Avaliação multidimensional do Transtorno do Déficit de Atenção e Hiperatividade (TDAH) e do Sluggish Cognitive Tempo (SCT) em adultos brasileiros

Abstract

The relationship between Attention Deficit/Hyperactivity Disorder (ADHD) and Sluggish Cognitive Tempo (SCT) is a subject of growing scientific investigation, mainly in child and teenagers samples, being comparatively scarce those with adults. The SCT is associated with ADHD inattentive presentation and the internalizing psychopathological dimension and does not associate or weakly correlates with hyperactivity-impulsivity. Executive functions (EFs) and temporal perception have been implicated previously in the cognitive mechanisms of SCT, but have not shown consistent response patterns. The main goal of this investigation was to measure the incremental validity of the Barkley Deficits in Executive Functioning Scale (BDEFS) in relation to ADHD and SCT symptoms in adults. In addition, the relationship between EFs, temporal perception, ADHD and SCT symptoms, internalizing mental health complaints, sociodemographic and general health variables was tested. The specific hypotheses were: (1) participants with higher SCT symptoms would have higher scores on the BDEFS factors; (2) ADHD and SCT would present a distinct pattern of relationship with other psychiatric symptoms, especially with the internalizing and externalizing dimensions; and (3) the scales adapted for the Brazilian context would present favorable psychometric fit indicators. Besides the BDEFS, two instruments were translated and cross-culturally adapted according to the recommended international parameters: the Adult Concentration Inventory (ACI) that measures symptoms of SCT and the Subjective Time Questionnaire (STQ) that assesses components of temporal awareness. The first two papers addressed the validity evidence for the abovementioned questionnaires using factor analysis techniques. The third article sample was split in two groups with and without significant symptoms of inattention and hyperactivity-impulsivity based on cutoff points, and compared them using correlations and t-tests. Additionally, multiple linear regression models were used to investigate predictors of SCT, inattention, and hyperactivity-impulsivity. The STQ showed a three latent factor structure with 10 items and acceptable evidence of reliability. As for the ACI, the single-factor structure of the SCT was replicated, with 10 of the 16 items from the original study, and satisfactory reliability indexes. The convergent and discriminant factor analyses of the ACI in relation to internalizing, inattention, and hyperactivity symptoms confirmed the hypothesis of a greater association of the SCT with inattention and internalizing symptoms. In the third article is shown differences of large effect size in EFs, SCT, and temporal perception, especially among the inattention group. The predictors of the regressions that contributed most to the explained variance in each model were BDEFS factors: Self- control for the hyperactivity/impulsivity group, Time management for the inattention group, and Organization/problem solving for the SCT group. Then, it was confirmed that the SCT presents a different pattern of association with the analyzed variables compared to ADHD, especially in the executive dysfunctions domain. This reinforces the hypothesis of SCT as a distinct psychopathology from ADHD. Studies with nationally representative samples will contribute to the clinical applicability of the scales, in addition to broadening the investigation of the relationship between these syndromes.