Investigating the Effect of Sluggish Cognitive Tempo Symptoms Independent of Attention Deficit and Hyperactivity Symptoms on Extremity Injuries in Children and Adolescents

Abstract

Objective: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. ADHD symptoms in childhood cause a number of comorbidities in adulthood, there is scarce information on whether ADHD in childhood increases the risk of sustaining injuries or accidents. Although previous studies have investigated ADHD-related accidents or extremity injuries, no study has yet examined whether the risk of injury increases in the presence of ADHD combined with Sluggish Cognitive Tempo (SCT) or—although still controversial as a diagnosis—in the presence of SCT alone. The aim of present study was intended to fill this gap in knowledge and to elucidate the effect of SCT on the risk of sustaining injuries in individuals with ADHD. Methods: The study included the following groups: Group 1 consisting of patients aged 6–17 years who presented to orthopedics outpatient clinics for extremity injuries and had suspected ADHD, and their parents; Group 2 consisting of children and adolescents aged 6–17 years who had no extremity injury but had ADHD, and their parents, and Group 3 consisting of children and adolescents aged 6–17 years without any extremity injury or psychiatric disorders, and their parents. After the sociodemographic questionnaire was filled, the DSM IV based Screening and Assessment Scale for Attention Deficit and Disruptive Behavior Disorders and Barkley Child Attention Scale (BCAS) were administered by a clinician specialized in pediatric and adolescent mental health. Results: The study included a total of 94 children and adolescents, of whom 37 had both fractures and ADHD (fracture + ADHD), 37 had ADHD alone and no history of fracture (ADHD), and 20 had neither a history of fracture nor psychiatric diagnosis (control). The groups differed significantly in terms of SCT, inattention and hyperactivity scores (p < 0.0001). Based on the results of the regression analysis, it was concluded that the decrease in SCT scores was associated with the fracture + ADHD group; male sex was associated with the ADHD group; and the increase in inattention and hyperactivity scores played a role in the differentiation of the fracture + ADHD group from the control group. Conclusion: The present study was intended to fill this gap in knowledge and to elucidate the effect of SCT on the risk of sustaining injuries in individuals with ADHD. Comparison of the groups in terms of attention deficit, hyperactivity, and SCT scores showed a statistically significant difference among the groups for all three parameters. Regression analysis showed that high SCT scores had a reverse causality with fractures. When evaluated within the context of our study, this seems to act as a mechanism that compensates impulsivity. Although the mechanism is unclear, the strong causality suggests that it may have a protective effect against sustaining injuries.