OK folks, pay attention, it’s attention lesson time. I know, I know you go through life not having to worry about such a thing, unless you have ADD or a screaming baby. But when life smacks you across the head, ringing your brain, it becomes über important to you and those around you because it’s gone. And its loss can become a source of a lot of BS pontificating and judging from those close and sometimes far who’d rather not know about it, pretend nothing’s changed, and accuse one of making excuses. Ahem. (Attention is also better understood by some psychologists than others in the brain injury field.) So here goes.
According to the Toronto Rehabilitation Institute and the 1994 McKay Moore Sohlberg paper Understanding Attention Impairments, there are five kinds of attention: focused, sustained, selective, alternating, and divided. I had difficulties with all five after my closed head injury, but brain biofeedback restored some of them. However, it has made little difference to the attention skills required when in groups, crowds, and at parties. Those are the ones I’ll address today. So listen up all you people who won’t read this because this is the last time I’m explaining attention issues.
Before I begin, I ought to give a little background information on fatigue and traumatic brain injury or closed head injury. Imagine a certain task takes x amount of energy. After a brain injury or insult, every task takes 10x amount of energy — at least. Whether it’s your heart beating, breathing, eating, nuking oatmeal, brushing teeth, opening the door, dressing, walking, navigating the TTC, talking, answering the phone, conversing, reading, writing, paying attention in a crowd, everything takes more energy, way more. When the brain has to execute a skill or function it no longer has or is now poor at doing, it takes even more energy. That drain is felt in the moment and oftentimes the day after and the day after that and after that as the brain recovers from the work it did. And so trying to use an attention skill that is lost or weak saps one’s energy quickly and for a long time afterwards too. That’s why priorities about when to exert which attention have to be set.
One pays attention to a task or person with one’s brain, but it’s done through the senses. Although this post is about attention in general, attention is mediated through each sense differently, depending on the person’s strengths and weaknesses. For example, one can have little problem paying attention to auditory stimuli but a lot to visual stimuli.
Selective: This attention skill allows you to ignore distractions in the environment and pay attention to important information, like the person you’re listening to.
As anyone who’s sat across from me at a coffee shop, with me facing the window, knows, I get easily distracted by cute dogs passing by, people walking, cars zipping across my field of vision, changing traffic lights. If I face indoors, then I get distracted by the noise of conversations, the servers, the odd quirks of people eating. If I face a wall, I can focus better, but I hate facing walls. Must be some old claustrophobic thing. Regardless, if I can’t see a person’s mouth, I have a much harder time understanding them because it’s harder for me to discriminate or select between auditory stimuli. It has nothing to do with my hearing because….
I have excellent hearing, always have had. But like with any typical person with a closed head injury, my senses were ratcheted up, filters damaged, and I hear everything: the clock ticking, cutlery dropping, plates being clanked, wrappers crinkling, people coughing, punctuations of laughter, footsteps. Those noises grab my attention like someone grabbing your coat collar. If those noises are in a theatre, they’re like gunshots to the head. If someone applauds behind me, it’s a physical sensation on my ears and back. They compete with what I’m supposed to be focusing on. And that’s just one sense. There are three others also ratcheted up — vision, smell, touch — taste is just odd. If auditory and visual noise is all around me, like at a party, it’s like a giant challenge to my selective attention and a great sucking vacuum on my energy levels.
“People with impairments in selective attention may become easily irritated and frustrated by such extraneous noise.” (From McKay Moore Sohlberg paper)
Grumpyface — from the Doctor Who episode The Time of Angels — is a good descriptor!
Alternating: This attention skill allows a person to switch their attention easily from task to task or person to person in a group or party. Apparently, this is a high-level attention skill.
I find it takes me a moment when I have to switch my attention. When someone suddenly forces me to switch attention by popping up behind me, asking a question, demanding I switch attention instantly from what I was doing or saying, without a gentle intro hello, it irritates me and actually slows me down more. Of course, this happens naturally in parties when someone will appear from seemingly nowhere (the nowhere part is an alpha-wave open-awareness issue where lack of awareness leads to easy startling — see how problems start overlapping?) and want to interrupt. This is rude from where I come from, but pretty commonplace here. A normal person may at worst get a bit anoyed with the rudeness of the interruption, but a person with a brain injury will also feel discombobulated and overwhelmed at the sudden need to switch attention. Irritation times 10!
Divided: This attention skill allows a person to pay attention to two or more things at once. Another way to look at this is multitasking.
A common divided attention scenario is driving a car and listening to the radio at once (frankly, I think simultaneous attention would be a better moniker, but I digress). Well…with poor divided attention skills, I can’t be a passenger in a car and listen to the radio at once, especially when the car starts to move at 50 or 60 kph or more. Then I start feeling overwhelmed, like being in an IMAX 3D movie theatre watching Star Trek and suddenly the screen goes to warp speed and Kirk is calling for Spock behind my seat and popcorn has been dumped all over me, all at the same time.
I first fully understood I had a problem with divided attention when my Dad was talking to me while I was trying to slice bread. Couldn’t do it. I still have trouble listening and slicing at the same time.
So imagine having deficits in these three attention types and being at a party — an event full of distractions by its very nature — with every sound cranked up to ultra-high in my ears, with the visual distractions of brighly-coloured people moving around like flashing beacons screaming “watch me, watch me”, and the smells of food and perfumes and shampoos shoving themselves up the nose, all demanding attention. Add to that people naturally placing demands on weak or nonexistent divided, alternating, and selective attention just by trying to converse with you or you trying to mingle. Fun, wow. Yet some people still insist I should show up to such shindigs because that’s what I used to do pre-injury and if I don’t, it’s proof I’m using “excuses” or don’t care.
The compassionate, human response is to understand these issues and then to listen, listen to the one with the brain injury when they say “I’d rather see you over coffee, in a quiet place, one-on-one, where I can be myself not Grumpyface, and when I won’t have to spend days recovering just because I chose to socialize.” The alternative is to be unaccepting and so build a stone barrier between yourself and the one with the brain injury.
The other two kinds of attention are focused and sustained.
Focused: This is the basic attention skill where one notices objects or events and specific sensory stimuli in the environment.
Sustained: This attention skill gives one the ability to stick with an activity over time, like reading a book or writing an essay or commuting on the highway. Inconsistent performance, varying from excellent to nonexistent, like one day remembering a phone number long enough to dial it, another day not, may be problems with sustained attention.