This is a pediatric attention training program that is modeled after the Attention Process Training (APT) program developed by Sohlberg and Mateer. This new second edition features an expanded manual, updated review of research studies, and additional attention activities.
Designed for children (ages 4-10) with attentional processing problems, activities are designed to systematically increase the child’s ability to sustain, select, divide, and alternate attention using a variety of hierarchical tasks designed for this age range and cognitive levels.
The manual includes:
Pay Attention! can be used by cognitive rehabilitation therapists, speech and language pathologists, educators, and other professionals in private practice, pediatric rehabilitation programs and schools. Research studies have demonstrated its effectiveness with children with traumatic brain injury, attention deficit hyperactivity disorders, and brain tumors. Extra Flashdrives are available separately.
Second edition 2005
The Clinical Attention Model
Studies of Attention Training in Adults
Studies of Attention Training in Children
Development and Efficacy of the Pay Attention! Materials
Utilization of the Pay Attention! Materials with Dyslexic Children
Cognitive Rehabilitation Strategy
The Pay Attention! Materials and Task Summary
Pre-Tests for Younger Children or Children with Suspected Cognitive Impairment
Complete text of CD #1 Stimuli
Alternating Auditory Attention Stimuli
Pay Attention! Card Sort Scoresheet (2 copies)
Pay Attention! Card Sort/Flip Scoresheet (2 copies)
Pay Attention! House Search Scoresheet (2 copies)
Pay Attention! Attention CD Scoresheet (2 copies)
Arithmetic Worksheets #1-#5 (2 copies)
The Pay Attention! children’s attention process training system is modeled after the Attention Process Training program (Sohlberg & Mateer, 1987a & b). It includes activities appropriate to the remediation of children’s (ages 4-10) attention processing problems. The materials are designed to remediate difficulties with sustained, selective, alternating, and divided auditory and visual attention skills, as defined below.
Attention is not a unitary construct. There are several models proposed to outline the major components of attention and their underlying neurological structures (Kerns & Mateer, 1996; Mirsky, Anthony, Duncan, Ahearn, & Kellam, 1991; Posner & Peterson, 1990). Regardless of which model is adopted, most models include separable components of attention such as the ability to sustain attention over time (vigilance), the ability to attend to stimuli selectively, the ability to alternate or switch attention between two things, and the ability to divide attention so as to maintain more than one ongoing process.
Sohlberg and Mateer (1989b) suggested that attentional capacity is hierarchical, such that in order to be able to succeed in tasks that require higher levels of attention (such as alternating or dividing), lower levels of attention such as focusing and sustaining attention are necessary. The higher order aspects of attention were felt to be dependent not only on these underlying skills, but also to involve more executive abilities such as the ability to disengage attention and inhibit. Such aspects of attention are dependent on the frontal regions of the brain and begin to overlap with some of what have been termed “executive functions”.
The Clinical Attention Model (Sohlberg & Mateer, 1987)
Focused attention refers to the ability to direct one’s attention to a specific stimulus. This construct generally applies to those with disrupted levels of consciousness; e.g., patients emerging from coma who are only beginning to gain the capacity to acknowledge external stimuli. The Pay Attention! materials are not utilized for the remediation of focused attention.
Sustained attention refers to the ability to maintain attention during continuous and repetitive activity. This construct includes the concepts of vigilance and persistence. At its highest level, sustained attention includes the ability to utilize “working memory” or “mental control,” as in one’s ability to hold information in mind and manipulate it in order to solve a problem. Sustained attention is necessary for most classroom seatwork, for example completing worksheets or reading silently.
Selective attention refers to the ability to attend to target stimuli and to inhibit responses to non-target stimuli. This construct incorporates the notion of “freedom from distractibility.” Selective attention skills are necessary, for example, for a student who must listen to a teacher while there are children playing outside.
