sluggish cognitive tempo, but there are two aspects that cause me concern.

The first is about clinical need. The point of a diagnosis is to identify people who require assistance from health professionals, and then use that diagnosis to inform treatment.

At this point, research hasn’t demonstrated that children with these behaviours require assistance from health and education professionals. Is sluggish cognitive tempo just pathologising normal variation in childhood behaviour?

My second concern is the unclear influence of pharmaceutical companies on this line of research. Pharmaceutical giant Eli Lilly has a long-standing association with Professor Russell Barkley, one of the key researchers in the sluggish cognitive tempo field, and the company has already funded drug trials in this area.

This may be a completely innocent relationship driven by a mutual desire to help children. But, at the very least, it’s a bad look.

Higher standard of evidence

Disorders of the body are typically diagnosed based on clear biological observations. A diagnosis of diabetes, for example, is based on fasting blood sugar levels, and a diagnosis of kidney disease is based on a suite of urine tests.

We don’t have that luxury with disorders of the mind. Diagnoses are based on behaviours, which makes it an inherently subjective task that will always attract vehemently opposing views.

For this reason, the field must demand the highest levels of scientific evidence showing this cluster of symptoms characterises a group of children who require assistance from health professionals.

At this stage, sluggish cognitive tempo is not even close to reaching these standards.

Join the conversation

81 Comments sorted by

  1. Anne Powles

    Retired Psychologist

    It is interesting to see the sociological effects on definitions over the years when we look at the differing educational definitions of a disability such as sight impairment. The difference in "blindness" or "visual impairment" has altered quite dramatically and this is much easier to physically measure than conditions emanating in the mind. Whilst many people need special help from time to time we must refrain from too much categorisation and accept that there are many differences in the world and the world is actually a richer place for these differences. Within an educational environment each individual child will learn a little differently.

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  2. Brandon Young

    Retired

    The mental health sciences are a disgrace. The incentives are all wrong, and the thinking is all backwards.

    The DSM should be considered as a guide to exploit people too ignorant to manage their own physical health and lifestyle well enough to maximise their own mental well being. Putting a label on a "disorder" gives an individual the opportunity to completely opt out of control of their own destiny, and a predatory industry a chance to swoop in and secure another sucker for life.

    The very concepts of normal and abnormal should be very narrowly applied to physiological conditions with specific and known agents, and completely abandoned for all symptoms of mental impairment that are subjective and/or systematic outcomes of poor quality of living.

    Outcomes will only get worse for the public, and more profitable for industry, while research funding is heavily influenced by profitability. A major rethink is needed, because the current system is absurd.

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    1. Robert Barnett

      logged in via Twitter

      In reply to Brandon Young

      Well, I look forward to your diagnosis of my childs disorder and what you think is an appropriate response to increase her quality of life.

      I think we're doing pretty well with DSM5 thanks.

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    2. Gary Luke
      Gary Luke is a Friend of The Conversation.

      IT services

      In reply to Brandon Young

      "cluster of symptoms characterises a group of children who require assistance from health professionals."

      Which comes first, the chicken or the egg - medication by health professionals or a cluster of symptoms? And who decides that a handful of separate symptoms constitutes a valid "cluster"?

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    3. Sam Jandwich

      Policy Analyst

      In reply to Brandon Young

      "people too ignorant to manage their own physical health and lifestyle well enough to maximise their own mental well being."

      Are you saying that mental illness is the result of individuals' own failure to address it??

      I would say rather that mental illness is characterised by the individual involuntarily losing control of their ability to maximise their own well being - which makes me wonder whether cynicism should be designated a mental illness.

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    4. Brandon Young

      Retired

      In reply to Sam Jandwich

      Yes, I probably should clarify that I was not thinking of 'ignorant' in a derogatory way. I meant those who have a poor understanding of well being and the connections between nutrition, lifestyle habits, immune function, sleep, neurochemicals, and mental health, and especially the cumulative effects of sustained deficiencies in any of these areas. Perhaps I have presumed that such understanding is general knowledge for most of the population, or at least for most readers here, and on reflection…

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    5. Terry J Wall

      Still Learning at University of Life

      In reply to Brandon Young

      Brandon, from my experience, you are spot on in your thinking.

