Poor Visual Attention Research Articles

Associations of prenatal exposure to phthalates with measures of cognition in 7.5-month-old infants

Background: Phthalates are endocrine disrupting chemicals found in consumer products. Prenatal exposure has been associated with adverse neurobehavior, but little is known about the influence on infant cognition. Methods: A visual recognition memory task was used to assess cognition in 239 7.5-month-old infants (122 females; 117 males) from a prospective cohort study. Phthalate metabolites were quantified in maternal urine from 16-18 gestational weeks and a pool of five urines collected across pregnancy. The cognitive task included familiarization trials (infant shown 2 identical images/stimuli) and test trials (infant shown a familiar image/stimulus paired with a novel one). During familiarization trials, average time looking at stimuli before looking away (measure of processing speed), and time to reach looking time criterion (measure of attention) were assessed. During test trials, proportion of time looking at the novel stimulus (measure of recognition memory) was assessed. Associations of monoethyl phthalate (MEP), sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP), and sum of di(isononyl) phthalate metabolites (∑DINP) with each outcome were assessed using generalized linear models adjusted for multiple potential confounders. Infant sex was considered a potential effect modifier. Results: Mothers were mostly white and college educated. Phthalate biomarker concentrations were consistent with the U.S. general population. Each interquartile range (IQR) increase of ∑DEHP at 16-18 weeks was associated with a 5.2-second (95%CI=1.8,8.6) increase in time to reach looking time criterion in males but not females. An IQR increase in ∑DINP in the pooled sample was associated with a 1.0% (95%CI=-1.8,-0.3) decrease in novelty preference across both sexes and similarly associated with 16-18 week ∑DINP. MEP was not associated with cognition. None of the phthalate biomarkers were associated with information processing speed. Conclusion: Prenatal exposure to DEHP may be associated with poorer visual attention in males and DINP with poorer recognition memory in both sexes. ES007326;ES022848;ES028607;RD83543401;OD023272.

Current Understanding of Dyslexia and Pilot Data on Efficacy of a Mindfulness Based Psychotherapy (MBR-RAM) Model

Background: Dyslexia, a heterogeneous syndrome, is the most recognized Developmental Reading Disorder (DRD) with 5-17% prevalence and poses as a significant disability. Its core deficits are: Phonological deficits, poor visual attention span, selective deficits in complex serial visual search tasks, sustained visual attention problems, visuospatial functioning and difficult image reproduction from memory. Much remains to be accomplished clinically to address these deficits. Methods: Mindfulness Based Rehabilitation of Reading, Attention & Memory (MBR-RAM©) is a translational mindfulness based cognitive behavioral therapy developed by the first author. MBR-RAM uses focused attention enhancement visual meditation techniques (Sanskrit: trataka) in therapist-assisted and home-practice formats to rehabilitate reading deficits, visual inattention, visual motor incoordination, information processing speed and visual memory. Visual motor incoordination indicates inability to control hand movements guided by the visual cues while reading letters. Three Caucasian subjects in this study included an 8-year-old girl and two boys aged 9 and 10 years. The objectives were to study the changes pre- and post-intervention with respect to their scores on the various clinical and neuropsychological measures. Results: Compared to the baseline, all three subjects showed clinical and statistically significant improvements in the outcome measures, which were sustained for at least 6 months after study completion. There were no adverse effects in them. Conclusion: Results of this pilot study indicate that MBR-RAM© is a feasible, low cost treatment, which is effective for rehabilitating some important deficits of dyslexia. The results need replication in future studies with better methodology to make definite conclusions. Keywords: Dyslexia, learning disorder, reading disorder, yoga, mindfulness, trataka.

Strong long-range temporal correlations of beta/gamma oscillations are associated with poor sustained visual attention performance.

