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I see kids every day at work and treat adhd. It is interesting- I see this presentation. And stimulants are not always very effective for it. It doesn’t seem to exactly cause harm, but parents are expecting their daydreaming, kinda lackadaisical kid almost do a 160 and I have to regularly explain that stimulants actually are realllly helpful for our impulsive and hyperactive kids. But straight up chronic daydreamers w sluggishness sometimes just get irritable and moody on a stimulant without the “shift.” I sometimes see fluoxetine, or for teens bupropion, be a better fit. There seems to be some form of anxiety or dysthymia/depression underneath these kids. But kids are terrible historians and so will say no they’re not anxious, no they’re not depressed. So parents don’t register it.
Edit: I’ll add that the CDS presentation is more often girls in my experience. Another anecdotal piece I’ve collected is…It seems more common (at least in this tiny little part of the world I’m in) in girls who go to highly demanding Catholic schools and have controlling parents. So I wouldn’t be surprised if there’s a correlation with “low-level”trauma. Like it’s the brain trying to protect itself. Which makes it a little extra sad when the controlling overbearing parents are like “sooo adhd meds will fix it! My daughter will be DRIVEN and SOCIAL like me now right?!” And I get front row seat to the parents getting disappointed their kid doesn’t turn magically into a totally different kid. Sigh. Sometimes the kid does perk up a bit and seems to enjoy school better, with no side effects, so we keep going. But I think these kids will go on to eventually need some other treatment.
But kids are terrible historians and so will say no they’re not anxious, no they’re not depressed.
Also it can be hard to understand that what you’re experiencing is anxiety, if it’s been a part of your life for a long time. I’m an adhd adult who got diagnosed at 29, and didn’t understand I had anxiety until my doctor prescribed me anti anxiety medication in my 30s and I experienced its absence for the first time.
Good point! I have had some adult pts get prescribed an anxiety med and for the first time ever say “…I didn’t know this was what normal felt like.” Anxiety is truly my favorite thing to treat!!!!!!!! It responds much more linearly to meds than depression (depression can be kind of a maybe?maybe not? Waiting game.) Brings me joy.
Do you have any suggestions for treating anxiety that aren’t medication related? I got diagnosed as an adult and was put on Lexaprone(sp?), but it absolutely killed my sex drive and seemed to do nothing else. I’m quite terrified of experimenting with different medications and potentially making my generally dysfunctional self irreparably worse.
Lexapro is an ssri (selective serotonin reuptake inhibitor) which are known for causing sexual dysfunction.
lots of other options exist.
wellbutrin - a dnri (dopamine, norepinephrine reuptake inhibitor) can cause increased sex drive, and, in an incredibly small amount of people, spontaneous orgasm
other drugs, like spari(serotonin partial agonist and reuptake inhibitor) also dont have sexual side effects.
sexual side effects from Lexapro and other ssris can also be treated with an anti-anxiety drug called buspirone
anxiety can also be treated with talk therapy. theres a lot of different modalities (or styles) - they'll sound like alphabet soup. some of them are cbt, dbt, ifs, emdr. theres a lot more. sometimes finding a good therapist takes some trial and error - in general; you want someone that you'll feel comfortable sharing your inner experience with; and someone that youre willing to learn and grow from. even though it's "just" talking, therapy can be incredibly difficult; you'll want someone that you'll feel comfortable being challenged a little by.
the best outcomes typically come from a mixture of both therapy and medications; however, both have a real effect on their own, too.
please talk with your doc about this.
a couple very quick screening tools are called gad7 and phq9 are designed to be generally understandable for lay people.
sometimes it gets worse before it gets better. sometimes it gets real fuckin dark. but it can get better. and there are a lot of people that want to help. they dont know you yet, but they still think you are inherently valuable as a human being. humanity's superpower is it's ability to help other humans through their struggles; please, let other people help you through these times
I am not a doctor, but I have been dealing with anxiety as well. I was put on Lexapro earlier this year and only stayed on it for a month because the side effects were terrible for me.
I started buspirone after that, which is strictly an anxiety medication and is a lot less intense than antidepressants like Lexapro. For me it doesn’t feel like I am on anything and I feel like my normal self. I’m honestly not sure how much it has helped me, but some people say that it has gotten rid of their anxiety. It could be worth asking your doctor about it if you are open to trying another drug. I know that hopping on medication can be really intimidating and scary, but for some people they can be life changing, so maybe don’t rule them out until you’ve tried some others.
For a non-medication option, have you gone to therapy? That can help you reflect on where your anxiety is coming from and teach you to address that and teach healthier thought patterns.
Some of the advice that has been most helpful to me is that anxiety is a thought process, so if you can retrain your brain to think more positively, you can teach your brain to stop worrying. It can be hard to identify negative thought patterns - I have generally viewed myself as a positive person. As I’ve spent more time reflecting, I’ve found that I have a lot of negative tendencies in my thinking. A lot of that I have found out, for myself, relates to self esteem.
I have been working on trying to be a more positive person. This is something that takes practice - it isn’t an automatic thing. I have to remind myself literally dozens of times a day and look for positives everywhere I can. It can be finding joy in my morning cup of coffee, gratitude for the job I have, or being thankful for spending time with friends. This has been the thing that I can say has helped me the most. I am not where I want to be yet with my anxiety, but I’ve made a lot of progress.
Anxiety sucks, but it can be treated, so keep your head up and don’t lose hope. Recovery is an active thing that takes a lot of effort, patience, and self reflection.
Yes! I love a high yield CBT program. A clinic that specializes only in anxiety and OCD is going to usually be the ticket. it’s usually twice a week for a few weeks, then goes down to once a week and then you eventually go into monthly check ins. Then…graduate! Very effective treatment. Time intensive, expensive. But works.
I suffered from severe anxiety attacks and severe anxiety for years, now i don’t feel an ounce of anxiety.
I did a combination of CBT and doing the things that made me anxious head on.
By engaging in the anxious thing + using CBT i was able to change how I thought about stuff which has practically reduced my anxiety to 0.
No medication necessary.
I do take stimulants for ADHD, which made my anxiety even worse at first, I’d take 5mg of dex and even that would spike my anxiety to the point I’d have to go to hospital.
Now I can take upwards of 20mg + coffee and be super chill.
Can you elaborate more on what you did when you were doing the thing that made you anxious? I’ve been doing that, and truthfully, I dread it more and more to the point where I have contemplated dropping grad school over it. The only thing stopping me is the fact that a crippling fear of public speaking and social anxiety is the absolute dumbest reason not to finish a PhD.
I didn't respond to any first line meds and ended up taking a gene panel to find a med that worked for me. Might be worth asking your provider about. I also hate what I call medication roulette.
I had anxiety from depression some 15 years ago and it took me literally months to figure out it was anxiety. Because for the first 25 years of my life I had never experienced anything like it and it manifested as nausea and vertigo, and that general weird feeling you get. I had no idea that was anxiety.
In my experience a lot of adults are bad at identifying their own depression and anxiety. I had to explain to my husband at one point, my anxiety doesn’t feel like being really stressed out, in fact most of the time it doesn’t “feel” like much of anything, it’s just like my brain won’t ever shut off for anything, which is why it’s so easy for me to not notice it getting gradually worse. I think as someone who hasn’t struggled with it he imagines it as like a persistent feeling or emotional state, which would be more obvious, but it just isn’t, at least for me. I’ve dealt with depression in the past too and that “felt” a bit more obvious to me, but even then, it sneaks up on you very slowly.
Atomoxitine works pretty well for my CDS. I had never had my brain be chill for 3 hours straight and could finally get so much work done without getting side tracked or needing to get up and walk around to get my brain back in gear. I used to live in my daydreams. I knew it wasn't good but couldn't really stop it myself. It was just a habit at that point and a place where I had control. Now that I am able to have more control in my daily life (with the help of medication) I don't have as desperate a need to manufacture the sense of control.
Oh! Yeah! I forgot that I do have a few younger folks w this presentation on this med too. It’s an NRI so kind of in the same boat as bupropion but hits kids differently. Some kids get wiped out on atomoxetine. Like, snooze fest. I tend to like it better for my teen or adult pts. And I’ve learned starting it low and graaaadually going up yields better results (despite the texts recommending starting at 40mg).
I still don’t see it as effective for adhd combo or hyperactive type. I usually use it second line if stimulants make somebody moody/angry.
I use 18mg and it was great for just making it where my current coping skills were more effective. I do not have ADHD but do have severe anxiety which I've had since I was very little. So I use a combo of SSRI and SNRI to combat my symptoms and it is really a relief to not have to constantly fight my brain.
What has been working very well for me with Strattera is opening the capsule and using a milligram scale to precisely control how much of it I need. Which allowed me to start very low and ramp up to the working dosage slowly and virtually with no side effects.
I'm also getting the strongest version (100 mg/cap), which saves me quite a bit of money.
That doesn't even sound like a syndrome so much as maladaptive daydreaming and the kid disengaging as a form of protection because their behaviour is the only thing within their control.
ETA: Incidentally, I was that kid, so I'm speaking from experience. I also have ADHD, that was only diagnosed at 30. I'm significantly quieter and more self-contained when medicated, though more gregarious and engaged than I was at my most miserable as a child.
A disorder is really….still super subjective. Like, one family’s interpretation of “impacting functioning” can be VASTLY different from another family”s interpretation. We do get collateral from schools and counselors. But every little “culture bubble” has its own standards. So that’s a challenge we wade through.
That makes a lot of sense too. Like, CDS certainly does seem to exist, both from research I've read and anecdotal experiences of other people in the comments who recognise their own experience from the article. Whether it strictly applies to some of the students in your care, well, at least they have all of you looking out for them either way. I know I would have appreciated that as a kid.