      The number of times one sees a trolley full of junk food and a shopper with kids, who at least outwardly appear to have at behavioral issues is too frequent to be just chance. Whats the saying? "Eventually you become what you eat" which has the obvious corollary "avoid shit".

      I like to add a solution or at least a suggestion of one:

      In the same way you can capture the mind of kids by teaching them religion at an early age, so you can teach them the importance of nutrition at the same stage of life.
      But no, at the moment we have too little leadership to overcome the power of American crap food lobbyists. Roll in the TPP and lets all go insane together. Few will notice.

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    6. Brandon Young

      Retired

      In reply to Terry J Wall

      I agree. There are some programs that have kids involved in growing their own vegetables at school, and while they also gain some knowledge about nutrition, more importantly they gain respect for natural food and pleasure from cooking and eating it. Kids may not be so sluggish if part of their school experience was something they really looked forward to and they were well nourished.

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    7. Malcolm Harrison

      journalist

      In reply to Robert Barnett

      i dont agree with you at all. i think the DSM is the most dangerous reference book in current use any where. it is dangerous to individuals who fall within its specifications, and more importantly it is dangerous to the credibility of the culture and civilisation that harbours it.

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    8. Allan Gardiner

      Dr

      In reply to Sam Jandwich

      "...the individual involuntarily losing control...'' doth beg the question somewhat, simply because, for someone to lose something implies that they first had hold of it, but if they were never aware of their perhaps having ability to control their mental well being then they are ignorant of the fact.

      It can be difficult to chart one's own course in life when there's many [b]others who have your life already map_ped'agogically for you.

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Malcolm Harrison

      "i think the DSM is the most dangerous reference book in current use any where."

      That type of comment probably reflects a lack of understanding of the structure and purpose of the DSM.

      In many areas of medicine, diagnoses are relatively straightforward - a fracture, appendicitis, gallstones, bowel obstruction. Some diagnoses are defined by test results (Xrays, blood levels, microbiology) or tissue analyses (cancers, infections).

      However, there are also diagnoses and syndromes that are…

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    10. Susan Ring

      Former nurse

      In reply to Brandon Young

      Study recently suggested that ADHD could be related to sleep apnoea, whereas the other group just sound like they are constantly too late to bed...or bored

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    11. Brandon Young

      Retired

      In reply to Susan Ring

      Yes, boredom should not be considered trivial. We know that regular stimulating intellectual activity has accumulating physiological effects, and there is evidence in its effects in slowing dementia, for example.

      It could be that chronic boredom is to mental well being what sedentary lifestyles are to physical well being, and the "cure" for ‘sluggish cognitive tempo’ is as simple as letting kids find something stimulating to do.

      Of course, once you start solving problems using such common sense, whole industries lose out.

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    12. Stephen Lehocz
      Stephen Lehocz is a Friend of The Conversation.

      Interested public.

      In reply to Brandon Young

      "...once you start solving problems using such common sense, whole industries lose out."
      This is oh, so, true! When common sense is used, many dubious industries, politicians, practitioners, etc, get very scared and start attacking these "common sense" solutions.
      And "common sense" is certainly not applied in this area of childhood problems (and quite a few other subjects), just the quick and easy expedient of restraint, ultimately makes the problem so much worse.
      Your excellent idea would put many out of business.

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  3. Jack Arnold

    Polymath

    It appears that psychology has entered the "name a new disorder" phase whereby practitioners earn merit by defining a new 'condition' regardless of the degree of symptoms.

    I am reminded that Education went through a similar phase about 40 years ago with 'Bloom's Taxonomy', a term much used, but rarely read or understood by lecturers, that retrospectively describes teaching style.

    Perhaps 'sluggish cognitive tempo' is just another way to describe growing up and being bored with adult questions.

