Wednesday, October 16, 2013

Speech Therapy Task Ideas for Treating Attention

Attention skills and avoiding distractions can be tough to target.

What do you do to target attention skills?
Even the Phantom struggles with attention span issues...

For my next few blog posts, I will be sharing portions of a student SLP project by Janelle Barrett.

Janelle was my student about a year ago.  For Janelle's project, she created a shared document and asked several of her student colleagues and my colleagues and others to contribute all their task ideas for a given area.  I'm going to divide each area into a separate post.  For this post, here are all the treatment task ideas for working on attention...  Functional, structured, high-level, low-level. These are ideas for sustained attention or focus, unless otherwise specified.  Please please please, comment and add some of your own!  We would love some more great ideas.  Janelle asked all of her student cohorts, and my colleagues, and many others to contribute to a shared spreadsheet, so these are ideas from several different SLPs.  Great, huh?  Who can get enough task ideas in their repertoire?  Not me.

By the way, what is attention?  The most basic cognitive skill- which is a prerequisite for the other skill areas in many ways.  It's the fundamental skills required for new learning and successful cognition.  Attention is generally divided into 5 types:
  • Focused Attention - the ability to respond discretely to specific visual, auditory, and tactile tasks.
  • Sustained Attention - ability to maintain cognitive dedication to a specific, continuous, or repetitive task.  requires vigilance and working memory.
  • Divided Attention - ability to respond or attend to multiple stimuli at once.  E.g., watching a small child while cooking a stir fry. Multitasking. 
  • Selective Attention - the ability to select and maintain cognitive focus in the presence of internal or external stimuli or distractions.  It's the ability to tune-out those distractions. 
  • Alternating Attention - involves the mental flexibility for moving between tasks with different cognitive requirements.  Shifting attention.  E.g., having a conversation while occasionally checking your email for an important incoming message. 
Evidence Based Practice suggests that some tasks can not be generalized, and actual real life tasks must be practiced in order to be effective.  AND that compensatory strategies are the most effective use of therapy time.

Most of these tasks below are for addressing sustained and focused attention, and then I'll try to label them if it's for a different type of attention.  

Tasks for targeting Attention skills:

  • Compensatory strategy training:  
    •  use of a timer to give breaks and goal time for maintaining attention to a given task
    • turning off other sounds and distractions 
    • Using finger to follow along when reading
    • Reading aloud
    • Changing the pace of reading
    • Making a list of disctractions or things that have helped you
    • Making a schedule of tasks to do do 
    • Educate the family so they or visitors are not distracting
    • Try performing a task with music on and then with music off to assess the effectiveness