The ability to switch the focus of attention from one stimulus to another is the hallmark of alternating attention. This skill is necessary when one is required to stop one task and begin another, or to switch rapidly between one or more tasks. For example, alternating attention skills are needed for children changing from one task to another within a lesson.
One’s ability to utilize divided attention is demonstrated through performance of two or more tasks simultaneously. Thus, divided attention skills are needed for a student note-taker, who must listen and write at the same time.
The premise of direct intervention or process specific approaches, as applied to the treatment of attention impairments, is that the ability to attend can be improved by providing structured opportunities for exercising particular aspects of attention. Treatments have usually involved having subjects engage in a series of repetitive drills or exercises that are designed to provide opportunities for practice on tasks with increasingly greater attention demands. Repeated activation and stimulation of brain systems responsible for attention is hypothesized to facilitate changes in cognitive capacity, which presumably reflect underlying changes in neuronal activity.
Effects of training can be measured at several levels including:
Studies of Attention Training in Children
There are fewer studies which have examined the efficacy of attention training programs in children. Some studies have examined attention training effects in older children and adolescents who demonstrated acquired impairments in attention secondary to traumatic brain injury (Thomson, 1995; Thomson & Kerns, 2000), while others have focused on attention training effects in children with the developmental attention deficits seen in ADHD (Semrud-Clikeman, Harrington, Clinton, Connor, & Sylvester, 1998; Semrud-Clikeman et al., 2000; Kerns, Eso & Thomson, 1999) or following chemotherapy and radiation treatment for cancer (Butler & Copeland, 2002; Penkman, 2004).
In children with ADHD, Semrud-Clikeman and colleagues (Semrud-Clikeman et al., 1998; Semrud-Clikeman et al., 2000) examined the efficacy of attention training coupled with training in problem solving within a school setting. Attention training materials were all from the Attention Process Training (APT) system developed for adults by Sohlberg and Mateer (1989b). Teachers selected children for treatment who were having problems in attention and completing work.
Using a multi-modal and multi-informant assessment, children were assessed as either having difficulty in this area or not and divided into one of three groups; ADHD children who would receive the intervention, ADHD controls with no intervention, and control children with no attention problems.
Children with poor attention skills identified in this manner had poorer performance on a visual and an auditory attention task, measures of visual-motor ability and cognitive flexibility. Children in the intervention group were administered tasks from the APT materials and also taught problem-solving strategies in small groups (5 to 7 children). Children were seen for one hour, twice weekly for a period of 18 weeks.
Pre and post-testing revealed significant changes on a measure of visual cancellation and a measure of auditory attention. On the visual cancellation task, the ADHD group receiving treatment performed more poorly than controls prior to treatment but did not differ from controls following treatment. On the test of auditory attention there was a significant improvement in the performance of the treated ADHD children following intervention, but no change in the controls.
The authors commented informally that children off medications appeared to make better gains than those on medication during the treatment. Additionally, qualitative interviews with teachers revealed that children who had undergone the treatment seemed more attentive and showed improvement in completing tasks in class.
Butler and Copeland (2002) examined the efficacy of a cognitive remediation program in children who are cancer survivors. The treatments for cancer (chemotherapy and irradiation) can result in significant cognitive impairment, most commonly in the areas of attention and concentration. In this study, the authors used a combination treatment including a direct intervention component (using modified APT materials), educational component (metacognitive strategies), and a clinical component (CBT modeling appropriate dialogue). They compared a sample of 21 treated and 10 control subjects and found that the group receiving the remediation exhibited a statistically significant improvement on all three attention measures used in the study, while the control group had no significant changes. The authors concluded that a program of cognitive remediation has the potential for improving attention and concentration.
For a comprehensive review of the pediatric attention training research, see Penkman (2004). Seven studies/case reports in three pediatric groups were reviewed: cancer survivors with CNS impairment, children who had sustained traumatic brain injuries (TBI), and children with attention deficit-hyperactivity disorder (ADHD). Six of seven studies described improvement on attention measures.