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  4. Patrick Maher

    Retired Doctor of Psychology and Academic

    Excellent article.
    I sometimes wonder if a sense of awe about the world produces some of these symptoms. I also suspect that parental aspirations of their kids, well ahead of actual development play a role. You would also have include free play as a factor and so many kids theses days ever get a chance to sparkle - it also regulated by well meaning parents.
    I see parents in my neighbourhood driving their kids to school and picking them up each day when they live only five hundred meters from the…

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    1. Rosemary Boulter Vickers

      Retired early childhood teacher

      In reply to Patrick Maher

      I totally agree. With the push-down of formal schooling to children as young as four and a half and the added pressure of NAPLAN testing in year three of school, no wonder we are seeing more problem behaviour in children.
      Compare Australia with most European countries where children begin formal schooling at age seven, an age when most are developmentally ready for the challenge.
      I think we are getting it very wrong by forcing young children into situations where they are denied a chance to develop socially, emotionally, physically and cognitively in developmentally appropriate ways.

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  5. Peter Parry

    Child and adolescent psychiatrist & senior lecturer at University of Queensland

    A good article and important questions raised by Prof Whitehouse. I have only heard recently about this proposed new "disorder" and am commenting off the cuff here.

    But in my experience I've seen a handful of children and teens over almost 20 years of child psychiatry who score very low on "Processing Speed" on the WISC-IV (Weschler Intelligence Scale for Children - currently 4th edition). This is the main IQ test that psychologist colleagues do. It measures intellectual functioning in 4…

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    1. Robin Allinson

      Teacher

      In reply to Peter Parry

      Thankyou for this, I too have come across kids who are bright but need more time. Recognition of the situation and understanding from teachers is probably all these kids need - firing quick questions at them & speed tables wouldn't be helpful. From my experience, the few I would have said had this problem improved as they got older.

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    2. Heidi Ruckriegel

      Public servant, farmer, teacher

      In reply to Peter Parry

      I think I recognised myself there - every school report from my past mentions "daydreaming" and "needs to pay attention". The slowness is worse in some areas (maths esp.) than in others, but over the years I have found ways to deal with it. Practice improves speed most of all.

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    3. Tom Fisher

      Editor and Proofreader

      In reply to Peter Parry

      "and getting family and teachers to adjust by giving them much more time in conversation, chores and schoolwork etc"

      Exactly, and spot on Peter. I withdraw part of my comment on the lack of awareness and inclusion of significant others in the child's life, who are not the worst enemy but given the right tools to work with the best friend and ally.

      Having said that, I stand by my comment on reinvestment away from pharmaceutical 'research' into better parenting education, and far better education generally.

      How about, in the meantime, we all start talking a lot more about good quality time with children, more parenting leave, or better giving up paid employment when you have children to focus full-time on raising them properly, as if it's not a full-time job anyway?

      Wouldn't that be better?

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    4. Robert Barnett

      logged in via Twitter

      In reply to Peter Parry

      It's a pity that there is a knee jerk reaction to frame disorders as an over-diagnosis epidemic. The wealth of psychology research available on ADHD and ASD is an invaluable tool for parents and educators. Highly successful techniques would never have been conceived and/or formalised if the incidence cut-off was tuned to be less than 0.1%.

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    5. Sam Jandwich

      Policy Analyst

      In reply to Heidi Ruckriegel

      Yes me too. Absolutely hits the nail on the head.

      However I would probably put it down to a malaise at being surrounded by an under-stimulating environment, rather than a disorder. Or to put it more technically, a combination of having a poor attention span, and of being bored.

      What's more I find I still operate in this way. I find it very difficult to keep up with conversations for example, because they move too quickly for me to keep up with. Unless they're really interesting of course - though this is rare.

      The only thing I've found that really overcomes it is MDMA... though this gets boring too after a while!

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    6. Gayle Dallaston

      logged in via email @gayledallaston.com

      In reply to Robin Allinson

      Bright kids are not performing monkeys. Processing speeds are for computers - people including babies and children are far more complex.

      Sometimes a slow answer is because they are thinking rather than regurgitating the expected answers.

      Sometimes it's because what you think is a simple question is not simple at all.

      Sometimes it's because the better answer is "it depends".

      Sometimes it's because they know the best answer would not be accepted as correct.

      Sometimes it's because they know the answer you want but they know there are alternative answers too.

      Sometimes it's because they feel that the whole thing is a waste of time.

      That goes for the questions on the WISC-IV as much as the questions in the classroom test.

      I've seen that WISC-IV pattern - it is not a sign of a learning disorder.

