Attention Process Training APT-1

Attention Process Training APT-1

McKay Moore Sohlberg, Ph.D. and Catherine Mateer, Ph.D.

Developed by McKay Moore Sohlberg, Ph.D. and Catherine Mateer, Ph.D., the APT1 program is for adolescents, adults and veterans with attention disorders due to mild, moderate or severe acquired brain injuries. The APT1 program uses audio CDs for therapy tasks and PDF files for scoresheets.

A new computerized program, the Attention Process Training APT3, is now available. The APT3 reflects expanded attention research and includes tasks targeting: Basic Sustained Attention as well as Executive Control Processes related to Working Memory, Selective Attention, Suppression and Alternating Attention. It can be found at http://www.lapublishing.com/apt3-attention-process-training/

Please see EXCERPTS for frequently asked questions.

Click here for a description of APT 1

Item: APT1
Price: $360.00 Market price: $450.00 save 20%
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Full Description

This clinical treatment program addresses attention as a comprehensive multi-level functional process. It provides a theoretically based, hierarchically organized method of retraining the process of attention and is based on extensive clinical research in cognitive rehabilitation.

What is APT-1?

  • Comprehensive, self-contained program designed to retrain attention and concentration deficits in persons with brain injury
  • Theoretically based set of treatment materials and tasks addressing five separate levels of attention process
  • Hierarchically organized auditory and visual tasks designed to improve sustained, selective, alternating and divided attention
  •  Easily administered and scored
  •  Proven effective in increasing attentional skills in published research studies

Who can use it?

Neuropsychologists, speech and language pathologists, occupational therapists, cognitive remediation specialists, and special education specialists.

Who is it designed for?

  • Inpatients or outpatients with brain injury
  • Patients with attention deficits ranging from mild to severe

Sample Treatment Activities include...

  • Number cancellation with visual distractor
  • Sustained attention in noise using audio files
  • Flexible shape cancellation
  • Set-dependent alternating attention tasks
  • Divided attention tasks.

APT-1 includes...

Theoretical background for a five level model of attention. Descriptions for over 50 separate attention treatment activities hierarchically referenced to the theoretical model.

The manual contains over 75 perfect bound pages with detailed administration procedures. An attention audio program contains 4 audio files on a USB. PDF files for 15 scoresheets are included on a USB.

Contains two visual stimulus sheets, 3 visual distractor overlays, reusable overlays, 2 marking pens, deck of playing cards, 4 response clickers, and stopwatch. Extra USB Drives are available separately.

Item: APT1 Full Kit $450 New price 2008 - ISBN 1-931117-29-4

Item: APT1P Extra USB Drive with PDF scoresheet files $25

Item: APT1D Extra USB with 4 audio stimuli files $80

Details
Item APT1
ISBN# 1-931117-29-4
Pages Full Kit
Year Third Edition 2005

Authors

McKay Moore Sohlberg, Ph.D.

Dr. Sohlberg is a nationally recognized leader in the field of traumatic brain rehabilitation. For the past 21 years she has worked as a clinician, researcher and administrator in the development of programs to assist individuals with brain injury to reintegrate into the community at maximal levels of independence. The types of intervention programs that she has developed and about which she has conducted research have become model programs adopted by rehabilitation centers throughout the United States, Canada and Europe.

Dr. Sohlberg received her master’s degree in Speech and Hearing Sciences and her Ph.D. in Educational Psychology at the University of Washington. She is currently professor in the Communication Disorders Program at the University of Oregon. She conducts clinical research aimed at developing and evaluating methods to help adolescents and adults manage cognitive changes after brain injury.

Catherine A. Mateer, Ph.D.

Dr. Mateer is a board-certified clinical neuropsychologist with an extensive background in clinical assessment, clinical intervention and both basic and applied research. She has published over 75 articles and book chapters and two previous books relating to brain organization for language, memory and praxis, as well as to the assessment and management of aquired disorders of attention, memory and executive functions in children and adults.

Dr. Mateer is known internationally for her pioneering work in rehabilitation of individuals who have sustained traumatic brain injury. She received her master’s degree in Communication Disorders from the University of Wisconsin and her Ph.D. in Psychology from the University of Western Ontario. Currently, she is professor in the Department of Psychology and the Director of the Graduate Program in Clinical Psychology at the University of Victoria in British Columbia, Canada.

