Note: ADHD (predominantly inattentive) and Sluggish Cognitive Tempo (SCT) are real conditions, but similar symptoms — inattention, slow processing, brain fog, low motivation — can occur due to other medical, psychological, lifestyle, or nutritional factors.
Ruling these out is critical.
Request for MOD to pin this in community
A. MEDICAL / PHYSICAL CAUSES
Thyroid disorders (hypo-/hyperthyroidism): Fatigue, slowed thinking, poor concentration. Research: Chaker et al., 2017, Lancet Diabetes Endocrinol – thyroid dysfunction linked with cognitive impairment.
Low testosterone / hypogonadism (♂️): Low motivation, poor focus, mental fatigue. Research: Shores et al., 2005, J Clin Endocrinol Metab – affects attention and executive function.
Cortisol imbalance: High or low cortisol → brain fog, poor memory, slow processing. Research: McEwen, 2007, Physiol Rev – chronic cortisol dysregulation impairs cognition.
Sex hormone fluctuations (Estrogen & Progesterone) (♀️): Changes in levels can affect attention, working memory, and cognitive speed. Research: Hampson, 1990, Psychoneuroendocrinology; McEwen & Milner, 2017, Nat Rev Neurosci.
Iron deficiency / anemia: Fatigue, poor concentration, memory issues. Research: Beard et al., 2003, J Nutr.
Vitamin deficiencies (B12, B6, Folate, D, magnesium, zinc, copper, selenium): Cognitive slowing, poor memory, reduced alertness. Research: Smith & Refsum, 2016, Nat Rev Neurol; Eyles et al., 2013, Front Neurosci.
Phosphorus is critical for ATP production and neuronal signaling; deficiency can impair cognitive performance and attention. Research: Cohn et al., 2008, Am J Clin Nutr – phosphorus status impacts brain energy metabolism.
Metabolic / Blood sugar issues: Hypoglycemia, insulin resistance, high homocysteine → brain fog, irritability, inattention. Research: Messier, 2004, Neurosci Biobehav Rev.
Sleep disorders: Sleep apnea, insomnia, RLS, circadian rhythm disorders → poor attention and executive function. Research: Beebe et al., 2010, Pediatr Clin North Am.
Neurological / Other conditions: Post-concussion, absence seizures, chronic inflammation, autoimmune disorders. Research: Marsland et al., 2015, Brain Behav Immun.
Sensory deficits: Hearing or vision problems → appear inattentive.
Medication / substance effects: Sedatives, antipsychotics, alcohol, cannabis → reduced attention and processing speed. Research: Gonzalez et al., 2012, Front Psychiatry.
B. PSYCHOLOGICAL / PSYCHIATRIC CONDITIONS
- Depression: Low energy, poor focus, indecision. Research: Willcutt et al., 2012, Clin Psychol Rev.
- Anxiety disorders: Constant worry → difficulty concentrating.
- Bipolar disorder: Inattention during depressive/manic phases.
- Autism spectrum: Attention differences, hyperfocus, distractibility.
- Learning disorders: Dyslexia, language disorders → appear inattentive.
- OCD / perfectionism: Overfocus on details → reduced attention to other tasks.
C. LIFESTYLE / ENVIRONMENTAL FACTORS
- Poor sleep, chronic stress, overwork, poor diet, lack of exercise, overstimulation (phones/social media). Research: Volkow et al., 2011, Nat Rev Neurosci.
D. EXECUTIVE-FUNCTION / CONTEXTUAL ISSUES
- Poor time management, organization, misaligned interests, boredom → situational ADHD-like symptoms.
E. RED FLAGS THAT IT MIGHT NOT BE ADHD/SCT
- Adult-onset only, no childhood history.
- Symptoms fluctuate with sleep, stress, or diet.
- Symptoms improve significantly with lifestyle adjustments.
