Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation Stephen P. Becker & Aaron M. Luebbe & Paula J. Fite & Laura Stoppelbein & Leilani Greening Published online: 29 January 2013 # Springer Science+Business Media New York 2013 Abstract As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred spe- cifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychi- atrically hospitalized children (N =680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demon- strated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, de- pression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children’ s general social prob- lems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manual- ized behavior modification program). These associations were significant above and beyond relevant child demo- graphic variables (i.e., age, sex, race), children’ s other men- tal health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents’ own anxiety and depression symptoms. Keywords ADHD . Anxiety . Attention deficit disorder . Attention-deficit/hyperactivity disorder . Comorbidity . Depression . SCT . Sluggish cognitive tempo . Social functioning There has been ongoing debate regarding the most empirically valid and clinically useful way to conceptualize and categorize developmentally inappropriate symptoms of inattention, hy- peractivity, and impulsivity. These symptoms are currently captured by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association [APA] 1994 ) category of Attention- Deficit/Hyperactivity Disorder (ADHD), which includes three subtypes: Predominantly Inattentive Type (ADHD-I), Predominantly Hyperactive-Impulsive Type (ADHD-HI), and Combined Type for cases with both inattention and hyperactivity-impulsivity (ADHD-C). As researchers and clinicians prepare for the publication of DSM-5, significant interest in the classification of ADHD remains (Adams et al. 2010; Diamond 2005; Willcutt et al. 2012). Recently, there has been a renewal of interest in the construct of sluggish cognitive tempo (SCT) in relation to ADHD. SCT is defined by a range of symptoms including confusion, drowsiness, daydreaming, physical hypoactivity, and lethargy. Two symptoms of SCT, daydreamy and slug- gish/drowsy, were evaluated as potential inattentive S. P. Becker (*) : A. M. Luebbe Department of Psychology, Miami University, 90 North Patterson Avenue, Oxford, OH 45056, USA e-mail: beckersp@miamioh.edu P. J. Fite Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA L. Stoppelbein Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA L. Stoppelbein Glenwood Autism and Behavioral Health Center, Birmingham, AL, USA L. Greening Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA J Abnorm Child Psychol (2014) 42:49–62 DOI 10.1007/s10802-013-9719-y