The Brief Test of Attention (BTA) is a test of attention based on Cooley and Morris’s conceptualization of attentional processes (Cooley and Morris 1990; Schretlen et al. 1996a). It was developed to be a pure measure auditory divided attention, and as such attempts to eliminate possible confounds of other attentional tasks such as motor and reasoning component (Schretlen et al. 1996a). It has also been suggested the BTA may be a useful embedded measure of cognitive effort (Busse and Whiteside 2012). The BTA has been used to assess attention in a variety of populations including Parkinson’s disease, sleep apnea, cancer, and traumatic brain injury (TBI; Aloia et al. 2003; Butler et al. 2008; Rao et al. 2010; Tröster et al. 1997; Wong 1999). Of note, the BTA is not intended to measure normal attention but instead to be a screening tool for attentional deficits (Schretlen 1997; Strauss et al. 2006). Additionally, the BTA does not assess visual attention (Strauss et al. 2006).
The BTA takes approximately 10 min to administer and has two parts (Schretlen 1997; Strauss et al. 2006). In both parts, individuals are asked to listen to a voice on a recording read 10 lists of letters and numbers. The length of each list ranges from 4 to 18 items. In the first part, individuals are asked count how many numbers are read, ignoring the letters in each list. In the second part, individuals count how many letters are read, ignoring the number for each list. The specific numbers and letters do not need to be recalled, just the total amount read per list. One point is given for each correctly counted trial. Possible scores range from 0 to 20 points. Normative data is available for individuals age 6–14 and 17–82 (Strauss et al. 2006). Recently, normative data of the BTA was published for Spanish speaking adults in 11 Latin America countries (Rivera et al. 2015).
The BTA has been shown to correlate most strongly with other known attentional test, and specifically may be more related to more complex attentional tasks (Trails B; digit backwards; Schretlen et al. 1996a). Initial validity and reliability measures for the BTA indicate acceptable internal consistency (coefficeint α = 0.82) in adults (Schretlen et al. 1996a). When both clinical and healthy populations were combined internal consistency was high (coefficient α = 0.91; Schretlen et al. 1996a). There have been variable results from examination of test-retest reliability for the BTA. In one study of adolescent girls tested 3 months apart, test-retest reliability was low (r = 0.45), however it was suggested that limited range may have contributed to this finding (Schretlen 1997). In contrast, an examination of older adults assessed at baseline and 9 months reported adequate test-retest reliability (r = 0.70; Schretlen 1997). While practice affects appear to be small or nonexistent, there have been concerns regarding a ceiling effect in the test (Schretlen 1997; Strauss et al. 2006). Age is the largest demographic variable predicting performance on the BTA, with older age associated with poorer performance (Schretlen 1997; Schretlen et al. 1996a; Strauss et al. 2006). Other demographic variables that may contribute to BTA performance include ethnicity, education level, and gender (Schretlen et al. 1996a; Schretlen 1997; Strauss et al. 2006). Demographic variables as a whole account for 17.5% of the variance in scores on the BTA, with age being the largest contributor to variance (Schretlen 1997).
BTA has been shown to be sensitive to individuals with mild head injury (Wong 1999). A report examining the validity of the BTA in Huntington’s disease patients found this group performed significantly worse than controls on the BTA. In contrast, a small group on amnestic patients were not found to perform differently from controls on the BTA, suggesting intact memory function may not be needed to successfully complete the BTA (Schretlen et al. 1996b).
Overall, the BTA appears to be a valid and relatively consistent measure of divided auditory attention. More research examining validity and reliability in minority populations is needed, as is further evaluation of test-retest reliability in different populations.
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McLaren, M.E., Woods, A.J. (2018). Brief Test of Attention. In: Kreutzer, J.S., DeLuca, J., Caplan, B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-57111-9_9090
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