F. LAB / BLOOD PANEL TO RULE OUT MEDICAL CAUSES
- Hormones: Testosterone, SHBG, FSH, LH, prolactin, cortisol, estradiol, progesterone.
- Vitamins & minerals: B12, B6, folate, Vitamin D, Choline, magnesium, zinc, copper, selenium.
- Metabolic: Fasting glucose, HbA1c, fasting insulin, lipid profile, homocysteine.
- Organ function: Liver & kidney tests, electrolytes.
- Blood & inflammation: CBC, CRP/ESR, ANA.
- Brain/nerve support: Omega-3 index.
- Optional: Thyroid antibodies, CoQ10, heavy metals.
Ruling out these factors first ensures cognitive issues aren’t secondary to another treatable condition. ✅
Mod note: This appears to be AI generated so be mindful of that and confirm accuracy for yourself, but it definitely addresses a lot of points of confusion that we see here (most commonly with other psychiatric conditions and things like sudden onset - for medical causes, basic lab panels may be able to rule out a lot of possible cases where there would be overlapping symptoms).
Yes I had ADHD-like, SCT-like, and autism-like symptoms that went away after discovering I had a lifelong gut issue. Addressing it has made me feel better than I ever have. Attacking it from the metabolic, vitamin deficiency, hypothyroid, and high cortisol angles. Chronic inflammation, sleeping issues and psychological issues were downstream of these. It's like a chain of comorbidities.
What type of gut issue, if you don't mind me asking?
Neurodevelopmental disorders and gut disorders are commonly comorbid as well.
I think (just speculating): The gut is either playing up because of a neurotransmitter issue or because of an issue that is actually starting in the gut, e.g.: immune disorder affecting the mucosa and making prone for dysbiosis or Giardia infections, Hirschsprung related issues, functional disorders of the gut such as enteric nervous system disorders (enteric neuropathy), autonomic neuropathy affecting the gut etc. and as a result affecting the brain. I was told by my gastroenterologist that the gut brain axis and the fact that neurotransmitter production also has to do with the gut: it is sometimes hard to distinguish where the issues started. If psychiatric medication helps the gut issues: great. E.g. Fluoxetine prevents colon inflammation and may even prevent colon cancer (this is cutting edge research not fully confirmed yet).
Yes, I have heard about serotonin modulating lots of gut effects, there are a surprisingly large number of neurons there.
Needed for a well functioning gallbladder as well which again impacts the microbiome. There is also research stating that SSRI lower enterococcus in the gut significantly. I would say the focus of research for psychiatric illnesses may change in the future and place the gut more central. Reduced number of short chain fatty acids also greatly impact the brain and are also researched as being a possible cause for neurodegenerative disorders. In a way I almost envy those who can address their issues with SSRI. In my case it completely backfired and they are even blacklisted for me (blood pressure crisis).
TL;DL; Be careful what assumptions and attributions you and others make as the actual complexity is vast, requires a lot of background understanding, and easily trips up a doctor with 12+ years of education, nevertheless anyone on reddit trying to figure out what is going on for themselves. (writing for people in general, not necessarily the person being responded to directly)
Very important to understand that things like serotonin, dopamine, norepinephrine, etc. in the brain, are NOT neurotransmitters in the body!! And DO NOT cross the blood brain barrier (BBB).
So, yes, the gut synthesizes more serotonin and dopamine than the brain does, but none of it reaches the brain. The brain synthesizes its own supply from the amino acid precursors of them. When some therapist orders a blood test to see your norepinephrine, dopamine, or serotonin levels, that is an instant red flag as results don't indicate levels in the brain, where you actually want to know. Then there are total, bound and free, etc. so you may have enough total, but free and active quantities may actually indicate hypofunctional levels. (don't know if bound and free is relative to these things mentioned. I do know they are relevant for testosterone and estrogen. As often tests are done for "total" amount, but bound is inactive so you want the test that checks "free" levels as well. Can have normal total levels, yet have hypofunctional symptoms due to low "free" and active levels. Can even have symptoms with normal free and total levels, which really gets confusing.