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  6. Marcos Hardy

    Physiologist/Biophysicist (retired); Psychiatrist (retired.) at Retired

    "That clinking/ Clanking sound of/Money money money money money money!"
    Kander and Ebb got it right.
    This is Psychiatry today, just a business that is totally bereft of anything even approaching Science.
    And now they are tapping the Golden Calf: Children.
    As it was said to Joe McCarthy: "Sir, at long last, do you know no shame?"

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  7. Emma Goodall

    logged in via LinkedIn

    I think the societal impact of the term disorder and the idea of normal versus abnormal are key here. For example homosexuality only stopped being a disorder after a large enough section of society deemed it a variant of normal rather than abnormal. I choose to describe the autism spectrum as just that without the word disorder as I think that it is a variant of normal. Yes some children and adults on the autism spectrum require support and assistance but there are also those that do not - much as…

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    1. Sam Jandwich

      Policy Analyst

      In reply to Emma Goodall

      That's not a good analogy, as being homosexual doesn't impair functioning.

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    2. Thomas Goodey

      Researcher

      In reply to Sam Jandwich

      It does impair reproductive functioning - arguably the most important functioning of any life-form.

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    3. Martin Male

      Somatic Psychotherapist

      In reply to Thomas Goodey

      I don't accept that reproductive functioning is the most important functioning. By this baseline any person who can reproduce is "better " than someone who cannot. There are people who may be capable of reproducing , yet incapable of caring for their offspring!

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    4. Thomas Goodey

      Researcher

      In reply to Martin Male

      In evolutionary thinking, the words "important" and "better" simply refer to being likely to produce more descendants who themselves produce descendants (etc.). In other words, they relate purely to perpetuating one's own genetic endowment. It's obviously true that being homosexual reduces the probable number of such descendants, or rather, the probable amount of one's own genetic pattern in the next generation. It has been hypothesized that the "uncle effect" in which homosexuals help to bring up their sibling's children may counteract the above tendency, but it's pretty obvious that the effect is minor compared to the basic effect: that homosexuals have far fewer children than heterosexuals. This "uncle effect" idea is obviously grasping at a straw in the face of the clear evolutionary fact: homosexuality runs counter to the survival of one's genes.

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    5. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Thomas Goodey

      And yet Thomas homosexuality just seems to hang about being "unevolutionary" ... and not just us humans either. If such folks are "excluded" from the genetic flow - why does the phenotype persist?

      Must admit I've always had my doubts about a purely individualistic concept of evolution ... as social animals perhaps we make more complex decisions than pure self-interest - in fact some such rationale seems necessary to explain at least some of our purely self-defeating behaviour ... like ANZAC day and the like.

      I suspect we are all much more complicated and multi-dimensional than proponents of the selfish gene notion might conceive.

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    6. Thomas Goodey

      Researcher

      In reply to Peter Ormonde

      Why does homosexuality continue to hang about? Because it is not a genetic condition, of course. The phenotype persists because it is not the result of a genotype.

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    7. Thomas Goodey

      Researcher

      In reply to Peter Ormonde

      Precisely. That's effectively what I said. The quoted article specifically says "It’s not genetics. It’s not DNA. It’s not pieces of DNA. It’s epigenetics."

      Note that there is no particular reason to think that these hypothesized "epigenetic marks" are inherited, despite the speculation in the article. If they were, then a tendency to homosexuality (not homosexuality itself) would be an inherited trait. True, there is some evidence to that effect from family analysis, but it could be a cultural thing, or it could be that the unbalanced uterine environment that seems sometimes to cause homosexuality, itself has a genetic component.

      When in the near future artificial wombs become cheaply available and are routinely used, one presumes that the pre-natal chemical environment of babies will be standardized to the optimum. It is an interesting speculation that perhaps this will result in the virtual elimination of homosexuality. Now this is real speculation!

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    8. Terry J Wall

      Still Learning at University of Life

      In reply to Martin Male

      I would agree about the lack of parenting skills, but from what I have learnt over the years, much reproductive failure is due to short term ignorance, propagated by those hoping to make a zillon out of expensive lab/theater/surgery intervention

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    9. Peter Ormonde
      Peter Ormonde is a Friend of The Conversation.

      Farmer

      In reply to Thomas Goodey

      Epigenetics has nothing whatsoever to do with genes??? OK another brave assertion.

