Dr Phil Bate Orthomolecular Pioneer

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The Sbordone Attention Battery (SAB) consists of a set of nine relatively brief tasks to evaluate the attentional functioning of patients with suspected brain dysfunction. Six of the nine tasks evaluate the patients ability to>engage in serial or alternating serial arithmetic operations. The remaining three tasks evaluate the patient’s ability to perform seqential and selective operations with letters. Each task requires the patient to attend to a specific set of operations for which practice is given. Tasks are administered in a specific sequence (1-9) to challenge the underlying cortical arid subcortical neural rnechanisms which regulate the patient’s attentional functioning. The patient’s responses (including errors) are carefully recorded. The examiner records the duration of time required to complete each task (in seconds. The examiner also records cues or special instructions provided to the patient necessary tocomplete the task.

RATIONALE

The development of the SAR grew out of the use of such widely used tasks as serial 3 addition and serial 7 subtraction by neurologists and psychologists to assess the patients attention. The latter task. in, particular. has been. utilized by both psychiatrists arid neurologists for many years in their mental examination. Errors on serial seven subtraction can occur for a variety of reasons such as: poor premorbid arithmetic skills, limited education. poor visual imagery, memory difficulties. age of patient, anxiety, depression. and attentional difficulties. Thus, various non-attentional factors may cause a patient to perform poorly on this test.

Many patients with frontal lobe injuries may perform serial 7 subtraction without error if they are educated and possess good arithmetic skills. However, if such patients are asked to perform alternating 3 and 5 subtraction from 100, they may make several errors. Thus, good performance on serial 7 subtraction may not necessarily rule out attentional difficulties. Similarly, patients with right hemisphere injuries may perform serial 7 subtraction without error, but do poorly when asked to which (Capital) letters in the alphabet contain only straight lines (without looking at the alphabet), or rhyme with the word "tree".

Patients with subcortical injuries may make errors on relatively simple tasks as reciting the alphabet, counting backwards from 20 to 1, or performing serial 3 arithmetic, but fail to make errors on more complex tasks which require more conscious effort (use of cortex). In addition, these patients tend to perform these tasks much slower.

Patients with left posterior lobe injuries will typically make some errors on serial 7 subtraction, but make more errors when asked to do 13 serial substraction.

Patients with posterior hemisphere injuries will generally do poorly on tasks which place emphasis on visual imagery, (i.e. serial 7 and 13 subtraction, and capital letters which contain only straight lines.), but will usually do well on serial 3 and alternating serial 3 and 4 subtraction.

Thus, a variety of attentional deficits can be seen in patients with various neurological disorders. For this reason, the SAR was constructed.