A lot of time my goal is to do 16 min of therapy with the family and about 9 min of med management. Med managements the easy part. The hard part is validating both the parent(s) and the kid in 16 min and sprinkling in some skills while also educating what is developmentally normal.
I bring in a lot of my own experiences too. “Wow I remember feeling so overwhelmed by some of the mean kids in 4th grade… it’s hard to focus on school when you’re also worried about Claire calling you a lesbian at recess everyday!”
And this helps reframe some of the inattention so it’s not just adhd, it’s also heightened stress levels. And when we get stress better managed often times the attention and focus and dysfunctional daydreaming improve
And if parents are the source of stress, sometimes I low key drop in how and when it’s developmentally expected to do xyz. So if mom is freaking out 14 year old girl is trying to text friends at 10pm, I’ll say “I remember being 14 and how important it felt to make those social connections, even if they were online or virtual. That wanting to connect is normal— we have to make sure it’s done safely and that you’re following the rules at home. Mom, what are the rules with phones and technology?”
And mom will explain their rules. I can see some of the parents who are TOO strict almost look embarrassed as they explain they’ve banned all video games all tv etc. I don’t shame or try to correct it. But it’s a good starting place to see they’re maybe having some doubts. Because these kids who are daydreaming often have very under stimulating social lives too….
It's context dependent. For example, If you can get parents, teacher, and the student to agree that the student is having trouble specifically at school, then that student has a disorder. It may only affect the student at school, but it still represents a disorder.
our framework we use to diagnose and treat (the DSM v) is theoretically supposed to transcend context- at least in western cultures. It’s both a little true and not true though. This is what I’m saying is the challenge. Trying to sort kids into boxes when the boxes look different in every single context ha.
The DSM classifies diagnoses, it doesn't make them. Good clinicians understand each patient's symptoms in detail and in context in order to identify disorder and recommend specific interventions. Sorting patients into DSM categories is for billing and coding. Parents and teachers really should dispense with these generalized clinical labels that imply a context independent disorder follows the child everywhere they go or that a typical treatment is the right treatment for that child.
I'm clarifying that clinicians don't "sort kids into boxes". Non-clinicians like parents and teachers do tend to do that when they get a diagnosis and suddenly all the particularities about their child are obscured by stigma and expectations about kids who share that diagnosis. A box like "You have ADHD so you have the same problems as other kids with ADHD and the same things that help them will help you", which I think we both agree is wrong.
Well in this specific scenario, MD is generally considered more of a poor coping mechanism in response to stress or trauma, whereas ADHD - and so therefore presumably also CDS - is defined as a lifelong neurodevelopmental disorder, of which daydreaming is a singular symptom. Basically, you can develop better skills to respond to stress than MD, but you can't grow out of or upskill your way out of having a developmental disorder. Presumably that also means daydreaming is more of a persistent characteristic over the life of someone with CDS vs. someone who learns healthier skills to manage stress than MD. Of course, I'm making some logical leaps here, but time will tell with further research.
Strictly defining 'daydreaming' seems to have been an important part of the research actually, from what I gathered with surface level research.
Sorry yes. I’m a bit distracted. Making my dogs 8th “gotcha day” cupcakes with my kids. They’re doing it mostly on their own per their request….but I’m not the best at trying to multitask ha
This is fascinating. I'm definitely of the description you named, to a T, and I find that stimulants are the only thing that can keep me out of my head (and I mean that genuinely. For example, one day when I was a teenager, I apparently went to the lake with my friends. A few days later, I had no memory of it at all. I had been completely checked out, and that remains true every time I'm off my meds). But I started them when I was 19, so maybe that's something. I had a lot of trauma at home and growing up, but moving out did wonders for my stress levels even if college made me stressed in a different way, and I had begun to heal very quickly. I also saw that I was struggling academically when no one else was and could almost sort of see the difference (without having a name for it), so I was actively trying to claw out of the world of daydreams and spaciness out too.
Quick question: is this not the same thing (or, at least, was not previously regarded as the same thing) as inattentive type ADHD? That's what I've always categorized myself as. I never heard of this term until this post.
My opinion is we just don’t really know enough about any of it yet. Neurodivergence I mean. I think our categories right now are wayyyyy too broad. Asd, adhd, SPD, giftedness. Other LD kind of all lumped together in another box.
Diagnosis for ADHD inattentive type can be done through behavior (teacher marks if kid is inattentive in school, messy, forgetful etc). Or adhd can be diagnosed through cognitive psychological testing. This testing is better able to differentiate adhd vs other reasons a kid might be inattentive, messy, and forgetful. Like, the kid has the behaviors at school but actually perform well when push comes to shove. And it’s these kids who don’t seem to do as well on the stimulants…. Because there’s likely some other process going on.
If you have functioning impairment and the meds help you, you probably have adhd inattentive type. If you wanted, you could get psychological testing done to confirm. But this can cost $1200-3000 unfortunately.
I would like to one day see all kids flagged w any neurodivergence get free psychological testing through the school system.
My friend and I constantly joke that I basically say that everything is cptsd. I’m glad I’m not the only one realizing that depression, controlling parents and environment are causing dissociation in children, which is a coping mechanism for dealing with this kind of low level trauma.
There’s a meme that runs around psychologist/psychiatry groups. It’s the astronaut with a gun pointing at another astronaut
The earth is labeled DSM V
First astronaut says “it’s all trauma”
The astronaut w the gun says something like “it always has been”
Basically one big thing tying most mental illness together is….trauma.
I would argue there is genetic predisposition to psychotic disorders. We know the VMAT2 gene plays a significant role in this. And even some youngsters w no trauma but maybe some big stress like college or breakup (not considered trauma) can be the activating factor. That being said, we see higher incidence of schizophrenia in folks w higher ACE scores… so trauma still plays a significant role
We also have to consider what is traumatizing to an infant that’s not forming visual memories but is forming a developing brain that’s adapting to its environment. There’s probably better words to say that.
I was diagnosed in the 80s, first with a now debunked diagnosis that my brain hemispheres didn't properly communicate, then with ADD. Now days I would probably be diagnosed with mild autism.
I would uncontrollably get lost in day dreams, often for hours at a time. Growing up i never watched TV and spent all my time in the woods around our home living out my day dream fantasies of adventure and conquests. Once I got into school it became a problem, I couldn't focus on anything and would zone out anytime something didn't immediately grab my attention.
I was diagnosed with ADD when it first came on the scene in the mid 80s and Ritalin actually really helped prevent my focus from wandering away. In high school I moved and went off the Ritalin and I remember a big science final I had where I zoned out for two hours right after the test started and ended up only completing about 3 questions then having a breakdown.
As i got older I started compensating for not being medicated by building up extreme anxiety to drive focus. I would freak out leading up to any event of deadline to keep my mind focused on it and not drift off or forget it.
It got worse and worse until I started having panic attacks and went on anti-anxiety meds, which worked wonders for my anxiety but now my ADD and focus is out of control again.
Recently I've become reliant on caffeine and coffee to keep focus at work as well as hyper stimulation, I'm known to take on and do 3 tasks at once to keep my brain active and engaged but it is still a constant fight and struggle.
I can absolutely see this subtype as a thing because I was never hyper, quite the opposite.
Yeah, you might be on to something with that demographic. I was just diagnosed, fairly late in life, with the inattentive type and went Catholic for most of my education. Even though I'm a guy I felt personally called out by that comment because it seems spot on.
There seems to be some form of anxiety or dysthymia/depression underneath these kids. But kids are terrible historians and so will say no they’re not anxious, no they’re not depressed. So parents don’t register it.
Alexithymia is an ability or issues with identifying or recognising ones own emotions. While it is a personality type, not a disorder, when people with Alexithymia develop conditions like depression or anxiety the presentation can often be very atypical. Alexithymia is common in those with Autism and ADHD.
Only realised I had anxiety when my psychiatrist spelled it out for me, and explained the symptoms and bodily sensations to me.
I am on fluexotine currently, Atomoxetine (AKA concerta, I think?) and dexamphetamine.
Fluexotine somewhat works. Difficult to tell with the atomox.
I've tried a fair few stimulants and whatnot. Vyvanse made me feel off, if memory serves and didn't seem to do much otherwise. Ritalin made me clench my teeth and feel "wired", not pleasant.
So far dexamphetamine seems to be the most effective, with the downside of being prone to irritability and teeth clenching again. Sucks because it's the only stimulant I've actually gotten a noticeable effects from.
I would love to pick your brain about my brain. I can’t seem to get out of my own head, have always had this issue, and now am not living up to my standards of a good employee, husband, and father. I’ve been seeking treatment, and spending 10% of my income that I can’t afford, fixing an issue no one seems to be able to help with. Genuinely need help desperately, and I can’t afford to keep throwing away money i don’t have.
Have you ever talked to a pediatric dentist?! I have 5 kids. Plus I have 6 siblings. (Not catholic or Mormon) just a fertile family (no joke, every woman on my mom side even with birth control have gotten pregnant the first time…honestly think it has to do with the red hair gene and none of us are red only the undertones) but even when I was a kid my dad found out about my older brother doing drugs at his 3 month braces tightening.
My kids dentist has talked to us about their anxiety. We also have this beautiful Nuero divergent thing going on in our family.
