Cognitive Disengagement Syndrome vs.

ADHD: Comparing Symptoms

Symptom ADHD CDS

Trouble sustaining attention on tasks and using executive Excessive internal distractibility — being lost in
Lack of Focus
function skills, like planning and working memory thought, mentally confused, foggy, and zoning out

Trouble starting and following through on tasks due to Taking longer to complete day-to-day activities due
Poor Task
external distractibility, forgetfulness, or difficulties with to a slower pace of movement and activity and/or
Completion
sustained mental effort internal distractions

At risk for anxiety, depression, and emotional At elevated risk for depression, anxiety, peer
Comorbid
dysregulation, leading to temper outbursts and withdrawal, social skills deficits, and daytime
Complications
argumentative behaviors sleepiness1

Cognitive Disengagement Syndrome: Interventions

Many pediatricians and mental health care providers are less familiar with CDS, perhaps because the DSM-5 has not recognized it as an official
disorder, meaning there are no guidelines for diagnosis and treatment. However, studies show that interventions designed for children
with inattentive ADHD may also help those with CDS. For instance, behavioral parent training (e.g., giving effective commands, using visuals,
simplifying daily routines), homework and organization skills training, and sleep interventions may address symptoms of CDS. 5 6 7 These studies
were designed for youth with ADHD and should be replicated for CDS.

Other promising interventions for CDS include mindfulness and cognitive behavioral therapy (CBT).8 9 Mindfulness may help youth increase
awareness of internal distractions, such as mind wandering, and re-engage their attention in the present moment. CBT may work on recognizing
unhelpful thinking patterns and using behavioral strategies to promote attention and social engagement.
Studies have found that stimulant medication may not help children with CDS as much as it helps children with ADHD.10 11 Results from two
studies suggest that atomoxetine (Strattera), a non-stimulant, may be effective for reducing CDS symptoms, but more research is needed to draw
firm conclusions.12 13

[Read: 5 Overlooked Signs of ADHD – the Inattentive Type]

For educators, we often recommend providing students with attention and comprehension checks, verbal or visual prompts, extended time on
assignments, structured check-ins or daily goals, simplifying language, and attention breaks.

If you suspect your child or teen has symptoms of CDS, it’s best to work with a provider specializing in inattentive ADHD from a behavioral
treatment or pharmacological perspective, since these interventions appear to be most effective to date.

3 internal struggles commonly reported by adults with ADHD

1. The activation spiral of thinking creates cognitive dissonance with relation to setting realistic limitations (what is
realistically achievable) in contrast with to-do lists that causes distress. Time blindness and difficulties with
prioritizing and organizing may result in chronic stress. When one's sense of value is associated
with productivity, survival mode thinking may activate the threat and drive systems.
2. The social anxiety spiral of thinking leads to subjugating, masking, reassurance-seeking, and/or
overcommitting to things. These behaviors are particularly adverse for mental health. The values people hold
(authenticity, loyalty, fairness, and kindness) may spiral into unrelenting expectations of the self, feeling guilt,
and the self-limiting belief of not feeling good enough.
3. The existential spiral of thinking is a questioning of one’s purpose, meaning, and connections in life.
Deconstructing this to the point of feeling lost may lead to symptoms of sadness and grief.