Understanding Attention Impairments
By McKay Moore Sohlberg PhD., CCC
What Does “Attention” Mean?
Human beings possess an amazing ability to process information. Every day we absorb vast
amounts of it through our senses, especially with our eyes and ears. We interpret this
complicated material rapidly in our everyday experiences.
This impressive information
processing system works in part because we have a unique attention system. Our abilities
enable us, for example, to hold a thought while dealing with an interruption, and then shift back to
it and continue the original conversation. Our brains are equipped to perform different types of
attentional skills, which in turn permit us to process all kinds of information under a variety of
conditions. Some types of attention can be impaired after a brain injury. They are described
next.
How Are Attention Impairments Recognized?
Attention problems frequently result from brain injury. Even seemingly minor blows to the head
can cause impairments in our attention skills, as can more severe blows. Although different types
of attention abilities are associated with different locations in the brain, the most common cause
of attention impairments is diffuse injury, or injury that is scattered throughout the brain. (This
kind of injury is often observed after car accidents or falls). Five types of attention problems that
are commonly seen after brain injury are described below.
Impairments in focused attention: Focused attention refers to the most basic level of attention
we can observe in others. Focused attention occurs when an individual takes notice of objects or
events in the environment. With this ability, one may focus on specific sensory stimuli (things that
can be seen, heard, or felt). Focused attention impairments are seen most commonly in people
with a decreased level of consciousness, such as those emerging from coma. When individuals
emerge from coma, they gradually progress from responding only to internal states (like pain or
changes in body temperature) to noticing events in the external environment.
Impairments in sustained attention: Sustained attention refers to the ability to stick with an
activity over time. After a brain injury, individuals often have difficulty maintaining their attention
or concentration on any one task. They may become easily tired or fatigued. Tasks that they
carried out prior to the injury, automatically, or without much effort (such as holding a
conversation, writing a sentence, driving a car), may now require a greater amount of energy and
concentration to complete. Problems with sustained attention may also show up as inconsistent
performance on an activity or task. There may be periods of very accurate performance, and
periods where the person makes lots of mistakes – or cannot do the task at all.
The ability to retain information temporarily represents the highest level of sustained attention.
Individuals who have a problem with this may experience more difficulty after their injury with
activities such as adding numbers in the head, or remembering a phone number long enough to
dial it.
Impairments in selective attention: A person with good selective attention can ignore
distractions in the environment and pay attention to the important information. Impairments in this
area are evident when individuals are easily distracted by surrounding noise in their environment.
For example, after brain injury, a person may have difficulty paying attention to a conversation or
task if traffic is going by the window, children are playing nearby, or other people are talking in the
background. People with impairments in selective attention may become easily irritated and
frustrated by such extraneous noise.
Impairments in alternating attention: People who can switch their attention easily from task to
task have good alternating attention abilities. This is a high-level attention skill. A person who
has difficulty moving from one task to another has an impairment in this area. You might notice
that lots of mistakes are made when your loved one tries, for example, to switch from a folding
task to a writing task. Sometimes people with this impairment continue to perform aspects of the
original task after they have moved on to a new activity. For example, if people with an
alternating attention disorder were asked to work on a particular puzzle, they may make lots of
mistakes when they try to switch to a writing task. Resuming an activity after an interruption may
also be a frustrating problem for people with an impairment in this area. They may find it easy to
lose their place while working on a task, and become unable to continue with it.
Impairments in divided attention: A person with good divided attention skills can pay attention
to two or more things at the same time. Normally our brains are able to take in information from
several sources simultaneously. For example, we can drive our cars while listening to the radio
or talking with a companion. After a brain injury, a person may have difficulty paying attention to
more than one thing at a time.
The degree to which attention deficits occur can vary greatly among individuals. Following a
brain injury, a person may experience one specific type of attention difficulty (such as not being
able to handle distracting noise), or have a more generalized attention problem, with difficulty
across all types of attention. The severity of attention problems people suffer covers a broad
range of experience. One person may encounter severe impairments in focused attention, while
another may be challenged by subtle problems with alternating or divided attention. Fortunately,
the severity of an attention impairment often lessens over time as the person recovers from the
injury.
Treatment for Attention Impairments
Only in the past ten years have rehabilitation professionals begun to treat attention impairments
with therapy. They use a variety of approaches, one of which involves attention training
exercises, in which clients practice such skills as shifting attention between different tasks, or
retaining information in their heads. Therapists may teach individuals how to set up their
environment or implement strategies so that their particular attention problems are least likely to
interfere with their daily functioning. Examples of this approach might be teaching someone to
utilise checklists, eliminate extraneous noise (for example, to turn off the radio while they work),
or say the steps of a task out loud as it is completed.
Medications that enhance attentional skills are another treatment option. Drug therapy is
experimental, however, and usually attempted only in extreme cases. Consultation with
rehabilitation professionals such as Occupational Therapists, Psychologists, Speech Language
Therapists, or a Physician may be helpful in determining whether treatment of attention disorders
is indicated for a particular person.
How the Family Can Help
The first step in helping someone who has an attention impairment is to understand that the
problem involves processing information. Reading this article should also help you prevent the
kinds of misunderstandings that frequently occur when a loved one is challenged by such an
impairment and behaves in unfamiliar ways. The hints below can help you help your relative or
friend cope with an attention impairment.
 Try and determine if there is a particular time of day (such as in the morning) when your family
member has more energy. Schedule activities or events that require more attention during
that time.
 Help your loved one pace him/her self. Taking short breaks during a task or activity may allow
someone to complete an activity that otherwise goes unfinished.
 Eliminate unnecessary distractions, such as the television or radio, during times when the
individual is trying to concentrate.
 Reduce the demands on your loved one’s attentional system by using organizational devices
such as written checklists, diaries, calendars, message boards, or stickie reminder notes.
 When communicating with a person challenged by attention impairments, present information
in a clear fashion. Try not to give too much information too rapidly.
 If appropriate, discuss the attention impairment with the individual and ask him/her what things
help to lessen the effect.
 If appropriate, educate significant others about the nature of the person’s attention impairment.
For example, discuss the problem with the teacher of a child with a brain injury. The
information may be useful in creating such helpful strategies as locating a child’s desk in the
front of the classroom. Talk to children about the nature of a parent’s attention impairment.
Such a discussion may help them understand that attention problems are caused by damage
to their parent’s brain, and that the parent feels very frustrated in certain situations (for
example, when there is extraneous noise). Increased understanding of the attention
impairment may encourage children to alter their behaviour to help their parent.
1994 By Communication Skill Builders. Inc 602-323-7500