ABSTRACT

Cognitive disengagement syndrome (CDS, previously referred to as sluggish cognitive tempo) is a unique set of symptoms distinct from ADHD inattentive symptoms that appear to be independently associated with neuropsychological and psychosocial outcomes in community and ADHD-specific samples of youth. However, our understanding of CDS in individuals with chronic or complex medical conditions is limited. The current systematic review is the first to summarize the literature on CDS prevalence rates and associations with neurocognitive and functional outcomes in youth with medical conditions, and to discuss areas of future research to guide clinical intervention. We conducted literature searches across four major databases and included studies assessing prevalence estimates, associations with neuropsychological and/or psychosocial functioning, or predictors of CDS in individuals with chronic or complex medical conditions. Twenty-five studies were identified and retained. Fifteen of sixteen studies reported elevations in CDS symptoms, though findings were mixed in studies comparing mean differences to typically developing youth. Seven studies provided inconsistent evidence for CDS being associated with neuropsychological or academic functioning, with six studies demonstrating consistent effects on psychosocial functioning. Finally, nine studies identified biological and sociodemographic factors associated with CDS, though almost all await replication. CDS symptoms are significantly elevated in youth with medical conditions and appear to be particularly linked with psychosocial functioning. Future research is needed to identify prevalence of CDS across a range of medical conditions, examine associations with neuropsychological and psychosocial functioning, and examine whether CDS impacts self-management.

摘要

认知脱离综合征（CDS，以前称为认知节奏迟缓）是一组与 ADHD 注意力不集中症状不同的独特症状，似乎与社区和 ADHD 特定青少年样本的神经心理和社会心理结果独立相关。然而，我们对患有慢性或复杂疾病的个体的 CDS 的了解是有限的。当前的系统综述首次总结了有关 CDS 患病率以及患有健康状况的青少年的神经认知和功能结果的相关性的文献，并讨论了指导临床干预的未来研究领域。我们对四个主要数据库进行了文献检索，包括评估患有慢性或复杂疾病的个体的患病率估计、与神经心理学和/或心理社会功能的关联或 CDS 预测因素的研究。确定并保留了 25 项研究。十六项研究中的十五项报告了 CDS 症状的升高，尽管在比较与正常发育青少年的平均差异的研究中，结果参差不齐。七项研究提供了不一致的证据，证明 CDS 与神经心理学或学业功能相关，其中六项研究表明对社会心理功能有一致的影响。最后，九项研究确定了与 CDS 相关的生物学和社会人口学因素，尽管几乎所有研究都有待复制。CDS 症状在患有疾病的青少年中显着加重，并且似乎与心理社会功能尤其相关。未来的研究需要确定 CDS 在一系列医疗状况中的患病率，检查与神经心理学和心理社会功能的关联，并检查 CDS 是否影响自我管理。