TSI: Focused Attention
Field Study Report
July 20, 2011

Problem Statement

The National Association for Child Development (NACD) was founded in 1979 by educator and lecturer Robert J. Doman, Jr. Since its founding, over 40,000 clients served by NACD have come to them with medical labels including: Learning Disabled, Dyslexic, distractible, ADD/ADHD, Down Syndrome, Fetal Alcohol Syndrome, Williams Syndrome, Tourettes Syndrome, Rett Syndrome, Fragile X, Developmentally Delayed, PDD, autistic, Cerebral Palsy, brain injured, comatose, retarded, Minimal Brain Dysfunction, normal, accelerated, and gifted (Efficacy, 2002). The families served by NACD have traveled to NACD centers from all 50 states, as well as from Europe, Asia, Africa, South America, Australia, and Canada because of its unique model of empowering parents to help their children achieve their potential. NACD staff members conduct comprehensive evaluations of a child’s development and provide targeted activities to remediate weaknesses and facilitate learning.

In evaluating children and speaking with their parents, NACD staff identified a frequently occurring weakness in auditory figure-ground processing, i.e., the ability to listen and attend to a specific stimulus in the presence of background sound. They observed that many children experienced difficulty in this area, but that it was especially common in specific groups, such as children with ADD and also those with Auditory Processing Disorder. For some children this affected their ability to attend to the teacher in a classroom setting. For some it manifested as a poor tolerance for contexts in which background sound was present. For others it was a matter of the child being described as distracted by random sounds. The common complaint the staff heard parents make was typically stated as, “My child can’t focus.”

In response to identifying this problem, staff began to search for an existing technique or treatment program that addressed this skill very specifically. The search yielded a number of tests that identified this problem, but no specific treatment programs for it.

In 2009, as part of their Targeted Sound Intervention – TSI®, NACD staff began to develop the TSI: Focused Attention program. They intended TSI: Focused Attention to be a tool to improve auditory figure-ground processing in both children and adults. It contains musical melodies, which were composed for the specific purpose of providing a high-intensity, appropriate target stimulus, set against a backdrop of various auditory environments (such as the sounds of a restaurant, public swimming pool, or amusement park). The program contains a progression of eight CDs and instructions for specific listening techniques the listener should use in order to maximize the benefit of the program.

The field study reported here was an attempt to get feedback on the initial program. The employees of NACD did not want to release a product that had not been tested. They wanted to make sure their theoretical basis was sound and that the program was doing what they set out for it to do.

Method

An NACD employee selected NACD clients between the ages of 6 and 12 years old with specific difficulties related to listening and auditory attention. The employee then approached each of the families about the study, explained the purpose, the process, and what all was involved. Twenty-five families expressed a willingness to participate.

Each family received instruction on how to conduct pre-testing, how to use the field test CD, and how to conduct post-testing. They received a packet containing their pre- and post-testing materials, a field test CD, a headphone splitter (necessary equipment for the program), and a timeline sheet, which showed them what they should complete each day. Families were told to contact the NACD employee if they had any questions during the course of the study.

Both the pre-test and post-test consisted of two subtests from the SCAN, a standardized screening tool for auditory processing disorders. The subtests tested a child’s ability to distinguish spoken single words in the context of background noise. In the subtest Auditory Figure-Ground +8 dB (AFG +8), the spoken word was 8 dB louder in volume than the background noise. In the subtest Auditory Figure-Ground 0 dB (AFG 0), the spoken word and background were equal volumes. In addition to the SCAN subtests, families filled out surveys as part of the pre- and post-testing.

The pre-survey asked a parent of the child to complete the following questions:

1. Rate your child’s ability to tune in, listen, and attend in general (scale of 1-10, 1=severe listening problems; 10=is a great listener).
2. Rate your child’s distractibility (scale of 1-10, 1=very distractible, distracted by anything and everything; 10=able to maintain attention in presence of distractions).
3. Rate your child’s ability to listen in the presence of background sound (1=unable to attend if background sound is present, even just air conditioner running or music playing at low volume; 10=No difficulty).