  • Focused attention: listening for a certain sound. 
  • Connect the dots 
  • Build an object based on written/picture instructions (could also target sequencing) 
  • Word search 
  • Sudoku (also could target Info processing and reasoning) 
  • List of words (find or list all words that start with __ ) 
  •  unscrambling words, sentences
  • putting words (or the words form a sentence) in alphabetical (or sequential) order (e.g., smallest to largest, earliest in the year to latest)
  • Calculating money amounts in ascending or descending order (e.g., 3 nickels, 2 dimes; 5 quarters, 4 pennies 2 nickels).
  • Word creation - provide a long word for patient to hold in memory and make smaller words out of a big word
    • App: Jumbline 2
  • Timer: attend for ___ minutes without a break
  • Reading comprehension/auditory comprehension task
  • Visual attention/neglect: 
    • letter/digit/symbol cross-out task, aka: cancellation worksheet
    • reading words, sentences, then paragraphs, and articles
    • Visual attention strategies: highlighting the side of the page, numbering the lines, following along with a finger, finding the edge of the page.  
      • however note that research suggests that internal strategy training is the most effective treatment (patient internalizes the need to look left, as opposed to external cues).  (Myers, 1994.) 
        • Myers and Mackisack suggest 2 techniques:
          • Edgeness - requires a rectangular work space with a raised border. The patient traces the border with their finger. SLP places colored cubes at various areas within the work space adn instructs the patient to locate adn remove the total number of cubes with the instructions, "Look until you have found them all." Increase the difficulty by placing most of the blocks on the left.  Or placing 2 colors of blocks and asking for only one.  Encourage patient to begin tracing boundaries of other work surfaces such as keyboards, books, etc. 
          • Bookness - Patient describes a closed book which is placed at midline. Patient opens the book, traces the perimeter, and again describes what they see.  Begin with matching tasks (a word on the left or right) and ask the patient to trace the book between every stimulus item. Over time, increase the number of stimuli, and add foils. 
  • Following multi-step directions 
  • Following complex written directions (e.g., "Place a line under each word that begins with a vowel.")
  • APT (Attention Process Training)
  • “Find the differences” picture/apps
  • “Find the hidden objects” Apps
  • I Spy Book
  • Where's Waldo book or app
  • Brain baseline app (also has alternating attention)
  • Doodle Find app
  • Little Things app
  • Short video with quiz questions after (like practicing for listening in school) 
  • Divided Attention: 
    • Could really do ANY of the attention tasks listed in this post but do them simultaneously
    •  Attend to multiple stimuli-- provide a page-length story with instructions to circle all capital letters, cross out commas, and to put a check over the prepositional phrases
    • Sort a deck of cards while listening to spelled words (and then stating the word)
      • rearrange the letters of scrambled words for increased difficulty
  • Completing a number pattern (verbally)
  • Math story problem
  • Decoding worksheets
  • Finding differences; easy to hard levels- attention to details
  • IPad app: Differences
  • Providing navigational directions to another person (Focus on Function p. 156)
  • Describe 5+ features/parts/characteristics of a given object
  • iPad app: Museum search (high complexity level)
  • iPad app: Doodle pro (timed, min-complexity)
  • iMazing, iPad app (mazes of increasing complexity)
  •  Listing (find all words that start with __ )
  • Selective Attention:
    • turning on the radio while giving instructions to the patient and during task
    • open the therapy office door
    • treat them in a busy area
    • open the window
    • talk with someone else or make a phone call while they complete a pen and paper task
    • tap the table with a pen or move your foot within their sight, turn pages of a book, or type on a computer. 
    • Assess which distractions have the more significant impact on performance by timing or checking accuracy on a comparable task with different distractions happening on each trial. 
    • Ask client to listen for only one of two voices on a recording and ask questions about what the voice said. 
    • listen for key words in a paragraph (or sentence)
  • Alternating Attention: 
    • On paper randomly put the letters A-J and numbers 1-10 have pt alternate between number and letters in ascending order
    • Alternation patterns could also include months, counting BACKWARD, alphabet BACKWARD (or part of it), colors of the rainbow (if they know them in order), days of the week, random WORDS in alphabetical order, planets (if they know them), playing cards in a standard deck, states (if they know the song), do re mi..., holidays, OR pick any category and have them alternate with something in a different category : e.g., any fruit and then a month in order
    • “Think It Through” tile game (we ordered this through Discovery Toys)
    • Task switch with cards: odd/even & high/low (also on the iPad)
    • Stroop tasks (both interactive- computer and on paper) color task, directionality, number task, objects task
    • Motor--Card sorting tasks (There are various.  We actually have a book of these tasks!)
    • Motor--Sort coins, small objects, photo cards colored rubber bands or paper clips, inventory pages, coupons, magazines by month, folders or papers. 
    • Respond to yes/no questions or simple WH- questions, open ended questions, opinion questions, state the advantages/disadvantages of a situation.  
    • Use phone or navigate the internet, send an email.
    • Solve math problems
    • Unscramble words, generate items in a given category, put a target word into a sentence
    • Fruit Ninja, Dr. Ben (iPad)
    • Blink Card naming or sorting tasks (I love these cards!  Example of a  high-level task: "Flip over the cards one by one, and with each flip, say the color of the objects, then on the next flip, the number of objects, then the shape of the objects.  Continue in that order- color, number, shape.)
    • Typing what's on a paper or typing the answers to questions on a page (patient has to alternate between the paper, their thoughts, the keyboard, the screen, the mouse). 
    • Name and company sorting - using business cards or business info on index cards-- instruct patient to sort alphabetically by names or company names on the left.  When you say switch, they sort by the names on the right. (Could also do it with street numbers or zip codes).
    • verbal interruptions while reading -- instruct the patient to read an article and prepare to discuss.  Provide paper and pen and randomly interrupt with instructions to write and to recall later (e.g., your wife wants you to call her after therapy. Bring your book back to the library by 8pm).  Then discuss the article to assess reading comprehension and review the written instructions to ensure accurate processing and recording of information. 

So, whaddya think?  Did you find any good ones?

Now be sure to comment and help us add to the list!!  What do you use to target attention skills in your patients?



  1. I like to utilize a Connect Four board for my lower level attention patients. I make a pattern on one side utilizing the red and black chips and they need to mimic that pattern across the whole board. This can also be done by borrowing the OT peg boards in your facility. This adds more colors to the pattern.

  2. Thank you so much for this list. Will use with my husband!!

  3. Great post! I am a doctoral student in instructional technology and distance education with a background in teaching ESL. I came upon your blog, as I am researching this attention issue in regards to my dissertation. It is wonderful to have such a list