Cognitive disengagement syndrome

Cognitive disengagement syndrome (CDS) is an attention syndrome characterised by prominent dreaminess, mental fogginess, hypoactivity, sluggishness, slow reaction time, staring frequently, inconsistent alertness, and a slow working speed. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.^[2]

Since 1798, the medical literature on disorders of attention has distinguished between at least two kinds, one a disorder of distractibility, lack of sustained attention, and poor inhibition (that is now known as ADHD) and the other a disorder of low power, arousal, or oriented/selective attention (now known as CDS).^[3]

Although it implicates attention, CDS is distinct from ADHD. Unlike ADHD, which is the result of deficient executive functioning and self-regulation,^[4][5][6] CDS presents with problems in arousal, maladaptive daydreaming, and oriented or selective attention (distinguishing what is important from unimportant in information that has to be processed rapidly), as opposed to poor persistence or sustained attention, inhibition and self-regulation.^[7] In educational settings, CDS tends to result in decreased work accuracy, while ADHD impairs productivity.^[8]

CDS can also occur as a comorbidity with ADHD in some people, leading to substantially higher impairment than when either condition occurs alone.

In contemporary science today, it is clear that this set of symptoms is important because it is associated with unique impairments, above and beyond ADHD. CDS independently has a negative impact on functioning (such as a diminished quality of life,^[9] increased stress and suicidal behaviour,^[10] as well as lower educational attainment and socioeconomic status^[11]). CDS is clinically relevant as multiple randomised controlled clinical trials (RCTs) have shown that it responds poorly to methylphenidate.^{[12][13][14][15]}

Originally, CDS was thought to represent about one in three persons with the inattentive presentation of ADHD,^[16] as a psychiatric misdiagnosis, and to be incompatible with hyperactivity. New studies found that it can be comorbid with ADHD – and present in individuals without ADHD as well. Therefore, some psychologists and psychiatrists view it as a separate mental disorder. Others dismiss it altogether or believe it is a distinct symptom group within ADHD (like Hyperactivity, Impulsivity or Inattention). It even may be useful as an overarching concept that cuts across different psychiatric disorders (much like emotional dysregulation, for example).^[17]

If CDS and ADHD coexist together, the problems are additive: Those with both (ADHD + CDS) had higher levels of impairment and inattention than adults with ADHD only,^[18] and were more likely to be unmarried, out of work or on disability.^[19] CDS alone is also present in the population and can be quite impairing in educational and occupational settings, even if it is not as pervasively impairing as ADHD. The studies on medical treatments are limited, however, research suggests that atomoxetine^{[20][21][22][23]} and lisdexamfetamine^[20][24] may be used to treat CDS.

The condition was previously called Sluggish Cognitive Tempo (SCT). The terms concentration deficit disorder (CDD) or cognitive disengagement syndrome (CDS) have recently been preferred to SCT because they better and more accurately explain the condition and thus eliminate confusion.^[19][25]