Contents

General Theoretical Framework

Theories of Attention

A Process Specific Approach to Cognitive Remediation

APT-1 Efficacy Study

References

APT-1 Treatment Activities

Sustained Attention

  • Shape Cancellation Tasks
  • Number Cancellation Tasks
  • Attention CDs Quiet l-16 and Math CDs 1-6
  • Serial Numbers

Selective Attention

  • Shape Cancellation with Distractor Overlay
  • Number Cancellation with Distractor Overlay
  • Attention CDs Noise

Alternating Attention

  • Flexible Shape Cancellation Tasks
  • Flexible Number Cancellation Tasks
  • Odd/Even Numbers Identification
  • Addition/Subtraction Flexibility
  • Set Dependent Activity I
  • Set Dependent Activity II

Divided Attention

  • Dual Attention CD and Cancellation Tasks
  • Card Sort

APT-1 Sample Forms

Attention Audio CD Stimuli Manual

Quiet Stimuli
1. A & B Listening for 1 number - slow & fast
2. A & B Listening for 1 letter - slow & fast
3. A & B Listening for B words - slow & fast
4. A & B Listening for St words - slow & fast
5. A & B Listening for 2 letters - slow & fast
6. A & B Listening for 2 numbers - slow & fast
7. A & B Listening for 2 consecutive numbers-slow & fast
8. A & B Listening for numbers ascending - slow & fast
9. A & B Listening for 2 numbers descending- slow & fast
10. A & B Days of the week ascending - slow & fast
11. A & B Months of the year descending - slow & fast
12. A & B Letters descending - slow & fast
13. A & B Add 3 - slow & fast
14. A & B Subtract 2 - slow & fast
15. A Multiply by 2, subtract 1 - slow only
16. A Multiply by 3, subtract 1 - slow only

Noise Stimuli
1. A & B Listening for 1 number - slow & fast
2. A & B Listening for 1 letter - slow & fast
3. A & B Listening for B words - slow & fast
4. A & B Listening for St words - slow & fast
5. A & B Listening for 2 letters - slow & fast
6. A & B Listening for 2 numbers - slow & fast
7. A & B Listening for 2 consecutive numbers-slow & fast
8. A & B Listening for numbers ascending - slow & fast
9. A & B Listening for 2 numbers descending - slow & fast
10. A & B Days of the week ascending - slow & fast
11. A & B Months of the year descending - slow & fast
12. A & B Letters descending - slow & fast
13. A & B Add 3 - slow & fast
14. A & B Subtract 2 - slow & fast
15. A Multiply by 2, subtract 1 - slow only
16. A Multiply by 3, subtract 1 - slow only

Math Stimuli (Quiet only)
1. A Addition Problems
2. B Subtraction Problems
3. A Multiplication Problems
4. B Division Problems
5. A Mixed Problems
6. B Mixed Problems

Excerpts

Frequently Asked Questions about Attention Process Training Programs

 

What are the computer requirements?

There are none. The APT 1, APT 2 and Pay Attention! have audio CDs. These can be run on any computer with a CD drive or a CD player. It is not a computer based program.

Is this a new version of the APT programs?

The APT 1 and APT 2 programs were revised in 2001 to update the literature review, produce PDF files with scoresheets for each exercise, and convert former audiotapes to CDs. If you have an earlier version, you can purchase an upgrade kit to receive the audio CDs and scoresheets.

Can I preview the program before purchasing?

Unfortunately, we do not offer a preview program. However, we have a full guarantee for our products. If you order any of the APT programs and find that it does not meet your needs, just return the item to us in good condition within 30 days and we will issue a refund.

What about norms and validity?

Because the programs are primarily designed as treatment tools and not as tests, perse, the issues around validity and reliability are quite different. Each manual describes and references research that has been conducted with the materials and contains information about efficacy and client selection.

What about efficacy?

Attention training and training using compensatory aids have recently been supported in review papers as efficacious and an appropriate component of best practices in brain injury rehabilitation. The National Institutes of Health also recognized these approaches as efficacious in the position paper on rehabilitation after traumatic brain injury. (Cicerone, K.D., Dahlberg, C., Kalmar, K., Langenbahn, D.M., Malec, J., Bergquist, T.F. Felicetti, T., Giacino, J.T. Harley, J.P., Harrington, D.E., Herzog, J., Kniepp, S., Laatsch, L. & Morse, P.A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81, 1596-1615).