My kids pediatrician knows I am diagnosed with severe combined adhd and not kidding my husband has add. Two of my kids for sure areADHD (not severe but it’s hard to miss) and the other 3 I thought for sure was some kind of autism as I also grew up around that, but the daydreaming and having to literally be looking at them in the face for them to listen. I got very lucky as all of them are intelligent (family of bookworms- I credit my obsession with the books and being young and poor)
The thing is, their pediatrician told me whenever it starts to interfere with school it’s time. The problem is I know this medication is not great to take before puberty. They put my older kids in honors- that just created another problem as yes they’re smart enough to keep up, but with honors in middle school where I am at, it literally just means more work and it’s slowly creating a burn out to the point they don’t want to be in honors. I completely understand.
So what I’m getting at if you got to the bottom of this, what would your opinion be on this? If I get them diagnosed they are protected and my 2nd grader instead having to do a reflection walk at recess because he called out the answer or my middle schoolers forgetting their laptops won’t be on lunch detention. But negative side, they automatically get labeled. Which is also a negative as my 4th grader a former speech kid- only for articulation (and after 10 years of constant doctors and myself advocating he finally got the neck xray and has severe inflammation of his adenoids) and at the end of the year was the ONLY kid in his 3rd grade class to get exceeds expectations in both math and English on the state exam, they put him in the the regular 4th grade class instead of the combo. His teacher literally told everyone at open house that every single kid was below the state average. Again a label.
Sorry it’s long. Please don’t feel obligated to answer. I know speak to your doctor is the best, but as someone on Kaiser, to get our pediatrician it’s email or at least a month for in person. Also I completely understand there are a lot of people waiting and it’s not an emergency.
C-PTSD looks similar to what is being referred to as CDS in this article. I’d be interested in further studies that isolated traumatic experiences as its own variable.
Yes, it seems like trauma could make kids feel unsafe engaging with other people and develop coping mechanisms like daydreaming. I wonder if CDS shows up mostly in interactions with adults or is more universal.
Facts. What is differentiating slower cognition from dissociation?
Only thing putting me off was despite higher scores associated with trauma CDS had lower rates of ODD. We needed more surveying to account for different potential issues this could arise from
I can only speak to my own symptoms but I actively have slower processing which is not dissociating. It's extremely frustrating as I am aware it's happening but cannot do anything about it. I'd liken it to having less RAM in a computer. Sure it can eventually get to the answer but dang if it isn't chugging. It's like trying to swim through a molasses river. Slow. Mine was sussed out with memory and cognitive puzzles and compared to averages.
As someone also having ADHD, your symptoms describe mine exactly. It's like standing in the middle of a highway and trying to pick out a specific model of car or something with all the vehicles racing past at impossibly fast speeds or something. Attempt after attempt I might finally get it, but other times my brain just blanks and plays static noise searching for answers that should be otherwise easy.
I have the same problem. Is this something that can be treated? As an adult it is frustrating in a work environment to be about 30 seconds behind everyone else.
I'm not a doctor but beyond exercising my brain with puzzles to make it recognize things like patterns faster, no, I haven't found any treatment for it. You CAN practice creating more mental associations for things to make retrieval faster but if it is something novel, it's still chuggy.
Sorry if this is forward but I would like to understand. Is what you’re describing variable depending on other factors, or are you saying that this sluggishness you’ve described is a fairly consistent baseline?
It can be variable in that it is worse when I'm tired and better when I eat and sleep well on a schedule but yes. It is a consistent baseline of slow thinking no matter what I do. I can still do very complex math and calculations, but it is noticably slower than my peers.
some of the symptoms of CDS mirror the negative/cognitive symptoms of schizophrenia. i personally wonder if NMDA receptors may be involved in both conditions, but CDS obviously doesn’t have enough dopamine to ever have psychosis.
Recent investigations into child psychology have provided evidence that a specific cluster of behavioral symptoms is separate and distinct from attention-deficit/hyperactivity disorder. The research indicates that this condition, known as cognitive disengagement syndrome, presents a unique set of challenges that shift as children mature into adolescents. These findings were published in the Journal of Attention Disorders.
Cognitive disengagement syndrome is a condition characterized by a specific pattern of mental functioning. Individuals with this syndrome often exhibit excessive daydreaming, frequent mental confusion, and a general slowing of thinking or behavior. These behaviors were historically described as “sluggish cognitive tempo” in older medical literature.
Psychologists and researchers have debated how to best categorize these symptoms for years. The primary question has been whether independence of the two conditions. The data showed that a distinct group of youth exhibited high levels of cognitive disengagement without significant symptoms of attention-deficit/hyperactivity disorder. This independence was observed in both the childhood and adolescent age groups.
The researchers found that approximately 2.5 percent of children and 1.5 percent of adolescents in the general population fit the “cognitive disengagement syndrome only” profile. This confirms that the syndrome can exist as a solo clinical entity. However, the study also provided detailed statistics on how often the conditions overlap.
That’s not quite what it shows. This is a common error in cluster analysis (not what was done here, but related) and related analyses. This article assumes there are distinct groups and indeed creates them based on arbitrary cutoffs, and then based on that assumption assesses differences on outcome variables. Yes, it then observes differences on the outcomes. That is only indirect evidence for the groups themselves, as it risks an affirmation of the consequent fallacy. Many many forms of cluster analyses are also presented and interpreted as providing evidence of distinct groups when they in fact assume that distinct groups exist; a more general form of ‘begging the question’ fallacy in statistics.
Good points. It seems like what they call “Cognitive disengagement syndrome” could just as easily be a different expression of the same inattention problem. A child placed in an environment where focus or task switching is harshly punished may learn that daydreaming or “shutdown” are safer options, for example.
As a personal anecdote, I think my own ADHD (primarily Inattentive type) often manifested in these behaviors when I was young. In a boring math lecture there were few options for me to shift my focus towards that would provide stimulation, other than causing disruption, but that was undesirable as well, as I didn’t enjoy negative attention. This internalizing coping mechanism also prevented my condition from being recognized and diagnosed until adulthood.
Good points. It seems like what they call “Cognitive disengagement syndrome” could just as easily be a different expression of the same inattention problem.
No, there are different outcomes from this condition. CDS leads to different impairments than inattentive adhd. For example higher depression and anxiety than would be predicted.
If there are multiple forms of depressive disorders. Why can't there be different attention disorders?
Using internalizing coping mechanisms could lead to depression and anxiety, as could the environmental factors or trauma that lead individuals to adopt them. I had those diagnoses myself.
I agree that there are likely many different configurations and symptom presentations for attention disorders, but the linked study reaches the conclusion that CDS is not an attention disorder, because the symptoms are different.
CDS is not an attention disorder, because the symptoms are different.
No the study says CDS is not ADHD. "Attention disorders" are just a broad category (likely to be made if this enters DSM 6) like "depressive disorders " or "anxiety disorders". That's what im communicating, CDS is an Attention disorder but it isn't adhd.
Using internalizing coping mechanisms could lead to depression and anxiety, as could the environmental factors or trauma that lead individuals to adopt them. I had those diagnoses myself
Im aware however it does say that there is a distinction from adhd. If these CDS symptoms lead to more internalizing disorders and ADHD leads to more externalizing conduct disorders. Different outcomes point to the disorders not being the same.
“In the adolescent group, roughly one-third of those with cognitive disengagement syndrome did not have a co-occurring attention disorder.”
ADHD and “attention disorder” are used interchangeably, and I don’t see any claim of CDS being an attention disorder.
They say it’s a syndrome that appears both concurrently and separately from ADHD diagnostic thresholds, and ADHD is the only currently recognized attention disorder.
My point is that the features of this syndrome are likely to impact diagnosis—a child with ADHD who is primarily utilizing daydreaming or defensive shutdown to cope with inattention isn’t going to get a high score on inventory items related to disruption, for example, which might lead them to be placed in the “non-ADHD” bucket. The fact that 1/2 of the cohort of children with CDS also met ADHD criteria, but only 1/3 of adolescents did seems to support my theory—children with CDS learn to use it to mask their ADHD more effectively by adolescence (as do most people.)
It does also seem highly likely that some who truly do not have ADHD are utilizing these same strategies to cope with other mental disorders, transitory environmental/cultural stressors, or trauma.
“In the adolescent group, roughly one-third of those with cognitive disengagement syndrome did not have a co-occurring attention disorder.”
Brother the only other attention disorder is ADHD. Attention disorders is the larger category they fall into. Like cars are one category and tesla and Toyota are a sub category.
I don’t see any claim of CDS being an attention disorder.
Not in this article. The research at large supports it. On top of the ICD-11 citing it with adhd.
highly likely that some who truly do not have ADHD are utilizing
It'd be nice if ADHD was able to have specifiers like depression. Honestly, diagnostic boxes are messy as hell. It's like labeling a painting surealism without letting you view it. You get the gist of what might be painted, but many individual factors lead to the final work. That's why RDOC has been pushed forward.
I agree, the brain network evidence for CDS is scant but so far instead of the prefrontal context being impaired. It seems to be more of a lack of anti correlation between the default mode network and the task positive network. Namely the dorsal attention network.
Now adhd also shows this tpn and dmn lack of anti correlation. However its larger in CDS and the adhd studies don't account for people with CDS until recently.
Hold on even if you dont make cutoffs. The researcher still shows different outcomes when you have more CDS traits than non CDS traits. The cutoffs just help us separate treat from not treat. The cutoffs for blood pressure are arbitrary but higher blood pressure would still lead to different outcomes than high sugar levels.
But the claim is that they’re distinct groups, not continuous predictors. See figure 2 of this article and the associated discussion. https://eiko-fried.com/wp-content/uploads/2022FriedDepressionMeasurement.pdf
Your example is example of exactly what I raise: higher blood pressure is a continuum, and the use of arbitrary cutoffs falsely creates the idea that there are distinct groups.
