Rehabilitationof

Attention

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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

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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

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Conscious Attention

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Conscious Attention

Conscious Attention

Conscious Attention

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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

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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

سپاسگزاریمwww.farvardin-group.com

@farvardin_group_channel

@neuroscience4family

@farvardin_group96