I'm curious what providers (fellow psychologists, pediatricians, neurologists, physiatrists, psychiatrists, etc., who might run across this) think about this literature.
An open access review article is available here: Frederick et al. (2024)
This is a nice piece also but is not open access: Becker (2025).
A sort of quick summary of the state of things is that the construct captures a group of individuals who show some overlap with inattentive ADHD, but who have certain kinds of symptoms - "daydreaming/mind-wandering, mental confusion/fogginess, and hypoactive/sleepy behaviors" for instance - that appear to be distinguishable from the typical ADHD-I phenotype. It is unclear if this presentation constitutes a neurodevelopmental disorder (like ADHD, although some studies suggest symptoms become more prominent over time during parts of life, somewhat unlike most neurodevelopmental disorders), or a psychiatric condition that can perhaps come and go (like depression), or not a condition at all but a sort of qualifier to other neurodevelopmental disorders or transdiagnostic set of symptoms. One of the active dimensions is how to think about these kinds of symptoms when they manifest after other kinds of illnesses (which there is some suggestion they do).
One of the proposed definitions is:
(1) cognitive symptoms involving the disengagement or decoupling of attention and conscious or effortful mental processing from the ongoing external context, as reflected in difficulties with staring, daydreaming, mental confusion, or fogginess, withdrawal, and sleepy appearance; and
(2) motor symptoms involving hypoactivity as manifested in underactivity, periods of passive or sedentary movement, and slow, reduced, or delayed motor movements.
The research on the topic goes back to the mid-20th century, but it particularly accelerated in the last 25 years. A number of "heavy hitters" in ADHD research have been involved in the research, which is not fringe per se.
I find in my experience the provider community though (and some patients) do take a sort of fringe approach to it. There are discussions of the topic in the psychology subreddits but it seems like the ones I've read are overwhelmed with people who are focused on whether not they have these features themselves rather than any real professional discussion. I find also that in my clinical experience, it's the kind of construct that tends to attract a breed of providers who love "new" diagnostic, evaluative, treatment modalities. It is not a diagnosis at all but some of these providers (in records I come across or mutual patients) have been "diagnosing" it for years (and frequently), without any clear consensus that it is a diagnosis or how to manage it.
Anyway the discussion here is great, I'm curious if anyone has thoughts.
Seems like another attempt to take vague, fuzzy symptoms and traits into a “diagnosis” based on questionnaires and checklists.
I’ve always struggled to get on board with viewing these symptoms as representative of a unique and separate diagnosis from ADHD. I attended a presentation on CDS a few years ago at a neuropsych conference. The more the presenters tried to explain how CDS is separate from ADHD, the more it sounded like ADHD. Seems like ADHD with vigilance and cognitive proficiency issues as the primary features.
Couldn’t they be attributed to fatigue or a sleep disorder? Seems like you would need to exclude quite a few organic causes to establish the psychiatric diagnosis
Sure, but that’s true for ADHD as well.
Over-medicalizing and pathologizing the normal human experience, as usual for this zeitgeist.
just wait till i start diagnosing some of my patients w breast insufficiency syndrome... 🤑🤑🤑
Well you are a microsurgeon!
The cure? Believe it or not also an indefinitely escalating adderall prescription.
Sufficiently jacked up on stimulants, manic pixie girl barely needs breasts to drive you wild. /s
Dead
you may be dead. but you'll be stacked after im done with you! :-p
I have a lot of concern about the clear distinction between what should not be happening and is maybe addressable and what is normal human diversity. Another layer of that is normal human response to environmental pathology (like when kids are misbehaving because schools were not designed for children).
Seems like a very broadly and vaguely defined thing that is going to be added to the large and growing bucket of vaguely defined things that gets attached to patients who feel vaguely and non-specifically “not right”. So now you have CFS and long COVID and POTS and EDS and Gastroparesis and chronic Lyme AND CDS! Does it change management? No!
I also think this is so broadly and vaguely defined that it’s gonna capture some amount of undiagnosed sleep apnoea, some amount of depression, some amount of systemic autoimmune disease and some amount of functional neurological disorder in addition to whatever primary disease entity is being proposed (?neurodevelopmental).
In any case, not my area of expertise but externally there does seem to be a march towards diagnosing ever broader spectrums of psychiatric and neurodevelopmental disorders and this feels in keeping with that.
With ADHD you are meant to exclude other causes. I assume this would be the same.
the thing is if you don't believe they have everyone one of those diagnoses you are a terrible doctor and they will make a TikTok about how you will not prescribe them infinite stimulants
Just as with classic ADHD and autism, there may he a social factor in addition to neurologic and psychologic influences on cognitive processing. I'm not sure aa it's a newish concept to me, to have a distinct phenotype from inattentive ADHD.
They’re just describing a person who’s sleepy. They should refer to sleep med to rule out sleep apnea/narcolepsy/ih and/or include exclusion of sleep disorders in the diagnostic criteria for the this new disorder.
Well, at this point there is no new disorder. Sleep does appear to play a role - one of the studies cited in the review did find moderate correlations with a range of peds sleep problems (r's in the high 0.3s).
overly broad generalization. this is not equivalent to sleepiness (though there is overlap)
Not sure how new this is. Neurasthenia has been around since the 1800s.
Diagnosis culture has become nauseating. At least these days it seems to be pointing less to everyone "needing" a stimulant.
I've seen CDS tentatively paired to ADHD and also NVLD.
“Sometimes I’m tired and day dream” is now a new diagnosis?
Great! Add it to the Long COVID / POTS / MCAS / hEDS / Fibro laundry list
My understanding is
Inattentiveness is a symptom and it’s not specific to ADHD (including the former entity ADHD-C).
CDS is differentiated by slow processing speed and inattentiveness without the behavioral hyperactivity and the conduct disorder commonly present in ADHD-C.
Prescribing stimulants is controversial. Prescribing stimulants for the benefit of treating inattentiveness is not justifiable to some people, but somehow prescribing stimulants for the benefit of parents of children with hyperactivity and/or conduct disorder is justifiable to many of those same people. Also, if a person has inattentiveness but doesn't fit the ADHD mold of hyperactivity, hx of conduct disorder, child, etc., then some prescribers are going to write those people people off entirely. A distinct diagnosis like CDS might afford those patients more consideration for treatment than they would receive otherwise, especially now that ADHD-PI (primarily inattentive) no longer exists.
In my opinion, diagnoses, especially psychiatric diagnoses, should aim to not only capture the underlying pathology, but also offer clearer conceptual representations / explanations of phenomena. As understanding progresses, diagnoses should get refined
Lots of “I don’t understand it, therefore, my belief that [insert XYZ bias against it] must be confirmed.” in this thread. (eg the platitude from the other commenter "Over-medicalizing and pathologizing the normal human experience, as usual for this zeitgeist")
The only "slow cognitive tempo" pt I've had was literally just slow. He was as engaged as anyone else, mind was not wandering, didn't act sleepy. But he'd have to think for a full two minutes before answering and he spoke slowly. His answers were otherwise very typical, with common questions and concerns about his medical problems.
A lot of what's being described in this post would previously been diagnosed as a Cluster A personality disorder, but those diagnoses have fallen out of favor in the past 30+ years.