This is all part of the problem I raise: an association with a thing is used to assume there are distinct groups, then the groups them are reified as if it is the groups are real and causal. The association with a continuous variable can’t show this.
and the use of arbitrary cutoffs falsely creates the idea that there are distinct groups.
Agreed, but remember in medicine binary decision need to made. Do we give blood pressure medication for this patient or do we not. Its true that this seems somewhat arbitrary but 0.05 being the threshold for significance in science is also arbitrary. Is all science just BS fanciful nonsense?
I believe that threshold for ADHD and CDS will be placed at 2 standard deviations from the mean. Making it like significance level at 5%. On top of this, functional impairment will be looked at to ensure that this isn't just a difference but a clinically meaningful difference.
This is a common shift in epistemology from what is the case to a pragmatism that happens in mental health diagnostics. We start with the claim that a disorder is real and distinct, and then quickly retreat to the argument that it’s a convenience for treatment. We rarely start by telling patients their supposed disorder isn’t real. This is a motte and bailey fallacy.
You’re really speed running the psychiatric fallacies here.
A disorder being "real" in psychiatry just means it needs to be distinct from other disorders, show a deviation from Gen pop. And show a distress and impairment in the life of the affected. Taking your logic, we can't take schizophrenia as real because its diagnosed on a rating scale and not with some test. We're moving to a time where we'll integrate genes and neuroimaging into the psychiatric paradigm. That's exciting for diagnostics and treatment.
Could this be that these children were born with an encoded high Differentiation of Self and are by nature more prone to higher planes of thinking and are in need of gentle grounding and management?
Today i learned that the simptoms that i experienced my whole life has a name and classification. I have been suffering my whole life because of this, not severely debilitating but enough to make my life really hard. And ofc that nobody ever understood me, why are you so sloppy, why can't you pay attention etc. Sigh.
Yeah, this resonates with me as well! I definitely don't have ADHD (I actually have a fantastic ability to sit still and focus) but I'm also a total space cadet. I once paid for food at a drivethrough and then drove away before they gave it to me.
I'm not running out to get diagnosed or anything (I'd rather NOT pathologize too much of my personality) but it is nice to hear someone make the distinction.
I’ve heard you can still be adhd while being able to focus really well at times. It depends on whether you are interested in the topic. If not, traditional adhd symptoms will present themselves. My friend is like this. He can concentrate for hours on really complex topics but is always losing his keys, phones, headphones, wallet ,etc.
Yes, exactly this. ADHD is not actually an attention deficit, but is better thought of as a deficit in the ability to correctly regulate attention. This sometimes looks like not paying enough attention to things, and other times looks like going on a deep focus binge where you are nose to the grindstone for eight hours and forget to eat and use the restroom and stuff.
Yeah, I get that, but it isn't really the case for me. I've never had any issue with regulating or directing my attention. I'm one of those weirdos who really will get up from my video game every hour or so to get a drink of water, stretch, check in on what my wife is doing, etc.
I like this avenue of research precisely because I get annoyed when people try to loop me into an overly broad diagnosis. I know people do it because their diagnosis was life changing and they're trying to share the good news--but I'm sorry, I just don't think the treatments and coping strategies for my memory issues and someone who has chronic procrastination or focus issues are going to be the same.
Also valid. My good-word preaching is solely that ADHD looks different in different people (AFAB people particularly); and that it’s more nuanced than “Little Billy can never pay attention to anything”. If this new research resonates while ADHD qua ADHD doesn’t, awesome!
Yeah, this isn't really a matter of hyper focus on special interests. I generally have an easy time of picking up and finishing even unpleasant tasks, and don't struggle with procastinating any more than any normie does. I'm just not always 100% present.
Oh yeah, I probably should have stated that, but I definitely am. I didn't get diagnosed until after college, I think it's because I've always found math and science very interesting and wanted to learn as much as possible, letting me succeed academically.
Haha, yes. I was very embarrased, but I figure the folks at the taco bell forgot about it 10 minutes after it happened so I didn't suffer too much psychic damage.
It's not hyperfocus, though. I can focus on more than just my special interests. I can focus on tasks that I think are unpleasant without procrastinating. And I don't get sucked into something and lose all sense of time and priority.
Really, I just have this very small cluster forgetful habits that I don't like having and wish I could get rid of... but whenever I talk to anyone who has ADHD about it, they will immediately try to diagnose me woth ADHD.
If it annoys you, I recommend trying to get on non stimulant ADHD meds. Complete game changer for me personally. I didn't even realize how bad it was until I could finally stay present without fighting for it.
This was me as a child, constantly daydreaming, i had built up complete cities in my mind. while everyone was playing with eachother i was daydreaming, when in class and teacher talked and talked, i heard nothing, it looked like i was listening, my eyes was pointing at him but i didn't see him, i was in my mind living life, however, it all stopped as i was nearing the age of 25, it got from cant stop it, to being able to choose it, to getting hard to daydream, and then it got impossible to do it, now i cant even if i want to, which i'm very glad for. It stops you from living your life.
This is very close to my own experience. I grew up in a very strict religious household. Many hours at church/Bible study every week. I seemed to realize at an early age that what I was being taught wasn’t landing but there was no option but keep trying and appear to be doing the right thing which at the very least meant sitting very quietly and looking attentive from the time I could walk. This lead to a very developed ability to totally check out mentally. I was able to escape into extremely detailed and involved fantasies that in hindsight were great exercises in creative thinking i guess, but sometimes it was just fog. I basically developed all the wrong muscles. The focus/executive function skills I desperately needed in school and other areas of my life atrophied. I was able to classically hyper focus but that was erratic and had other issues. I seemed to only be able to manage these 2 extremes until a midlife Adult AD diagnosis and medication began clearing things up.
If you don’t mind me asking could you share how you were able to overcome this problem to the extent that you have? I struggle with daydreaming now and I’m 27, although it isn’t as bad as it was when I was a kid!
Unfortunately i dont know, maybe as my brain finished developing it just fixed the problem, there probably is ways to train yourself to not daydream, but i do remember that my fantasy life was so good that every time i snapped out of it i got depressed, my real life was so bad compared to it, which made me hate daydreaming, also i cant count how many times i was driving my car and ended up just driving past where i was going and continued for like half an hour until i realized i dont recognize the road, it was so weird, i could drive the car at the same time as i'm not even consiosly seeing the road because i was in my fantasy, but somehow i was driving like on "autopilot" but very badly.
Have you noticed a gradual decrease in daydreaming? it could be that it will be gone before you are 30. I do have one suggestion, i took Sertraline Hexal and i remember it actually helped with it, could be worth a try.
I second what slim said about the sertraline. I took it for panic and anxiety problems but it also completely took away my ability to daydream. I just cannot focus on it anymore the way I used to. I actually miss it a lot since it was so comforting but yeah if I could I would waste my life daydreaming so it is probably for the best.
It’s called Sluggish Cognitive Tempo, and has been known and identified for a very long time. Sort of unclear what this research adds to the literature other than renaming a known construct.
Is it a separate mechanism with its own treatment, or is it just ADHD lite? Obviously there's a high overlap in symptoms with ADHD, but this one is missing the impulsivity and hyperactivity, so very close to the inattentive ADHD type
There are differential treatments to an extent. Methylphenidate doesn't work well on CDS. However straterra does. Highlighting some similarities but key differences.
wait methlyphenidate doesn’t work well for CDS?? i’m diagnosed with adhd and i present mostly as inattentive and im currently on methlyphenidate and find it… lackluster at best. i’m wondering if there’s some sort of correlation but i can’t really find anything solid besides this
Correct, I switched from MPH to vyvanse and found it worked better. I want to try atomoxetine now. Since it has the best evidence for treating CDS. If you thing you have CDS you can join us on r/SCT, we love new members.
I also wonder if this goes along with “sluggish cognitive tempo”. Some kids just need more time to process and more 1:1 attention in order to do well (at school).
Edit: nevermind- apparently it’s the same thing, just renamed!
It’s great there’s a name for this- these kids might not qualify as adhd but could get a 504 plan at school for cognitive disengagement syndrome.
Cool to see evidence it can exist on its own, but for me the key question is: does “CDS-only” actually predict anything clinically meaningful beyond just “high inattention/low arousal” on a continuum? If it doesn’t change prognosis or treatment response, it risks becoming another label chasing the same underlying trait.
We do NOT need another label without meaningful treatment. This is just another disorder that patients will be begging their doctors to give them without any direction or solution.
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I see kids every day at work and treat adhd. It is interesting- I see this presentation. And stimulants are not always very effective for it. It doesn’t seem to exactly cause harm, but parents are expecting their daydreaming, kinda lackadaisical kid almost do a 160 and I have to regularly explain that stimulants actually are realllly helpful for our impulsive and hyperactive kids. But straight up chronic daydreamers w sluggishness sometimes just get irritable and moody on a stimulant without the “shift.” I sometimes see fluoxetine, or for teens bupropion, be a better fit. There seems to be some form of anxiety or dysthymia/depression underneath these kids. But kids are terrible historians and so will say no they’re not anxious, no they’re not depressed. So parents don’t register it.
Edit: I’ll add that the CDS presentation is more often girls in my experience. Another anecdotal piece I’ve collected is…It seems more common (at least in this tiny little part of the world I’m in) in girls who go to highly demanding Catholic schools and have controlling parents. So I wouldn’t be surprised if there’s a correlation with “low-level”trauma. Like it’s the brain trying to protect itself. Which makes it a little extra sad when the controlling overbearing parents are like “sooo adhd meds will fix it! My daughter will be DRIVEN and SOCIAL like me now right?!” And I get front row seat to the parents getting disappointed their kid doesn’t turn magically into a totally different kid. Sigh. Sometimes the kid does perk up a bit and seems to enjoy school better, with no side effects, so we keep going. But I think these kids will go on to eventually need some other treatment.