Neuronal oscillations exhibit complex amplitude fluctuations with autocorrelations that persist over thousands of oscillatory cycles. Such long‐range temporal correlations (LRTC) are thought to reflect neuronal systems poised near a critical state, which would render them capable of quick reorganization and responsive to changing processing demands. When we concentrate, however, the influence of internal and external sources of distraction is better reduced, suggesting that neuronal systems involved with sustained attention could benefit from a shift toward the less volatile sub‐critical state. To test these ideas, we recorded electroencephalography (EEG) from healthy volunteers during eyes‐closed rest and during a sustained attention task requiring a speeded response to images deviating in their presentation duration. We show that for oscillations recorded during rest, high levels of alpha‐band LRTC in the sensorimotor region predicted good reaction‐time performance in the attention task. During task execution, however, fast reaction times were associated with high‐amplitude beta and gamma oscillations with low LRTC. Finally, we show that reduced LRTC during the attention task compared to the rest condition correlates with better performance, while increased LRTC of oscillations from rest to attention is associated with reduced performance. To our knowledge, this is the first empirical evidence that ‘resting‐state criticality’ of neuronal networks predicts swift behavioral responses in a sensorimotor task, and that steady attentive processing of visual stimuli requires brain dynamics with suppressed temporal complexity.

The Impact of Preexisting Illness and Substance Use on Functional and Neuropsychological Outcomes Following Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant public health problem in the US. Specific preexisting medical illnesses delay recovery after TBI and increase mortality or risk of repeat TBI. This study examined the impact of preexisting illness and substance use on patient rehabilitation outcomes following TBI. The Functional Independence Measure total score and Disability Rating Scale score measured functional outcomes at discharge from inpatient rehabilitation, while the Trail Making Test A and B and Total Trials 1-5 of the California Verbal Learning Test-II measured neuropsychological outcomes in 128 TBI survivors with moderate or severe TBI. Results showed that the presence of a heart condition or diabetes/high blood sugar was associated with lower functional outcomes by discharge. A history of a heart condition, stroke, or respiratory condition prior to TBI was associated with reduced cognitive flexibility. Those with preexisting diabetes/high blood sugar demonstrated poorer visual attention, visuomotor processing speed, and ability to learn and recall verbal information. Those with pre-TBI cancer also had greater auditory-verbal memory deficits. The findings showed that specific preexisting medical conditions are independently associated with lower functional and cognitive outcomes for patients with TBI. By screening patients for preexisting medical conditions, multidisciplinary TBI rehabilitation teams can identify patients who require more aggressive treatments or greater length of stay.

Visual attention for social information and salivary oxytocin levels in preschool children with autism spectrum disorders: an eye-tracking study.

This study was designed to ascertain the relationship between visual attention for social information and oxytocin (OT) levels in Japanese preschool children with autism spectrum disorder (ASD). We hypothesized that poor visual attention for social information and low OT levels are crucially important risk factors associated with ASD. We measured the pattern of gaze fixation for social information using an eye-tracking system, and salivary OT levels by the Enzyme-Linked Immunosorbent Assay (ELISA). There was a positive association between salivary OT levels and fixation duration for an indicated object area in a finger-pointing movie in typically developing (TD) children. However, no association was found between these variables in children with ASD. Moreover, age decreased an individual's attention to people moving and pointed-at objects, but increased attention for mouth-in-the-face recognition, geometric patterns, and biological motions. Thus, OT levels likely vary during visual attention for social information between TD children and those with ASD. Further, aging in preschool children has considerable effect on visual attention for social information.