The complexity is vast and overwhelming. There are 5 main receptor types for dopamine (ignoring sub types) and at least 14 known types for serotonin. They are distributed in different parts of the body and brain in different densities. And even the same "type" or even "subtype" may have opposite or unrelated functions depending on location. Drugs can be selective (limited relatively on what they target) or non selective (hit a bunch of things which may be indiscriminate). That is before considering secondary, 3rd, 4th, etc. effects on other things. Which is why we often have "side effects".
There are also competitive / noncompetitive / uncompetitive antagonists. Channel blockers, inhibitors and inducers, catalysts, positive / negative allosteric modulators, inverse agonists, kinases, various transports, reuptake inhibitors, transport reversers. G coupled protein receptors, autoreceptors, positive and negative feedback loops., cascades, cations and anions, analog molecules.... And that is off the top of my head and I do not even consider myself to have rudimentary level of neurological knowledge. Don't know if you noticed, but I didn't even get to individual parts or pathways of the brain or body which actually do something with the signals.
Here is a link to a chart on wikipedia for clonidine that lists known targets and affinity for that site, which may be from human or animal studies. Clonidine is not selective.
https://en.wikipedia.org/wiki/Clonidine#:\~:text=%5B70%5D-,Site,-Ki%20(nM
Another example are over the counter allergy drugs. i.e. "antihistamines". Benadryl blocks certain histamine receptors and stops the allergic response to it. Allegra, does the same but unlike Benadryl, does not make you drowsy. The difference....Benadryl crosses the blood brain barrier and blocks the same type of histamine receptors in the brain as it does in the body. Allegra does not cross the blood brain barrier and that is why it does not make you drowsy. In the brain, histamine is a neurotransmitter associated with wakefulness, attention, focus. In the brain, it does not make your brain itchy. It is however critical for ADHD and SCT symptoms as it works with other neurotransmitters, pathways, and parts of the brain for wakefulness, attention, focus, etc.
Guanfacine, clonidine, tadalafil, sildenafil - All are blood pressure medications originally. And have been FDA approved for other things they are found to work on based on the receptors they target. 2 are now also approved for ADHD, the other 2 are approved for erectile dysfunction (E.D.). Yet, you don't take Viagra for ADHD (maybe you do, who am I to judge?). In the brain, Guanfacine does one of norepinephrines jobs, and that is what the therapeutic effect comes from.
I am aware of this which is why I am also aware how randomly psychiatric meds are prescribed. The first thing I did years and years ago was an amino acid test and it did show (accurate) issues. Although this test may also be unreliable. Tryptophan levels and HIAA specifically might be telling. I have given up on western meds about 9 months ago and went deep into traditional medicine and made more progress than I ever made on meds. It is exhausting though and pricy. I am also seeing a genetic specialist but this is also pointless unless you have a suspected gene in mind already (which I do based on research, family and some extra markers that I have) but whether that brings clarity in the end: not sure.
They have like you said, found mental health issues for some people to originate from the gut. And/or can be influenced by the gut.
Look up "fecal transplants". Some people with anxiety for example, have been cured by swallowing capsules filled with someone else's #%$@!! They screen donors, collect samples, add water and set blender to puree. Then it goes in one end or the other. Which changes the flora in the gut.
I have looked this up a long time ago and believe that the brain can be changed through the gut or rather the influence a healthy gut has on the enteric nervous system. Interestingly traditional eastern medicine had their hacks ages ago to influence the gut microbiota and enteric nervous system whilst western medicine really is in its infancy when it comes to the gut brain axis.
What exactly did you do?
Very interested in your journey, I may be in this same state.
Hi, what are your autistic-like traits if you don't mind?