More from the Authors, McKay Moore Sohlberg, Ph.D., and Catherine Mateer, Ph.D. on the Attention Process Training Programs, APT 1 & APT 2

The treatment exercises are not normed for a reason. We wanted to discourage clinicians from being overly task focused since the exercises in and of themselves are not functional. In other words, a certain percent improvement on a task may or may not be indicative of improved processing and so change needs to be measured in other ways.

The tasks are designed to stimulate very discrete types of cognitive processing. Improvement should be measured on:

1) standardized neuropsychological tests or other attentional measures, which do not replicate the tasks, but require the same types of processing; and

2) change, which should be measured on functional tasks.

The exercises are not functional tasks (e.g., check balancing, cooking etc.) because most functional tasks are multimodal and confound many types of processing (e.g., executive function/memory/multiple types of attention).

The APT exercises are designed to engage the client in increasingly demanding, hierarchically organized tasks in several domains of attention which have been well described in the literature (e.g., sustained, selective, alternating and divided attention). The goal is to increase accuracy and efficiency in areas of attention that are critical to many other cognitive and functional abilities.

Since we know that the brain is plastic to some degree, we re relying on "experience dependent plasticity". The programs (particularly the APT 2) encourage generalization training to make sure that everyday tasks, which require this type of processing, are being used to promote generalization of changes.

Publications on Attention and Memory by Sohlberg and Mateer

The authors have published extensively on their work and sources are readily available through a medline data base search. Relevant books and articles include:

Sohlberg, M.M. & Mateer, C. (2001). Cognitive Rehabilitation: An Integrative Neuropsychological Approach. New York: Guilford Press.

Sohlberg, M.M. & Mateer, C.A. (2001). Improving attention and managing attentional problems: Adapting rehabilitation techniques to adults with ADD. In J. Wasserstein, L.E. Wolf, & F. LeFever (Eds.) Adult attention deficit disorder: Brain mechanisms and life outcomes. Annals of the New York Academy of Sciences. June, Vol 931, 310-341.

Friesen, I.C. & Mateer, C.A. (2001). Memory and executive dysfunction in elderly people: The role of the frontal lobes.” In J. Leon-Carrion & M.J. Giannini (Eds.) Behavioral Neurology in the Elderly. Boca Raton, Fl: CRC Press.

Sohlberg, M.M., McLaughlin, K., Pavese, A., Heidrich, A. & Posner, M. (2000). Evaluation of attention process training and brain injury education in persons with acquired brain injury. Journal of Clinical and Experimental Neuropsychology, 22(1).

Raskin, S. A. & Mateer, C. A. (2000) (Eds.) Management of Mild Traumatic Brain Injury. New York: Oxford University Press.

Mateer, C.A. (1999). Executive function disorders: Rehabilitation challenges and strategies.” Seminars in Clinical Neuropsychiatry, 4, 1, 50-59.

Mateer, C. (1999). The rehabilitation of executive disorders. In D. Stuss, G. Winocur and I. Robertson (Eds.) Cognitive Neurorehabilitation. Cambridge, UK: Cambridge University Press, pp 314-332.

Mateer, C.A. & Raskin, S. A. (1999). Cognitive rehabilitation. In M. Rosenthal, E.R. Griffith, J.S. Kreutzer and B. Pentland (Eds.). Rehabilitation of the Adult and Child with Traumatic Brain Injury. Philadelphia. F.A. Davis Company/Publishers, pp 254-270.

Mateer, C.A. & Mapou, R.L. (1996). Understanding, evaluating and managing attention disorders following traumatic brain injury.” Journal of Head Trauma Rehabilitation, 11, 1-16.

Mateer, C.A., Kerns, K.A. & Eso, K.L. (1996). Management of attention and memory disorders following traumatic brain injury.” Journal of Learning Disabilities, 29, 618-632.

Mateer, C.A. (1996). Rehabilitation of individuals with frontal lobe impairment. In J. León-Carrión (Ed.), Neuropsychological Rehabilitation. Delray Beach, FL. St. Lucie Press.