      It has instead to do with what switches genes on and off ... sorry, there's that g word again!

      Or to quote the article I hoped you might grasp: "Epigenetics is not a new concept exactly, but the field has exploded within the past decade. Where once it seemed that genes and environment were distinct, or that nature and nurture were distinct, now it seems clear that environment itself may change the ways in…

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    10. Terry J Wall

      Still Learning at University of Life

      In reply to Peter Ormonde

      Peter
      you can wander when you want cause your words are good.
      keep writing

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Terry J Wall

      ''much reproductive failure is due to short term ignorance''

      Hasn't the internet cured that?

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    12. Thomas Goodey

      Researcher

      In reply to Peter Ormonde

      I merely postulated a possible trend in society, assuming certain technological developments. This is called "extrapolation". I offered no opinion as to whether such a trend would be "good" or "bad".

      As for the epigenetics, it's a question of words. We all accept that, in an epigenetic scenario, the genotype does not change.

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  8. Mike Swinbourne

    logged in via Facebook

    ".....The disorder is characterised by behavioural symptoms such as drowsiness, daydreaming, mental confusion, physical lethargy and apathy,..."

    So every kid in history has had it then?

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  9. Peter Ormonde
    Peter Ormonde is a Friend of The Conversation.

    Farmer

    "Low levels of mental energy" ... hmmm.

    Anyone measured these "low levels of mental energy" at all? Or have we just got a dreamy kid?

    I wonder what they mean by "mental energy". Seems a bit woolly to me. Do they mean "affected" kids have brains running at 110 volts instead of god's standard 240 ... or does it mean that they are easily bored, easily distracted, can't do arithmetic as well as that Crewdly-Snodgrass boy? Do nice drawings count? Does listening to bird-calls?

    Inherently normative - sociological yes but bad sociology - sociology that allows no variability and difference ... at its core deeply conformist, authoritarian and intolerant.

    Where on earth will the artists, novelists and daydreamers come from in a "healthy" world?

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  10. Nicola Robson

    Student

    "The disorder is characterised by behavioural symptoms such as drowsiness, daydreaming, mental confusion, physical lethargy and apathy"... which describes many adults - especially at work on a Monday morning. Maybe the research would present a great case for Monday-itis.

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    1. Jack Arnold

      Polymath

      In reply to Nicola Robson

      There appears to be an outbreak of sluggish cognitive tempo disorder among the Coalition politicians preparing the budget ... or are those symptoms reflecting other mental disorders that require using Parliamentary Entitlements & Allowances to mitigate?

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  11. Meg Thornton

    Dilletante

    I can see where this is coming from - there's one set of kids who distract classmates and have learning difficulties because their brains are running too hot (the academically gifted and talented, the ADHD kids) so possibly there's another group which are going to distract classmates and have learning difficulties because their brains are running too cool (the academically less able, these SCT kids). What I suspect it points to, more than anything, is a problem in our educational systems, where…

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    1. Emma Goodall

      logged in via LinkedIn

      In reply to Meg Thornton

      Good points Meg, in NZ they have whanau rooms in schools (which translates as family classrooms) which have 3-6 years spread of chronological ages within them. When I trained as a teacher, I was taught to have multiple levels of a topic all at one time so having mixed ability classes was easier. Seeing different as variant not deviant is crucial for this though!

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    2. Tony Dickson

      Farmer at Farm Forestry and ecological services

      In reply to Meg Thornton

      Hear hear. I agree with all you say. As an identified gifted child, my son had a terrible time at school. He was bored out of his brain, was bullied by both teachers and students and accused of needing medication (you guessed it ADHD ). Oddly, at home he was just fine. Fortunately the local high school got a new principle that actually had some wit and it all ended well. Unfortunately, for so many kids, the outcome does rely on serendipity.

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  12. Will Hunt

    Farmer

    All these 'disorders' mostly become apparent once a kid is in primary school. Could it be that the root cause of these problems is a school system which spends much of its time dulling diamonds and polishing turds?

