Determination of clinical and neurocognitive characteristics in children between 8-12 years diagnosed with Attention Deficit Hyperactivity Disorder with Sluggish Cognitive Tempo and comparison to children with ADHD and with ADHD+ODD

This study aimed to develop measurement tools to determine loneliness preference and exclusion from social relationships in children between the ages of 8-12 and conduct a Turkish validity and reliability study of the Solitude Scale for Children (SSC) and the Social exclusion scale for Children (SESC). Also, it is aimed to examine the predictive and mediating effects of family functioning, emotion dysregulation, loneliness preference, social exclusion, internalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Sluggish Cognitive Tempo (SCT) and comparison to ADHD+Oppositional Defiant Disorder (ODD) and ADHD. The pilot study consisted of 337 children aged 8-12 years who applied to child and adolescent psychiatry clinics, determined by a convenient sampling method. The basic study consisted of 841 children aged 8-12 years who applied to child and adolescent psychiatry clinics and were diagnosed with ADHD (n =246), ADHD+ODD (n=212), and ADHD+YBT (n=176) according to DSM-V diagnostic criteria. Sociodemographic characteristics and data form, Family Rating Scale (FAS), Emotion Regulation Difficulty Scale (DDG), Behavior Rating Scale for 6-18 Years Old Children and Adolescents (CBCL), Barkley Child Attention Questionnaire, Turgay DSM for Disruptive Behavior Disorders-IV Based Screening and Evaluation Scale, Loneliness Scale for Children, Social Exclusion Scale for Children (SESC) and Solitude Scale for Children (SSC) were applied. In addition, the Kiddie-SADS-lifetime version was used for diagnostic evaluation, and the computer-based neuropsychological test battery CNS-VS was used for the evaluation of executive functions. In the pilot study, item analysis, Exploratory, and Confirmatory Factor analyses were used within the scope of scale validity and reliability. In the descriptive analysis of the whole study, Chi-Square Test, Independent Sample T-Test and One-Way Analysis of Variance; Pearson Correlation Test, Independent Sample T-Test, One-Way Analysis of Variance, Stepwise Multiple Linear Regression Analysis, Process Macro analyses were applied to examine the relationships between variables. Exploratory factor analysis and oblique rotation indicated one factor for SSC and SESC with an explained total variance of 65.57% and 66.25% respectively. Confirmatory Factor Analysis results of SSC, and SESC indicated that the scales had acceptable goodness of fit. The overall Cronbach's alpha coefficient of SSC and SESC was 0.94 and 0.95. Split-half reliabilities of them were high. As a result of the analysis of the main study, it was determined that family functionality and the severity of SCT symptoms did not directly or indirectly affect executive functions in children with ADHD+SCT. It was determined that family functionality affected the severity of SCT symptoms by predicting internalizing disorders separately through emotion regulation difficulties and solitude. In the ADHD+SCT group, it was found that emotion dysregulation had a mediating effect between executive functions and SCT symptom severity and internalizing disorders, both on its own and on solitude; It was also found that emotion dysregulation had a mediating effect on the relationship between SCT symptom severity and solitude. Internalizing disorders were determined by selective attention and sustained attention scores only through emotion dysregulation and emotion dysregulation on solitude in ADHD+SCT children. As a result of stepwise multiple linear regression analysis, only CBCL Social Introversion sub-dimension (66.1%), Solitude (3%), FAD Communication sub-dimension (0.3%), CNS-VS Psychomotor speed (0.2%) and Neurocognitive Index (0,2%) scores. When the diagnostic groups were compared, ADHD+SCT children had higher FAD problem-solving and communication sub-dimensions, DDG clarity and awareness sub-dimensions, internalizing disorders, solitude total score averages, and cognitive flexibility scores related to executive functions, compared to ADHD. It was determined that psychomotor speed scores related to executive functions were low. In conclusion, SESC and SSC can be accepted as reliable and valid criteria to evaluate loneliness preference and exclusion from social relationships in childhood. It is thought that this study will contribute to the accurate clinical evaluation of children with SCT, determine the factors that may affect the treatment methods, collect more data on etiological factors, and determine the protective factors for the future. Keywords: SCT, ADHD, Executive Functions, Emotion Dysregulation, Solitude