Attention deficits are very common after acquired brain injuries. Most people with aphasia, for example, have an attention deficit (Varkanitsa, 2023; Murray, 2012).
In this post, you’ll find dozens of attention activities for adults, broken down by type of attention.
You’ll also find printable worksheets—with instructions for how to turn each into an attention task!
More Attention Articles
Types of Attention
There are different ways to categorize attention. Below, we selected from Sohlberg and Mateer (2001)’s model to keep it practical for busy SLPs.
When working on attention, keep in mind that distractions can be both external, such as background noise, and internal, such as anxiety or worry.
1. Sustained Attention
What is it? The ability to attend to a chosen task for a sustained period of time.
What does a sustained attention deficit look like? A short attention span. Or good attention at first, but it decreases over time. For example, one can only focus on a mental math task for a few seconds.
2. Selective Attention
What is it? The ability to attend to a chosen task in the presence of distractions.
What does a selective attention deficit look like? Unable to attend when distractions are present. For example, losing attention after a door is opened.
3. Alternating Attention
What is it? The ability to switch between dissimilar cognitive tasks. The ability to allocate where you pay attention.
What does an alternating attention deficit look like? Difficulty switching between two tasks. Difficulty initiating a task after you’ve been engaged in a different task. For example, losing your place when switching between reading a recipe and cooking.
4. Divided Attention
What is it? The ability to complete two tasks at the same time while maintaining a certain level of accuracy.
What does a divided attention deficit look like? Decreased performance while doing two tasks. For example, difficulty answering questions and folding laundry at the same time.
Other Signs of Attention Deficits
- Difficulty following directions/instructions
- Distractible
- Unable to focus for long periods
- Poor memory
- Unable to hold a conversation
- Difficulty with problem-solving
- Difficulty finishing tasks
- Impulsive
(Adapted from the University of Maryland Rehabilitation & Orthopaedic Institute, n.d.)
How to Isolate Attention (…as best you can)
First, a reminder: All you can do is interpret the patient’s behaviors the best you can. While you can use attention-specific tests and activities to try to isolate attention, it won’t always be exact. And that’s okay.
With a thorough assessment and a solid treatment plan, you’ll help your patient improve their independence, safety, and quality of life.
First, Assess Attention
The first step is an assessment. When assessing attention, determine:
- If an attention deficit is present, what type(s) is present, and the severity of the deficit.
- The attention deficit’s impact on your patient’s life.
- The patient’s metacognition. How aware are they of their attention deficit?
Read How To Assess Attention for recommended assessments and screens.
Once you’ve determined that your patient has an attention deficit, the next step is to decide with your patient if working on attention would improve their daily function and quality of life.
You’ve decided it would? Time for treatment!
Need help writing goals? Check out our free Goal Bank and Goal Writing Guide.
Next, Make An Attention Treatment Plan
- Choose attention activities (below) based on your patient’s goals.
- Figure out what other cognitive processes are required to complete the activity.
- This is to help you understand what aspect of the activity is attention and what is a different cognitive process.
- For example, a task may treat memory and attention. Focus on attention.
- Be consistent. If you’re working on attention for an activity, stick with attention.
Then, Measure Attention
There are several ways to measure attention. Again, be consistent by sticking to the same measure when doing a task.
- Measure cues. Keep track of the cues the patient needs to remain on task during a specific time period.
- How many cues needed to attend.
- The type of cues (verbal, written) needed to attend.
- The frequency of cues (rare, occasional, frequent) needed to attend.
- Measure accuracy. Measure the patient’s accuracy during attention tasks. For example, minutes spent focused on cooking, accuracy while reading aloud, etc.
for example
How To Isolate Attention
You choose 20 mental math problems for a patient with an attention goal.
You determine that these math problems require both attention and memory to solve. You’ve observed that when solving a math problem, your patient loses focus midway through counting on his fingers, but can continue the task after you repeat your prompt.
You decide that every time he needs help staying focused, you will count it as a cue for attention (not memory).
During the 20 math problems, you measure that your patient required 8 verbal cues for attention.
When documenting, you record, “The patient completed simple mental math problems while sustaining attention at 60% accuracy (12/20) independently, increasing to 100% accuracy given occasional minimal verbal cues.”
Attention Activities for Adult Speech Therapy
1. Improve Metacognition
Help patients increase awareness of their attention deficit and how it impacts their lives.
