Attention Process Training APT-2

Attention Process Training APT-2 for Persons with Mild Cognitive Dysfunction

by McKay Moore Sohlberg, Ph.D., Lori Johnson, Laurie Paule, Sarah Raskin, and Catherine Mateer

The APT2 program is for adolescents, adults and veterans with mild cognitive impairments and attention disorders due to acquired brain injury. The APT2 program uses audio CDs for therapy tasks and PDF files for score sheets

Full Description

This program is for treating impairments in attentional processing in persons with relatively mild cognitive disturbance, such as post-concussion syndrome.

Activities address difficulties with sustained attention, slowed speed of information processing, distractability, shifting attention between multiple tasks, and paying attention to more than one source of information at a time.

What is APT-2 ?

• A library of auditory attention CDs and hierarchically organized attention exercises grouped according to specific types of attention disorders
• Generalization program with suggested activities, record logs, and data collection protocols to facilitate generalization from the clinic to real world settings

Who can use it?

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

What’s in the manual?

The APT-2 manual explains how to administer the attention training program and methods for scoring and analyzing client performance. All clinical and generalization tasks contain data collection graphs and charts, detailed task descriptions, and suggestions for increasing or decreasing task difficulty level.

APT-2 includes...

• 216 page manual with 5 tabs in a 3-ring binder
• 46 activity sheets and forms
• 6 audio CDs
• 4 response clickers and stopwatch
• CD with PDF files scoresheets.

All packaged in a sturdy handy carrying case.

Extra sets of CDs are available separately

Contents

Introduction
Background on attention and the APT-2 clinical program
Target population
Models of attention
APT-2 clinical model of attention
Treatment of attention deficits
Assessment of attention deficits
 
APT-2 Clinical program
Principles of treatment
Analysis of patient performance
Adjunct therapy
Sample therapy regimen
 
List of APT-2 clinical task descriptions 
Sustained attention task descriptions and sample scoresheets 
Alternating attention task descriptions and sample scoresheets 
Selective attention task descriptions and sample scoresheets 
Divided attention task descriptions and sample scoresheets 
 
APT-2 Generalization program 
General philosophy 
Procedures for promoting generalization 
Initial evaluation 
Designing generalization activities 
Generalization activities for sustained attention 
Sample scoresheet 
Generalization activities for alternating attention 
Sample scoresheet 
Generalization activities for selective attention 
Sample scoresheet 
Generalization activities for divided attention 
Sample scoresheet 
 
References
 
Appendix A 
Stimuli for clinical tasks
 
Appendix B 
Scoresheets/protocols for clinical tasks and generalization activities 
Auditory CD Stimuli

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).

The treatment activities contained in this program were developed and tested at a rehabilitation clinic which serves individuals with mild brain dysfunction mostly due to head trauma. Unlike the rehabilitation of individuals with moderate to severe head trauma, there has been very little focus on treatment issues relevant to persons with “post-concussive syndrome” sometimes termed minor brain injury. Indeed, there is significant controversy over the legitimacy of such a diagnosis. Typically, the mild brain injury population is described as those individuals who, after a blow to the head, do not suffer prolonged loss of consciousness and often demonstrate relatively rapid and complete physical recovery with few to no hard neurologic signs (e.g., no positive findings on neuroimaging studies) to account for their symptoms. The common cognitive and somatic complaints include: difficulty concentrating; difficulty organizing and remembering information; increased fatigue and irritability; headache pain; and vestibular problems. The cognitive symptoms often are not recognized by the individual until there is an attempt to resume responsibilities at home, work or school (Raskine & Mateer, 2000). Professionals and researchers who have studied and worked with this population agree that the entity of mild brain injury represents difficulties produced by an interaction of organic, psychological and environmental variables (e.g., Kay, 1990; Lezak, 1991; Raskine & Mateer, 2000).

