How Occupational Therapy can Help Optimise Attention in Children

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Common Mistakes in How Attention is Perceived

To manage issues with attention, it is important to first understand what attention means. It is important to recognise that sometimes our perception of what attention is can be one-dimensional. We often mistakenly penalise the child when he/she seems to display behaviours that do not fit into our perceived definition of attention.

Some Scenarios for Thought

A child is watching TV. You call the child's name. The child continues to watch tv without responding. Is the child being attentive here?

Here, the child is displaying selective sustained attention (active attention) and filtering distractions (passive attention). So, do we then accept that as attention or do we label that as being inattentive/ignoring the call?

Our perception can be revised if we see this as Attention Priority - What someone chooses to attend to at that point in time - instead of Attention Deficit.

A person will attend to a task or a stimuli if it is interesting, achievable and the environment promotes and supports the attention. Attention does not necessarily refer only to onseat behaviour (ability to remain on the seat) during desktop activities.

For instance, when we command a child to "Sit down, don’t fidget, keep your back straight, look at me, listen carefully and pay attention” – these are in effect 6 tasks and not just one task we are instructing the child to perform. 

We need to recognise that sensory children (children with sensory processing difficulties) may need to use one sense to support the other to understand the things around them. They may need to jump to listen; run and look; rock and listen to write. 

When a person can receive information and use their strong sense (be it visual, tactile, auditory, vestibular and/or proprioceptive), process stimuli and produce a response, we can say that the person is attentive.

Attention is defined as an act of directing the mind to an idea, task or object.

Types of Attention

Description

Selective Attention

This refers to attention to specific stimuli only.

Sustained Attention

This refers to the ability to sustain/maintain one's attention to a particular task (e.g. while watching TV, playing games on an iPad, building lego, colouring or reading a book).

Divided Attention
(multi-tasking)

This refers to paying attention to multiple tasks (e.g. a mother who multi-tasks: cooking, helping with child's homework and answering the door while talking on the phone). 

Children with sensory processing challenges (children with diagnosis of SPD, ADHD, ASD, GDD, PDD) often have difficulty paying attention. This is likely due to impaired executive functions or incomplete maturation of the child’s primitive reflexes. This means the body, mind and various senses may not work in sync to produce the attention needed in their daily lives. 

In many cases, the environment around the child plays a large part in affecting the quality of attention. The biological state (hunger/ thirst/ bowel movement/ sleep/ sickness) and sensory needs of the child (to feel safe and comfortable with the sound, texture, smell and noise of the immediate surroundings) should be taken into consideration when designing supportive environments.

Recommended Design

To provide an environment that can help support sensory needs and promote attention in such children, 

  1. Remove sensory environmental offenders: The offenders can be visual (light), olfactory (smell), tactile (touch) or auditory (noise) elements.

  2. Use appropriate light, appropriate wall colour, preferred contrast, appropriate clothing, supportive furniture, calming environment.

  3. Include outdoor play or exercise in daily routine to get the body ready to attend and focus. Physical activity increases the inflow of oxygen into and within the brain and helps calm the senses.Encourage and facilitate correct breathing through the nose by doing deep breathing exercises or activities involving suck and blow to help optimise breathing and to support attention. Mouth breathers tend to breathe inefficiently, leading to a sluggish brain and inattention. 

Physiological Needs To Note when Designing a Supportive Sensory Environment

Type of Senses

Physiological Needs

Visual
(sense of seeing –
through the eyes)

  • White light may not be conducive as it may produce glare for people who have difficulty filtering light, making it hard to focus, causing inattention. A sign of difficulty in filtering is squinting at light. 

  • Light should be directed on work rather than on the person so that he/she does not need to process shadow and competing stimuli. 

  • Some children find it easier to process information when presented with different colour contrasts. This can be facilitated by the use of coloured overlays for reading/writing/drawing or printing in blue colour on a yellow paper.

  • Passive lighting - Avoid glare/sharp bright background like white walls. 

Auditory
(sense of hearing -
through the ears)

  • Auditory sensitive people may need noise-cancelling music to be played. Others may prefer using headphones to drown out background noise. 

  • Some children focus better during mathematics lessons when rhythmic music is played in the background. 

  • Some children cannot focus due to the fear of sudden loud background sounds (proximity to construction site, sound of vacuum cleaner or hair dryer). For such children, it helps to soundproof the room with pile carpet, firmly shut windows and doors to minimise fear and insecurity. Fear causes the child to be hyper-vigilant as it puts their body in a constant survival (flight or fight) mode. Biologically, this means the body produces excessive amounts of cortisone, which is the hormone produced when the body is under stress. This biological reaction can result in a physical display of task-avoidance due to the desire to leave the offending environment. 

Olfactory
(sense of smell -
through the nose)

Some children may pay better attention when exposed to calming smells in the environment. This can be facilitated by diffusing suitable essential oils in the room where the child is in. Using fragrant flowers may also be helpful where appropriate (priority should be given to a child's preference while choosing an appropriate oil/flower).

Gustatory
(taste and eating -
through the mouth)

  • Children usually cannot focus when they are hungry. Scheduling snack breaks in between work tasks is usually helpful.

  • Some children can focus better when their mouths are engaged in deep pressure exercises by chewing e.g. eating dried fruits like apple, raisins, apricots. 

Tactile
(sense for touch and temperature -
through the skin) 

  • Clothing should be comfortable and suited to the surrounding environment and temperature. Extreme temperatures can affect focus and concentration.

  • Some people react to the fabric of the clothes (clothes tags)or material of furniture like table and chair. Many prefer neutral colour and textures like wood. 

Proprioceptive
(joint sense and
body awareness)

  • Activities such as stretching to reach the sky, applying deep pressure massages can help increase body awareness and help the child feel more secure.

  • Using chairs with arm rests help increase the sense of space, stability and safety (for children with low tone, it reduces leaning on table thus reducing fatigue and inattention). 

  • Chairs should be adjusted in height so that the elbow rests on the table, with the hips and knees at right angles, feet flat on the floor or stool to promote correct posture for desktop activities. (STOKKE chairs can be adjusted)

  • The use of beanbags for children with low tone. 

  • Therapy ball chair for sensory-seeking children to sustain body alertness through movement when engaged in desktop activities.

Vestibular
(movement and balance
through vestibular apparatus
in the inner ear) 

  • Some children focus better with movement. 

  • Some children need to rock, run, swing legs, flick a pen, or chew a pencil in order to regulate. Regulation helps them to concentrate and process information thus displaying attention. For such children, the use of sensory tools like chewllery (chewing jewellery) allows the child to regulate his/her senses and find a functional balance, managing the need to constantly move while steadying the mind to focus 

When we provide a nurturing environment that supports the child's body and senses, we can facilitate attention and promote learning. We can then help a child thrive in his learning journey without unnecessary stress.

Anita Yadava (Anita Leo)

Clinical Director, Principal Occupational Therapist
Insight N Access Pte Ltd

She can be reached at insightnaccess@gmail.com

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