Thanks so much. I think anyone should have a thorough psychiatric evaluation (in my case this was a whole day at a clinic), neurological evaluation (this was 2 days for me at a specialist neurological clinic), and of course blood tests for the usual suspects which should almost come first, an endocrinologist visit with labs, and an honest contemplation if the symptoms truly meet the known criteria since early childhood.
People who have had a normal life and experience symptoms after Covid do not match this disorder. They may have overlapping symptoms, but SCT shows up when you are 3 years old. It makes everything more difficult like true developmental disorders from relationships to work to participating in sports etc etc. There is no such thing as: I developed SCT later on in life. And so many people not matching the true criteria then misleading others with: I have found the cure or: just take stimulants and you will be good: this should almost not be allowed here. It makes many walk down the wrong path. The usual ADHD stimulants are not helpful for SCT/CDS which Barkley clearly explains. If they help, it was likely not SCT.
I am well aware that in the end I may also not have SCT but I have had all symptoms since 3 years old and I ruled out all of the above. I even had spinal tabs, multiple neurologists, sleep tests, auditive processing disorder tests etc. At this point SCT/CDS caused by a hardly known spectrum disorder which I am now getting genetically tested for remains plausible. And I dare say it is RARE. Not a common comorbidity to depression, ADHD etc but a standalone neuro-profile.
Barkley is one of the best sources for ADHD and SCT understanding. But, personally I think he sometimes falls short on the medication topics.
There was an article I read like 5 times in 2023, posted the link in responses. But can't find the article again. Had it bookmarked but the bookmark default name did not indicate what the article was. And with hundreds of bookmarks just added indiscriminately, lost track of it.
Article took modafinil ( CNS stimulant, but more specifically a wakefulness medication) and an ADHD CNS stimulant (think it was ritalin but may have been adderall). And contracted their effect on ADHD and SCT symptoms.
Result, modafinil attenuated the SCT symptoms and only partially the ADHD ones. The ADHD stimulant attenuated the ADHD symptoms but only partially the SCT ones. So, there is clinical proof of benefit even if not optimal.
Also concluded that those who are comorbid may benefit best from combined drug therapy, but did not test that (which speaking for myself, is vastly superior to either alone)
Drug companies have been actively testing their ADHD drugs against SCT symptoms preemptively being ready for the future when SCT becomes a recognized disorder officially, with an entry in the DSM and ICD codes, etc. I recall strattera specifically has been found to attenuate SCT symptoms. Pretty sure ritalin or concerta also did but that needs to be rechecked. Pretty sure Vyvanse also did a study or 2. These are clinical trials with statistically significant repeatable results. Even if the medication are not the best drug for SCT, they are therapeutic.
I am officially comorbid ADHD and SCT. 99% sure narcolepsy as well but have not been able to do the diagnostic sleep study yet. Can say Strattera, ritalin, concerta, adderall xr, adderall ir, dexedrine ir as monotherapy worked for all 3 of my hypofunction disorders. Until dosage escalation issues eventually made them no longer strong enough.
One person's reaction to meds is not everyone's. I am a counter example to the Barkley claim regardless. As well as his claim that he knows of no evidence that ADHD meds cause (forget for sure how frazed but something like) damage or downregulation. In which I say, maybe he should f##%@#^ look for the evidence. Not knowing means nothing if you don't even look. Amphetamine based meds ruined my life with damage and accumulating side effects. And reddit is where others like me turn for answers when prescribers fail. Which is not only backed up in research, but by the actual FDA literature that comes with the drug for the people that prescribe it!
Which country are you in to be officially SCT? I thought it is not a recognised diagnosis anywhere. Modafinil did absolutely nothing for me and I think if it was that helpful for SCT people here would jump up in joy but it scored pretty poorly for most according to the medication stat I looked at when I first joined this group. I still think that people who are hugely helped by Wellbutrin (one of the best meds for atypical depression presenting more as lethargy and difficulties getting out of bed) might be more in the depression group and those responding well to stimulants might be more in the ADHD group. I personally think that SCT is a separate neuro-profile and not "comorbid". Symptoms overlap though because almost all psychiatric disorders have an aspect of being "exhausted", barely able to respond etc. And yes, I agree: Psychiatric meds are NOT harmless. It sometimes took me weeks to get over side effects. My issues with blood pressure worsened longterm, I do better on herbs with a lot of patience and well aware that that is not a cure.
