Post on 21-Jan-2018
Rehabilitationof
Attention
:ارائه شده در
کارگاه تخصصی آگاهی، توجه، عصب شناسی
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Diagnosis: Inattentive Subtype
Careless mistakes in schoolwork
Poor attention in tasks or play
Doesn’t listen when spoken to directly
Fails to finish things
Difficulty organizing
Avoids/dislikes tasks requiring focusing
Loses necessary items
Distracted by extraneous stimuli
Forgetful in daily activities
What do we mean when we say we are “paying attention?”
Focus on one task to exclusion of others Selectivity Inhibition of irrelevant information Ability to shift attention (disengage from one task and engage with another task)
Maintaining focus Vigilance – sustained attention to one task
Division of effort across multiple tasks Multitasking Allocation of resources to multiple tasks The Role of Automatization
Treatments
Stimulant medications – 1st line (MTA)
Alternative non-stimulant medications
Community support
Behavioral interventions
School interventions
Cognitive rehabilitation
What is Cognitive Rehabilitation?
A brain injury often dismantles the capacity for or at least timing and coordination of various brain functions
Antonio Damasio
“In the brain, timing is everything!”
Cognitive rehabilitation follows a process of:
Identifying areas of impairment
Facilitating compensatory mechanisms to rapidly improve some function
Challenging the brain to restore function
• Team work• Drug and food• Resting and sleep• State dependency of Attention• Emotion and impatiency• Task diversity to avoid impatiency• Do not stay on one point too long• Periodic resting
• Physical Exercise
• Gold times and Tiredness
• Time management
• Reward for reaching goals
• Meditation and Relaxation
• There is not a unit protocol for everybody
• Set definite goals
Start… Ethic
to assure
Security
play
Compensatory approachSummarization
Schema and pictures
Notes and Categorization
Conceptual or Structural Relationships
Use Auditory Cues to prompt Attention on Multitasking
Use the Alarm on your phone and keep hitting ** Snooze **
Self Alerting ProceduresAs a consciousness strategy
Convergence light
Blue light
Avoid busy locations and Interruptions
What is the effect of practice?Automatic & Controlled Processing
Controlled Processing
Attentional processing
Sequential, slow, flexible, requires resources
Automatic Processing
Distributed processing
Parallel, fast, inflexible, requires few resources
11
Conscious Attention
repeat
Conscious Attention
Conscious Attention
Conscious Attention
repeat
And more repeat
Motivation
Automatization of
Interests
Consciousness
Cognition
Inhibition
VolitionDetermination
Costs of consciousness
Challenging the brain to restore
function
Perception and attention
Bilateral relationship
• Mapping of world • Conceptual clustering
Dual Task Performance
Divided attention is difficult when:
Tasks are similar
Tasks are difficult
When both tasks require conscious attention
Divided attention is easier when:
Tasks are dissimilar
Tasks are simple
When at least one of the tasks does not require conscious attention
Tasks are practiced
Cuing Attention
Give people a cue where a target will appear in the visual field
Manipulate the kind of cue
Valid Cue
Neutral Cue
Invalid Cue
How does cue affect performance?
Stroop Task
Stimulus activates competing responses
Color name (generated by reading)
Color name (generated by perception of color)
Two possible task demands:
Read the word
Name the ink color
Must inhibit one response to make the correct response for the task demands
Selective Attention
Selective Attention
The cocktail party
Shadowing Listening to two different messages and repeating back only one of the messages
as soon as possible after you hear it
Dichotic presentation Listening to two different messages (presenting a different message to each ear)
and attending to only one of them Report by time of arrival
Report by location (left ear, right ear)
Dichotic Listening Task
Vigilance Sustained attention
Example – (Mackworth, 1948)
Participants were watching when a clock …
Substantial deterioration after half an hour of observation
Vigilance can be increased with training
Sustained Attention
Write start and stop times on assignmentsUse incentive systemsBreak down tasks into steps
Make tasks interesting for children
Give child something fun to do when task is completed
Provide attention and praise when child is remaining on task
Scan the environment for particular features
Whereas vigilance involves passively waiting for a signal stimulus to search involves actively seeking out target
Search
AttentionSearch
2 kinds of search:
Feature search
When we can look for some distinctive features of a target we simply scan the environment for those features
Conjunction Searches
Target is a combination of features
Different sources of stimulation
Modulating of stimulations
Play with Undesirable stimulation
Focused attention to a location required to detect integrations of features
Find the T
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Find the Blue Letter
LL
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Find the Blue Letter
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Find the vertical T
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Find the vertical T
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Find the vertical T
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Find the Blue L
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Find the Blue L
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All Searches Are NOT Equal
A Is More Difficult Than B
A B
Is There Trouble?