- Predict. Before a task, ask the patient to predict how they’ll do.
- Assess. After the task, ask them to assess how they did.
- Compare. Discuss how their prediction compared with how they actually did on the task.
- Improve. Identify and/or modify strategies to improve performance.
You’ll find a link to a free self-awareness worksheet below.
2. Teach Attention Strategies
Teach strategies to help your patients improve their ability to pay attention.
These may be compensations, like turning off the TV to decrease distractions (more on these below).
Or you may teach a strategy for how to plan an activity. For example, a plan for how to cook dinner in less than one hour or to finish college homework on time.
For patients with milder attention deficits, use the Game Plan Worksheet to teach a step-by-step process for how to work through their attention deficit to reach a goal.
Read Executive Functioning Strategies for Adults for detailed instructions on how to use these worksheets.
Executive Functioning Worksheets
Download the Executive Functioning Worksheets to teach your patients a step-by-step process for how to work through attention and executive functioning deficits to achieve a goal. Your download comes with:
3. Computerized Attention Training Programs
A systematic review by the U.S. Department of Veterans Affairs found that computerized rehabilitation improved cognitive function (including attention) in people with acquired brain injuries, including those with traumatic brain injuries and strokes (Bogdanova et al, 2016).
One well-regarded computer training program specific to attention is Attention Process Training (APT).
APT is a ‘direct’ attention training approach. This means that it targets specific attention areas of the brain. It uses repetition and neuroplasticity to strengthen the attention pathways.
BrainHQ & Other Apps
BrainHQ was developed by the neurophysiologist who invented the cochlear implant.
It offers subscription-based online exercises (~$10 per month) that treat attention, brain speed, memory, people skills, navigation, and intelligence.
Luminosity also offers several attention apps that target divided attention and selective attention.
4. Sustained Attention Activities for Adults
Work towards paying attention to a single task for increasing periods of time while maintaining (or improving) accuracy.
- You may start with a worksheet to teach strategies and build confidence, rapport, and buy-in
- Read aloud (recipes, magazine articles, paragraphs, novels, etc.)
- Balance a checkbook
- Sort mail
- Cook
- Write a letter or email
- Typing tasks
- Do homework for a certain time period
- Stock shelves
- Put away laundry or groceries
- Do physical therapy exercises or a workout program
5. Selective Attention Activities for Adults
Work towards paying attention to a chore or cognitive task when distractions are present.
- Do a worksheet with music on
- Cook while someone else uses the kitchen
- Type with the window open
- Read a menu in a cafe
- Grocery shop
- Work on homework in a public library
6. Alternating Attention Activities for Adults
Work towards being able to switch between 2 different cognitive tasks with improving accuracy.
- You may start with a worksheet to teach strategies and build confidence, rapport, and buy-in
- Cooking task while consulting a recipe
- Read a bill and then pay it online
- Have patients review their attention strategies while doing another task
- Switch between a task and answering questions or responding to a text
- Switch between the phone and typing on a computer
- Do a construction task while switching between reading plans and assembly (a craft, origami, etc.)
- Navigation tasks involving walking while consulting a map
- Exercise program using multiple machines or pieces of equipment (hand weights then theraband)
- Complete a list of errands
- Sort coins, cards, or other small objects
- Type the answers to questions on a computer
7. Divided Attention Activities for Adults
Work towards being able to do 2 tasks at the same time while improving accuracy.
- Cooking task with 2 components that require simultaneous monitoring (boiling noodles and simmering sauce)
- Talk on the phone while doing another task
- Take notes in real-time
- Have a conversation while doing another task
- Teach someone a familiar activity, like a board game, while simultaneously doing it
- Listen to a podcast while sorting coins, cards, or other small objects
- Keep score during a game while playing it
People with attention deficits often also struggle with working memory.
For patients with milder attention deficits, read 10 Working Memory Tasks For Adults for practical treatment ideas.