The APT-2 is designed to address the information processing deficits observed in this population. An underlying assumption of the program is that the attention and concentration difficulties, which concern individuals with mild brain injury, are valid and amenable to treatment. Again, it is recognized that these problems are often a result of a combination of emotional and physiological changes. As described by Mateer, Sohlberg & Youngman (1990), the approach to cognitive rehabilitation inherent in the APT-2 program in combination with psychosocial support can be effective at assisting this population in resuming productive lifestyles.

These materials have been tested predominantly with individuals who have experienced mild brain trauma; however, there are a number of other etiologies for which this intervention approach may be applicable. Attention deficits have been described in persons who suffer a variety of relatively mild forms of neuropsychological impairment due to ailments such as multiple sclerosis, attention deficit disorders, chronic fatigue, chemical toxicity, and immunodeficiency syndrome. Although the central nervous system dysfunction itself may not be mild, the information processing deficits are often mild in comparison to those observed after severe traumatic brain injuries (Raskine & Mateer, 2000). One goal of publishing the APT-2 materials is to provide clinicians who serve such clients a cognitive intervention resource, albeit experimental. It is hoped that the tools contained in this program may serve as a starting point for evaluating methods to address the information processing deficits suffered by such individuals.

Although many of the aforementioned kinds of brain insults may be labeled as “mild” or “minor”, the impact of cognitive and emotional disturbances is often life altering. Relationship stresses and employment challenges are well documented (Raskine & Mateer, 2000). There is a great need for designing and evaluating cognitive and psychological interventions in order to prevent such problems as job loss and family disruption.

APT-2 Clinical Model of Attention

Focused Attention

This refers to the ability to focus on specific sensory information. Focused attention represents the most basic level of attention observed when an individual can acknowledge visual, auditory or tactile stimuli. Focused attention is most commonly disrupted in persons with decreased level of consciousness, such as those emerging from coma who gradually progress from responding only to internal stimuli to showing increasing responsiveness to stimuli in their external environment.

Sustained Attention

This refers to the ability to maintain attention during continuous and repetitive activity. It incorporates the concepts of vigilance, persistence and task consistency. At the highest level, sustained attention includes the ability of mental control or working memory incorporating the notion of holding and manipulating information in one’s head such as required doing mental math. Impairments in sustained attention may manifest as difficulty maintaining attention over time, increased fluctuation in task consistency, or increased vulnerability to the effects of fatigue.

Selective Attention

This third component refers to the ability to selectively process target information and inhibits responding to nontarget information. It is the ability to maintain a behavioral set in the presence of distractors or other competing stimuli and thus incorporates the notion of “freedom from distractibility”. Impairments in selective attention may be seen in individuals who are easily disrupted by surrounding noise or movement (external distracters) and/or who are distracted by emotional states such as worry or anxiety (internal distracters). The importance of selective attention is demonstrated by students in a classroom who must ignore noise from the playground outside in order to attend to classwork.

Alternating Attention

This component refers to the ability to shift one’s focus of attention. It is essentially the capacity for mental flexibility that allows an individual to switch attention between tasks or activities that demand different behavioral responses or cognitive sets. Impairments in alternating attention may be seen in patients who have difficulty starting up a task after they have been engaged in an alternate activity, or who continue performing according to the parameters of the previous task after they are supposed to shift to a new task. An example of the need for alternating attention may be seen in the work of a secretary who must rapidly switch between typing and answering phones.

Divided Attention

This final component refers to the ability to simultaneously respond to two or more events or stimuli. It is the capacity that allows an individual to divide his or her attention between two or more ongoing events. Deficits in this ability are evident when an individual can only process one source of information at a time. Divided attention is a critical ability for many daily tasks such as driving where an individual must simultaneously process traffic information, operate the vehicle and perhaps converse with a companion.

The above five components of attention: focused attention, sustained attention, selective attention, alternating attention and divided attention form the organizational framework for treatment tasks in the APT-2 program. This mode