Teaching Object Permanence: An Action Research Study

Object permanence, also known as object concept in the field of visual impairment, is one of the most important early developmental milestones (Fazzi & Klein, 2002; Morss, 1984). The achievement of object permanence is associated with the onset of representational thought and language (Bruce & Zayyad, 2009; Wright, Lewis, & Collis, 2006). Object permanence is important to orientation, including the recognition of landmarks (Anthony, Bleier, Fazzi, Kish, & Pogrund, 2002). Independent mobility (such as crawling) improves visual attentiveness, which is critical to the achievement of later object permanence tasks (Bozeman& McCulley, 2010). Direct instruction can accelerate the mastery of object permanence in children with disabilities (Kahn, 1976; 1984; Morss, 1984; Rogers & Puchalski, 1988) and is more effective than general stimulation programs (Sloper, Glenn, & Cunningham, 1986). This article presents an action research study on teaching object permanence to a child with multiple disabilities and visual impairment. It illustrates some of the principles of assessment and instruction described in Bruce and Vargas (2012). The Institutional Review Board at Boston College approved this study, which was part of a set of action research studies on pivotal milestones that were conducted with children with multiple disabilities. THE PARTICIPANT Jamie, the participant in the study, was a 4-year old girl with severe, global developmental delays; a seizure disorder; and nonambulation (with no other independent means of mobility). Jamie had progressive myopia (with higher myopia in her right eye), staphyloma, and a tilted optic disc in her right eye; hypoplasia (in both eyes); nystagmus; and probable ocular motor apraxia. Although Jamie's visual acuity for stripes was measured at 20/94 with the best correction, this method underestimates visual responses to more complex and typical visual stimuli. Thus, her ophthalmologist determined that she was legally blind and referred her for registration with the state's Commission for the Blind. Jamie had poor visual attention; she struggled to make eye contact and to share joint visual attention on an object. Her visual attentiveness improved with prompts paired with pauses that allowed her time to direct her visual attention. Jamie had a history of sporadic ear infections and had tubes in her ears. Although later testing indicated that she had normal hearing, it is reasonable to suspect that she may have had a history of intermittent, mild hearing loss because of ear infections. However, she was consistently able to respond to verbal inputs during the study and was often observed to smile when provided with verbal praise. Jamie was also nonambulatory and displayed immature grasp patterns. RESULTS OF THE ASSESSMENT The action research team selected the following three assessment tools to determine Jamie's present level of performance on object permanence tasks: the Hawaii Early Profile (Parks, 2004); Assessment, Evaluation, and Programming System for Infants and Children, Second Edition, Volume 2, Test Birth to Three Years and Three to Six Years (Bricker et al., 2003); and Structured Informal Assessment of Object Permanence (Bruce & Vargas, 2012). The baseline assessment revealed that Jamie had achieved the following precursor behaviors to object permanence: She visually focused on a person or object (when prompting and pause were provided), visually followed an object moving in horizontal and vertical directions, and reacted to the disappearance of a slow-moving object or person (with a smile). She also exhibited the following early object permanence behaviors: She located a partially hidden object when concealment was observed and occasionally located a concealed object (when concealment was observed) and a constant auditory sound (emitting from the concealed object) was provided. Jamie was not able to locate a concealed object without sound cues or when concealment was not observed. …

Impaired Letter‐String Processing in Developmental Dyslexia: What Visual‐to‐Phonology Code Mapping Disorder?

Poor parallel letter-string processing in developmental dyslexia was taken as evidence of poor visual attention (VA) span, that is, a limitation of visual attentional resources that affects multi-character processing. However, the use of letter stimuli in oral report tasks was challenged on its capacity to highlight a VA span disorder. In particular, report of poor letter/digit-string processing but preserved symbol-string processing was viewed as evidence of poor visual-to-phonology code mapping, in line with the phonological theory of developmental dyslexia. We assessed here the visual-to-phonological-code mapping disorder hypothesis. In Experiment 1, letter-string, digit-string and colour-string processing was assessed to disentangle a phonological versus visual familiarity account of the letter/digit versus symbol dissociation. Against a visual-to-phonological-code mapping disorder but in support of a familiarity account, results showed poor letter/digit-string processing but preserved colour-string processing in dyslexic children. In Experiment 2, two tasks of letter-string report were used, one of which was performed simultaneously to a high-taxing phonological task. Results show that dyslexic children are similarly impaired in letter-string report whether a concurrent phonological task is simultaneously performed or not. Taken together, these results provide strong evidence against a phonological account of poor letter-string processing in developmental dyslexia.

