Attention/Concentration: The Distractible Patient

Abstract

Attention and concentration are simple concepts on the surface but become complex when asked to assess or differentiate among capacities. While, at its most basic, attention refers to an organisms ability to recognize and respond to changes in its environment. The concept of attention when applied in neuropsychology represents a range of behavior which is dependent on functional integrity of many anatomical regions. The range of behavior includes everything from autonomic and reflexive auditory and visual orientation to sound and movement, to the ability to process several stimuli simultaneously or alternate back and forth from competing stimuli (see Kolb B, Whishaw, 2009 for review). While a universally accepted definition of attention and concentration would be broad and potentially unusable, the models of attention typically have common features including orienting, selecting stimuli and maintenance for a necessary time or successful completion of a task. These factors are represented in Fig. 6.1. Attention is typically viewed as a sequence of processes that occur in several different regions of the brain, which are involved with the acquisition and sustaining of attention. Attention is organized hierarchically, usually modality-specific at its origin and then multi-modality or multi-cortically mediated as in rapid alternation or switching of attention or maintenance of concentration.

In addition to attention, concentration refers to two elements: the capacity to sustain attention on relevant stimuli and the capacity to ignore irrelevant competing stimuli. Again, while simple, the concept of concentration is objectively difficult to differentiate in an orthogonal manner, several models of attention and concentration have been proposed and the interested reader is referred to Posner (1990) for elaboration.