Introduction
Cognitive Disengagement Syndrome (CDS) is characterized by daydreaming, mental confusion, and hypoactivity. Distinct from ADHD, it is linked to internalizing symptoms, autistic traits, and impaired well-being. Whether CDS should be considered a transdiagnostic construct, a specifier, or an independent entity remains debated, requiring systematic comparison across clinical groups.
Purpose
This study aimed to (1) compare CDS across ADHD, autism and internalizing disorders, (2) test age and sex effects, and (3) examine functional impact on quality of life and CBCL DSM-oriented scales.
Methods
Participants were 958 referred children and adolescents (32.3% female; mean-age 10.66±2.84) at Karakter Child and Adolescent Psychiatry, the Netherlands, diagnosed for ADHD, autism, or internalizing disorders. CDS was measured with CBCL items 13, 17, 80, and 102 (CBCL-CDS-4). To address overlap with the CBCL-Affective Problems scale, an alternative score excluding item 102 (CBCL-CDS-3) was computed. Quality of life was assessed with the KIDSCREEN-27. Group differences were examined using t-tests, Welch's ANOVAs, and MANCOVAs controlling for sex and age. Sensitivity analyses excluded comorbidities. Functional impact was tested with regressions predicting KIDSCREEN-27 from CBCL-CDS-4, replicated with CBCL-CDS-3. Correlations with CBCL DSM-oriented scales were calculated, and Steiger tests compared their strength across domains.
Results
Autism and internalizing groups showed higher CDS scores than ADHD, both at total and item level, with findings confirmed in comorbidity-free sensitivity analyses. Adolescents scored higher than children on CBCL-CDS-4 in ADHD and autism; no sex-effects were detected. Across all groups, higher CBCL-CDS-4 scores predicted lower quality of life, with results replicated using CBCL-CDS-3. Steiger comparisons showed that correlations of all four CBCL-CDS items with CBCL-autistic traits and with CBCL-Affective Problems were consistently stronger than with CBCL-ADHD.
Conclusion
CDS was higher in autism and internalizing disorders compared to ADHD, predicted poorer quality of life, and was more strongly linked to affective and autism domains than to ADHD, highlighting its relevance as a transdiagnostic clinical construct.