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Future twin studies would be therefore necessary to further deepen the understanding of the comorbidity
between CDS and the whole spectrum of INT-EXT symptoms. Overall, the evidence of latent susceptibility
between CDS and INT disorders, as well as between CDS and EXT disorders, could be valuable in clinical
settings, both for encouraging clinicians to assess and monitor symptomatic manifestations of INT and EXT
problems when subjects come to clinical attention for CDS symptoms (and vice versa), and for
implementing interventions aimed at modifying the environmental variance in the onset of
symptomatology, such as parent-training protocols. Furthermore, evidence concerning the validity of CDS
as a stand-alone syndrome would be pivotal in developing specific assessment scales. Up to now, CDS can
only be assessed through the use of the Child Behavior Checklist (CBCL) developed by Achenbach . This
[76]
scale assesses CDS through a specific subscale, which includes items “13” is confused or seems to have their
head in the clouds, “17” daydreams, gets lost in their thoughts, “80” stares into space, and “102” is not very
active, slow in movements, not energetic’ . However, despite being useful at addressing the core features of
[77]
CDS, this scale has some limitations. Firstly, it is composed of only four items, making it impossible to
unravel the various dimensions of this syndrome, fully distinguishing it from ADHD, and to ensure great
internal validity. Secondly, being a parent report, the CBCL tends to underestimate INT symptomatology
while overestimating the EXT counterpart . As literature has shown that the best raters for INT
[2]
[2]
symptoms in childhood and adolescence are the subjects themselves, developing specific self-reports would
be pivotal in enhancing the diagnosis of CDS and developing specific treatments and protocols.

DECLARATIONS
Authors’ contributions
Conceptualized the work and laid out the manuscript’s structural framework: Scaini S and De Francesco S
Carried out the comprehensive literature review: Amico C, De Giuli G
Collaborated on the manuscript’s writing: De Francesco S, Amico C, De Giuli G
Played a pivotal role in refining the initial draft through meticulous revision: Giani L
Contributed significantly to the revision of the second draft, particularly focusing on the sections
concerning the methodological aspects: Fagnani C, Medda E
Took charge of the final draft revision, providing crucial insights for the article’s conclusions: Scaini S
All authors approved the final version of the manuscript.

Availability of data and materials
Not applicable.

Financial support and sponsorship
Not applicable.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2024.