What is attention?
Attention is the ability to stay focused on a task from the beginning until completion. Attention skills allow us to “tune out” information that isn’t important to the task at hand. Having the ability to stay on task and finish activities is important for skill development. Attention is one piece in the puzzle of executive function.
So what are executive functioning skills? There are three main skills that make up executive functioning: working memory, mental flexibility, and self-regulation. Executive function serves as the control system of the brain. It allows us to organize incoming information, ignore distraction, and change gears. Self-regulation allows us to control our own level of arousal and alertness and adjust it to suit a specific activity. It allows us to pay attention and make safe choices.
Children born with the ability to develop executive functioning skills, but some children may need more help than others to acquire them. Children with ADHD or a sensory processing disorder (SPD) may have a more difficult time gaining executive functioning skills. They may have difficulties getting started on tasks, keeping their attention on a task, following multi-step directions, organizing materials, and managing their time. Children with executive functioning impairments may over or under react to problems, they may have difficulty making and keeping friends, and have low self-esteem.
Occupational therapists work with children to identify how these challenges are impacting their daily occupations. These occupations include performing self-care, being a good student, interacting socially with family and friends, and being successful at play and leisure activities.
Occupational therapists have tools to help children with executive function and self-regulation issues. An occupational therapist may use specific programs and strategies when working directly with a child or recommend changes to the child’s home and school environments and routines.
There are a few programs that occupational therapists use to teach children about self-regulation. These include The Alert Program (How Does Your Engine Run?) and The Zones of Regulation. These programs teach children to identify their own state of arousal, understand when different alertness levels are appropriate, and use sensory strategies to adjust their alertness when necessary.
Occupational therapists may develop a personalized Sensory Diet for children to help them maintain an optimal alertness level for school and/or home. Some children may need calming strategies to improve attention at school or to prepare for bedtime. Other children may need arousing strategies to combat lethargy. Different sensory integration techniques and strategies can be taught to children, families, and teachers. Examples of these include the Wilbarger Brushing Protocol, Mindfulness Training, and yoga practice. Diet may also play a part in self-regulation.
Occupational therapists can also target executive functioning skills through practicing discrete skills (i.e. activities that have a clear start/stop point such as puzzles, mazes, and dot-to-dots), using picture schedules so that the child can understand the sequence of an activity or his/her day, moving through obstacle courses, using timers to teach time management and help with transitions, and playing memory games.
Some of the environmental modifications that occupational therapists may recommend include:
- Set up a distraction-free environment. Use privacy dividers, noise cancelling headphones, or ear plugs, or seat the child facing away from other children or a window/door.
- Establish a homework routine to avoid procrastination and distractions.
- Use aids like calendars, daily planners/organizers, computers, or watches with alarms.
- Use visuals; Prepare visual schedules and review them several times a day.
- Create checklists and “to do” lists, estimating how long tasks will take. Use checklists for getting through and activity or assignment.