Attention Activities for Adults: Dozens of Useful Speech Therapy Ideas

Attention deficits are very common after acquired brain injuries. Most people with aphasia, for example, have an attention deficit.

But it can be hard to differentiate attention from the other cognitive functions that are at play. And it can be hard to pinpoint how to treat and measure the different types of attention.

In this post, you’ll find attention activities for adults (including metacognition)—plus the different types of attention and how to tell the difference between them.

You’ll also find printable worksheets—with instructions for how to turn each into an attention task!

More Articles

• Goal Bank for Adult Speech Therapy (150 Goals!)
• 21 Practical Cognitive Tasks That Work

Types of Attention

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. 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.

2. Sustained Attention

What is it? The ability to attend to a chosen task for a continued period of time.

What does a sustained attention deficit look like? A short attention span. Or good attention initially, but it decreases over time. Difficulty with working memory (recalling short-term information, like instructions). For example, you can only focus on a mental math task for a few seconds.

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 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 of time
• Poor memory
• Unable to hold a conversation
• Difficulty with problem-solving
• Difficulty finishing tasks
• Impulsive

Adapted from the University of Maryland Rehabilitation & Orthopaedic Institute

How to Isolate Attention (…as best you can)

First, a reminder: All that you can do is interpret the patient’s behaviors the best you can. You can use standardized tests and best practices to try to isolate attention…but it’s an imperfect science.

That’s okay. With a thorough assessment and a solid treatment plan, you can still help your patients, and that’s what matters.

Assessing Attention

The first step is an assessment. When assessing attention, determine:

1. IF an attention deficit is present, what type(s) is present, and the severity of the deficit.
2. The attention deficit’s impact on your patient’s daily functioning.
3. The patient’s metacognition. How aware are they of their attention deficit?

Once you’ve determined that you patient has an attention deficit, the next step is to decide—with your patient—whether 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.

Treatment Planning for Attention

1. Choose one of the attention activities for adults based on your patient’s goals.
   
   
   • THERAPY HACK: Use language, visual neglect, memory, and problem-solving worksheets and everyday tasks to treat attention!
     
     
2. Figure out what other cognitive processes are required to complete the activity.
   
   
   • This is to help you become very clear about what aspect of the activity is attention and what is a different cognitive process.
     
     
3. Be consistent. If you’re working on attention for an activity, stick with attention. Yes, you could, for example, measure both attention and memory on a mental math problem. But there are some issues with this:
   
   
   • It can get messy for you to try to measure and record both.
   • It can confuse the patient about the purpose of the activity. Instead, we recommend keeping it as simple as possible for everyone involved.

Ways to Measure Attention

1. Count how many cues the patient needs to remain on task during a specific time period.
   
2. Measure the patient’s accuracy in completing cognitive tasks (correctly identifying an object, accurately reading aloud, etc).
   
3. Also, remember to measure:
   • The type of cues (verbal, written, etc.) needed to attend.
   • The frequency of cues (rare, occasional, frequent, etc.) needed to attend.

For example:

1. You choose 20 mental math problems for a patient with an attention goal.
2. You determined that these math problems require both attention and memory to solve.
3. 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.
4. For these reasons, you decide that every time he needs help with this aspect of the task, you will count it as a cue for attention (not memory).
5. During 20 math problems, your patient required 8 verbal cues for attention.
6. 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 Adults

1. Metacognition Activities

Help patients increase awareness of their attention deficit and how they perform on a task.

• Before the task, ask the patient to predict how they’ll do
• After the task, ask them to assess how they did
• Discuss how their assessment of their performance compares with how they actually did on the task
• Be encouraging as you help them identify and correct errors
• Identify and/or modify strategies to improve performance

2. Computerized Attention Training Programs

A systematic review by the U.S. Department of Veterans Affairs found “improvements in cognitive function [including attention] following computerized rehabilitation for acquired brain injury populations including traumatic brain injury and stroke.”

One well-known program is Attention Process Training (APT). APT is a “direct” attention training approach. This means that it aims to target specific attention areas of the brain via repetition, counting on neuroplasticity to strengthen those pathways.

Online Apps & Games

Luminosity offers several attention apps that target divided attention and selective attention.

Constant Therapy offers subscription-based online exercises that target attention.