Also it can be hard to understand that what you’re experiencing is anxiety, if it’s been a part of your life for a long time. I’m an adhd adult who got diagnosed at 29, and didn’t understand I had anxiety until my doctor prescribed me anti anxiety medication in my 30s and I experienced its absence for the first time.
Good point! I have had some adult pts get prescribed an anxiety med and for the first time ever say “…I didn’t know this was what normal felt like.” Anxiety is truly my favorite thing to treat!!!!!!!! It responds much more linearly to meds than depression (depression can be kind of a maybe?maybe not? Waiting game.) Brings me joy.
Do you have any suggestions for treating anxiety that aren’t medication related? I got diagnosed as an adult and was put on Lexaprone(sp?), but it absolutely killed my sex drive and seemed to do nothing else. I’m quite terrified of experimenting with different medications and potentially making my generally dysfunctional self irreparably worse.
Lexapro is an ssri (selective serotonin reuptake inhibitor) which are known for causing sexual dysfunction.
lots of other options exist. wellbutrin - a dnri (dopamine, norepinephrine reuptake inhibitor) can cause increased sex drive, and, in an incredibly small amount of people, spontaneous orgasm other drugs, like spari(serotonin partial agonist and reuptake inhibitor) also dont have sexual side effects. sexual side effects from Lexapro and other ssris can also be treated with an anti-anxiety drug called buspirone
anxiety can also be treated with talk therapy. theres a lot of different modalities (or styles) - they'll sound like alphabet soup. some of them are cbt, dbt, ifs, emdr. theres a lot more. sometimes finding a good therapist takes some trial and error - in general; you want someone that you'll feel comfortable sharing your inner experience with; and someone that youre willing to learn and grow from. even though it's "just" talking, therapy can be incredibly difficult; you'll want someone that you'll feel comfortable being challenged a little by.
the best outcomes typically come from a mixture of both therapy and medications; however, both have a real effect on their own, too.
please talk with your doc about this. a couple very quick screening tools are called gad7 and phq9 are designed to be generally understandable for lay people.
sometimes it gets worse before it gets better. sometimes it gets real fuckin dark. but it can get better. and there are a lot of people that want to help. they dont know you yet, but they still think you are inherently valuable as a human being. humanity's superpower is it's ability to help other humans through their struggles; please, let other people help you through these times
Wow, I scored a 14 on depression. 15 points is moderately severe.. I didn't think I was even close to that. Thank you for posting.
I experienced hydroxyzine helping a great deal against anxiety before I got diagnosed with ADHD/autism and getting ADHD medication.
I am not a doctor, but I have been dealing with anxiety as well. I was put on Lexapro earlier this year and only stayed on it for a month because the side effects were terrible for me.
I started buspirone after that, which is strictly an anxiety medication and is a lot less intense than antidepressants like Lexapro. For me it doesn’t feel like I am on anything and I feel like my normal self. I’m honestly not sure how much it has helped me, but some people say that it has gotten rid of their anxiety. It could be worth asking your doctor about it if you are open to trying another drug. I know that hopping on medication can be really intimidating and scary, but for some people they can be life changing, so maybe don’t rule them out until you’ve tried some others.
For a non-medication option, have you gone to therapy? That can help you reflect on where your anxiety is coming from and teach you to address that and teach healthier thought patterns.
Some of the advice that has been most helpful to me is that anxiety is a thought process, so if you can retrain your brain to think more positively, you can teach your brain to stop worrying. It can be hard to identify negative thought patterns - I have generally viewed myself as a positive person. As I’ve spent more time reflecting, I’ve found that I have a lot of negative tendencies in my thinking. A lot of that I have found out, for myself, relates to self esteem.
I have been working on trying to be a more positive person. This is something that takes practice - it isn’t an automatic thing. I have to remind myself literally dozens of times a day and look for positives everywhere I can. It can be finding joy in my morning cup of coffee, gratitude for the job I have, or being thankful for spending time with friends. This has been the thing that I can say has helped me the most. I am not where I want to be yet with my anxiety, but I’ve made a lot of progress.
Anxiety sucks, but it can be treated, so keep your head up and don’t lose hope. Recovery is an active thing that takes a lot of effort, patience, and self reflection.
Well-written. Thank you
Yes! I love a high yield CBT program. A clinic that specializes only in anxiety and OCD is going to usually be the ticket. it’s usually twice a week for a few weeks, then goes down to once a week and then you eventually go into monthly check ins. Then…graduate! Very effective treatment. Time intensive, expensive. But works.
Just curious, what do you think your final cost (without insurance) was? For the full experience?
If they accept insurance maybe $40 a session, 24 sessions…
If they don’t accept insurance, probably 2-3k
Thank you. I feel like more people might be able to budget for it if we actually knew the total cost without insurance.
I suffered from severe anxiety attacks and severe anxiety for years, now i don’t feel an ounce of anxiety.
I did a combination of CBT and doing the things that made me anxious head on.
By engaging in the anxious thing + using CBT i was able to change how I thought about stuff which has practically reduced my anxiety to 0.
No medication necessary.
I do take stimulants for ADHD, which made my anxiety even worse at first, I’d take 5mg of dex and even that would spike my anxiety to the point I’d have to go to hospital.
Now I can take upwards of 20mg + coffee and be super chill.
CBT changed my life completely.
Note : I will add that it did take like 4 years of constant therapy and practice to get to where I am now
Can you elaborate more on what you did when you were doing the thing that made you anxious? I’ve been doing that, and truthfully, I dread it more and more to the point where I have contemplated dropping grad school over it. The only thing stopping me is the fact that a crippling fear of public speaking and social anxiety is the absolute dumbest reason not to finish a PhD.
I didn't respond to any first line meds and ended up taking a gene panel to find a med that worked for me. Might be worth asking your provider about. I also hate what I call medication roulette.
I had anxiety from depression some 15 years ago and it took me literally months to figure out it was anxiety. Because for the first 25 years of my life I had never experienced anything like it and it manifested as nausea and vertigo, and that general weird feeling you get. I had no idea that was anxiety.
In my experience a lot of adults are bad at identifying their own depression and anxiety. I had to explain to my husband at one point, my anxiety doesn’t feel like being really stressed out, in fact most of the time it doesn’t “feel” like much of anything, it’s just like my brain won’t ever shut off for anything, which is why it’s so easy for me to not notice it getting gradually worse. I think as someone who hasn’t struggled with it he imagines it as like a persistent feeling or emotional state, which would be more obvious, but it just isn’t, at least for me. I’ve dealt with depression in the past too and that “felt” a bit more obvious to me, but even then, it sneaks up on you very slowly.
Atomoxitine works pretty well for my CDS. I had never had my brain be chill for 3 hours straight and could finally get so much work done without getting side tracked or needing to get up and walk around to get my brain back in gear. I used to live in my daydreams. I knew it wasn't good but couldn't really stop it myself. It was just a habit at that point and a place where I had control. Now that I am able to have more control in my daily life (with the help of medication) I don't have as desperate a need to manufacture the sense of control.
Oh! Yeah! I forgot that I do have a few younger folks w this presentation on this med too. It’s an NRI so kind of in the same boat as bupropion but hits kids differently. Some kids get wiped out on atomoxetine. Like, snooze fest. I tend to like it better for my teen or adult pts. And I’ve learned starting it low and graaaadually going up yields better results (despite the texts recommending starting at 40mg).
I still don’t see it as effective for adhd combo or hyperactive type. I usually use it second line if stimulants make somebody moody/angry.
I use 18mg and it was great for just making it where my current coping skills were more effective. I do not have ADHD but do have severe anxiety which I've had since I was very little. So I use a combo of SSRI and SNRI to combat my symptoms and it is really a relief to not have to constantly fight my brain.
What has been working very well for me with Strattera is opening the capsule and using a milligram scale to precisely control how much of it I need. Which allowed me to start very low and ramp up to the working dosage slowly and virtually with no side effects.
I'm also getting the strongest version (100 mg/cap), which saves me quite a bit of money.
That doesn't even sound like a syndrome so much as maladaptive daydreaming and the kid disengaging as a form of protection because their behaviour is the only thing within their control.
ETA: Incidentally, I was that kid, so I'm speaking from experience. I also have ADHD, that was only diagnosed at 30. I'm significantly quieter and more self-contained when medicated, though more gregarious and engaged than I was at my most miserable as a child.
A disorder is really….still super subjective. Like, one family’s interpretation of “impacting functioning” can be VASTLY different from another family”s interpretation. We do get collateral from schools and counselors. But every little “culture bubble” has its own standards. So that’s a challenge we wade through.
That makes a lot of sense too. Like, CDS certainly does seem to exist, both from research I've read and anecdotal experiences of other people in the comments who recognise their own experience from the article. Whether it strictly applies to some of the students in your care, well, at least they have all of you looking out for them either way. I know I would have appreciated that as a kid.
A lot of time my goal is to do 16 min of therapy with the family and about 9 min of med management. Med managements the easy part. The hard part is validating both the parent(s) and the kid in 16 min and sprinkling in some skills while also educating what is developmentally normal.
I bring in a lot of my own experiences too. “Wow I remember feeling so overwhelmed by some of the mean kids in 4th grade… it’s hard to focus on school when you’re also worried about Claire calling you a lesbian at recess everyday!”