Dominant-Negative Mutations in α-II Spectrin Cause West Syndrome with Severe Cerebral Hypomyelination, Spastic Quadriplegia, and Developmental Delay

A de novo 9q33.3-q34.11 microdeletion involving STXBP1 has been found in one of four individuals (group A) with early-onset West syndrome, severe hypomyelination, poor visual attention, and developmental delay. Although haploinsufficiency of STXBP1 was involved in early infantile epileptic encephalopathy in a previous different cohort study (group B), no mutations of STXBP1 were found in two of the remaining three subjects of group A (one was unavailable). We assumed that another gene within the deletion might contribute to the phenotype of group A. SPTAN1 encoding alpha-II spectrin, which is essential for proper myelination in zebrafish, turned out to be deleted. In two subjects, an in-frame 3 bp deletion and a 6 bp duplication in SPTAN1 were found at the initial nucleation site of the alpha/beta spectrin heterodimer. SPTAN1 was further screened in six unrelated individuals with WS and hypomyelination, but no mutations were found. Recombinant mutant (mut) and wild-type (WT) alpha-II spectrin could assemble heterodimers with beta-II spectrin, but alpha-II (mut)/beta-II spectrin heterodimers were thermolabile compared with the alpha-II (WT)/beta-II heterodimers. Transient expression in mouse cortical neurons revealed aggregation of alpha-II (mut)/beta-II and alpha-II (mut)/beta-III spectrin heterodimers, which was also observed in lymphoblastoid cells from two subjects with in-frame mutations. Clustering of ankyrinG and voltage-gated sodium channels at axon initial segment (AIS) was disturbed in relation to the aggregates, together with an elevated action potential threshold. These findings suggest that pathological aggregation of alpha/beta spectrin heterodimers and abnormal AIS integrity resulting from SPTAN1 mutations were involved in pathogenesis of infantile epilepsy.

A case study of developmental phonological dyslexia: Is the attentional deficit in the perception of rapid stimuli sequences amodal?

The attentional blink (AB) refers to a decrease in accuracy that occurs when participants are required to detect the second of two rapidly sequential targets displayed randomly in a stream of distracters. Dyslexic individuals have been shown to exhibit a prolonged AB in the visual modality, interpreted as evidence of sluggish attentional shifting (SAS). However, the amodal SAS theory predicts that the disorder should further extend to the auditory modality, then resulting in a phonological disorder as typically found in developmental dyslexia. Otherwise, it has been demonstrated that a visual attention (VA) span deficit contributes to the poor reading outcome of dyslexic individuals, independently of their phonological skills. The present study assesses the amodality assumption of the SAS theory together with questioning its relation with the VA span deficit. For this purpose, visual and auditory ABs were explored in a well compensated young adult, LL, who exhibits a pure phonological dyslexia characterised by poor pseudo-word processing and poor phonological skills but preserved VA span. The investigation revealed two different kinds of deficits in LL. Her AB was prolonged and marginally deeper in the visual modality whereas a primarily deeper in amplitude and a subtle prolonged AB was found in the auditory modality. The atypical performance patterns of LL in both modalities suggest that her perceptual attention disorder is amodal as predicted by the SAS theory. This amodal disorder was here reported in a dyslexic participant with a phonological disorder, well in accordance with the hypothesis that sluggish auditory attention shifting contributes to difficulties in phoneme awareness and literacy acquisition. Furthermore, prolonged VA blink was observed in the absence of VA span disorder, thus suggesting that visual attentional shifting and VA span might be distinct mechanisms, contributing independently to reading acquisition and developmental dyslexia.

Dissociations in Visual Attention Deficits among Persons with Mild Cognitive Impairment

ABSTRACT Impairments in visual attention and visual information processing have been identified as part of the neuropsychological features of Alzheimer's disease (AD), even in its earliest stages. There is increasing recognition that these deficits may be selective rather than global, with some attentional subtypes being more vulnerable than others. The few studies that have investigated attentional deficits in mild cognitive impairment (MCI), a putatively prodromal phase of AD, have not satisfactorily addressed the possible selectivity in attentional deficits in MCI. This study examined potential dissociations in visual attention deficits in MCI using a measure that assesses simple, divided, and selective attention. The results indicated a hierarchy of attentional impairments, with divided attention being the most affected and simple attention the least. Among participants with MCI, 53% showed evidence of impairment in divided attention compared to 19% of controls (OR = 4.81, p < .001). Poorer visual attention was also associated with poorer overall cognitive status. The implications of these findings for early identification of MCI, prevention of functional decline in MCI, and delay/reversal of cognitive degradation in MCI are discussed.

