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Parenting a preemie can be tough and it's important to find ways of coping and looking after your own health. It can also make you feel more in control if you can learn some great strategies to help with your prem's learning and development.


Finding a balance and a way forward

Parenting a preemie can be challenging and is a significant life transition. It is important that you find time and ways of taking care of your own health and wellbeing. Eating well, staying fit and healthy, and getting enough rest and relaxation are vital for optimal health. Maintaining and caring for relationships, especially with your partner is also important. If you need it, don't discard the option of professional assistance. Also, find advice about optimizing development and learning strategies to help with thinking & behavior difficulties.

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Strategies for Attention Difficulties

Some children, whether they are born preemie or not, have difficulties with some aspects of thinking. This section provides some recommendations for specific skills that are important for learning.

Attention Skills in General

Attention is the ability to selectively choose parts of our environment to process, whilst at the same time ignoring other irrelevant information.

(Mirsky, Anthony, Duncan, Ahearn, & Kellam, 1991)

Children with attention problems may have difficulty in some of these areas:

  • Lack attention to detail
  • Show variable attention depending on the task as well as from day to day
  • Maintaining concentration for sustained periods (i.e. for the whole task or lesson)
  • Avoiding distraction
  • Staying seated
  • Remembering routines, activities, and personal belongings
  • Organising their work and activities
  • Getting started on tasks
  • Avoid tasks that require high mental effort

Strategies for Attention Skills in Preemies at Home

Working together

Ideas that can be utilized for the entire family have a greater chance of success. Behavioural strategies are also more effective when the whole family works together and consistently to achieve behavioural change and reach goals.

Quiet Homework Areas

Child benefit from working in a quiet study environment at home, so that they are not easily distracted. Individuals with attention problems have greater success at completing their homework when they are able to work in an area with few visual distractions. Completing homework in front of the television or at the kitchen table is very difficult for them. In contrast, some children actually attend to tasks better with some unobtrusive background sound and action. This is called “white noise”, which is repetitious background sound and it can mask or cover up potentially distracting noises like the dog barking or the telephone ringing.

Daily Schedules

Children with attentional difficulties can be better prepared and are better able to cope with activities that require increased concentration when they have a posted schedule of daily activities. A visual representation will provide another opportunity to internalise home routines, such as a chart posted somewhere in the house. This will include important daily routines such as meal time and home work schedules, as well as necessary self-care routines, such as showers, and bedtimes.

Making the chart can also be a good opportunity to work together and can be a fun, creative activity for children.

Mornings are particularly difficult for families with someone who has the typical structural and organisational problems associated with attention problems. Aim to plan the morning routine in the evening; for example clothes can be chosen and put out ready, back packs can be checked and left in the same place by the front door, permission slips and homework can be checked and signed, etc.

Leaving fifteen to thirty minutes of extra time in the morning schedule can also relieve pressure. A tight schedule leaves little room for error and provides many opportunities for frustration and arguments.

Limit Choices

Individuals with attention problems are easily overwhelmed by a large number of clothes and toys. When making selections of clothes, it is important to simplify the process (and leave the room less cluttered). Try removing out of season clothing from drawers and closets. You can do the same thing for toys and games. This system of rotation usually results in less clutter and more interest when the objects are switched back.

Plan High-Attention Demand Activities

Children with attention problems have more difficulty focusing and controlling their activity-level as the day progresses. Therefore, schedule the most demanding attention tasks in the morning.

Making Optimal use of Medication

If your child is taking medication for attention difficulties check with your doctor to find out the time of maximum-medication effects, in other words when is the medication going to work the best. If possible, it is best to schedule the most attention-demanding tasks during this medication window.

Task Modification

Long tasks and tasks that have multiple steps, like cleaning a room or completing a homework project are often overwhelming. When too many instructions are given, children with attention problems find it difficult to remember beyond the first direction.

After giving instructions on what you want done, it is helpful to break the task into smaller parts. For example, instead of asking your child to clean their room, ask them to remove their clothes and toys from the floor or ask them to make their bed. When this step is finished move on to the next one or two steps. And so on.

It is helpful to do projects together and to prioritize the tasks that need to be completed. Individuals with attention problems will often misjudge the importance of certain tasks or try to complete everything at once and finish nothing at all and become frustrated and upset.

Monitoring and Feedback

Homework is more difficult when fatigued. Check on them during homework as much as possible or have them check with you. Establish a “point system”.


Attention Skills At School

In order to enhance the classroom environment for optimal concentration, the following points should be taken into consideration.

Classroom environment

Students with attentional problems do better in classrooms with 4 walls rather than in an open-style arrangement. Open “pods” allow too many visual and auditory distracters.

