Journal of Clinical Child & Adolescent Psychology ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: http://www.tandfonline.com/loi/hcap20 Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal, Peer Ignoring, and Low Engagement Stephen P. Becker, Annie A. Garner, Leanne Tamm, Tanya N. Antonini & Jeffery N. Epstein To cite this article: Stephen P. Becker, Annie A. Garner, Leanne Tamm, Tanya N. Antonini & Jeffery N. Epstein (2017): Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal, Peer Ignoring, and Low Engagement, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2017.1286595 To link to this article: http://dx.doi.org/10.1080/15374416.2017.1286595 Published online: 13 Mar 2017. Submit your article to this journal Article views: 55 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hcap20 Download by: [University of Iowa Libraries] Date: 31 March 2017, At: 09:20 Journal of Clinical Child & Adolescent Psychology, 00(00), 1–10, 2017 Copyright © 2017 Society of Clinical Child & Adoloscent Psychology ISSN: 1537-4416 print/1537-4424 online DOI: 10.1080/15374416.2017.1286595 Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal, Peer Ignoring, and Low Engagement Stephen P. Becker Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine Annie A. Garner Department of Psychology, Saint Louis University Leanne Tamm Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine Tanya N. Antonini Department of Rehabilitation Psychology/Neuropsychology, TIRR Memorial Hermann and Department of Physical Medicine and Rehabilitation, Baylor College of Medicine Jeffery N. Epstein Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine Sluggish cognitive tempo (SCT) symptoms are associated with social difficulties in children, though findings are mixed and many studies have used global measures of social impair- ment. The present study tested the hypothesis that SCT would be uniquely associated with aspects of social functioning characterized by withdrawal and isolation, whereas attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms would be uniquely associated with aspects of social functioning characterized by inappropri- ate responding in social situations and active peer exclusion. Participants were 158 children (70% boys) between 7–12 years of age being evaluated for possible ADHD. Both parents and teachers completed measures of SCT, ADHD, ODD, and internalizing (anxiety/depres- sion) symptoms. Parents also completed ratings of social engagement and self-control. Teachers also completed measures assessing asociality and exclusion, as well as peer ignoring and dislike. In regression analyses controlling for demographic characteristics and other psychopathology symptoms, parent-reported SCT symptoms were significantly asso- ciated with lower social engagement (e.g., starting conversations, joining activities). Teacher-reported SCT symptoms were significantly associated with greater asociality/with- drawal and ratings of more frequent ignoring by peers, as well as greater exclusion. ODD symptoms and ADHD hyperactive-impulsive symptoms were more consistently associated with other aspects of social behavior, including peer exclusion, being disliked by peers, and poorer self-control during social situations. Findings provide the clearest evidence to date Correspondence should be addressed to Stephen P. Becker, Center for ADHD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH 45229. E-mail: [email protected] 2 BECKER ET AL. that the social difficulties associated with SCT are primarily due to withdrawal, isolation, and low initiative in social situations. Social skills training interventions may be effective for children displaying elevated SCT symptomatology. Sluggish cognitive tempo (SCT) is characterized by beha- study found teacher-rated SCT to be associated with viors such as daydreaming, mental confusion and fogginess, poorer social skills, whereas parent-rated SCT was unas- behavioral slowness/hypoactivity, and drowsiness/sleepiness sociated with social skills after controlling for ADHD (Becker & Barkley, in press; Becker et al., 2016). Although symptoms (Bauermeister, Barkley, Bauermeister, SCT symptoms were once considered potentially useful for Martinez, & McBurnett, 2012). Other studies have identifying “purely” inattentive children with attention def- found the opposite. For example parent-rated SCT symp- icit/hyperactivity disorder (ADHD), SCT appears to be dis- toms were associated with poorer social skills beyond tinct from ADHD inattention (Barkley, 2014; Becker, ADHD and depressive symptoms, but teacher-rated SCT Marshall, & McBurnett, 2014). Indeed, bifactor modeling was unassociated with social skills when controlling for studies demonstrate that the SCT construct does not fall ADHD and depression (McBurnett et al., 2014). In a under the umbrella of either ADHD (Garner et al., 2014) longitudinal study of Spanish children, parent-reported or a general disruptive behavior factor (Lee, Burns, SCT symptoms, but not teacher-rated SCT symptoms, Beauchaine, & Becker, 2015). As such, research has turned predicted later social impairment (Bernad, Servera, toward investigating whether SCT uniquely predicts mean- Becker, & Burns, 2016). Fenollar Cortés and colleagues ingful external constructs after controlling for ADHD symp- (2014) examined separate inconsistent alertness (e.g., toms, which are clearly associated with a wide range of daydreams, loses train of thought) and slowness (e.g., functional impairments (Faraone et al., 2015). slow moving, seems drowsy) dimensions of SCT and Alargebodyofliteraturedemonstratesthatpeerrela- found that the inconsistent alertness factor was uniquely tionships are a potent determinant of concurrent and long- associated with parent-rated peer problems above and term adjustment, both in youth with and without ADHD beyond ADHD inattentive symptoms, whereas the SCT (Gardner & Gerdes, 2015;Parker,Rubin,Erath, slowness factor was not. Last, two studies reported that Wojslawowicz, & Buskirk, 2006). Several studies have SCT was either positively or unassociated with social sought to determine whether SCT is uniquely associated impairment when parent ratings were used but associated with social functioning. A recent meta-analysis demon- with less social impairment when teacher ratings were strated that SCT is bivariately correlated with social used (Belmar et al., 2015;Watabe,Owens,Evans,& impairment in children and adolescents (Becker et al., Brandt, 2014). In considering their findings, Watabe 2016). However, when examining individual studies and et al. (2014)hypothesizedthatSCTmaybelessnotice- various methodological factors, the story is less clear. able or viewed as less problematic to teachers who have a Many studies investigating SCT in relation to children’s large number of students in their classroom at any given social functioning have relied on broad measures of glo- time and are more readily drawn to disruptive behaviors bal social functioning. These studies have reported mixed as compared to the more passive behaviors of SCT findings, particularly when evaluating whether SCT (though, see Burns, Becker, Servera, Bernad, & García- remains associated with social impairment beyond Banda, 2017,forsomeevidenceincontrasttothis ADHD symptoms. A number of studies have shown hypothesis). Clearly, more research is needed to better parent- or teacher-reported SCT to remain associated understand the mixed findings across studies to date that with greater social difficulties and impairment beyond have evaluated SCT in relation to social functioning. ADHD (Becker, 2014;Becker&Langberg,2013; What might account for these discrepant findings? As Becker, Luebbe, Fite, Stoppelbein, & Greening, 2014; previously noted, the studies just reviewed relied on Burns, Servera, Carrillo, & Cardo, 2013;Khadka, broad, often single-item measures of social functioning/ Burns, & Becker, 2016;Lee,Burns,Snell,& impairment. Consequently, although a moderate-to-strong McBurnett, 2014), whereas others have not (Becker, bivariate correlation was found between SCT and social Luebbe, & Joyce, 2015;Belmar,Servera,Becker,& impairment in a recent SCT meta-analysis (Becker et al., Burns, 2015). Still others have found that whether SCT 2016), it was also noted that “future studies should remained associated with social impairment beyond increase the specificity used in examining various ADHD symptoms varied based on whether parent or domains of impairment” (p. 172). There is some indica- teachers were the informant. For instance, in a study of tion that SCT may be uniquely related to greater with- children from South Korea, SCT remained associated drawal and isolation. Two studies found that children with greater social impairment beyond ADHD when tea- diagnosed with ADHD Predominantly Inattentive Type cher ratings were