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GETTING AND MAINTAINING ATTENTION IN YOUNG CHILDREN WITH SHORT ATTENTION SPAN.
By Nwokolo Okey-Martins ( Mphil/ Ph.D Student, Dept. of Psychology,University of Lagos).
ABSTRACT
This article examines the meaning of short attention span as well as the difficulties that parents, therapists and teachers encounter in their effort to help young children with such conditions learn.

The author shares insights from practical experience and modern research on short attention span and Attention Deficit Hyperactive Disorder (ADHD).These insights demonstrate the need to understand the impact of the various types of learner environments (including the physical, sensory, dietary, and emotional environments) on the child’s ability to attend for a length of time sufficient to complete a given task. An understanding of how these environments influence attention span as well as the different methods of manipulating them will enable those working with such children to develop effective intervention techniques. Since each child is different, and what works for a given child may not be effective with another child, the author concludes with a general guideline for improving attention span.
 
ATTENTION SPAN:
The term attention span refers to the amount of time a person can concentrate on a single activity. If you are unable to complete a thought, or are easily disturbed by other stimuli, you may have a short or abnormal attention span. A short attention span interferes with a person’s ability to focus and attend, thereby making a learning difficult. Because, most learning requires the active, conscious and directed effort of the learner, the ability to attend and focus is considered to be of prime importance.

Many children with special needs, particularly those with developmental disabilities and specifically Autistic Spectrum Disorders (ASD) often present with short attention span. Some are easily distracted, have fleeting eye contact, spinning objects, hand flapping, rocking, insistence on sameness, act aloof, restlessness, running from one end of the room to the other repeatedly, hand biting, head banging, temper tantrums, starring and several other challenging behaviors that disrupt attention.

Bayo, a two and half year old boy, avoids eye contact with his parents and siblings and turned away if they tried to engage him in a play. He wandered aimlessly around a room, touching everything, holding on to one object until he finds another he likes better, then dropping that for another. He couldn’t sit still, and he resisted any attempt to engage him by screaming and throwing tantrums. Parents reported that they were devastated, exhausted, confused and frustrated. They kept wondering how on earth they could get Bayo to look at their face, play with them or even listen to their songs for a few seconds.

Recently, I interviewed twenty-eight (28) therapists and parents asking what they felt their greatest problems working with special needs children was; 85% of them gave answers indicating problems that arose from difficulties in getting the children’s attention and keeping it long enough to complete a given task. They complained that if only the children could concentrate, focus and pay attention, they can learn much more.

Getting a child to attend by making eye contact, focus/reference, sit properly, self-regulate and be in a calm-alert state is an initial goal in the Acceleration therapy programme.

SOME CAUSES OF INATTENTIVENESS AND SHORT ATTENTION SPAN IN CHILDREN WITH ASD
There are strong differences in professional opinion about the exact causes of inattentiveness and short attention span. However, evidences abound for neurological, genetic, behavioral, sensory and nutritional causative factors. In spite of the disagreement over the exact cause(s) of attention span problems, it is important to recognise that whatever is responsible for the sensory, behaviour, social and communication deficits in autism does in fact, directly or indirectly interfere with the concentration and attention abilities of those living with it. When these deficits or needs are compensated for or met, the children focus, concentrate and their attention span increase.

 
ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD)
Meaning: ADHD has to do with inattentiveness, impulsivity, over-activity, or a combination. These problems must be out of the normal range for the child’s age and development before they can be labeled ADHD. Attention deficit disorder is the commonly diagnosed behavioral disorder of childhood (Smith & Iwata, 2002). It is more common in boys than girls and affects about 3 – 5 % of school aged children.

ADHD interferes with a person’s ability to pay attention, focus and learn. It affects a child’s performance at school, relationship with peers and leaves parents/teachers exhausted and sometimes frustrated.

CAUSES OF ADHD
Research suggests that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters i.e. brain chemicals (including dopamine, serotonin and adrenalin) differently from their peers. ADHD is genetic and may run in families.

