Cognitive disengagement syndrome (CDS): What it is and how it relates to ADHD

Cognitive disengagement syndrome (CDS) is a set of symptoms marked by frequent daydreaming, brain fog, slow processing speed, daytime sleepiness, and low energy. In the mid-1980s, clinicians and researchers started documenting this neurodevelopmental pattern. Back then, they called it “sluggish cognitive tempo.” In 2023, it was renamed as cognitive disengagement syndrome.opens in a new tab The new name highlights the symptoms a person experiences. The old term, with the word “sluggish,” made it seem like a personal fault — like laziness. 

Signs of CDS often show up in childhood. But you can experience symptoms in adulthood as well. The syndrome shares many symptoms with ADHD, particularly the inattentive type. In fact, 25 to 40 percent of kids and teens with ADHD and 46 percent of adults with ADHD also experience CDS symptoms.opens in a new tab 

But it’s important to keep in mind that CDS and ADHD are distinct, says Melissa Miller, PhD,opens in a new tab a pediatric psychologist at Cincinnati Children’s Hospital who studies CDS. 

“ADHD is represented by this external distraction … kind of like your brain’s noticing everything all at once,” she explains. “Whereas for individuals with CDS, they might be internally distracted. So, distracted by their own thoughts, excessively daydreaming, or almost just having a blank mind at times.”

And while you might have difficulty sustaining attention with ADHD, with CDS you experience “more of slow processing or even a lower alertness to even get started on a task,” Miller says. 

This overlap between ADHD and CDS symptoms can be confusing. So we’ll break down which symptoms are associated with CDS, how they can affect daily life, and how it’s different — but connected — to ADHD. 

There are both cognitive and motor symptomsopens in a new tab of CDS in kids, teens,opens in a new tab and adults, according to Nicholas Fogleman, PhD,opens in a new tab a child clinical psychologist and director of the UNC ADHD Program. 

These CDS symptoms can show up in school, work, or home lifeopens in a new tab and include:

• Daydreaming

• Fogginess or mental confusion

• Drowsiness or daytime sleepiness 

• Low activity 

• Slow processing speed

• Asking people to repeat questions or losing your train of thought

• Difficulty following instructions 

• Not engaging in or withdrawing from social interactions

• Poor school or work performance opens in a new tab

• Not completing home chores and tasksopens in a new tab

• Feeling like you’re dragging yourself along all day 

• Higher likelihood of internalizing conditions, like depression and anxietyopens in a new tab

Daydreaming is the symptom people most often think of when it comes to CDS. That’s because with CDS, you’re often distracted by your own thoughts. And completing tasks can take longer because of frequent internal distraction. 

Another hallmark symptom of CDS is drowsiness. “We see that there’s a lot of daytime sleepiness, especially difficulties in the morning,” says Miller. “I’ve also heard from parents before describe differences in kids with CDS taking a really long time, for example, in the shower, because it’s an ideal place to daydream.” 

Another common symptom of CDS is slow processing speed. That’s when someone needs a lot of time to take in, make sense of, and respond to information. And this is where the old term “sluggish cognitive tempo” came from. If you have CDS, it can take a few repetitions to understand instructions. Or it may take longer for you to complete tasks. 

Symptoms of CDS depend on the person, though. “Just like ADHD, we know that not everyone with ADHD is the same and what they experience is not always the same,” says Miller. “And I think the same thing is true for CDS.”

Symptoms of CDS may sound similar to ADHD, especially the inattentive type. But you can have CDS without having ADHD,opens in a new tab and vice versa. 

Here are some important differences between CDS and ADHD. It’s important to note that there is still significant overlap between CDS and ADHD, such as executive function challenges. And some people with ADHD (especially the inattentive subtype) may have symptoms of both CDS and ADHD. 

To highlight their differences, Miller points out how CDS and ADHD might show up in a classroom. A teacher may notice that a student with ADHD is looking around the room instead of focusing on their assignment. “Whereas someone with CDS might look like they’re working on their assignment, but they might just be staring at it,” Miller says. “So they’re not distracted by things around them, but they’re … on the same problem for 10 minutes.”

CDS can also mimic other health conditions outside of ADHD, including the following: 

• Autism and AuDHD: CDS is a symptom pattern that people with autism or AuDHD can experience, but having these symptoms does not give you an autism diagnosis.opens in a new tab Autism involves other traits that CDS doesn’t include, like repetitive behaviors and ongoing challenges with social communication.

• Burnout: Burnout, a state of exhaustionopens in a new tab that comes from nonstop stress, is usually a temporary change in cognitive engagement, specifically towards work, school, or other activities like caregiving. CDS symptoms are not specific to certain contexts. 

• Perimenopause or menopause: Brain fog is a common symptom of CDS as well as perimenopause and menopause. However, the brain fog associated with perimenopause and menopauseopens in a new tab happens during a specific period of life when hormone levels change. Brain fog with CDS can occur at any age, usually starting in childhood. 

Psychologist Melissa Miller explains how CDS differs from ADHD.

Although the symptoms associated with CDS have been identified by scientists and clinicians since the mid-1980s, there’s no official diagnosis for it in the DSM-5. That’s the reference book used by clinicians to officially diagnose a patient with a psychiatric condition. And that’s because for a long time, CDS symptoms were thought to be part of ADHD. 

In more recent years, CDS has separated from ADHD. A review of the research around CDSopens in a new tab has added additional evidence that CDS is its own condition. 

In the meantime, researchers are trying to better understand the underlying cause of CDS. And clinicians can still evaluate for CDS alongside ADHD, depression, anxiety, and other conditions with similar symptoms. 

It’s not yet possible to get an official CDS diagnosis. Because CDS symptoms have been associated with ADHD in the past, and because there’s no official DSM-5 diagnosis, some health care providers may be unaware of the differences. Working closely with a psychologist, counselor or therapist, or a psychiatric practitioner to explore CDS is a great first step. 

Research around treatmentsopens in a new tab specifically for CDS is limited. There’s some thinking that certain treatments for ADHD may benefit individuals with CDS. But support for research is limited. 

Fogleman notes that sleep interventions and environmental strategies at home and school can help you manage CDS symptoms day to day. 

And there are practical steps you can take:

• Allow extra processing time to reduce pressure while completing tasks. 

• Use visual timers or verbal prompts to gently re-anchor yourself or your child to the task at hand. 

• Explore informal school and work accommodations to allow for extra time, repeating instructions, and changes in work volume.

• Work with a mental health professional to manage anxiety and depression symptoms.opens in a new tab

Miller also adds that, “Having a routine in the morning where you’re up, alert, and getting active right away, as well as mindfulness interventions” can help with CDS symptoms. 

Thumbnail image credit: Bevan Goldswain via Getty Images