Clinical Considerations: Assessment and Treatment

Abstract

The clinical assessment of attention depends on three primary sources of information: (1) direct behavioral observation and measurement; (2) psychometric tests designed to measure other cognitive functions (e.g., intellectual measures), which provide indirect information about attention, and (3) neurocognitive tests developed speci fi cally to assess attention and its underlying component processes. As attention is a multifaceted process, the assessment of attention requires that the clinician obtains information about the characteristics of the patient's performance under different conditions. Therefore, to adequately assess attention, it is usually necessary to use more than one test. Since the publication of the fi rst edition of this book, the number of tests and paradigms for assessing attention has increased dramatically. Twenty years ago, clinicians tended to rely on analysis sub-tests of the WAIS-R, along with data from a few tests sensitive to both attention and executive functions. A few continuous performance tests (CPTs) were available for assessing sustained attention , though few options existed. Most of the commercially available tests did not adequately assess for vigilance decrement or performance variability, limited normative data had been collected from different clinical populations. With the exception of cancellation tasks, very few tests of selective attention were available. There were essentially no test batteries speci fi cally designed to assess attention or executive function. This is no longer the case. While there remain some gaps in tests available to assess all of the component processing underlying attention, a much larger number of tests now exist, including several attention batteries. Furthermore, a number of experimental paradigms developed by cognitive neuroscientists now exist, which will likely eventually be incorporated more formally into clinically normed tests. The biggest constraint on the assessment of attention is no longer the availability of appropriate tests, but rather the time that may required to assess all elements of attention if a comprehensive workup of attention is desired. In this chapter, we discuss current approaches to the clinical assessment of attention, taking into consideration these three sources of information. The initial discussion focuses on the traditional approaches to assessing attention. The reader is encouraged to review Lezak a more detailed account of the actual test procedures and norms for many of the standard tests of attention and executive functioning [ 1 ]. This is followed by a discussion of several attention batteries. At the end of the chapter, experimental attentional paradigms that may be useful for neuropsychologists studying or clinically assessing attention are discussed.