SYMPTOMS OF ADHD
According to the Diagnostic and statistical manual (DSM – IV), the symptoms of ADHD can be divided into two – namely:

(a) Those of inattentiveness
(b) Those of Hyperactivity / impulsivity

(A) Inattentiveness Symptoms:
1. Difficulty sustaining attention in tasks or play
2. Fails to give close attention to details
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish drills, exercises or home work
5. Difficulty organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort
7. Often loses toys, pencils or items needed for tasks
8. Easily distracted and inability to sit at a place.
9. Fidgets with hands or feet or squirms in a seat
10. Leaves sit when remaining seated is required
11. Often forgetful in daily activities
12. Difficulty playing quietly
13. Often in motion or “on-the-go”, acts as if driven by a motor

(B) Impulsivity Symptoms:
1. Difficulty awaiting turn.
2. Interrupts or intrudes on others games or conversation.
3. Blurts out answers before question have been completed.

Not everyone with short attention span has Attention Deficit Hyperactive Disorder, but many do manifest the inattentiveness symptoms. For a person to be diagnosed ADHD, such a person should have at least 6 attention symptoms or 6 activity/impulsivity symptoms to a degree beyond what would be expected for children their age.

The symptoms must be present for at least 6 months, observable in two or more settings, and not caused by another problem.

TECHNIQUES FOR GETTING AND MAINTAINING YOUR CHILD’S ATTENTION
1. Getting attention through behaviour modification techniques – the Ivar Lovaas technique
2. Getting attention through your child’s senses; obtaining calm-alert state.
3. Getting attention through diet and medication.
4. Getting attention by improving the learning / teaching environment.
5. General guidelines.

1. GETTING ATTENTION THROUGH THE  LOVAAS TECHNIQUE:
Lovaas, (1982) described a behaviour technique for getting and maintaining attention in developmentally disabled children. He developed a preparation program called “Getting ready to learn”. The first steps when you begin to implement this program include to teach: proper sitting, directed attention and elimination of disruptive behaviour.

DIRECTED ATTENTION:
Teaching directed attention using Lovaas technique involves two procedures. The first is teaching the child to visually attend to your face (establishing eye contact). The second is a general procedure for teaching the child basic behaviors such as visually attending to objects in the environment to which you wish to direct his attention.
To establish eye contact, you have to use the command “Look at me” There are 7 steps and they include:
Step 1: Have the child sit in a chair facing you
Step 2: Give the command “Look at me” every 5-10 seconds
Step 3: Reward the child with praise and food for correctly looking at your face. In the beginning, a correct response occurs when the child looks in your eyes for at least 1 second and looks within 2 seconds after the command is given. Say “good looking” and simultaneously feed him.
Step 4: If the child does not visually attend to your face within the 2-seconds interval, look away for 5 seconds and then give the command again.
Step 5: Some children will not look at you when you say “look at me”. Therefore, you have to prompt the response. You can prompt eye contact by holding a piece of food (or something else the child will look at) directly in the line of vision between your eyes and the child’s eyes at the same time you give the command. Therefore, repeat the command (“look at me”) and simultaneously present the prompt (move the piece of food into his line of vision and level with your eyes.
Step 6: When eye contact occurs within the 2 –second interval on 10 consecutive commands, gradually and systematically fade the prompt, by increasingly hiding the food in your hand and minimizing the movement of your hand and over successive commands.
Step 7: To increase the duration of the child’s eye contact, gradually delay giving the food while maintaining eye contact with praise, that is, increase the length of time that the child must look before he is given food.

You must have a clear idea of what is the correct response, and you have a clear idea of what is an incorrect response. It is best to start teaching eye contact while the child is sitting in the chair, because of less distraction. However, generalize to other chairs, have him look at you while standing, walking, when in other rooms as well. When the child has mastered how to sit properly, stand, sit up straight, hands quiet, look at me, it becomes easy to get attention and the child is ready to learn.

Maintaining the attention would require the therapist/teacher to be firm, consistent in insisting that the child does not lose what he has already learned. Also, reinforcements must be made effective at all times. Don’t use food reward after meal!

 
GETTING AND MAINTAINING ATTENTION THROUGH YOUR CHILD’S SENSES:
When you try to capture your child’s attention, it is important to remember his strengths and difficulties in processing sensory information. It is equally necessary to notice whether the child is under-aroused or over-aroused. If the child is irritable or overexcited, sleepy or withdrawn, it may be very difficult to engage him or get him to attend.