Kerns, K.A. & Mateer, C.A. (1995). Walking and chewing gum: The everyday implications of attention.” In R. Shordone and C. Long (Eds.), The Ecological Validity of Neuropsychological Tests, Delray Beach, FL: St. Lucie Press.

Mateer, C.A., Sohlberg, M.M. & Youngman, P.K. (1990). The management of acquired attention and memory deficits. In R.Wood & L.I. Fussey (eds) Cognitive Rehabilitation in Perspective. London: Taylor and Francis, 68-96.

Sohlberg, M.M. & Mateer, C.A. (1987). Introduction to Cognitive Rehabilitation: Theory and Practice. New York: Guilford Press.

Sohlberg, M.M. & Mateer, C.A. (1987). Effectiveness of an attention training program. Journal of Clinical and Experimental Neuropsychology, 9, 177-130.

Sample excerpt from Attention Process Training APT-1 by McKay Moore Sohlberg and Catherine A. Mateer, 2nd Edition 2001

General Theoretical Framework

 

The treatment activities contained in the Attention Process Training (APT) are organized according to a model of attention designed to guide the remediation of attention deficits in persons with acquired brain injury (Sohlberg and Mateer, in press). This model views attention as the capacity to focus on particular stimuli over time and to flexibly manipulate the information. Attention is conceptualized as a multidimensional cognitive capacity fundamental to information processing.

Deficits in memory and learning are frequently a consequence of impaired attentional processing. APT provides a variety of treatment activities which train the basic attention components critical to new learning. There are four levels or components of attention addressed in this training program: Sustained Attention, Selective Attention, Alternating Attention and Divided Attention. Descriptions of each level of the model are provided below.

Sustained Attention: The ability to maintain a consistent behavioral response during continuous or repetitive activity.

Selective Attention: The ability to maintain a cognitive set which requires activation and inhibition of responses dependent upon discrimination of stimuli. This includes the ability to screen out extraneous visual or auditory information.

Alternating Attention: The capacity for mental flexibility which allows for moving between tasks having different cognitive requirements.

Divided Attention: The ability to simultaneously respond to multiple tasks.

Hierarchies of treatment tasks were developed for each of the four attention components. This training approach is designed to be utilized with individuals who demonstrate impaired attentional processing as a result of brain injury.

Theories of Attention

Deficits in attention and concentration often go unrecognized or are misdiagnosed in the assessment of cognitive function following brain injury. Disruption of the physiological systems critical to the regulation of attention may occur as the result of seemingly minor, as well as severe, neurological damage. Deficits which initially present as memory impairments are often found to reflect underlying impairments in attention. Although the severity of an attention deficit nearly always lessens over the course of recovery, significant deficits in attention and concentration are often present many months or even years post injury.

In the past, clinical models of attention have been largely restricted to the domain of asymmetries in spatial responsiveness or neglect. The experimental literature views attention in a somewhat broader framework, but this has not been tied in to clinical phenomena. A broadly based view of attention served as the basis for the development of this attention retraining program. Briefly, attention is conceptualized as the capacity to focus on particular stimuli over time and to manipulate flexibly the information. Examples of cognitive tasks which we feel are likely to reflect attentional deficits, based on the APT model, include: backward digit span, serial number sets, Trails B, and backwards spelling.

There is far from universal agreement in the information processing literature regarding the mechanism of attention. Most models of attention are based on the human information processing approach first introduced by Broadbent (1958). According to these models, attention is usually viewed as a selectivity phenomenon by means of which target stimuli receive priority processing over concurrent nontarget stimuli. That is, attention is considered to be the process by which one selectively responds to a specific event and is able to inhibit responses to simultaneous events (Johnston and Wilson, 1980).

Under the rubric of selectivity models there appears to be two basic classes of attention theory. The first class consists of the earlyselection theories which are based on the view that the differential processing demands accorded target and nontarget stimuli operate at the perceptual level. Target stimuli are processed more fully because there is perceptual suppression of nontarget stimuli (Broadbent, l958; Johnston and Wilson, 1980; Treisman, 1969). Brain mechanisms act to omit the amount of sensory input that an individual must process.

