Attention Intervention Management

Impairments in attention are among the symptoms most frequently reported by parents and
teachers following pediatric traumatic brain injury (TBI_. These cognitive disabilities are
responsible for a wide range of academic and adjustment issues. Broadly defined, attention
encompasses all of the mental processes, operations, and systems requisite for acquiring and
applying information. It interacts with other cognitive functions including perception,
memory/learning, organization, and reasoning; attention is core to the integration of those
systems. A number of different attentional subcomponents with interconnected neural systems
have been identified and shown to be differentially disrupted following trauma and other
brain disorders, including maintenance or sustained attention, attentional selectivity,
attentional capacity, and ability to effectively shift attention. Given the prevalence of
attention difficulties and secondary attention deficit hyperactivity disorder (ADHD)
following TBI, it is imperative to identify treatments to effectively address attention
impairments.

The study will develop and pilot the Attention Intervention and Management program (AIM).
AIM focuses on direct attention training in conjunction with metacognitive strategy
training. Strategies are designed to improve focus and self regulation, reduce distractions,
and enhance problem solving in academic settings. Integration of attention training and
metacognitive strategies will help to ensure that the student can apply the skills across
settings and situations.

The Randomized Controlled Trial (RCT) in Phase 2 of this project will address two
interrelated hypotheses:

Hypothesis 1: Children receiving the Attention Intervention and Management (AIM) program
will evidence better performance on standardized tests of attention and executive functions
(EF) than those in the wait list control (WLC) group.

Hypothesis 2: Children receiving AIM will have fewer attention and EF problems than those in
the WLC on parent and teacher rating scales of attention and EF.

Participants will include children ages 10-18 with significant evidence of attentional
impairments.

Inclusion Criteria:

- ages 10-18

- significant evidence of attentional impairments

- moderate to severe TBI

- time since injury at least 6 months

- completion of inpatient rehabilitation (if needed

- English as the primary spoken language in the home.

Exclusion Criteria:

- Child does not live with parents or guardian

- Child or parent has history of hospitalization for psychiatric problem

- TBI is a result of child abuse

- Child suffered a non-blunt injury (e.g., projectile wound, stroke, drowning, or other
form of asphyxiation)

- Diagnosed with moderate or severe mental retardation, autism, or a significant
developmental disability