The post-survey asked a parent of the child to complete the following questions:

1. Rate your child’s ability to tune in, listen, and attend in general (scale of 1-10, 1=severe listening problems; 10=is a great listener).
2. Rate your child’s distractibility (scale of 1-10, 1=very distractible, distracted by anything and everything; 10=able to maintain attention in presence of distractions).
3. Rate your child’s ability to listen in the presence of background sound (1=unable to attend if background sound is present, even just air conditioner running or music playing at low volume; 10=no difficulty).
4. Y/N: My child enjoyed the CD.
5. Y/N: Do you think your child benefited from listening to the CD?

After conducting the pre-test the families started using the TSI: Focused Attention field test CD. The field test CD contained six demonstration tracks from the program. (The complete program contains 80 tracks.) They used the CD for six weeks and then conducted the post-testing.

Results

Twelve families completed the program and returned the test and survey results.  The thirteen who did not complete the field test dropped out of the study for personal reasons, such as: discontinued as NACD clients and therefore chose to discontinue their participation in the study; did not complete due to scheduling conflicts, holidays, or illness; or were not consistent enough with the program to feel that they could fairly complete the testing.

For the 12 families who completed the field test, the average scores are listed in the table below (see Table 1.1).

Table 1.1.  Average scores taken from pre and post tests from the TSI: Focused Attention field test.

Notice that the number of words identified correctly was higher for the 8 dB group than for the 0 dB group. This is to be expected because it is easier to determine the difference between two sounds of different loudness levels than to differentiate between sounds of equal loudness. (It should also be noted that the stimuli, the actual words used, were different in the two subtests. This is important in order to prevent a test-retest effect, yet it could also contribute to a difference in scores.)

Correlated t tests were done to determine if the increases in SCAN values were statistically significant after the training procedures. For the 0 dB group, t = 4.69, df = 10, a significant increase at the .01 level. (Values were not obtained for one person in this group.) For the 8 dB group, t = 2.33, df = 11, a significant increase at the .05 level. Note that the difference between means was greater for the SCAN test with the 0 dB group than for the 8 dB group. Training appears to have had a greater impact on the more difficult task, which was the 0 dB group.
The survey questions numbered 1-3 also showed significant change in the positive direction. (Some people did not give results for these items.) For question 1 (tune in), t = 3.33, df = 8, significant at the .01 level. For question 2 (less distractible), t = 4.02, significant at the .01 level. For question 3 (ability to listen), t = 5.38, df = 9, significant at the .01 level.

In the post-test, parents were asked two yes-or-no questions.  When asked if they thought their child enjoyed the CD, 11 parents said yes (92%) and one was undecided.  When asked if they thought their child benefited from listening to the CD, 10 parents said yes (83%), one parent said no, and one parent said “some.”

Conclusions

According to the results from the field test, the TSI: Focused Attention program made a statistically significant difference in both of the SCAN subtests. In addition, participation in the TSI: Focused Attention program significantly increased the ratings of the child’s performance in three main areas:

1. ability to tune in, listen, and attend in general
2. less distractibility
3. ability to listen in the presence of background sound

In test results, the increase in scores was consistent with an increase in the parents’ perception of the child’s performance.  The increase in scores may be due to other circumstances, such as familiarity with test procedures, an enjoyment of individualized attention, or outside activities that also contributed to an increase of auditory processing skills.  These other circumstances were not addressed in this field study.  However this is only a field study on a demonstration of the program, not the complete program. Acknowledging that the current study is for an abbreviated version of the complete program, NACD will continue to research the effects of the full TSI: Focused Attention.  With the complete program, the change is expected to be even more significant.

Works Cited

Efficacy of the NACD Program. (2002). Department of Social Work at BYU-Hawaii. Retrieved from: http://www.nacd.org/learn_more/docs/efficacy_of_the_nacd_program.pdf