Week 4:  Attending to Attention with a Focus on Focusing

What is the  SART test?  Here is an expanded explanation:

The Go/No-Go Sustained Attention to Response Task (SART) is a psychological test designed to measure a person's ability to maintain focused attention over a period of time and to control their impulses. It is a useful tool for determining how well someone can maintain focus and control impulses over time.

Here’s a simple breakdown of how it works:

• Go and No-Go Signals: During the test, participants are presented with various stimuli, such as letters, numbers, or shapes, on a screen. Among these stimuli, there are "Go" signals, where participants are supposed to respond (usually by pressing a button), and "No-Go" signals, where they are supposed to inhibit or withhold their response.

• Task Objective: The main objective for the participant is to respond as quickly and accurately as possible to the "Go" signals while not responding to the "No-Go" signals. This tests the ability to maintain attention (by quickly recognizing and responding to "Go" signals) and impulse control (by not responding to "No-Go" signals).

• Measuring Attention and Impulse Control: By analyzing the speed and accuracy of responses, as well as the errors made (like responding to a "No-Go" signal or missing a "Go" signal), researchers can gather information about an individual's sustained attention and impulse control abilities. Commonly, the task is used to study attention in various populations, including children and adults, and can be particularly useful in research on attention deficit hyperactivity disorder (ADHD), among other conditions.

• Sustained Attention: The term "sustained attention" refers to the ability to focus on a task over a long period of time without getting distracted. The Go/No-Go SART challenges this ability by requiring consistent attention to stimuli that are not inherently interesting, making it a good measure of how well an individual can maintain focus.

• Results Interpretation: The results from the SART can provide insights into various cognitive functions, such as the efficiency of an individual's executive function, which includes planning, decision-making, error detection, and impulse control. High numbers of mistakes on "No-Go" signals might indicate difficulties with impulse control, while consistent responses to "Go" signals can indicate good sustained attention.

The original SART is a no-go task with a quasirandom presentation of digits from 1 to 9, in which the participant has to respond to all the digits except for 3, which is the no-go target. Digits are presented for 250 ms, followed by a 900-ms mask. The task takes about 4 minutes. The no-go trials represent only 11% of total trials, in order to favor an automated response to go trials. Therefore, the SART requires one to withhold the response to targets and to respond to nontargets. Researchers argued that sustained attention to the task would be more difficult if the automatic response was directed to nontarget stimuli. In this sense, the commission errors (i.e., response to target) are the main indicator of the impaired sustained attention ability. Commission errors are indeed positively correlated with a tendency to report everyday cognitive errors (Vallesi, A., Tronelli, V., Lomi, F., Pezzaetta, R. 2021).

Sustained attention is essential for functioning in everyday life. Therefore, it is important to understand how it changes across the adult lifespan, and in particular with aging. Several studies reported that older adults showed longer response times and fewer errors on sustained attention tasks than younger adults. Longer response times could be in line with an age-related processing speed deficit, which has been attributed, among other factors, to the reduction in white matter integrity associated with aging (Vallesi, A., Tronelli, V., Lomi, F., Pezzaetta, R. 2021).

However, the longer response times and the difference in the number of errors also suggest a conservative strategy to compensate for their poor response inhibition. In other words, older adults could be more cautious in responding on go trials to avoid errors on no-go trials (Vallesi, A., Tronelli, V., Lomi, F., Pezzaetta, R. 2021).

Although Attention Deficit Hyperactivity Disorder is often associated with children, it can be present throughout adulthood, and into our senior years as we may struggle with attention, memory, and planning. We may even find ourselves procrastinating more as we age, leading to feelings of anxiety and/or guilt (Collier, 2020).

Attention Deficit Hyperactivity Disorder (ADHD) includes those who have attention challenges. But it may or may not include hyperactive behaviors. Indeed, some with ADHD are very calm, and even lethargic. A lack of focus can seem subtle or even invisible to observers.

Preliminary research is beginning to paint a picture of what ADHD looks like in adults over the age of 60. Kathleen Nadeau, Ph.D., studies ADHD in aging populations. She conducted in-depth interviews with more than 130 women and men diagnosed with ADHD, covering their symptom progression, their experience with medical professionals, and their biggest challenges, both ADHD-related and otherwise, associated with aging (Nadeau, 2023).

Findings show that ADHD can look markedly different throughout a person’s lifetime. Symptoms may shift during the transition from childhood to adolescence and young adulthood, again when a person enters midlife, and again during our senior years. 

Normal Aging or ADHD?

When people share concerns with their doctor about their memory, attention, or difficulty completing tasks, they may receive a diagnosis of mild cognitive impairment (MCI), a stage between normal aging and dementia. However, older adults with ADHD may never have received a diagnosis of ADHD, especially if they had learned skills to compensate during their lifetime. To help doctors differentiate between mild cognitive impairment and ADHD in old age, the timing of symptoms and family history can provide good clues, after ruling out potential medical causes, such as thyroid or seizure disorders (Nadeau, 2023).

ADHD is one of the most heritable disorders in medicine. Having children, grandchildren, or siblings with ADHD should increase a physician’s suspicion that a patient’s symptoms may be the result of ADHD.

Many clinicians misdiagnose ADHD later in life due to lack of specialized training. Most physicians receive 20 minutes (or less) of instruction on ADHD in medical school, and nearly all that time is spent on pediatric diagnosis and treatment. In one survey, 40% of primary care physicians said they had never encountered an adult patient (of any age) with ADHD. In reality, that’s an impossibility. Rather, the likely problem is that they may have absolutely no idea what ADHD looks like later in life.

Prefrontal Cortex, Fusiform Face Area, & Parahippocampal Place Area

A study by MIT neuroscientists reveals how the brain achieves focused attention on faces or other objects. It has long been established that a part of the prefrontal cortex known as the inferior frontal junction (IFJ) controls visual processing areas that are tuned to recognize a specific category of objects (Trafton, 2014).

The prefrontal cortex, the control center for most cognitive functions, appears to take charge of the brain’s attention and control relevant parts of the visual cortex, which receives sensory input. For spatial attention, that involves regions of the visual cortex that map to a particular area within the visual field (Trafton, 2014). 

In the study, the researchers found that IFJ coordinates with a brain region that processes faces, known as the fusiform face area (FFA), and a region that interprets information about places, known as the parahippocampal place area (PPA) (Trafton, 

  PITd

Decades of research has suggested that the control of selective attention, belongs to a handful of areas in the brain’s parietal and frontal lobes. More recently, it has been determined that another area in an unlikely location, the temporal lobe, also steers the spotlight of our attention. This area is the PITd, named for its location in the dorsal part of the posterior inferotemporal cortex (Freiwald, 2019).

The brain’s attention areas hold an internal map of the outside world, a kind of control panel that ensures we are directing our processing resources toward the small part of the world that’s relevant to our goal at any given time. A telling sign of an attention control area is that its neurons don’t care about what we are looking at. It may be a flying bird, a pitched ball, or a single word on a page full of words. It only cares where that thing is. Neurons in the PITd code for a specific area in our field of vision, only firing when that part is being attended to (Freiwald, 2019).