Is It Cognitive Disengagement Syndrome Symptoms or Family Context? The Relationship Between Cognitive Disengagement...

Cognitive disengagement syndrome (CDS), formerly known as sluggish cognitive tempo, is characterized by excessive daydreaming, mental fogginess, slowed behaviour and low initiative. In addition to attentional difficulties, CDS has been linked to social withdrawal and internalizing symptoms. This study examined the association between maternal social anxiety symptoms and CDS severity in children and adolescents with attention deficit hyperactivity disorder (ADHD), while also considering maternal depressive symptoms and child ADHD symptom dimensions.

This cross-sectional study included 116 children and adolescents aged 6-18 years diagnosed with ADHD and their mothers. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and confirmed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Participants with psychiatric comorbidity were excluded. CDS symptoms were assessed using the Barkley Child Attention Scale, and participants were classified into high-CDS (n = 54) and low-CDS (n = 62) groups based on a cut-off score of 23. Maternal depressive symptoms were measured with the Patient Health Questionnaire-9, and maternal social anxiety symptoms were assessed with the Liebowitz Social Anxiety Scale. Group comparisons, Spearman correlation analyses and multivariable linear regression analyses were conducted.

The mean age of the sample was 13.59 years, and 50.0% of participants were boys. Compared with the low-CDS group, the high-CDS group had significantly higher inattentiveness scores (13.87 vs. 11.68, p < 0.001) and lower hyperactivity/impulsivity scores (12.59 vs. 13.76, p = 0.022). Mothers of children in the high-CDS group had significantly higher Liebowitz Social Anxiety Scale avoidance scores (40.76 vs. 35.21) and total scores (79.61 vs. 70.59). In the high-CDS group, CDS scores were positively correlated with inattentiveness (rho = 0.39, p < 0.01), maternal social anxiety total score (rho = 0.45, p < 0.01) and maternal depressive symptoms (rho = 0.40, p < 0.01). In multivariable linear regression, inattentiveness (B = 0.823, p = 0.002) and maternal social anxiety total score (B = 0.095, p = 0.002) independently predicted CDS severity (F[4,49] = 9.111, p < 0.001, R² = 0.427).

Among children and adolescents with ADHD, greater CDS severity was associated not only with attentional difficulties but also with higher levels of maternal social anxiety. These findings suggest that maternal social anxiety may be a clinically relevant familial correlate of CDS and should be taken into account when assessing youths with prominent CDS symptoms.