And this helps reframe some of the inattention so it’s not just adhd, it’s also heightened stress levels. And when we get stress better managed often times the attention and focus and dysfunctional daydreaming improve
And if parents are the source of stress, sometimes I low key drop in how and when it’s developmentally expected to do xyz. So if mom is freaking out 14 year old girl is trying to text friends at 10pm, I’ll say “I remember being 14 and how important it felt to make those social connections, even if they were online or virtual. That wanting to connect is normal— we have to make sure it’s done safely and that you’re following the rules at home. Mom, what are the rules with phones and technology?”
And mom will explain their rules. I can see some of the parents who are TOO strict almost look embarrassed as they explain they’ve banned all video games all tv etc. I don’t shame or try to correct it. But it’s a good starting place to see they’re maybe having some doubts. Because these kids who are daydreaming often have very under stimulating social lives too….
It's context dependent. For example, If you can get parents, teacher, and the student to agree that the student is having trouble specifically at school, then that student has a disorder. It may only affect the student at school, but it still represents a disorder.
our framework we use to diagnose and treat (the DSM v) is theoretically supposed to transcend context- at least in western cultures. It’s both a little true and not true though. This is what I’m saying is the challenge. Trying to sort kids into boxes when the boxes look different in every single context ha.
The DSM classifies diagnoses, it doesn't make them. Good clinicians understand each patient's symptoms in detail and in context in order to identify disorder and recommend specific interventions. Sorting patients into DSM categories is for billing and coding. Parents and teachers really should dispense with these generalized clinical labels that imply a context independent disorder follows the child everywhere they go or that a typical treatment is the right treatment for that child.
Yes, I agree. I think we’re ultimately saying the same thing, not sure why you’re framing your response as something oppositional to mine.
I'm clarifying that clinicians don't "sort kids into boxes". Non-clinicians like parents and teachers do tend to do that when they get a diagnosis and suddenly all the particularities about their child are obscured by stigma and expectations about kids who share that diagnosis. A box like "You have ADHD so you have the same problems as other kids with ADHD and the same things that help them will help you", which I think we both agree is wrong.
What’s the difference between maladaptive daydreaming and “a” “syndrome” besides semantics?
Well in this specific scenario, MD is generally considered more of a poor coping mechanism in response to stress or trauma, whereas ADHD - and so therefore presumably also CDS - is defined as a lifelong neurodevelopmental disorder, of which daydreaming is a singular symptom. Basically, you can develop better skills to respond to stress than MD, but you can't grow out of or upskill your way out of having a developmental disorder. Presumably that also means daydreaming is more of a persistent characteristic over the life of someone with CDS vs. someone who learns healthier skills to manage stress than MD. Of course, I'm making some logical leaps here, but time will tell with further research.
Strictly defining 'daydreaming' seems to have been an important part of the research actually, from what I gathered with surface level research.
https://www.sciencedirect.com/science/article/pii/S3050713825000117
Did you maan 160 instead of 180 to indicate mostly a turn around in symptoms but not entirely?
I presume they were going for 180, based on the context of the sentence.
Of course the presumption is 180. That’s why they asked if it was a deliberate deviation. But thank god you added your one cent.
It's a science sub. If we aren't going to hold each other to a higher standard then we may as well stop following it at all.
Sorry yes. I’m a bit distracted. Making my dogs 8th “gotcha day” cupcakes with my kids. They’re doing it mostly on their own per their request….but I’m not the best at trying to multitask ha
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Oh yea, I'm sure.
I've got ADHD and a 160 seems more fitting.. close to finishing but not quite.
This is fascinating. I'm definitely of the description you named, to a T, and I find that stimulants are the only thing that can keep me out of my head (and I mean that genuinely. For example, one day when I was a teenager, I apparently went to the lake with my friends. A few days later, I had no memory of it at all. I had been completely checked out, and that remains true every time I'm off my meds). But I started them when I was 19, so maybe that's something. I had a lot of trauma at home and growing up, but moving out did wonders for my stress levels even if college made me stressed in a different way, and I had begun to heal very quickly. I also saw that I was struggling academically when no one else was and could almost sort of see the difference (without having a name for it), so I was actively trying to claw out of the world of daydreams and spaciness out too.
Quick question: is this not the same thing (or, at least, was not previously regarded as the same thing) as inattentive type ADHD? That's what I've always categorized myself as. I never heard of this term until this post.
My opinion is we just don’t really know enough about any of it yet. Neurodivergence I mean. I think our categories right now are wayyyyy too broad. Asd, adhd, SPD, giftedness. Other LD kind of all lumped together in another box.
Diagnosis for ADHD inattentive type can be done through behavior (teacher marks if kid is inattentive in school, messy, forgetful etc). Or adhd can be diagnosed through cognitive psychological testing. This testing is better able to differentiate adhd vs other reasons a kid might be inattentive, messy, and forgetful. Like, the kid has the behaviors at school but actually perform well when push comes to shove. And it’s these kids who don’t seem to do as well on the stimulants…. Because there’s likely some other process going on.
If you have functioning impairment and the meds help you, you probably have adhd inattentive type. If you wanted, you could get psychological testing done to confirm. But this can cost $1200-3000 unfortunately.
I would like to one day see all kids flagged w any neurodivergence get free psychological testing through the school system.
My friend and I constantly joke that I basically say that everything is cptsd. I’m glad I’m not the only one realizing that depression, controlling parents and environment are causing dissociation in children, which is a coping mechanism for dealing with this kind of low level trauma.
There’s a meme that runs around psychologist/psychiatry groups. It’s the astronaut with a gun pointing at another astronaut
The earth is labeled DSM V
First astronaut says “it’s all trauma”
The astronaut w the gun says something like “it always has been”
Basically one big thing tying most mental illness together is….trauma.
I would argue there is genetic predisposition to psychotic disorders. We know the VMAT2 gene plays a significant role in this. And even some youngsters w no trauma but maybe some big stress like college or breakup (not considered trauma) can be the activating factor. That being said, we see higher incidence of schizophrenia in folks w higher ACE scores… so trauma still plays a significant role
We also have to consider what is traumatizing to an infant that’s not forming visual memories but is forming a developing brain that’s adapting to its environment. There’s probably better words to say that.
I was one of those kids.
I was diagnosed in the 80s, first with a now debunked diagnosis that my brain hemispheres didn't properly communicate, then with ADD. Now days I would probably be diagnosed with mild autism.
I would uncontrollably get lost in day dreams, often for hours at a time. Growing up i never watched TV and spent all my time in the woods around our home living out my day dream fantasies of adventure and conquests. Once I got into school it became a problem, I couldn't focus on anything and would zone out anytime something didn't immediately grab my attention.
I was diagnosed with ADD when it first came on the scene in the mid 80s and Ritalin actually really helped prevent my focus from wandering away. In high school I moved and went off the Ritalin and I remember a big science final I had where I zoned out for two hours right after the test started and ended up only completing about 3 questions then having a breakdown.
As i got older I started compensating for not being medicated by building up extreme anxiety to drive focus. I would freak out leading up to any event of deadline to keep my mind focused on it and not drift off or forget it.
It got worse and worse until I started having panic attacks and went on anti-anxiety meds, which worked wonders for my anxiety but now my ADD and focus is out of control again.
Recently I've become reliant on caffeine and coffee to keep focus at work as well as hyper stimulation, I'm known to take on and do 3 tasks at once to keep my brain active and engaged but it is still a constant fight and struggle.
I can absolutely see this subtype as a thing because I was never hyper, quite the opposite.
Yeah, you might be on to something with that demographic. I was just diagnosed, fairly late in life, with the inattentive type and went Catholic for most of my education. Even though I'm a guy I felt personally called out by that comment because it seems spot on.
Alexithymia is an ability or issues with identifying or recognising ones own emotions. While it is a personality type, not a disorder, when people with Alexithymia develop conditions like depression or anxiety the presentation can often be very atypical. Alexithymia is common in those with Autism and ADHD.
Only realised I had anxiety when my psychiatrist spelled it out for me, and explained the symptoms and bodily sensations to me.
I am on fluexotine currently, Atomoxetine (AKA concerta, I think?) and dexamphetamine.
Fluexotine somewhat works. Difficult to tell with the atomox.
I've tried a fair few stimulants and whatnot. Vyvanse made me feel off, if memory serves and didn't seem to do much otherwise. Ritalin made me clench my teeth and feel "wired", not pleasant.
So far dexamphetamine seems to be the most effective, with the downside of being prone to irritability and teeth clenching again. Sucks because it's the only stimulant I've actually gotten a noticeable effects from.
Thank you, your input is very valuable. I really appreciate the view of the brain doing its best to protect itself, especially in strict environments.
I would love to pick your brain about my brain. I can’t seem to get out of my own head, have always had this issue, and now am not living up to my standards of a good employee, husband, and father. I’ve been seeking treatment, and spending 10% of my income that I can’t afford, fixing an issue no one seems to be able to help with. Genuinely need help desperately, and I can’t afford to keep throwing away money i don’t have.
What kind of treatments have you been doing?
Have you ever talked to a pediatric dentist?! I have 5 kids. Plus I have 6 siblings. (Not catholic or Mormon) just a fertile family (no joke, every woman on my mom side even with birth control have gotten pregnant the first time…honestly think it has to do with the red hair gene and none of us are red only the undertones) but even when I was a kid my dad found out about my older brother doing drugs at his 3 month braces tightening.
My kids dentist has talked to us about their anxiety. We also have this beautiful Nuero divergent thing going on in our family.