Divided visual attention as a predictor of bumping while walking: the Salisbury Eye Evaluation.

The purpose of this study was to determine the association between bumping while walking and divided visual attention, as measured by the useful field of view (UFOV). The Salisbury Eye Evaluation is a population-based study of community-dwelling adults, aged 72 to 92 at the third round of data collection. Participants walked a circuitous 32.8-m course, seeded with obstacles, and the number of bumps made while traversing the course was counted. UFOV divided attention score was based on processing speed: the time taken to identify a central target, and the location of a peripheral target simultaneously. Association between number of bumps and UFOV score was assessed in a generalized linear model, with adjustment for vision and attention measures that might explain the UFOV score. Of the 1504 participants in this study, 10.1% did not attempt the mobility course. In a model adjusting for demographic, physical, cognitive and attention, and vision measures, a decrease of 50 ms in processing speed for the divided-attention task was associated with a 4.9% increase (P = 0.004) in number of bumps made over the course. Receiver operating characteristic curves were created for the UFOV and visual field tests, to determine accuracy in detecting those with a high number of bumps. The visual field test had slightly higher area under the curve, but positive predictive value for both tests was low. The UFOV test of divided attention, as measured by processing speed, independently predicted bumping while walking. These data suggest that poor visual attention is a significant risk factor for bumping while walking.

Vision and driving self-restriction in older adults.

To assess driving self-restriction (vision related and nonvision related) in relation to vision test performance of older adults. Cross-sectional study. Population-based cohort of community-dwelling older adults. Six hundred twenty-nine current drivers aged 55 and older had driving behavior, health, and physical function assessed and vision function tested in 1993-95. Self-report of driving restriction as vision or non-vision related and performance on a comprehensive battery of vision tests (visual acuity; contrast sensitivity; effects of illumination level, contrast, and glare on acuity; visual fields with and without attentional load; color vision; temporal sensitivity; and the effect of dim light on walking ability). Demographic, health, and functional characteristics differed significantly between restrictors and nonrestrictors but not between vision- and nonvision-related restrictors. Controlling for potential confounding, only vision-related driving self-restriction was significantly associated with reduced performance on nonstandard measures of acuity. Poor depth perception was significantly associated with restriction for both vision- and nonvision-related reasons. Poor performance on attentional visual field tests, analyzed individually and in combination with standard field tests, was not associated with driving self-restriction. Older adults with early changes in spatial vision function and depth perception appear to recognize their limitations and restrict their driving even if they do not acknowledge the visual impairment as the cause for restriction. Poor visual attention, a risk factor for crashes, may not be recognized. Additional studies of driving self-restriction in relation to risk factors for crashes in older adults may help refine this strategy of reducing driving-related injury and death.

Use of the UFOV to Evaluate and Retrain Visual Attention Skills in Clients With Stroke: A Pilot Study

The objective of this pilot study was to examine the use of a visual attention analyzer in the evaluation and retraining of useful field of view in clients with stroke. Fifty-two clients with stroke referred to a driving evaluation service were evaluated with a visual attention analyzer referred to as the UFOV. The UFOV assesses three aspects of visual attention: processing speed, divided attention, and selective attention. Seven participants were retested to determine the test-retest reliability of the UFOV. Six participated in the development of a training protocol and in a 20-session visual attention retraining program. UFOV scores indicated substantial reduction in visual attention in clients after stroke, with older participants performing the most poorly. Test-retest reliability was moderate (ICC = .70). Mean UFOV scores improved significantly after retraining. Although UFOV scores indicated poor visual attention skills in clients with stroke, preliminary information suggests that UFOV scores significantly improve with training.

Neuropsychological, Learning and Psychosocial Profile of Primary School Aged Children with the Velo-Cardio-Facial Syndrome (22q11 Deletion): Evidence for a Nonverbal Learning Disability?

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.

