How to Help a “Sluggish,” Forgetful Child

Some children (and adults) who daydream or are foggy and forgetful may need prescription drugs for attention deficit hyperactivity disorder.

Some children daydream more than others. They take in information slowly, get sleepy when they’re bored, and act withdrawn. They may be sad and anxious but usually aren’t disruptive problem kids.

In a study that tested a rating scale teachers used to identify students with behavior problems, one was defined as “sluggish tempo.” At the time, attention deficit hyperactive disorder (ADHD) researchers were debating whether two kinds of ADHD, called predominantly hyperactive/impulsive and predominantly inattentive, were, in fact, separate issues. Of the six million U.S. children who have been diagnosed with ADHD, about two million fall into the inattentive group.

The clinical psychologist Russell Barkley, PhD, of Virginia Commonwealth University Medical Center, concluded that the predominantly inattentive group suffered from a distinct illness that now goes by the name Sluggish Cognitive Tempo, or SCT.

In 2014, the Journal of Abnormal Child Psychology devoted a special issue to SCT, though the idea that the condition is a separate illness remains controversial. Still, the term caught on among people with attention issues. A Reddit group for SCT has more than six thousand members, many of them adults who think they may have had this problem beginning in childhood.

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What is sluggish cognitive tempo (SCT)?

The term SCT is not included in the Diagnostic and Statistical Manual of Mental Disorders, a recognized manual used by doctors. But a psychiatrist or psychologist may diagnose SCT based on symptoms.

People with SCT may stare blankly into space, lose their train of thought, and have trouble expressing themselves or forget what they were thinking or about to say.

While people with ADHD can do well when they are in a “high-load” demanding situation that doesn’t leave room for distraction, people with SCT would not.

How is SCT treated?

There is no standard treatment plan or research comparing medications or therapy on this group. One study of atomoxetine (Strattera), a non-stimulant prescribed for ADHD, was the first to report a drug having a positive effect on SCT, but another study found that it wasn’t especially helpful for SCT symptoms. A doctor might also prescribe methylphenidate hydrochloride (Ritalin), a standard ADHD drug, and antidepressants and therapy could help with sadness and anxiety. A drug called fluvoxamine (Luvox), an antidepressant used to treat social anxiety or obsessive-compulsive behavior, may be prescribed as well.

A non-stimulant medication has been approved for children with ADHD. It may be helpful, though it carries the risk of triggering thoughts of suicide.

A 2020 case study described a boy whose parents brought him to a clinic when he was five years and six months old. He learned to read and write on time, and when he was seven his teacher “reported that he used to move very slowly, look at something for a long time with empty eyes, [and] daydream, but academically did not have problems.” He eventually was treated with Ritalin. When that didn’t help his sluggishness, by the time he was almost 10, he received Strattera for seven months and improved.

It’s important, of course, to check whether sluggishness is caused by lack of sleep or sleep apnea, a condition in which your sleep is disrupted. Your child might have another learning disorder or neurological problem. Every medication carries the risk of side effects, and they might just mask a problem.

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