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  13. Tony Dickson

    Farmer at Farm Forestry and ecological services

    Well, there seems to be an unusual degree of consensus on this one. My wife is an educational psychologist of .....(many)....years experience and I think I can safely add her voice to the chorus in absentia. I am on more dangerous ground if I endorse an observation I read many years ago that psychology was the most imperialistic of all the professions.
    Taking a slight tangent, I would like to voice my concern that another example of over pathologising the fringes of normal behaviour, is that of…

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  14. Matt Fisher

    Research Fellow in social determinants of health at Flinders University

    It is of course true that the most proximal causes of any child's (or anyone else's) behaviours are events occurring in the brain and body. However, it is equally true that those events occur in structures which have been shaped by the interaction between the actions of genes and effects of the environment from conception onward. The great, usually unspoken, assumption underlying many of our social and political responses to DSM specifications of mental 'disorders' is that they are 'just' organic…

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  15. Cate Moss

    logged in via email @hotmail.com

    It would be great if research was directed towards the connection between cranial bone impact on neural pathways in the brain, particularly around birth process. I've had two children with impacted brain function that improved when this was dealt with. We understand how to maintain the 'wiring' of a motor vehicle, but completely ignore the remedial issues around our nervous system and brain function and cranials. There's so much research that could be done in this area. Pharmaceuticals, without looking for root causes seems to be a bandaid measure.

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  16. Mia Masters

    person

    "Dysphoric Social Attention Consumption Deficit Anxiety Disorder"? Anyone?

    "This new disease is somewhere in between attention deficit disorder, depression and anxiety disorder. It is only treatable with Havidol. "

    "The disease as well as the drug (Have it all) are fake.
    Australian artist Justine Cooper created the marketing campaign for a non-existent drug called Havidol for Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD), which she also invented.
    From Reuters interview…

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    1. Jack Arnold

      Polymath

      In reply to Mia Masters

      Could it be a disorder made to fit the drug ... a little like the case with ADD ... ???

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  17. Julanne Sweeney
    Julanne Sweeney is a Friend of The Conversation.

    tree farming teacher

    3 simplistic considerations :

    1. What of the products of the misguided Baby Bonus ( now facing abolition )?

    2. What of the excessive screen -time many children now indulge in from very early years?

    3. What of the decrease in actual conversation with parents/ peers due to digital obsession of all ages?

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  18. Sue Ieraci

    Public hospital clinician

    I wonder whether the increasing demand to help children focus in the classroom is a result of a technological society that requires thinkers more than doers?

    If inattention or ''slowness of cognition'' results in a child's inability to later find rewarding employment, then perhaps that can be construed as a disability, just like physical ones.

    Every child is now being driven to ''achieve their full potential'' in an academic setting, while, in the past, their full potential might have been developed outdoors or alongside adults.

    I'm not pushing for a return to old-fashioned classrooms where those who couldn't keep up were left behind or ridiculed - I'm just trying to think through the reasons why different attributes become ''disabilities'' in a changing world.

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  19. Tom Fisher

    Editor and Proofreader

    Spare a thought for the poor parents happy with their children being the way they are, and as often qualified themselves in some associated area of child development studies and a wake-up to the way the game is played, who are as rightly critical of the DSM and instead take time out to look after them and raise them themselves.

    Always, Andrew, nobody in these discussions bothers with the elephant in the room, being the child's parents, and siblings and family, and age-peers and all the others…

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  20. Dennis Alexander

    logged in via LinkedIn

    The band comprising 'normal' is narrowing daily. Perhaps we should redefine that band as 'abnormal' and all the others as 'normal'. At least then we would be giving help to 'normal' children - work it out for yourselves ;-)

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  21. Gayle Dallaston

    logged in via email @gayledallaston.com

    OK good - now let's have an article passing the same critical view over ADHD, autism and aspergers syndrome. How are they any different to sluggish cognitive tempo?

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  22. Thomas Goodey

    Researcher

    This is a classy way of saying "laziness and stupidity", isn't it?

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    1. Lyndal Breen

      logged in via Facebook

      In reply to Thomas Goodey

      Perhaps it is another way of saying "laziness and stupidity". Having worked in High Schools for a number of years in Education Support, I have been very sad for that group of kids who clearly could not think quickly, comprehend instructions immediately, spit out an answer directly etc. I doubt a diagnosis is the total answer, but making people aware that these kids are not just "lazy" "stupid" "dunces" "dopes" or merely "thick" could perhaps lead to the development of strategies that recognise this is a syndrome that requires extra assistance and thereby reduce some of the misery experienced by those who are a little "slow"

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    2. Tim Allman

      Medical Software Developer

      In reply to Thomas Goodey

      Frankly, this is insulting. You need to become more informed about the research over the last quarter century into ADHD and similar disorders.