My kids pediatrician knows I am diagnosed with severe combined adhd and not kidding my husband has add. Two of my kids for sure areADHD (not severe but it’s hard to miss) and the other 3 I thought for sure was some kind of autism as I also grew up around that, but the daydreaming and having to literally be looking at them in the face for them to listen. I got very lucky as all of them are intelligent (family of bookworms- I credit my obsession with the books and being young and poor)
The thing is, their pediatrician told me whenever it starts to interfere with school it’s time. The problem is I know this medication is not great to take before puberty. They put my older kids in honors- that just created another problem as yes they’re smart enough to keep up, but with honors in middle school where I am at, it literally just means more work and it’s slowly creating a burn out to the point they don’t want to be in honors. I completely understand.
So what I’m getting at if you got to the bottom of this, what would your opinion be on this? If I get them diagnosed they are protected and my 2nd grader instead having to do a reflection walk at recess because he called out the answer or my middle schoolers forgetting their laptops won’t be on lunch detention. But negative side, they automatically get labeled. Which is also a negative as my 4th grader a former speech kid- only for articulation (and after 10 years of constant doctors and myself advocating he finally got the neck xray and has severe inflammation of his adenoids) and at the end of the year was the ONLY kid in his 3rd grade class to get exceeds expectations in both math and English on the state exam, they put him in the the regular 4th grade class instead of the combo. His teacher literally told everyone at open house that every single kid was below the state average. Again a label.
Sorry it’s long. Please don’t feel obligated to answer. I know speak to your doctor is the best, but as someone on Kaiser, to get our pediatrician it’s email or at least a month for in person. Also I completely understand there are a lot of people waiting and it’s not an emergency.
C-PTSD looks similar to what is being referred to as CDS in this article. I’d be interested in further studies that isolated traumatic experiences as its own variable.
Yes, it seems like trauma could make kids feel unsafe engaging with other people and develop coping mechanisms like daydreaming. I wonder if CDS shows up mostly in interactions with adults or is more universal.
Facts. What is differentiating slower cognition from dissociation?
Only thing putting me off was despite higher scores associated with trauma CDS had lower rates of ODD. We needed more surveying to account for different potential issues this could arise from
I can only speak to my own symptoms but I actively have slower processing which is not dissociating. It's extremely frustrating as I am aware it's happening but cannot do anything about it. I'd liken it to having less RAM in a computer. Sure it can eventually get to the answer but dang if it isn't chugging. It's like trying to swim through a molasses river. Slow. Mine was sussed out with memory and cognitive puzzles and compared to averages.
As someone also having ADHD, your symptoms describe mine exactly. It's like standing in the middle of a highway and trying to pick out a specific model of car or something with all the vehicles racing past at impossibly fast speeds or something. Attempt after attempt I might finally get it, but other times my brain just blanks and plays static noise searching for answers that should be otherwise easy.
Mine blanks out when I get too tired but I'm too stubborn to let it just give up. Which gets pretty exhausting keeping it whipped into moving forward.
I have the same problem. Is this something that can be treated? As an adult it is frustrating in a work environment to be about 30 seconds behind everyone else.
I'm not a doctor but beyond exercising my brain with puzzles to make it recognize things like patterns faster, no, I haven't found any treatment for it. You CAN practice creating more mental associations for things to make retrieval faster but if it is something novel, it's still chuggy.
Sorry if this is forward but I would like to understand. Is what you’re describing variable depending on other factors, or are you saying that this sluggishness you’ve described is a fairly consistent baseline?
It can be variable in that it is worse when I'm tired and better when I eat and sleep well on a schedule but yes. It is a consistent baseline of slow thinking no matter what I do. I can still do very complex math and calculations, but it is noticably slower than my peers.
Thank you so much for responding. I think you helped me understand something I didn’t have the words for.
Aka brain fog
some of the symptoms of CDS mirror the negative/cognitive symptoms of schizophrenia. i personally wonder if NMDA receptors may be involved in both conditions, but CDS obviously doesn’t have enough dopamine to ever have psychosis.
Close enough.
Welcome back ADD!
Recent investigations into child psychology have provided evidence that a specific cluster of behavioral symptoms is separate and distinct from attention-deficit/hyperactivity disorder. The research indicates that this condition, known as cognitive disengagement syndrome, presents a unique set of challenges that shift as children mature into adolescents. These findings were published in the Journal of Attention Disorders.
Cognitive disengagement syndrome is a condition characterized by a specific pattern of mental functioning. Individuals with this syndrome often exhibit excessive daydreaming, frequent mental confusion, and a general slowing of thinking or behavior. These behaviors were historically described as “sluggish cognitive tempo” in older medical literature.
Psychologists and researchers have debated how to best categorize these symptoms for years. The primary question has been whether independence of the two conditions. The data showed that a distinct group of youth exhibited high levels of cognitive disengagement without significant symptoms of attention-deficit/hyperactivity disorder. This independence was observed in both the childhood and adolescent age groups.
The researchers found that approximately 2.5 percent of children and 1.5 percent of adolescents in the general population fit the “cognitive disengagement syndrome only” profile. This confirms that the syndrome can exist as a solo clinical entity. However, the study also provided detailed statistics on how often the conditions overlap.
https://journals.sagepub.com/doi/10.1177/10870547251344719
That’s not quite what it shows. This is a common error in cluster analysis (not what was done here, but related) and related analyses. This article assumes there are distinct groups and indeed creates them based on arbitrary cutoffs, and then based on that assumption assesses differences on outcome variables. Yes, it then observes differences on the outcomes. That is only indirect evidence for the groups themselves, as it risks an affirmation of the consequent fallacy. Many many forms of cluster analyses are also presented and interpreted as providing evidence of distinct groups when they in fact assume that distinct groups exist; a more general form of ‘begging the question’ fallacy in statistics.
Good points. It seems like what they call “Cognitive disengagement syndrome” could just as easily be a different expression of the same inattention problem. A child placed in an environment where focus or task switching is harshly punished may learn that daydreaming or “shutdown” are safer options, for example.
As a personal anecdote, I think my own ADHD (primarily Inattentive type) often manifested in these behaviors when I was young. In a boring math lecture there were few options for me to shift my focus towards that would provide stimulation, other than causing disruption, but that was undesirable as well, as I didn’t enjoy negative attention. This internalizing coping mechanism also prevented my condition from being recognized and diagnosed until adulthood.
No, there are different outcomes from this condition. CDS leads to different impairments than inattentive adhd. For example higher depression and anxiety than would be predicted.
If there are multiple forms of depressive disorders. Why can't there be different attention disorders?
Using internalizing coping mechanisms could lead to depression and anxiety, as could the environmental factors or trauma that lead individuals to adopt them. I had those diagnoses myself.
I agree that there are likely many different configurations and symptom presentations for attention disorders, but the linked study reaches the conclusion that CDS is not an attention disorder, because the symptoms are different.
No the study says CDS is not ADHD. "Attention disorders" are just a broad category (likely to be made if this enters DSM 6) like "depressive disorders " or "anxiety disorders". That's what im communicating, CDS is an Attention disorder but it isn't adhd.
Im aware however it does say that there is a distinction from adhd. If these CDS symptoms lead to more internalizing disorders and ADHD leads to more externalizing conduct disorders. Different outcomes point to the disorders not being the same.
“In the adolescent group, roughly one-third of those with cognitive disengagement syndrome did not have a co-occurring attention disorder.”
ADHD and “attention disorder” are used interchangeably, and I don’t see any claim of CDS being an attention disorder.
They say it’s a syndrome that appears both concurrently and separately from ADHD diagnostic thresholds, and ADHD is the only currently recognized attention disorder.
My point is that the features of this syndrome are likely to impact diagnosis—a child with ADHD who is primarily utilizing daydreaming or defensive shutdown to cope with inattention isn’t going to get a high score on inventory items related to disruption, for example, which might lead them to be placed in the “non-ADHD” bucket. The fact that 1/2 of the cohort of children with CDS also met ADHD criteria, but only 1/3 of adolescents did seems to support my theory—children with CDS learn to use it to mask their ADHD more effectively by adolescence (as do most people.)
It does also seem highly likely that some who truly do not have ADHD are utilizing these same strategies to cope with other mental disorders, transitory environmental/cultural stressors, or trauma.
Brother the only other attention disorder is ADHD. Attention disorders is the larger category they fall into. Like cars are one category and tesla and Toyota are a sub category.
Not in this article. The research at large supports it. On top of the ICD-11 citing it with adhd.
No evidence to this effect.
It'd be nice if ADHD was able to have specifiers like depression. Honestly, diagnostic boxes are messy as hell. It's like labeling a painting surealism without letting you view it. You get the gist of what might be painted, but many individual factors lead to the final work. That's why RDOC has been pushed forward.
I agree, the brain network evidence for CDS is scant but so far instead of the prefrontal context being impaired. It seems to be more of a lack of anti correlation between the default mode network and the task positive network. Namely the dorsal attention network.
Now adhd also shows this tpn and dmn lack of anti correlation. However its larger in CDS and the adhd studies don't account for people with CDS until recently.
Hold on even if you dont make cutoffs. The researcher still shows different outcomes when you have more CDS traits than non CDS traits. The cutoffs just help us separate treat from not treat. The cutoffs for blood pressure are arbitrary but higher blood pressure would still lead to different outcomes than high sugar levels.
But the claim is that they’re distinct groups, not continuous predictors. See figure 2 of this article and the associated discussion. https://eiko-fried.com/wp-content/uploads/2022FriedDepressionMeasurement.pdf Your example is example of exactly what I raise: higher blood pressure is a continuum, and the use of arbitrary cutoffs falsely creates the idea that there are distinct groups.
This is all part of the problem I raise: an association with a thing is used to assume there are distinct groups, then the groups them are reified as if it is the groups are real and causal. The association with a continuous variable can’t show this.