It is usually better to have students seated near the teacher, for ease of prompting and directing, and away from other challenging students. However, if the student is easily distracted by noise and other children talking, consider seating the student at the rear of the classroom. This may eliminate the need to keep turning around to find out where the source of noise is coming from. It might be beneficial to play around with seat location i.e. near the board, in front of teacher, instructional area, back of class.

The student is likely to function better when able to anticipate times requiring increased concentration. A visual representation of the day’s schedule will provide another opportunity to internalise classroom routine.

Schedule a regular time and day for cleaning the desk; should be at least once a week. This will improve their ability to find their materials.

Teaching Style

The student is likely to respond better to situations they find stimulating and engaging. Varying the instructional medium and pace will help sustain their interest. Keeping the time required for sustained attention on task balanced with more active learning will improve their performance. Changes in the instructor’s voice level and variation in word-pacing will also increase their attention during instruction.

Students are more likely to lose focus as the day progresses so it is a good idea to schedule the most demanding attentional tasks in the morning. Schedule breaks after tasks requiring high mental effort.

Students often bring toys and other items from home to show-off at school. Make a classroom rule about appropriate times and places to share these with classmates. Limit their visibility in the classroom, place them somewhere that is not in clear view and a distraction to students. Having a rule about bringing certain items for a particular day can limit the number of items.

Tasks can be modified to improve opportunities for optimal attention. For example, some students may get overwhelmed with large assignments; you may be able to adjust the assignment into smaller parts, or you could assign every 2nd problem, rather than every question to increase the likelihood of it being accomplished.

Seated work is often challenging for students with attention difficulties. In group work have the student check in with the teacher at specified times, consider using a point system.

Establish eye contact when giving directions/instructions, this will improve their understanding and follow through on the task.

Combine verbal instructions with illustrations or demonstrations of the desired task. Using multiple modes of instruction and delivery of information increases the probability of successful learning of the task and is more likely to engage the student for longer.

After giving instructions, have the student paraphrase what has been said. This will increase their comprehension and provide an opportunity to check for understanding.

Rewards and praise should be given on a regular basis and are likely to change the attentional problem the most effectively. The “point system” is often an effective one. To reiterate, delayed feedback or inconsistent, variable feedback is problematic, in that the student may have difficulty in correlating delay and gratification. (Go to the Point System for more details).

Encourage the student to take their time and think about their approach before attempting an activity. Encourage Child to double check their completed work accurately and make it part of the regular work routine. Students tend to complete work and turn it in without checking it over. Give the student some instruction in how to check their work and practice it with them. Give sheet work one sheet at a time, if possible. This will prevent the student from feeling overwhelmed. This is also a helpful technique in testing them.


Completing school work and maintaining behaviour during a school day can be exhausting. Large homework loads on a regular basis can become discouraging for them and very stressful for children’s parents. Consider reducing the amount of homework, if possible, and limited to guided practice on material that they have begun to master.

Attempt to break down long-term assignments into steps to reduce the chance of overwhelming the student.

Consider having the student complete every second problem, instead of answering each one.

Emphasize practice and assignment completion on the computer to lower the frustration many students feel with written work.

Since fine motor activities and spelling can often be a problem as well, consider emphasising use on a computer at an early age. Software to practice keyboarding should have stimulating graphics to motivate their use. Using a “spell check” program can be helpful. Actively monitor the student during tests, especially multi-choice tests. They can get off track and fill in the wrong places or become so frustrated that they might answer at random to simply complete the test.

Testing and Examination Considerations

Consider modifying the test environment for the student to accurately assess their ability/achievement on subject areas and standardised tests. Individual administration in a distraction-limited area with frequent breaks will give a more accurate assessment/evaluation than group administration.

Other Considerations

Allow frequent breaks to move around inside and possibly outside the classroom. Perhaps to run some errands, or maybe do some classroom stretches.

A characteristic of students with attentional problem is that they often seek highly stimulating materials; computer-assisted instruction and tasks can be highly successful and may also enhance keyboarding skills as well as fine-motor coordination.

It may be necessary to supervise the student in potentially dangerous situations. Although they may be aware that their actions are wrong or dangerous, they may not be able to stop from following through.

Referral to a Clinical Psychologist to assist with behaviour management. 

(Cicerone, 2002)

Technical Reference List

Cicerone, K. D. (2002). Remediation of 'working attention' in mild traumatic brain injury. Brain Injury, 16(3), 185-195. Mirsky, A. F., Anthony, B. J., Duncan, C. C., Ahearn, M. B., & Kellam, S. G. (1991). Analysis of the elements of attention: a neuropsychological approach. Neuropsychology Review, 2(2), 109-145.



Verbal mediation

AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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