Attention

If you struggle with concentration, this can make it hard to follow a good book, or a film. You may find situations with a lot of people difficult, or find that you lose track following a conversation. 

Tasks involving complex attention are the ones that people with MS often find the most difficult. Complex attention tasks require a lot of concentration and usually require thinking of two things at once. 

Concentration is involved in almost everything we do. It can affect how much we are able to enjoy TV shows or theatre trips. It can affect how well we can remember a message or conversation. It can affect how long we can work effectively on a household or employment task.

The strategies that tend to work best for concentration problems often involve minimising distractions and organising your day to make the best use of your concentration skills.

• It is easier to concentrate in short bursts and when you are interested in the information.
• Try to schedule important discussions at a time when you won't be tired or fatigued, or arrange to have a rest beforehand.
• If you want to read a lot of material, for example you enjoy reading novels, try alternating short bursts of reading with another activity. It may be enough to just put the book down and look away or stretch at the end of every page. You may find reading a chapter a day is enough and fill the rest of the day with other activities.
• It helps to consciously review what you are reading or watching at regular intervals. For example, if it is hard to keep track of the plot of a book, at the end of every paragraph you might try saying a few words to yourself that summarise that paragraph's developments. If you are finding it hard to keep track of a soap, you might try reminding yourself of what has just happened when the adverts come on.
• If your attention wanders during conversation, you can always repeat or summarise what the other person had just said before making your comment. For example, you could say "I hear that you enjoyed your holiday in France, because the weather was so good. Have you ever been to France when it rained?". It might feel a bit strange at first, but it will soon feel natural. In fact, this kind of summary when replying is used by professional interviewers and called "active listening". You will find that your friends will feel flattered that you are paying so much attention to what they are saying.
• If you know that your attention is poor, think carefully about adding distractions to your environment. For example, using a satnav or listening to the radio whilst driving might not be a good idea.

Problems with concentration and attention are most easily picked up through standard cognitive testing. The more demanding the task, the more likely it is that you will have trouble with it. 

If your concentration problems are fairly mild, and you are just concerned with slips at work, then a psychologist can work with you on tasks that mimic the work situation. For example, if you need to read insurance policies at work, the therapist may arrange for you to read old, anonymous policies while attempting to spot deliberate errors, using various strategies. By measuring how well you do, the therapist can assess how effective a strategy is.

If your concentration problems are more severe, for example it is hard for you to follow a conversation that contains important information about your health, more factors will be taken into account. Your health professional will then individually target the most important issues using a combination of strategies.

Research shows that cognitive training can help you to improve your abilities. This is called cognitive rehabilitation, and can be delivered through computer games or training programmes. As you practice skills like alertness, selective attention and vigilance, you will improve.

Problems with attention can have subtle effects which wear away at communication and intimacy. You may have become aware of attention or concentration difficulties through not understanding information, or finding it hard to follow a TV soap. These difficulties will not be obvious to the people around you. Once they understand that this is part of your MS, they are likely to want to help. They can do this easily by:

• having important discussions at the best part of the day for you.
• speaking slowly and summarising the content of spoken information.
• checking your understanding of what has been said.
• being part of important conversations, to help you and be a back-up for the information.

Once you and your family are working together to overcome concentration problems, you can:

• start to identify when lapses occur.
• work out what could be done to make things easier in that or similar situations.
• implement the new technique.