INTRODUCTION
Sluggish Cognitive Tempo (SCT) is a disorder characterized by a range of symptoms such as mental slowness, daydreams, lack of energy, staring with empty eyes (1).  Although SCT and Attention-Deficit/ Hyperactivity Disorder (ADHD) are often presented together, increasing current evidence supports that SCT is a separate and independent diagnostic entity differentiating from ADHD. Many researches highlight the overlap between SCT and ADHD. 39% of individuals with ADHD were found to have SCT; whereas 59% of individuals with SCT had ADHD as well (2). In another study, it was stated that the proportion of patients with pure SCT but not diagnosed with ADHD was 40% (3).
The literature on possible treatment modalities of SCT is very scarce. It was detected that methylphenidate improves attention problems, although it does not improve core SCT symptoms in limited studies (4). There are also literature findings indicating that methylphenidate therapy has not association with improving SCT symptom load (5, 6). A current study also points out that Sluggish/sleepy symptoms of SCT do not respond to methylphenidate, whereas SCT/Daydreamy symptoms have no association with methylphenidate nonresponse (7). The results of a study, in which atomoxetine was used, showed that SCT symptom scores decreased as a result of 16 weeks of treatment of atomoxetine, and academic improvement was observed (5). This study is important because it was the first study to demonstrate improvements in SCT with medication. On the other hand, another double-blind placebo-controlled study suggested that atomoxetine provides control over ADHD symptoms but has minimal effect on SCT symptoms (8).
When existing data are scrutinized, the lack of studies on SCT treatment is noticeable. In addition, there are no case reports on the differential diagnostic process and psychopharmacologic treatment process in individuals with SCT. Exploring how the standard ADHD treatment protocol affects SCT symptoms in a case with subthreshold ADHD, and intense SCT symptoms, is very crucial for clinicians in terms of shaping their treatment approaches about this kind of patients. For these reasons, we aimed to investigate the differential diagnostic procedure of a case with SCT and subthreshold ADHD symptoms and to determine if there are improvements in SCT symptoms and to what extent there has been improvement along with pharmacological treatment process.