by McKay Moore Sohlberg, Ph.D. and Catherine A. Mateer, Ph.D.
The APT test is a screening measure originally designed for use with the APT1 and APT2 programmes. It is an indicator to help clinicians target different types of attention in the client’s assessment and development of a treatment programme. It is not a normed psychometric test.
Users of the new computerised APT3 program need not use the APT Test as the APT3 manual details a number of standardised attention tests as well as rating scales that can provide a good indication of what attention areas to work on and offer an outcome measure. The APT3 can be found at http://www.lapublishing.com/apt3-attention-process-training
The APT test can be used with the APT 1 and APT 2 programmes.
It includes methods to screen for:
simple sustained attention in target detection format (level 1)
more complex sustained attention using sequential stimuli (level 2)
selective attention with distraction of background noise (level 3)
divided attention using visual and auditory tasks (level 4)
alternating attention using two different tasks (level 5)
How is it used?
What’s included in the manual?
background and introduction
theoretical basis for understanding attention
description of APT Test and other measures
guidelines for administering APT Test
1 set of scoresheets (12 pages) with instructions
audio CD with attention activities
CD with PDF files for easy printing of scoresheets
1 response clicker
Sample excerpt. Preview only – please do not copy
Background and Introduction
The Attention Process Training Test (APT-Test) is used to evaluate several components of attention based on a clinically derived taxonomy of attention skills. The test is an outgrowth of, and was specifically designed for use with, the Attention Process Training (APT) materials. This is a set of treatment tasks designed to improve attention in adolescents and adults with acquired disorders of attention and working memory (Sohlberg & Mateer, 1987; 1989, 2001). The APT training materials are based on a 5-level clinical model of attention and have been documented to facilitate improved attentional functioning in multiple clinical trials. Performance on the APT-Test can be used to help identify different components of attention that are impaired and the nature and level of APT treatment tasks that will be most appropriate for individuals.
The APT-Test was designed to provide a screening measure of attentional skills which conformed to the theoretical framework underlying the attentional training package. Age adjusted norms are provided for 277 adults ranging in age from 18 to 80.
Part I: This subtest samples simple sustained attention in a target detection format.
Part II: This subtest samples more complex sustained attention involving mental control and decision making based on comparison of sequentially presented stimuli.
Part III: The selective attention subtest is identical to that in Part II but with the added distraction of background noise.
Part IV: This subtest evaluates divided attention in a dual task paradigm combining visual and auditory tasks.
Part V: The alternating attention subtest requires frequent shifting in response set between two different tasks.
assist in evaluating possible attentional impairment
document appropriateness of initiating attention training
determine the level at which training needs to begin
Determination of attention impairment should always be based on multiple psychometric measures of attention, not solely on the APT-Test. Also, the APT-Test should not be used to document treatment efficacy when APT training is used, as the tasks that make up the APT-Test closely approximate the APT treatment tasks. Rather, use of an independent psychometric measure such as the Brief Test of Attention or the Paced Auditory Serial Addition Test (Gronwall, 1977), attention rating scale data, and functional measures should be used to document efficacy of interventions. For a more comprehensive discussion of attention and the treatment of attention disorders, the reader is referred to the chapter on attention from Cognitive Rehabilitation: An Integrated Neuropsychological Approach (Sohlberg & Mateer, 2001).
Sohlberg and Mateer (1987; 1989) proposed a model of attention based upon clinical observations of a variety of discrete attentional problems demonstrated by patients with brain injuries under their care. They proposed five subsystems of attention organised in a hierarchical fashion, in that the integrity of each component is dependent on the integrity of those below it. The subsystems are: focused, sustained, selective, alternating, and divided attention.
Focused attention was defined as the ability to respond to a specific auditory, visual, or tactile stimulus. Although almost all patients recover this level of attention, it is often disrupted in the early stages of emergence from coma. The patient may initially be responsive only to internal stimuli (pain, temperature, etc.) and only gradually start responding to specific external events or stimuli.
Sustained attention refers to the ability to maintain a consistent response during a continuous and repetitive activity. It incorporates the notion of vigilance. Disruption of this level of attention is implied in the patient who can only focus on a task or maintain responses for a brief period (i.e., seconds to minutes) or who fluctuates dramatically in performance over even brief periods (i.e. variable attention or attentional lapses). It also incorporates the notion of mental control or working memory on tasks that involve manipulating information and holding it in mind. Thus, one can conceptualize simple and more complex sustained attention.
Selective attention refers to the ability to maintain a behavioural or cognitive set in the face of distracting or competing stimuli. It incorporates the notion of "freedom from distractibility". Individuals with deficits at this level are easily drawn off task by extraneous or irrelevant stimuli. These can include both external sights or sounds, and/or internal distractions (e.g. worry, rumination, or focus on personally important thoughts). Examples of problems at this level include an inability to perform therapy tasks in a stimulating environment (e.g., an open treatment area) or to prepare a meal with children playing in the background.
Alternating attention refers to the capacity for mental flexibility that allows an individual to shift his/her focus of attention, and move between tasks having different cognitive requirements. Problems at this level are evident in the client who has difficulty changing tasks once a "set" has been established and who needs extra cuing to pick and initiate new task requirements. Real-life demands for this level of attention are frequent. Consider the student who must shift between listening to a lecture and taking notes, or the secretary who must continuously move between answering the phone, typing, filing, and responding to inquiries.
Divided attention involves the ability to respond simultaneously to multiple tasks or multiple task demands. Two or more behavioural responses may be required or two or more sources of stimuli may need to be monitored. This level of attentional capacity is required whenever multiple simultaneous demands must be managed. Performance under such conditions (e.g., driving a car while listening to the radio or holding a conversation during meal preparation) may actually involve either rapid and continuous alternating attention or dependence on more automatic processing for at least one of the tasks.
Sohlberg & Mateer’s model was used as the basis for both the Attention Process Training (APT) materials and the APT-Test.