Is Sluggish Cognitive Tempo a Thing?

The DSM remains a source of perpetual controversy, not just within the field of psychiatry, but within the press and public as well. It isn’t hard to see why. With its dogmatic tone and Orwellian self-certitude, this foundational document bears all the hallmarks of a holy text rendered into the scientific milieu. But the DSM is also unfairly maligned at times. As a touchstone for useful analytic therapy and psychiatric care, the manual has undoubtedly helped millions of people discover and name what ails them. The DSM has also been a tool of political progress over time, not least in its evolution over LGBT identity and recognition.

But now a new diagnosis is banging at the gates. A number of doctors are telling the public that we must accept a brand new attention disorder: Sluggish Cognitive Tempo, or SCT. Never mind that the name seems ripe for revision in the very near future (sluggish?), the diagnosis itself remains frustratingly vague. It describes, in the broadest sense, those who “tune out” or daydream, causing them to lose focus without any hyperactivity.

Some people are unhappy with this idea, and many of them have a pretty good argument that this latest malady may be little more than a rearguard effort by pharmaceutical companies to sell us more pills. Attentional deficit disorders as a group are already somewhat controversial, as few prescribing doctors ever bother to discuss subtler behavioral solutions such as improving sleep patterns before they reach for the pad. (We have learned the lesson many times before that prevention is always safer than prescription; consider this example from the world of orthopedic medicine.)

And there is this:

Yet some experts, including Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications — problems that A.D.H.D. already faces.

Daydreaming is simply what we do in childhood, and it’s unclear whether some people do so much of it that it should be pathologized. Until we know, it is probably best to let nature run its course, engage in talk therapy wherever it may help, and medicate only as a last resort.