You should add food intolerances. I took out wheat and I’m less foggy
Food intolerances, SIBO, slow motility disorders can affect the brain dramatically. I know someone who had Hirschsprung and all her SCT like symptoms disappeared when she got the malfunctioning part of her colon taken out (ostomy). If there is a problem in the gut, it affects the vagus nerve, causes a constant low level panic stress issue and brain fogginess, attention issues, mental fatigue and much more. It is so important to pay close attention to your symptoms and advocate for yourself.
I have cut up rice because it makes me sleepy and replace with roti made with wheat now you are saying wheat can also make you foggy wtf
Thank you, thank you, thank you. This is hard to type because I am so impaired. My condition has only gotten worse. I'm with a naturopath doctor now and this is what she's trying. Thanks for putting it down for everyone. I hope others can use the data.
Generally made this point over and over but not in a structured way like the original post. Very glad to see this done.
Adding some points about it and the concepts....
"Symptoms improve significantly with lifestyle adjustments." Symptoms can improve significantly in this manner with lifestyle adjustments and/or non medicinal coping mechanisms and/or tools from therapists. But that doesn't necessarily mean it is not a disorder. Especially if clinically significant symptoms persist. And for some, coping mechanisms and lifestyle chances are enough to manage symptoms of a disorder without medication. It is a nuanced statement.
Almost anyone can look at a list of symptoms and related to having them. The difference between things we may all experience at times and clinical diagnosable symptoms is the "degree" in which they affect our everyday lives. It would be up to a therapist to determine clinical or non clinical significance. But people should be aware of the concept. Which may help some people avoid misdiagnosing themselves.
Note: it is often joked about for first year psych majors, thinking they have every disorder in the book till they finally grasp the concept of clinical significance.
The original post touches on the concept that in order to diagnose something, you not only have to match the symptoms to a disorder in a clinically relevant way, but also rule out other possible causes of same or similar symptoms. This is the "differential" in differential diagnosis. When doctors talk of diagnosing things, what they really mean is "differential diagnosis".
Additionally, therapists have the factor of determining causation vs comorbidity. People with SCT are shown to often internalize their issues, which can easily lead to depression, anxiety, low self esteem, etc.
Example: Depression symptoms can look like SCT or ADHD. Depression can also be caused by SCT or ADHD. Depression can also amplify symptoms of ADHD and SCT. Can also be none of them and a totally different cause or causes of symptoms, that may be temporary or permanent.
Often therapists will hold off on a diagnosis till they can get one or more disorders under control so they can more clearly determine and "differentiate" how the symptoms manifest and what they are most likely from.
Nature vs. Nurture. The environment someone lives in may influence the propensity for symptoms to manifest in a clinically significant way. I recall a research article on early/late selective attention and how stress and pressure affects performance as they relate to ADHD and to SCT. Performance for people with SCT is much more (typically according to the study) affected negatively by pressure and stress while ADHD it can actually be a motivator and be the impetus to get things done. Working in a stressful, pressure filled environment may overwhelm coping mechanisms a person may not have realized they had and put SCT front and center in their life as a result. Just a potential example, not to read too much into it specifically.
Several studies have shown people with SCT often have a harder time falling asleep at a typical time and maintaining quality sleep. May be more / only relevant for the first half of the night. But, with SCT not represented in the DSM-5, and decreased sleep exacerbating SCT symptoms during the day, can easily look like a sleep disorder to some, or excessive daytime sleepiness (EDS), etc. Just an example as to why mental health can often be complex and the need to keep an open mind to new information and things other people / therapists may bring to the table.