Agreed, but remember in medicine binary decision need to made. Do we give blood pressure medication for this patient or do we not. Its true that this seems somewhat arbitrary but 0.05 being the threshold for significance in science is also arbitrary. Is all science just BS fanciful nonsense?
I believe that threshold for ADHD and CDS will be placed at 2 standard deviations from the mean. Making it like significance level at 5%. On top of this, functional impairment will be looked at to ensure that this isn't just a difference but a clinically meaningful difference.
This is a common shift in epistemology from what is the case to a pragmatism that happens in mental health diagnostics. We start with the claim that a disorder is real and distinct, and then quickly retreat to the argument that it’s a convenience for treatment. We rarely start by telling patients their supposed disorder isn’t real. This is a motte and bailey fallacy.
You’re really speed running the psychiatric fallacies here.
A disorder being "real" in psychiatry just means it needs to be distinct from other disorders, show a deviation from Gen pop. And show a distress and impairment in the life of the affected. Taking your logic, we can't take schizophrenia as real because its diagnosed on a rating scale and not with some test. We're moving to a time where we'll integrate genes and neuroimaging into the psychiatric paradigm. That's exciting for diagnostics and treatment.
Reddit comments are the best to help you speed run a new idea
Could this be that these children were born with an encoded high Differentiation of Self and are by nature more prone to higher planes of thinking and are in need of gentle grounding and management?
Today i learned that the simptoms that i experienced my whole life has a name and classification. I have been suffering my whole life because of this, not severely debilitating but enough to make my life really hard. And ofc that nobody ever understood me, why are you so sloppy, why can't you pay attention etc. Sigh.
Yeah, this resonates with me as well! I definitely don't have ADHD (I actually have a fantastic ability to sit still and focus) but I'm also a total space cadet. I once paid for food at a drivethrough and then drove away before they gave it to me.
I'm not running out to get diagnosed or anything (I'd rather NOT pathologize too much of my personality) but it is nice to hear someone make the distinction.
I’ve heard you can still be adhd while being able to focus really well at times. It depends on whether you are interested in the topic. If not, traditional adhd symptoms will present themselves. My friend is like this. He can concentrate for hours on really complex topics but is always losing his keys, phones, headphones, wallet ,etc.
Yes, exactly this. ADHD is not actually an attention deficit, but is better thought of as a deficit in the ability to correctly regulate attention. This sometimes looks like not paying enough attention to things, and other times looks like going on a deep focus binge where you are nose to the grindstone for eight hours and forget to eat and use the restroom and stuff.
Yeah, I get that, but it isn't really the case for me. I've never had any issue with regulating or directing my attention. I'm one of those weirdos who really will get up from my video game every hour or so to get a drink of water, stretch, check in on what my wife is doing, etc.
I like this avenue of research precisely because I get annoyed when people try to loop me into an overly broad diagnosis. I know people do it because their diagnosis was life changing and they're trying to share the good news--but I'm sorry, I just don't think the treatments and coping strategies for my memory issues and someone who has chronic procrastination or focus issues are going to be the same.
Also valid. My good-word preaching is solely that ADHD looks different in different people (AFAB people particularly); and that it’s more nuanced than “Little Billy can never pay attention to anything”. If this new research resonates while ADHD qua ADHD doesn’t, awesome!
Yeah, this isn't really a matter of hyper focus on special interests. I generally have an easy time of picking up and finishing even unpleasant tasks, and don't struggle with procastinating any more than any normie does. I'm just not always 100% present.
This is how I am, I can hyper focus when programming but it's something I've always found interesting and personally fulfilling.
Maybe you’re adhd, bro
Oh yeah, I probably should have stated that, but I definitely am. I didn't get diagnosed until after college, I think it's because I've always found math and science very interesting and wanted to learn as much as possible, letting me succeed academically.
Did you go back and get it?
Haha, yes. I was very embarrased, but I figure the folks at the taco bell forgot about it 10 minutes after it happened so I didn't suffer too much psychic damage.
My wife will never let me live it down though.
Yeah so a central symptom of ADHD is hyperfocus.
It's not hyperfocus, though. I can focus on more than just my special interests. I can focus on tasks that I think are unpleasant without procrastinating. And I don't get sucked into something and lose all sense of time and priority.
Really, I just have this very small cluster forgetful habits that I don't like having and wish I could get rid of... but whenever I talk to anyone who has ADHD about it, they will immediately try to diagnose me woth ADHD.
r/SCT is a subreddit that deals with the subject. Glad we might be able to help.
Thank you I will give a look!
If it annoys you, I recommend trying to get on non stimulant ADHD meds. Complete game changer for me personally. I didn't even realize how bad it was until I could finally stay present without fighting for it.
Thank you for the recommendation, i will definitely go after this and have a diagnosis.
This was me as a child, constantly daydreaming, i had built up complete cities in my mind. while everyone was playing with eachother i was daydreaming, when in class and teacher talked and talked, i heard nothing, it looked like i was listening, my eyes was pointing at him but i didn't see him, i was in my mind living life, however, it all stopped as i was nearing the age of 25, it got from cant stop it, to being able to choose it, to getting hard to daydream, and then it got impossible to do it, now i cant even if i want to, which i'm very glad for. It stops you from living your life.
This is very close to my own experience. I grew up in a very strict religious household. Many hours at church/Bible study every week. I seemed to realize at an early age that what I was being taught wasn’t landing but there was no option but keep trying and appear to be doing the right thing which at the very least meant sitting very quietly and looking attentive from the time I could walk. This lead to a very developed ability to totally check out mentally. I was able to escape into extremely detailed and involved fantasies that in hindsight were great exercises in creative thinking i guess, but sometimes it was just fog. I basically developed all the wrong muscles. The focus/executive function skills I desperately needed in school and other areas of my life atrophied. I was able to classically hyper focus but that was erratic and had other issues. I seemed to only be able to manage these 2 extremes until a midlife Adult AD diagnosis and medication began clearing things up.
If you don’t mind me asking could you share how you were able to overcome this problem to the extent that you have? I struggle with daydreaming now and I’m 27, although it isn’t as bad as it was when I was a kid!
Unfortunately i dont know, maybe as my brain finished developing it just fixed the problem, there probably is ways to train yourself to not daydream, but i do remember that my fantasy life was so good that every time i snapped out of it i got depressed, my real life was so bad compared to it, which made me hate daydreaming, also i cant count how many times i was driving my car and ended up just driving past where i was going and continued for like half an hour until i realized i dont recognize the road, it was so weird, i could drive the car at the same time as i'm not even consiosly seeing the road because i was in my fantasy, but somehow i was driving like on "autopilot" but very badly.
Have you noticed a gradual decrease in daydreaming? it could be that it will be gone before you are 30. I do have one suggestion, i took Sertraline Hexal and i remember it actually helped with it, could be worth a try.
I second what slim said about the sertraline. I took it for panic and anxiety problems but it also completely took away my ability to daydream. I just cannot focus on it anymore the way I used to. I actually miss it a lot since it was so comforting but yeah if I could I would waste my life daydreaming so it is probably for the best.
I've heard Dr Russell Barkley talk about something similar. I'm not sure if he used a different term for it.
It’s called Sluggish Cognitive Tempo, and has been known and identified for a very long time. Sort of unclear what this research adds to the literature other than renaming a known construct.
My question here is how this interacts with Inattentive ADHD, the kind without much hyperactivity. Related, or different?
Is it a separate mechanism with its own treatment, or is it just ADHD lite? Obviously there's a high overlap in symptoms with ADHD, but this one is missing the impulsivity and hyperactivity, so very close to the inattentive ADHD type
There are differential treatments to an extent. Methylphenidate doesn't work well on CDS. However straterra does. Highlighting some similarities but key differences.
wait methlyphenidate doesn’t work well for CDS?? i’m diagnosed with adhd and i present mostly as inattentive and im currently on methlyphenidate and find it… lackluster at best. i’m wondering if there’s some sort of correlation but i can’t really find anything solid besides this
Correct, I switched from MPH to vyvanse and found it worked better. I want to try atomoxetine now. Since it has the best evidence for treating CDS. If you thing you have CDS you can join us on r/SCT, we love new members.
I also wonder if this goes along with “sluggish cognitive tempo”. Some kids just need more time to process and more 1:1 attention in order to do well (at school).
Edit: nevermind- apparently it’s the same thing, just renamed!
It’s great there’s a name for this- these kids might not qualify as adhd but could get a 504 plan at school for cognitive disengagement syndrome.
Sounds a lot like a bunch of traumatized kids dissociating.
Is cognitive disengagement separate from maladaptive daydreaming? If so, are they related?
I feel I can kind of relate, but I got a ADHD-PI diagnosis.
You can get both maybe someday
hey that sounds like me!!!
Bad wording: it doesn't confirm. Since K. R. Popper we talk about papers trying to falsify hypothesis.
Never heard of this before but I have inattentive ADHD and also all the symptoms for CDS so. That’s fun. (It’s not, I am disabled)
Does CDS have the same constellation of signs/symptoms that has been referred to as sluggish cognitive tempo (SCT) by other authors?
Cool to see evidence it can exist on its own, but for me the key question is: does “CDS-only” actually predict anything clinically meaningful beyond just “high inattention/low arousal” on a continuum? If it doesn’t change prognosis or treatment response, it risks becoming another label chasing the same underlying trait.
We do NOT need another label without meaningful treatment. This is just another disorder that patients will be begging their doctors to give them without any direction or solution.
How do you begin finding treatment for something without labeling, funding and eventually diagnosing it.