SENSE OF SIGHT:
Observe carefully and identify the kind of visual stimuli that attract your child. It is well documented that many children with autism are strongly visual learners (Greenspan & Wieder, 1998). They attend to and pick up pictorial information quicker than via other modalities.

* If bright colours attract your child, use his interest in colours to attract his attention. When you find him gazing at something bright, use a brightly coloured paper or object and stand between him and what he is looking at. If possible, use it to reward him if he makes eye contact or gives a desirable response.
* You can train directed gaze, focusing and attention by making a room dark and using two flash lights to explore the room or track the light around objects.

SENSE OF SMELL AND TASTE:
If you find that your child loves a particular perfume or a certain food or drink, use it to get his attention. Wear the perfume or spray it each time he concentrates. If it is food, eat from the same bowl or feed him if he is still very young. While he is eating, cue him with your actions and voice, holding his attention as long as possible. Coo, laugh and make funny faces at him. Introduce concepts of “give” “take” “more” and “please”.

SENSE OF HEARING:
If the child listens well, use a variety of sounds and words to woo him while keeping your gestures uncomplicated. Some children with special needs especially ASD may not respond when you call their names or be comforted by a soothing voice. They sometimes act as though they are deaf. Such children may be having problems with receiving aid processing auditory stimuli. Auditory processing problems make it difficult for the child to tune in to you, because he may miss or misinterpret some of your signals.

To get across to such a child, talk slowly, make sounds that are distinct and energetic. Also, use a lot of hand gestures and facial animations. Change your tone quickly if he covers his ears, you can get attention by expressing words and sounds with great emotion and rhythm. Talk slowly to help him process the words.

GETTING AND MAINTAINING YOUR CHILD’S ATTENTION BY OBTAINING THE CALM – ALERT STATE.
A calm-alert state refers to a learning ready-state. It is one in which a person’s ability to register and orient to sensory information is optimal. According to Murray-Slutsky and Paris, (2000), a calm-alert state is a window in which our ability to function is maximized. When in this state, the nervous system is sufficiently aroused for peak attention and task performance. It makes the child to be alert, attentive and open to learning.

The therapist or teacher who wants to get and maintain a child’s attention must therefore help the child function in the calm-alert state. A child who is under-aroused or over-aroused is not in this learning ready state, therefore, aim to achieve a balance.

GETTING AN UNDER-AROUSED CHILD INTO A CALM ALERT STATE:
An under-aroused child may have difficulty registering or processing sensory information within his environment and may appear bored, tired, sluggish, uninterested. He may not want to participate in activities, and may react or over-react if he is not feeling well. He may prefer to watch TV.
To bring such a child into a clam-alert state, the therapist or teacher should engage him in sensory-based activities that increase the child’s arousal. Some of such activities are repetitive, regular and fast in nature. Also linear vestibular, deep-touch or proprioceptive input helps to arouse and organize the nervous system. Examples include:
· jogging
· Bicycle riding
· Jumping on a trampoline
· Bouncing while sitting on a ball

To help an under-aroused child into the calm alert state, the therapist can also do the following: -
· Work with high level of enthusiasm and energy
· Use voice with changing inflections
· Brighten or illuminate the room
· Sing faster rhythms and songs
· Exaggerate gestures and animations.

GETTING AN OVER-AROUSED CHILD INTO A CALM-ALERT STATE:
A child will not register and process sensory information very well if he is over-stimulated or over-aroused. Such a child may have difficulty sitting still to complete a drill, “always on-the-go”. He may not be able to tolerate frustration or control his impulses.
To get an over-aroused child into the calm-alert state, the therapist should introduce activities that reduce anxiety, and lower arousal levels. They include calming techniques such as:
· Deep pressure (touch) firm deep strokes
· Proprioceptive inputs

1. Animal walks such as crab or bear
2. Wheel barrow walks
3. Chair push ups in which the child lifts up his body weight while sitting in his chair.
4. Quiet enclosed rooms
5. Slow rhythms and songs
6. Low voices, slow calm speech
7. Avoid animations and exaggerated actions

GETTING AND IMPROVING YOUR CHILD’S ATTENTION THROUGH DIET AND MEDICATION:
DIET:
My experience working with children in the spectrum has shown that quite a number of them lose concentration and focus after taking foods and drink that contain sugar and in some cases milk and dairy related foods.