3. Selective Attention Activities for Adults

• Doing a chore or task (cooking, typing, watching TV, sorting mail, eating, etc.) WITH distractions present (background noise, other people around, an open window, an open door, etc.)
• Use a worksheet

4. Sustained Attention Activities for Adults

• Reading aloud (recipes, magazine articles, paragraphs, novels, etc.)
• Balancing a checkbook
• Sorting mail
• Cooking
• Writing a letter or email
• Typing tasks
• Stocking shelves
• Putting away laundry or groceries
• Work towards maintaining attention to a single task for increasing periods of time while maintaining accuracy
• Use a worksheet

5. Alternating Attention Activities for Adults

• Cooking task while consulting a recipe
• Cooking while monitoring laundry
• Chores with multiple tasks (reading a bill and then paying it online)
• Chores with interruptions
• Asking a patient to review their cognitive strategies during another task
• Doing a task while interrupted by phone call or tex
• Switch between the phone and typing on a computer
• Construction tasks while switching between reading plans and assembly (a craft, origami, etc.)
• Mental math with frequent interruptions
• Navigation tasks involving walking while consulting a map
• Exercise program involving the use of multiple machines or pieces of equipment (hand weights then theraband, etc.)
• Completing a list of errands
• Sorting coins, cards, or other small objects
• Typing the answers to questions on the computer
• Use a worksheet

6. Divided Attention Activities for Adults

• Cooking task with 2 components that require simultaneous monitoring (boiling noodles and simmering sauce)
• Talking on the phone while doing another task
• Taking notes in real-time
• Playing a game in a dynamic setting
• Have a conversation while doing another task
• Teaching someone a familiar activity while simultaneously doing it
• Keeping score during a game while playing it

7. Compensatory Strategies to Support Attention

• Set a visual or auditory timer for switching tasks
• 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 potentially distracting thoughts and ideas. Then return to it after the task is completed
• Take breaks between cognitively challenging tasks
• Giving patients a ‘heads up’ before discussing important information
• Using a finger to follow along while reading
• Reading aloud
• Frequently checking for comprehension and accuracy
• Increased time to complete activities
• Closing eyes
• Visualizing the task
• Re-auditorization (verbally rehearsing the task)
• To increase task understanding: repeating instructions, written reminders, asking for a model
• Rewards to promote desired behavior of improved attention (positive reinforcement)

8. Environmental Modifications to Support Attention

• Avoid or modify problematic or distracting settings (turn off the TV, avoid noisy settings)
• Choose the best time of day to complete important tasks (when the patient is least tired, when a caregiver is available to help, etc.)
• Organize the space and remove distracting items (remove clutter, place loose items into labeled bins, etc.)
• Set up functional systems (for bill-paying, refilling medications, etc.)

9. Pharmacological Management

Refer out as appropriate to explore medication options that can help with inattention.

Attention Worksheets for Adults

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: Increase sustained attention (this task also utilizes language and visual scanning skills)

Instructions: Ask the patient to read the menu aloud. Measure accuracy by counting number of words correctly read over total number of words.

To increase complexity: focus on alternating attention. Ask 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). Finally, ask them to continue to read aloud.

Measure accuracy by either counting how many cues they need to complete the task (cues to find their spot, cues to find answers to your questions) or by measuring reading aloud accuracy (same as above).

2. Reading Worksheet

Reading Worksheet: Make it an Attention Activity

Goal: Increase sustained or alternating attention (see instructions above).

3. Cancellation Task Worksheet

Cancellation Task Worksheet: Make it an Attention Activity

Goal: Increase selective or alternating attention (this task also utilizes language and visual scanning skills).

Instructions: Ask the patient to cross out the target letters. Measure accuracy by how many letters they correctly crossed out over the total number of target letters (you can mark skipped letters and crossed-out non-target letters as incorrect).

For an easier task, ask them to cross out only one target letter.

Increase complexity by adding background noise or asking them questions during the task (divided attention).

4. Word Search Worksheet

Word Search Worksheet: Make it an Attention Activity

Goal: Increase sustained attention (this task also utilizes language and visual scanning skills).

Instructions: ask the patient to complete the puzzle. Measure accuracy, cues needed, and/or time needed to complete the task.

References

• Right Hemisphere Damage (ASHA)
• Attention Processing Training III Manual (University of Oregon)
• Pay Attention! Attention and Attention Processing Training in Brain Injury (University of Maryland Rehabilitation & Orthopaedic Institute)
• Evaluation and Treatment of Patients with Executive Dysfunction Following Brain Injury (Children’s Healthcare of Atlanta)
• The Adult Speech Therapy Workbook (Chung Hwa Brewer)

More Resources: Attention Activities for Adults