8. Compensatory Strategies to Support Attention
- Set a visual or auditory timer
- Use a planner and other reminder systems
- Use headphones to block excess noise
- Break down larger tasks into smaller chunks
- Develop a timeline to complete each step of the task
- Write down distracting thoughts and ideas. Return to it after the task is completed
- Take breaks between cognitively challenging tasks
- Give patients a heads-up before discussing important information
- Use a finger to follow along while reading
- Read aloud
- Frequently check for comprehension and accuracy
- Extra time to complete activities
- Close eyes
- Visualize the task
- Re-auditorization (verbally rehearse the task)
- Increase task understanding by repeat instructions, give written reminders, and model the tasks
- Reward and celebrate improved attention (positive reinforcement)
9. Environmental Modifications to Support Attention
- Avoid or modify problematic or distracting settings (turn off the TV, avoid noisy settings)
- Organize the space and remove distracting items (remove clutter, place loose items into labeled bins, etc.)
- Choose the best time of day to do important tasks (when the patient is least tired, when a caregiver can help, etc.)
- Set up systems (for bill-paying, refilling medications, to remember appointments)
10. Medications
Refer out as appropriate.
11. Attention Worksheets for Adults
Below are examples of how you can use worksheets to treat attention.
Again, you may start with worksheets to teach strategies and build confidence. Then move on to functional tasks that are meaningful to your patient.
Feel free to copy, paste, and print the following worksheets.
These activities are from The Adult Speech Therapy Starter Pack, where you’ll find many more time-saving resources.
1. Menu Worksheet
Menu Worksheet: Make it an Attention Activity
Goal: Improve sustained attention.
Instructions: Ask the patient to read the menu aloud. Measure accuracy by counting the number of words read correctly compared to the total number of words. Or by counting how many and what types of cues they needed to complete the task.
To increase complexity: Focus on alternating attention by asking the patient to read aloud, then ask them a question about what they just read. How many types of crackers are there? How much do sweets cost? Then have them continue reading aloud.
2. Reading Worksheet
Reading Worksheet: Make it an Attention Activity
Goal: Increase sustained or alternating attention.
Instructions. Ask the patient to read the paragraph aloud, then summarize what they read. Measure accuracy by counting how many and what types of cues they needed to complete the task.
3. Cancellation Task Worksheet
Cancellation Task Worksheet: Make it an Attention Activity
Goal: Increase sustained attention.
Instructions: Ask the patient to cross out the target letters. Measure accuracy by how many letters they correctly crossed out compared to the total number of target letters.
To make it easier: Ask them to cross out only one target letter.
Increase complexity: Add distractions (like background noise) to target selective attention. Interrupt to ask questions or have them switch between the worksheet and a different task to target alternating attention. And have them do another task at the same time as the worksheet to target divided attention.
4. Word Search Worksheet
Word Search Worksheet: Make it an Attention Activity
Goal: Increase sustained attention.
Instructions: Ask the patient to complete the puzzle. Measure accuracy by the number and types of cues needed or the time needed to complete the task.
Increase complexity: Add distractions to target selective attention. Interrupt to ask questions or have them switch between the puzzle and a different task to target alternating attention. And have them do another task at the same time as the puzzle to target divided attention.
More Attention Activities for Adults
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References
- American Speech-Language-Hearing Association. (n.d.). Right hemisphere Disorder [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Right-Hemisphere-Disorder/
- Bogdanova, Y., Yee, M. K., Ho, V. T., & Cicerone, K. D. (2016). Computerized Cognitive Rehabilitation of Attention and Executive Function in Acquired Brain Injury: A Systematic Review. The Journal of head trauma rehabilitation, 31(6), 419–433. https://doi.org/10.1097/HTR.0000000000000203
- Brewer, C.H. (2021). The Adult Speech Therapy Workbook (M. Aparo, Ed.). Harmony Road Design, LLC.
- Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
- Murray L. L. (2012). Attention and other cognitive deficits in aphasia: presence and relation to language and communication measures. American journal of speech-language pathology, 21(2), S51–S64. https://doi.org/10.1044/1058-0360(2012/11-0067)
- Sohlberg, M., & Mateer, C. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. (2nd ed.). The Guilford Press.
- University of Maryland Rehabilitation & Orthopaedic Institute. (n.d.) Pay Attention! Attention and Attention Processing Training in Brain Injury. [Powerpoint Presentation]. Retrieved from https://www.biamd.org/uploads/8/5/7/7/85779996/peters_-_apt.pdf.
- Varkanitsa, M., Godecke, E., & Kiran, S. (2023). How Much Attention Do We Pay to Attention Deficits in Poststroke Aphasia? Stroke, 54(1), 55–66. https://doi.org/10.1161/STROKEAHA.122.037936