Examining the Relationship between Sluggish Cognitive Tempo and internalizing Symptoms in Attention Deficit Disorder with Hyperactivity Children and Adolescents: A Systematic Review and Meta-analysis.

Authors

Xinyu Yang, Xiawei Li, Yu Zhou, Wenhao Han, Xin Li, Fuli Yan, Wei Pang, Jing Gao

Published in

Child psychiatry and human development. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents, frequently comorbid with sluggish cognitive tempo (SCT) and internalizing symptoms (INT), with anxiety and depression as the core subtypes. Clarifying the relationship between SCT and INT in individuals with ADHD is essential for enhancing diagnostic and intervention strategies. Following the PRISMA guidelines, we systematically searched PubMed, EMBASE, Web of Science, the Cochrane Library, and CNKI for peer-reviewed observational studies published up to May 10, 2025. Random-effects meta-analysis was performed using Pearson's correlation coefficient (r) as the effect size measure. Subgroup analysis and meta-regression were conducted to explore sources of heterogeneity. The meta-analysis of nine studies (n = 1,767) revealed a significant, moderate positive correlation between SCT and INT (r = 0.426, 95% CI: 0.342, 0.503, P < 0.001), with substantial heterogeneity (I²= 77.5%). Subgroup analyses indicated a stronger correlation for self-reported INT (r = 0.436) compared to parent-reported INT (r = 0.387). The correlations between SCT and the core internalizing subdomains were both significant, with a pooled correlation of r = 0.397. Age, sex, or sample size did not significantly moderate the heterogeneity. Heterogeneity remained partly unexplained, likely due to differences in internalizing symptom instruments, informant sources, and sampling frames across studies. SCT is consistently associated with higher levels of internalizing symptoms in youth with ADHD, particularly when assessed via self-report. These findings support the integration of SCT screening within ADHD evaluations and underscore the importance of multi-informant assessment to improve identification and management of co-occurring internalizing problems.

PMID:
42961763
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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