Understanding Attention Goals in Music Therapy: Sustained Attention (Part 2)
by Madison Michel, MM, MT-BC
Clinical 5 Model of Attention
Thaut and Gardiner developed a model for attention that breaks down attention skills into five specific skills that sequentially build on each other (Thaut & Gardiner, 2014). Part 2 of this blog series targets sustained attention.
1. Focused Attention: Focusing on a stimulus in light of distraction from other stimuli
2. Sustained Attention: Maintaining attention to a stimulus over time
3. Selective Attention: Selecting salient information from a larger body
4. Alternating Attention: Shifting between focusing on different stimuli
5. Divided Attention: Maintaining focus on two sources of information at the same time
How do sustained attention skills present in everyday life?
Imagine you are back in college or high school in the library to study for finals. You’ve set up in a quiet corner with minimal distractions with your computer, notes, and textbooks in front of you. You’ve set yourself up to focus your attention on studying. As you are reading through your notes, your phone buzzes and you recall you told a friend you’d call them back after missing a call earlier. You decide to wait to check your phone and try to continue to focus your attention and read. Another student walks by with a snack from the vending machine in hand, and you wonder where you should pick up dinner on the way home. You decide to think about this later and continue to read. You are purposefully sustaining your attention to a task over time.
Focused attention (see Part 1 of this series) involves filtering out distractor stimuli and selecting a primary stimuli to center attention on, sustained attention involves continually doing this over a period of time.
When is it appropriate to address sustained attention with clients in music therapy?
In a clinical setting, if a client successfully attends to a purposeful stimuli when cued, but turns away to distraction stimuli after a duration of time, sustained attention may be a primary area of need. How long should clients sustain attention? This depends on the task at hand and the client’s developmental level. In our library metaphor, a long duration of sustaining attention is required. In a clinical setting, you may be looking at shorter intervals of time, attainable to track within a session. If a client attends to a motivating, developmentally appropriate task, but disengages attention before completing the task, consider tracking the intervals of time your client sustains focused attention in a wide variety of activities to look for potential patterns. If there is a pattern of motivation and attendance to task, followed by disengaging attention to task after a similar period of time across goal areas, sustained attention may be your area of need.
Interventions for Sustained Attention
Building on focused attention, sustained attention interventions should require clients to focus for longer durations of time. This can be as simple as playing the same instrument to the music for a given consecutive or non consecutive duration of time. Interventions where the continuation of highly motivating music is contingent upon a sustained attention task (like instrument play) are a good place to start. Sustained attention could also focus on a musical story song or folder with fading amounts of redirection until it is completed. For clients who read music, adaptively or not, it could be sustaining attention on the reading task for the entire duration of the given song. There are many ways music can pull in cognitive processes and make sustained attention attainable – it’s the music therapist’s job to tap into those.
Goal Writing for Sustained Attention
Objectives for sustained attention should typically involve a duration of time as a primary tracking tool. Counting different kinds of redirects to the task (verbal, musical, physical, etc) within a specified duration of time could also be appropriate. Remember objectives are not universal and should always be individualized for each client’s needs and adjusted overtime.
Goal: Client will improve sustained attention in 80% of sessions.
Music Therapy Objective Example:
Client will sustain attention within a musical task such as improvising, playing sheet music, or continuously playing an instrument for the duration of 5 consecutive minutes with no more than 1 additional verbal redirect to stay on task.
Multidisciplinary Objective Example:
Client will sustain attention within a daily task for the duration of 5 consecutive minutes with no more than 1 additional verbal redirect to stay on task.
In summary, sustained attention is maintaining focused attention for a duration of time which must be present in order to address a wide variety of skills. There are many elements of music that naturally pull attention that can be used when designing sustained attention tasks.
In the next post in this series, I will focus on selective attention.
Thaut, Michael H., & Gardiner, James, C. (2014). Musical attention control training. In Thaut, Michael H., & Hoemberg, Volker (Eds.), Handbook of neurologic music therapy. (1st ed., pp. 257-269). Oxford University Press.