The second class of selective attention theories consists of the lateselection theories in which the differential processing accorded to target and nontarget stimuli is conceived of as being nonperceptual in nature. According to these models, a special attentional capacity within the organism allows for preferential processing of target stimuli over concurrent nontarget stimuli. All perceptual information enters the system, but only that which is selected by the special attention mechanism reaches higher processing centers (Johnston & Wilson, 1980; Shiffrin & Schneider, 1977). Hence, the basic difference between early and lateselection theories lies in their view of the processing stage at which unimportant aspects of information or stimuli are screened out. The earlyselection theories propose that certain stimuli are never processed due to perceptual suppression of nontarget stimuli; whereas lateselection theories propose that the unimportant information enters the system but simply is not chosen for further processing.

A shortcoming of the selectivity models is that they often stop at the level of signal detection or target selection. Additional processing of information tends not to be addressed in these theories. A more comprehensive view of attention is necessary to adequately describe the attention deficits observed in brain injured populations.

The theoretical construct of working memory as described by Baddeley (1974, 1981) does begin to address the comprehensive nature of attention. The Central Executive, one component of Baddeley’s model, is hypothesized to provide for temporary storage of information. The capacity for such temporary storage allows for division of attention during information processing. Modeled as a controller of memory, the Central Executive allows information to be held in shortterm storage while attention is temporarily shifted to other stimuli. This model thus incorporates additional levels of information processing.

The problem with all of the current models of attention, however, is that they do not adequately address the clinical phenomenon of attention deficits or their remediation The few treatment programs for attention which do exist, tend to be task oriented without a strong theoretical base. At best, treatment programs address restricted components of attentional requirements. APT-1 is a clinical treatment program which considers attention to be a comprehensive and multilevel functional process. It provides a theoretically based, hierarchically organized method of retraining attention in persons with brain injury.

Basic Tenets of a Process Specific Approach to Cognitive Remediation

1. Theoretical Model: The use of theoretical model to guide treatment is extremely important. In the case of attention, the theoretical model consists of the four component attention areas including: Sustained Attention, Selective Attention, Alternating Attention and Divided Attention. A model is important because it forces clinicians to be theoretically based and utilize what is currently known about cognition from the experimental literature. It further provides a structure which encourages systematic delivery of clinical tasks.

2. Comprehensive Assessment: Assessment procedures should lead to the identification of specific brain processes that are disrupted and that interfere with the individual’s ability to function and learn effectively. Five basic cognitive processes that must be evaluated include:

  1. Attention/Concentration Abilities
  2. Visual Processing
  3. Memory
  4. Reasoning and Problem Solving; and
  5. Language.

Each of these major process areas contain specific subcomponents that must be individually addressed in therapy when the process is impaired. Sustained and Selective Attention are, for example, two important subcomponents of attention.

3. Process Approach: It is the disruption of basic cognitive processes that are responsible for changes in function. Because impaired cognitive systems are the underlying source of problems, they should be addressed prior to, or at least in addition to, the rehabilitation of more complex behavior such as independent living skills or vocational training.

4. Repetition: The training of cognitive process relies on the reorganization of brain systems. This reorganization requires repetitive performance of retraining tasks within a target process area. This forces the activation of processing within the deficit skill area.

5. Knowledge of Results: Patient knowledge of results can be a powerful motivational factor, useful for facilitating improved cognitive processing. Scoresheets and graphs, such as those provided in the APT, provide a convenient and concrete manner of displaying data such that patients can easily view progress. Many individuals can be taught to chart their own treatment data.

6. Use of Generalization Probes: Measurement of success in training deficit cognitive process areas should be accomplished using assessment tools which measure performance in the target process area, but which do not simulate any treatment tasks that may have been used during therapy. The Paced Auditory Serial Addition Task (Gronwall, 1977) is a sensitive measure of attentional processing appropriate for assessing changes in attention. Ultimately, success should be measured in terms of vocational and independent living outcomes.

As regards implementation of the APT, the clinician should identify the attention component(s) (Sustained, Selective, Alternating and/or Divided Attention) in which an individual is deficient. Specific tasks should be selected under each target component such that the patient performs with at least 50% accuracy. Tasks should be administered repeatedly until an 85% or greater success rate and no less than a 35% decrease in time from baseline trials (for timed activities) is achieved. Intensity and repetition are important factors for training and improving cognitive processes. More difficult tasks or levels should be selected as the individual improves. Independent measures of cognitive ability (i.e., neuropsychological and/or functional assessments) should intermittently be administered to ensure generalization of improved attention ability to functional behavior.

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