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  23. Martin Male

    Somatic Psychotherapist

    I would just to like to say thank you, firstly for this article and for the comments included. In my experience of over 30 years in the health an welfare area I have seen a trend to seek a diagnosis promptly. This is often (not always) driven by parents and health professionals who seek to have an answer or resolution for their child's behaviour. I do accept the validity of informed and accurate diagnosis by the way.
    I agree wholeheartedly with the history of the diagnosis of autism discussed here…

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  24. Malcolm Harrison

    journalist

    I think the writer is being too kind and too trusting of human endeavour. Having raised five children and navigated the quagmire that is child psychology, I have learnt to distrust over confident psychologists, all psychiatrists, and all pharmaceutical companies.
    some psychology is useful, but psychiatry has always had a speculative and dubious data base. As for pharmaceutical companies, they have a social morality similar to that of the fossil fuel industry.

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  25. Stephen Lehocz
    Stephen Lehocz is a Friend of The Conversation.

    Interested public.

    What I find interesting is that, always there is a new disorder that needs attention. So the number of disorders keeps increasing and hence there would be a greater number of sick people that need attention.
    But, all they are able to do is either lock them away and put them in straight jackets which are either the physical straight jackets, which stops them from doing anything or the latest "cure" a chemical straight jacket which also constrains them from living and feeling and enjoying life. These are not cures.
    It really does seem that they have no solution to restoring people to a happy productive life, other than providing more mental disorders, which enables them to pretend that they know what they are talking about. To which they can prescribe another expensive drug.
    They don't have cures, just methods of subduing problem people.

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    1. Martin Male

      Somatic Psychotherapist

      In reply to Stephen Lehocz

      I agree Stephen , it is imperative that there be some benefit for the people seeking support involved. The silver bullet approach doesn't work.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Stephen Lehocz

      ''They don't have cures, just methods of subduing problem people''

      On the contrary - it was the old-fashioned "lazy or stupid" label that led to children being humiliated or just ignored in the classroom.

      While I am no advocate of over-diagnosis, I am also aware that getting a label can often help children access help, whether it is classroom support, psychology or occupational therapy sessions, or at least some understanding that our brains don't all work in the same way.

      To imply that a diagnosis just brings a "chemical straight jacket which also constrains them from living and feeling and enjoying life" is to devalue the important collaborative work of educators, occupational therapists, psychologists, GPs and paediatricians that helps children transform from "naughty" or "lazy" to enjoying their childhood.

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    3. Stephen Lehocz
      Stephen Lehocz is a Friend of The Conversation.

      Interested public.

      In reply to Sue Ieraci

      No Sue, my put was that all these different labels gives someone an excuse to to find more "problems" that need expensive medication. Medication as practised is just chemically straightjacketing patients and making them pliable and less active, and hence pretending to cure them.

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  26. Allan Gardiner

    Dr

    "Diagnoses are based on behaviours, which makes it an inherently subjective task that will always attract vehemently opposing views."

    Dr David Rosenhan proved this beyond all doubt with his famous experiment http://en.wikipedia.org/wiki/Rosenhan_experiment.

    One example of where behaviour was misinterpreted by staff as stemming from within the patient, rather than the environment, was when a psychiatrist pointed to a group of patients waiting outside the cafeteria half an hour before lunchtime…

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  27. Tim Allman

    Medical Software Developer

    I'm not by any means an expert on mental disorders but I have had a lot of personal experience with ADHD. Anyone familiar with the disorder will understand that there is an abundance of public opinion that is, to be kind, skeptical of its existence, much as with climate change and vaccines. This column and many of the comments remind me of what has been said of ADHD in the popular press and to me personally, especially if you start to read between the lines.

    The author may well have justification…

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    1. Gayle Dallaston

      logged in via email @gayledallaston.com

      In reply to Tim Allman

      "The difference between 'normal' and a disorder is the severity and frequency of the symptoms."

