Correlates of functional impairment in adolescents with ADHD: delineating the relationship between cognitive disengagement syndrome and dissociation

Abstract

Objective: There is substantial evidence supporting the distinction between cognitive disengagement syndrome (CDS) and attention-deficit/hyperactivity disorder (ADHD), particularly from the inattentive subtype. However, despite proposed etiological and phenomenological similarities, the relationship between CDS and dissociation remains underexplored. This study investigates the relationship between CDS and dissociation and evaluates their combined impact on functional impairment while accounting for comorbid internalizing and externalizing problems in adolescents with ADHD.Method: A total of 103 adolescents with ADHD (aged 11-17, M = 14.15, SD = 1.71) and their parents participated in this multicenter, cross-sectional study. ADHD diagnosis was established using the Best Estimate Clinical Diagnosis method. Standardized assessments included the Adolescent Dissociative Experiences Scale (A-DES) and the Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) for self-report, while parents completed the modified version of Sluggish Cognitive Tempo Scale (SCT-S), Strengths and Difficulties Questionnaire-Parent Form (SDQ-P), and Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P).Results: No significant correlations were observed between the parent-reported CDS Modified Total and the adolescent-reported A-DES Total score (r = -.024, p = .811), or any of its subdomains, after controlling for anxiety symptoms. Regression analyses revealed that CDS Modified Total (beta = .0121, p = .032), and A-DES Absorption & Imaginative Involvement (beta = .0085, p = .042) were independent predictors of parent-reported functional impairment along with SDQ-P Emotional Symptoms (beta = .0399, p = .040), SDQ-P Conduct Problems (beta = .0752, p < .001), RCADS-CV Separation Anxiety Disorder (beta = .0245, p = .017). The dominance analysis indicated that the parent-reported SDQ Conduct Problems subscale had the highest average R2 contribution (M = 0.1625) while the parent-reported CDS Modified Total demonstrated the lowest average R2 contribution across models (M = 0.0498).Conclusion: The findings suggest that CDS and dissociation represent distinct constructs, at least when rated by different informants, and that both may have significant and independent contributions to functional impairment in adolescents with ADHD. These results highlight the need to consider a broader range of contributing factors beyond symptom severity alone for the effective management of ADHD.