It has been documented that people with short attention span, especially those with attention deficit disorders have a high carbohydrate; low protein diet that may be linked to the neurobiological etiology of ADHD. In other words, their diet can be causing an imbalance in the production of neurotransmitters required for attention and proper focusing abilities. NutraSweet or Aspartame also has a detrimental effect on these neurotransmitters.

Most of the time, eliminating sweets (NUTRASWEET), reducing carbohydrates and increasing vegetables (especially those rich in vitamin B) and protein help tremendously.

MEDICATION:
Although differences in professional opinion do exist over the use of drugs to improve attention span, medication remains a popular treatment option for ADHD, stimulant medicines like Ritalin, Dexedrine and Adderall are still being prescribed by medical doctors. These drugs are said to have a good track record. There is now a newer medication called Strattera. Strattera is not a stimulant but is used for children who have not done well on the stimulants. It is necessary to remind parents not to administer any medication without an experienced doctor’s prescription.

GETTING AND MAINTAINING ATTENTION BY IMPROVING THE TEACHING/LEARNING ENVIRONMENT
In order to get and maintain attention and or increase attention span, we should create an enabling environment for optimal function. Murray – Slutsky and Paris, (2000) suggested that challenging behaviors and attention problems would most likely occur in environments where: -
1. There is a high child-adult ratio
2. Sessions are conducted in a large room
3. Transitions are poorly planned
4. Tasks are unstructured
5. Tasks are adult-directed
6. Child has no space; with people physically near
7. The child is stressed and frustrated
8. The environment is noisy and cluttered
9. There is no repetition and routine. People, activities, place change
10. The child is bored, unstimulated
11. Waiting time is excessive

The children we work with have difficulties organizing themselves and recognizing which aspects of the environment are important. They need predictability, structure and organization.
* Defined boundaries help to improve attention - Rooms with boundaries help our children to maintain a sense of organisation and control thereby leaving them calm. Large open rooms appear to have no boundaries and are therefore, not good for maintaining attention.
* Distraction – free work area – Therapists and teachers should ensure that they work in a clutter free environment. Do not clutter your work area or walls with pictures, drawings, words and other irrelevant visual information that distracts.
* Free your work table and keep materials that are not in use out of sight until needed.
* Put away toys and equipment when you complete each task. Progress to next activity and do not spend time on clean-up. Simply keep items away from child’s visual field.
* Sensory Environment – Ensure that the environment meets each child’s sensory needs. Odours, visual distractions, noise levels, and number/proximity of other children contribute to the sensory environment. If a child is hypersensitive to sound or noise, an open classroom, or a large play field with many children making noise, will be a bad environment.
 
GENERAL GUIDELINES
* Use picture schedules and planned activities. Attention and concentration will increase if schedules are provided. Schedules help the child to predict what’s next.
* Reduce waiting time – Minimize down time, i.e. time between activities. Always keep the child mentally involved and make activities to proceed at rapid rate. Position all needed materials handy.
* Plan transitions – Give advance notice and prepare your child for a change. Use visual reminders.
* Don’t forget to use effective reinforcers
* Make defined rules – specify rules clearly and concisely and enforce them consistently. Post the rules pictorially and even review them before each session.
* Do not be in a hurry with instructions. Be patient; allow the child time to process the instruction.
* Break down tasks.
* Make drills interesting
* Foresee emotional crisis – You can decrease inattentiveness by learning to sense when the child is about to lose control and remove him from the situation or circumvent the crisis. Monitor the environment for sensory overload.
* Use Rhythmic Activities – Repetitive, regular pace rhythmic activities and songs are organizing - use this to maintain
attention.
* Avoid verbal overload irrespective of child’s apparent language ability
* Use visual cues, prompts and schedules
* Monitor yourself and know when you burn out or become less enthusiastic and bored.
* Be firm; insist on proper sitting and no disruptive behavior when you teach.
* Pace instruction properly – Attention is enhanced when instruction is delivered in a fast paced manner (short inter-trial interval (Lovaas, 1982).
* Intersperse easy and difficult demands – Presenting several easy tasks (which brings frequent reinforcements) intersperse with difficult tasks sustain attention (Homer, Sprague, Teusday – Heatfield, 1991)
* Keep demands low at first.
* Limit TV viewing. TV watching is now linked to short attention span.
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