Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, April 16, 2014

The Nose Knows

I'd really like to just gloss over this topic, but I can't bring myself to do so. Have you read about "Sluggish Cognitive Tempo" (SCT)?

Check it:

...powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children.

Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship A.D.H.D. drug might treat it.

And there it is, black on white. Researchers helping Lilly market a drug. Really, "identified a new disorder"? Like what, they found a new bacteria under a microscope?

Here's Allen Frances' comment from his article, No Child Left Undiagnosed:

"'Sluggish Cognitive Tempo' may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered."

Right on Dr. Frances!

When I googled "Sluggish Cognitive Tempo", the first thing that came up was itself, followed by sluggish thyroid and sluggish bowels. I'm not sure what that implies. Anyway, SCT was the main topic in the January 2014 issue of the Journal of Abnormal Child Psychology.

According to the introductory article, SCT is characterized by "drowsiness, daydreaming, lethargy, mental confusion, and slowed thinking/behavior". Then there are a couple articles about the validity of SCT, and more discussing the relationship with ADHD.

One article I found, Symptom Properties as a function of ADHD Type: An Argument for Continued Study of Sluggish Cognitive Tempo, by McBurnett et al,  published in 2000, noted that SCT had been discarded from the inattention symptom list in the DSM IV Field Trials, due to poor negative predictive value. But then McBurnett et al decided to look at SCT again, and found that "Sluggish Tempo Items showed substantially improved utility as symptoms of Inattention, " and that a "Sluggish Tempo factor could be distinguished from an Inattention factor." It wasn't clear to me from reading the abstract why they decided to take another look at SCT.

The thing is, even if SCT is a "real thing", even if a child can "have" SCT, who says that child needs a label, or meds, or even treatment?

Note also the messy interaction between Allen Frances' opinion about SCT and his role as chair of the DSM IV task force. Maybe he does have a conflict of interest. I still think he makes more sense than this crusade to label every aspect of the human condition as pathology.

What's next, pathologic nose-picking?

1. Nose-picking at least 3 times per day, present most days, for at least 2 weeks.
                     a. Booger-Eating Type or      
                     b. Non-Booger-Eating Type

2. The patient is often unaware of the nose-picking behavior while it is happening (in children, the  behavior may be noted by a family member or teacher)

3. The nose-picking does not take place in the context of recent trauma to nose.

4. Nose-picking is not a culturally accepted norm for the patient.

5. The nose-picking is not better explained by another condition, such as OCD.

6. The nose-picking causes significant distress for the patient or patient's family, such as frequent    nosebleeds, teasing at school, or booger-encrusted undersides of furniture.



  1. I think it is a disservice to some of the researchers in this field to ridicule their research without knowing anything about it. I think that is a typical strategy these days, often justified by the appearance of conflict of interest and the final questions are far from settled. It is unfortunate but expected that major newspapers and of course any blogger with an axe to grind can do a hatchet job on the researchers doing this work without knowing anything about their research.

    Most people did not have a clue about SCT until they read about it in the papers.

    Conflict of interest on the part of the critics? Now that is a novel idea!

    1. Fair point. I certainly didn't know anything about SCT. I think reactions are contextual, and there have been too many instances of pharmaceutical companies directing research without regard to facts or consequences (Paxil 329 comes to mind), and too many misleading conclusions not to wonder about a claim of a new diagnosis.