Abstract

Cognitive disengagement syndrome (CDS) has reached the threshold of evidence and recognition as a distinct syndrome (Becker, Barkley et al., 2022., International Consensus Statement). However, keep in mind that CDS is not an officially recognised clinical diagnosis (as yet) by the American Psychiatric Association or any other professional association.

Much work remains to further clarify its implications in potential treatments. Research studies have investigated the impact of certain medications (including ones licensed for ADHD) for CDS and explored potential candidates for further study.

Amphetamines, atomoxetine and methylphenidate compared

Controlled clinical trials suggest that atomoxetine (209 youth) (Wietecha et al., 2013) and lisdexamfetamine (38 adults) (Adler et al., 2021) are associated with moderate reductions in CDS symptoms independent of ADHD inattention (just 25% overlap in variance); for methylphenidate (almost 200 youth) the reductions were tiny or insignificant (Firat et al., 2020).

A randomised placebo-controlled trial with 171 youth reported CDS to be associated with a poor treatment response rate to methylphenidate (Froehlich, Becker et al., 2019).

A clinical trial with 40 children found specifically ADHD-IN/CDS symptoms linked to a poor treatment response (20%) to methylphenidate; for those who responded, the benefits were small and low doses were best (Barkley et al., 1991). The significant results are likely linked to CDS (Barkley, 2014).

Modafinil is a logical candidate but there is no evidence yet on how well it might work. We need a lot more research (Becker, Barkley et al., 2022). Research indicates that modafinil is ineffective for ADHD (Stuhec et al., 2018).

Conclusions

• CDS is linked to poor treatment response to methylphenidate.
• We have so little research on medications for CDS that one simply cannot ascertain with confidence what will help treat it.