Study: AuDHD Children Face Elevated Risk for Cognitive Disengagement Syndrome

January 27, 2025

Autism spectrum disorder (ASD) and cognitive disengagement syndrome (CDS) are distinct disorders, despite overlapping symptoms and high rates of comorbidity with ADHD, suggests a new study published in Research on Child and Adolescent Psychopathology¹.

The study found that autistic children with ADHD (auDHD) have a higher risk for CDS than do those with only one of these disorders. However, only 6% of the 2,000-plus children studied had an autism diagnosis without ADHD, a relatively small sample compared to the roughly 950 autistic subjects with ADHD.

CDS, previously called “sluggish cognitive tempo,” was also found to be significantly correlated with anxiety and depression, a finding supported by previous research².

With its internal distractibility, slow pace of movement, and daytime sleepiness, CDS impacts up to 40% of children with ADHD³ and around 30% to 63% of children with inattentive ADHD. Although the condition also co-occurs with ASD, research studying the link is scarce, and CDS is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM).

“Most studies examining CDS in youth with ADHD have failed to evaluate for and rule autism in or out, which is important given that most referred children with autism also have ADHD,” the researchers wrote. “The primary aim of our study was to determine if the relationship between autism and CDS is due to overlapping traits or whether the two conditions are empirically distinct.”

Distinguishing CDS from other disorders, like ASD, ADHD, and depression, can be difficult for clinicians due to lookalike symptoms, according to Joseph Frederick, Ph.D., in his 2023 ADDitude webinar, “Cognitive Disengagement Syndrome: A Distinct Kind of Inattention.”

“They’re related, but they’re also separate,” Frederick said. “The high level of comorbidity is one of the challenges that we have in the ADHD field, but also in mental health in general.”

For example, social disengagement can be indicative of both ASD and CDS. “I have individuals [where] it may look like autism because they’re socially disengaged,” Frederick said. “But a lot of these children have the skills if they’re in a comfortable environment. I think the underlying reasons why a child with autism versus CDS may have these challenges may be different.”

The new research examined data from 2,209 children, ages 4 through 17, referred to a psychiatric and behavioral clinic. The subjects’ caregivers filled out a Pediatric Behavior Scale (PBS) measuring symptoms of ASD, CDS, ADHD inattentive subtype, ADHD combined subtype, and several psychopathological disorders. Factor analyses revealed that the measures for CDS and ASD did not overlap.

This means that questions on the PBS measuring CDS symptoms, such as how often children appeared “in a fog/confused,” were significantly separate from those measuring autism, an important finding for understanding how CDS should be identified and treated in people with ASD.

CDS is an attention disorder characterized by slow processing speed, hypoactivity, and daydreaming. Although it causes attention difficulties like ADHD, CDS is more associated with internal distractibility and mind-wandering.

Children with CDS are “preoccupied by what is going on in their own minds — they frequently daydream, get lost in thought, stare, or zone out,” Frederick said. “These children may appear sleepy, confused, and take longer to finish activities.”

According to the researchers, this lack of formal DSM-5 recognition does not mean clinicians should ignore CDS. Instead, this study suggests that clinicians and caregivers should pay attention to CDS as a distinct experience in individuals with ADHD and autism that may impact diagnosis and treatment.

“These results have important clinical implications, suggesting that a comprehensive assessment of CDS, autism, and ADHD is needed to make accurate diagnoses and for effective intervention planning,” the researchers wrote.

The researchers suggest that future studies examine these patterns in more diverse, population-based samples, especially considering the children in this study were predominantly male. Further research may be imperative considering how both ADHD and ASD often go underdiagnosed and misdiagnosed⁴ in girls.

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