      Tim, I don't dispute that for a moment. However, criticising a diagnosis doesn't necessarily mean dismissing the real difficulties that people experience in their lives. It just means that they are questioning the interpretations and solutions proposed.

      "disparaging by innuendo of Russel Barkley is, in my opinion, unprofessional"

      Vested interests need to be considered in everything. It's not just grubby financial deals. Everyone builds or protects careers, reputations, relationships with colleagues, friends and family, and even their own self-image in just about everything they do - how can it be any other way? Being aware of that in oneself as well as others is important and can help you understand why many people do and think as they do.

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    2. Terry J Wall

      Still Learning at University of Life

      In reply to Gayle Dallaston

      Hi Gayle
      Well written and good words. Silly as it may sound and read, I think that:

      It is better to trust and risk being deceived, than not to trust those who should be believed.... yep read it again,,,,

      That is the way I have lived for best part of my 70 years and I can assure you that the benefits make me sleep well. I cannot stand the recently advocated mantra in NSW that telling your kids that white lies are OK. It is bloody crap. How in hell are kids going to know when is little and when is it life changing. Rest my case if you watch the news

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    3. Tim Allman

      Medical Software Developer

      In reply to Gayle Dallaston

      Gayle,

      I don't have a problem with your first comment. I don't think I suggested otherwise but perhaps I could have been a bit clearer.

      However, the comment on Barkley reminds me of a drive by shooting. Certainly we have to be aware of conflicts of interest but the author says nothing about what it might be. He just plants a seed of doubt and goes on. I won't defend Barkley here, largely because I don't know the details and it's not my job, but I think that if one is going to damage someone's reputation one should clearly explain why. Here there is not enough said.

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    4. Gayle Dallaston

      logged in via email @gayledallaston.com

      In reply to Tim Allman

      Yes, I see what you mean. I guess that didn't press any of my buttons because in real life I have found that the non-financial conflicts of interest can be the most insidious and difficult to overcome.

      In fact, one of the many ironies about this site is the disclosure statements that they make about financial interests as though that is the only conflict that there is. Having a swipe at someone for having a possible direct financial interest is par for the course in academia while empire/career…

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  28. Terry J Wall

    Still Learning at University of Life

    I think it is about time that "The Conversation" reiterates the reason why we are unable to see at least an indication of numbers of "Recommendations" that a persons comment receives. An example of where they do this is the Guardian.

    I do admit that it can be a trifle distracting, especially if one has been imbibing a tincture or two. Like one has to restrict the desire to skid down looking for the more prominent protrusions.

    My suggestion is that colour might be the answer. Different shades up to blood red, when the comment reaches say 50 likes?

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  29. Graham Martin

    logged in via Twitter

    Much of this article, and the discussion, completely miss the point. The description given simply meets criteria for the old ADD - that is ADHD without hyperactivity. But diagnosis is such a waste of time and resources.
    Ultimately, working therapeutically with the child and family to resolve each presented problem or behavioural issue, over time, and towards agreed upon goals, is all that matters. And unfortunately clinicians in child mental health services are rather poorly trained in actually doing this work. In addition, they are expected by bureaucracy to spend most of their time arguing about diagnoses so they can fill in little boxes, and are rarely supported to spend the time necessary to actually meet the child's and the family's needs.

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  30. john mills

    artist

    Thanks for the great story--reminds me of when i was at school-- by grade three the teacher refused to teach me-- couldn't cope with me-- i didn't fit the mold-- glad i wasn't born in the last twenty years that's for sure-- these poor kids today being tagged and vegetated--its all about tolerance--has to be-- the next year i was fine-- the teacher, and how tolerant they are, means everything--personalities mean everything too--i didn't like her , she didn't like me, she just couldn't admit that…

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  31. john mills

    artist

    Just a bit i mistakenly didn't add to the end of my last post------

    Id just like some of these judgemental doctors to take a good look at who they are, and how they are, how intolerant or tolerant, to the differences, idiocyncrisies,peronalities,off-beat natures in people.because when they point their finger at others they set wheels in motion that disable the little kids that they might just not be tolerant enough or personality compatible enough with, to be judging or disabling or helping in…

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