Part 2: Personal experience/anecdote as 1 example:
My ADHD diagnosis took about 4 months and had involved a number of other healthcare workers (physical exam and blood tests, neurologist, trazodone ( low dose as sleep aid) to check symptoms with full week of quality sleep (rule out sleep disorder), hearing and eye exams, 3 visits with a psychologist specializing in psychological testing, many in depth visits with my own therapist covering my whole life's history (was 32 at the time), started Strattera during the process and made a HUGE difference with my symptoms. And my therapist wouldn't tell me which way he was even leaning till he was ready and confident in the complete differential diagnosis.
But, I had a lot of "that's not ADHD" symptoms that several therapists could not identify for years. And as my meds, when working well, also covered those symptoms, and they had ruled out other known causes of them in the ADHD diagnosis, they remained a mystery (and pain in the ass). Turned out to mostly be SCT symptoms which only took 16 years to find an answer, and another 1.5 years to get diagnosed (got lucky with therapist who worked with the person who named it and was aware of the disorder).
But, there was 1 more piece to the puzzle. Narcolepsy!! Had looked at the lists of ways people who have it are affected by it with a few therapists and the list did not fit well, not even a little. But, current therapist has deeper training and knowledge on the disorder than most and treats it. He brought up the actual symptoms used in the diagnosis which were not the same as the list of common symptoms/ways people are affected by it. The diagnostic symptoms fit like a glove!! And discussing my history affected by it, he said "classic narcolepsy".
Diagnosis, evaluation, etc. is dynamic and may change as information and symptoms evolve. I think the statistic is something like 80% of those with ADHD will be diagnosed with at least 1 other disorder in their lifetime. Whether comorbid or causal, mental health is fluid and not cut and dry.
My current mental health primary issue, is the long term cognitive and endocrine side effects from prescription amphetamine (Adderall / Dexedrine), far far more of an issue than 3 hypofunction disorders it was supposed to treat. I am one of the people sensitive to side effects and long term pathway downregulation and even damage. And it is known to affect the endocrine system (actually mentioned in official FDA prescriber medication accompaniment document if you know what to look for).In which it made a mess of things. But, don't be dissuaded, as most people to the best of my knowledge, are stable on a manageable therapeutic dose of whatever their medication may be. It is a process, not an immediate solution and finding the right medication and dose may take time.
Sir What diet and med are you taking to deal with it After you found out that it is sct
As you know I from nepal, here classic ADHD is not recognized as well as america but now awareness is spreading and you can imagine about sct. Luckily atomoxetine and buoproprin is legal here.
Which clinic helped you to recognize sct
*How you dealed withl slow processing speed of brain
*What bring major changes in you in cognition, verbal processing inner (thinking, reasoning,)and outer (conversation, consuming info)
*How you attend lectures in your college days
It would be more helpful if you respond
This is all reasonable advice. But as to the adult onset. Some people may only realize the symptoms in adulthood because of a more structured environment in their youth.
I almost took this down because I thought it was another CDS= x+y , but this post is useful to consider for everyone. I hope Dr.B is working on that scale so that we can at least have one tool to differentiate us.
yeah
last checked b12 was 912 ng/dl
vit d was 27ng/dl ( i think it has raised more than 30)
my mood suddently raised there was improvement because first time i checked b12 was 182 and d was 11ng look at that
Testosterone last check was 275 ng/ml
.......
thyroid is fine
in lipid profie everything was fine except hdl is little bit low
ferrtin is fine
magnesium, phosphorus etc fine
Good one u/Green_Hedgehog8317! I've been wanting to post something like this eventually, and I've pinned this one for now. I would like to post something that demonstrates possible conditions as an offshoot of different symptom clusters, as well, but I'm thinking that might be quite involved and this might be a more reasonable approach, anyways.