“a neuropsychological concept referring to the cognitive processes required to plan and direct activities, including task initiation and follow through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal-directed persistence.”
An executive function is
Deficit: Response Inhibition
This is “the capacity to think before you act”
Children with this deficit tend to be impulsive.
They will say things without thinking
Response Inhibition Reduce situations where the child can get into trouble
Proximity Control: Increase supervision of the child
Control impulses by modeling appropriate behavior
Reinforcement of Volition
To teach the skill:
Give options to the child Today X…. Tomorrow Y
Reinforce the skill
Ignore inappropriate behavior
Yes or No match
Deficit: Self-Regulation Of Affect
This is “the ability to manage emotions in order to achieve goals, accomplish tasks, or control and direct behavior”
These children tend to become upset quickly with situations, unable to control their emotions.
Self-Regulation Of Affect
Prepare child for problem situations
Break tasks down into small steps
Give breaks to child during tasks as needed
To teach this skill:
Practice with the child
Reinforce child when strategies are used
Discuss real life situations of using the strategy
Deficit: Planning
This is “the ability to create a roadmap to reach a goal or tocomplete a task. It also involves being able to make decisions aboutwhat’s important to focus on and what’s not important”
These children tend to wait till the last minute to complete tasksand then not know what to do when they go to complete them.
Planning
Use rubrics Break long assignments into smaller pieces
with deadlines for each piece Create planning sheets of time management
To teach the skill:
Walk through the planning process with the child
Tell student to create roadmaps for tasks
Ask questions such as “What do you have to do first?”
Deficit: Organization
This is “the ability to arrange or place things accordingto a system”
These students tend to have messy desks or cubbies.
They frequently lose objects instead of placing them inappropriate spots.
Organization
DisciplineCreate schemes for organizing
backpacks and folders
Color-code folders, notebooks, and papers for classes
To teach the skill: Teach child to separate papers and categorize them
Have them create their own organization plan
Deficit: Flexibility
This is “the ability to revise plans in the face of obstacles, new information, or mistakes”
These children have difficulty in transitions and new situations.
These children have limited problem solving strategies.
Give warning for new schedules or activities
Provide rubrics to follow
Read social stories to teach coping strategies in problem situations
Offer positive reinforcement and step by step assistance with difficult
problems
To teach the skill:
Teach them what inflexibility is and how to recognize it
Teach and model coping strategies with plans and cues
Teach relaxation strategies
Social stories
Deficit: Metacognition
This is “the ability to stand back and take a bird’s-eye view of oneself ina situation.
It is an ability to observe how you problem solve.
It also includes self-monitoring and self-evaluative skills”
These children make careless mistakes frequently.
They also will complete one step then stop instead of finishing theseries of steps.
Metacognition
Define the skill and what is needed to use the skill appropriately
Practice the skill bird’s-eye view
Create error-monitoring checklists
Teach children to ask themselves self-monitoring questions while tasks are being completed
Processing Speed and Task Initiation
• Working too slowly on tasks…. How do i get there?
• Requiring personalized attention to grasp new concepts
• Struggling to meet deadlines or anything timed
Practice a specific skill…
Help child to be more efficientWork on planning and organization skills
meet deadlines….
Other Solutions To Helping The ADHD Child
Make tasks very clear
Use lots of visuals
Provide hand signals
Play beat the clock
Use behavioral contracts
Use sticker charts
Allow them to move around
Allow more time for tasks
Use manipulatives such as Koosh balls or hand exercisers for children
Neurofeedback
TMS
tDCS
کارگاه تخصصی
آگاهی، توجه، عصب شناسی و
توانبخشی
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@neuroscience4family
@farvardin_group96