Visual attention and symptoms in schizophrenia: a 1-year follow-up

Visual attention and positive and negative symptoms were assessed in a sample of inpatients with a relapse of schizophrenia and 3 months later during a period of relative remission. Visual attention was measured with the Continuous Performance Task (CPT) and the Span of Apprehension Task (SPAN). A previous report showed that in 59 schizophrenia subjects, poor visual attention was significantly associated with high levels of negative, but not positive, symptoms at the 3-month follow-up. Although symptoms improved significantly, the schizophrenia subjects' performance on the CPT and SPAN was relatively stable over time. In this follow-up study, symptoms were re-assessed 12 months ( n=40) after the acute relapse. There were no associations between attention at 3 months and negative or positive symptoms assessed at 12 months. These results appear contradictory to the hypothesis that deficits in visual attention are negative symptom-linked indicators.

Attentional vulnerability indicators in schizophrenia and bipolar disorder

Visual attention and positive and negative symptoms were assessed in 59 inpatients with a relapse of schizophrenia and 3 months later during a period of relative remission. Visual attention was measured with the Continuous Performance Task (CPT) and the Span of Apprehension Task (SPAN). At follow-up schizophrenia subjects were compared on visual attention to 40 outpatients with bipolar disorder and 40 normal controls. Although symptoms improved significantly, the schizophrenia subjects' performance on the CPT and SPAN was relatively stable over time. Poor visual attention was significantly associated with high levels of negative, but not positive symptoms at the 3-month follow-up. The schizophrenia subjects had poorer visual attention than the normal controls. There were no differences between the schizophrenia and the bipolar subjects. These results offer partial support to the hypothesis that deficits in visual attention may be negative symptom-linked vulnerability indicators.

Permanent cortical visual impairment in children.

Fifty patients with permanent cortical visual impairment were evaluated. They had a characteristic behaviour profile, usually with residual sight but poor visual attention. 30 of the 50 also had damage to the anterior visual pathway. Visual evoked potential mapping was shown to have a clear advantage over visual evoked responses, and using that in conjunction with CT and clinical data enabled several subgroups of cortical visual impairment to be identified. The diagnosis probably is more common than previously recognised, and should be suspected when there is greater delay in visual development in other areas and the degree of visual loss is unexplained by ocular findings. Using traditional criteria for cortical blindness may mean that many children are not diagnosed, which has serious implications for their rehabilitation.

1348 CAVITARY PERIVENTRICULAR LEUKOMALACIA (PVL): INCIDENCE AND SEQUELAE

Recent real-time ultrasonographic studies have shown that the diagnosis of cavitary PVL can be made in vivo. From 1-31-82 to 6-30-84 all infants weighing ≤ 1200 g were screened for intracranial hemorrhage (ICH) using real-time ultrasonography at 1, 2, and 4 weeks postnatal age and at least monthly through term corrected age. PVL was diagnosed in 6/119 survivors. ICH was seen in 45/119 including 4 of 6 infants with PVL. Cavitary lesions of PVL were first diagnosed at 4-6 weeks postnatal age in all. Some lesions were undetectable by 10-12 weeks. Follow-up data is presented below. Poor visual attention at term was noted on the Brazelton Neonatal Assessment Scale in all patients. *Age corrected for prematurity in months. Conclusion: PVL is a marker for cerebral palsy and may occur in the absence of ICH. Careful longitudinal scanning, past the usual time of ICH is mandatory for diagnosis.

Neuropsychological abnormalities in Gilles de la Tourette's syndrome.

Seven patients with Gilles de la Tourette's syndrome underwent an extensive psychological and neuropsychological examination. On psychological examination, it was found that consistent with previous reports these patients had a high incidence of Verbal IQ-Performance IQ discrepancies on the Revised Wechsler Intelligence Scale for Children, and had average mental arithmetic but poor written arithmetic. On neuropsychological examination, no single measure was performed poorly by all subjects, but there was a high incidence of poor performance on several measures from the Halstead-Reitan Battery. High frequency of abnormal performance for age was observed on the Category, Trail Making and Tactual Performance Tests. In addition, the patients had an interesting pattern of average auditory attention span but poor visual attention span. The pattern of visuomotor and visuospatial deficits was discussed with respect to possible underlying mechanisms.