EFFECTIVENESS OF CONCENTRATION ENHANCEMENT

ACTIVITY ON ATTENTION AND CONCENTRATION

AMONG SCHOOL AGE CHILDREN

Dissertation Submitted To

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE AWARD OF

DEGREE OF

MASTER OF SCIENCE IN NURSING

OCTOBER 2014.
 A STUDY TO ASSESS THE EFFECTIVENESS OF
CONCENTRATION ENHANCEMENT ACTIVITY
ON ATTENTION AND CONCENTRATION
AMONG SCHOOL AGE CHILDREN IN
MADHA MATRICULATION SCHOOL
AT CHENNAI 2013 – 2014.

Certified that this is the bonafide work of

Ms. SHINEY VARGHESE

MADHA COLLEGE OF NURSING,
KUNDRATHUR, CHENNAI – 600 069.

COLLEGE SEAL :

SIGNATURE :
Dr. Mrs. TAMILARASI. B
R.N., R.M., M.Sc.(N)., M.Phil., Ph.D.,
Principal,
Madha College of Nursing,
Kundrathur,
Chennai - 600 069, Tamil Nadu.

Dissertation Submitted To

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE AWARD OF

DEGREE OF

MASTER OF SCIENCE IN NURSING

OCTOBER 2014.
 A STUDY TO ASSESS THE EFFECTIVENESS OF
CONCENTRATION ENHANCEMENT ACTIVITY
ON ATTENTION AND CONCENTRATION
AMONG SCHOOL AGE CHILDREN IN
MADHA MATRICULATION SCHOOL
AT CHENNAI 2013 – 2014.

Approved by the dissertation committee on: 27.09.2013

Research Guide & Clinical Guide :

Dr. Mrs. TAMILARASI. B
R.N., R.M., M.Sc.(N)., M.Phil., Ph.D.,
Principal,
Madha College of Nursing,
Kundrathur,
Chennai - 600 069, Tamil Nadu.

Medical Guide :
DR. SHRINIVAS V.C
MD, DCH (Senior Consultant
Pediatrician)
MIOT INTERNATIONAL,
Mount Poonamallee road,
Chennai – 600 089.

Dissertation Submitted To

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI

IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE AWARD

OF DEGREE OF

MASTER OF SCIENCE IN NURSING

OCTOBER 2014.
 ACKNOWLEDGEMENT

To say that ‘I’ have done this work up to its fulfillment is never solitary is to
defy Aristotle’s social fact that ‘man is a social animal’. Everybody in this world
strives for success with every person’s help and therefore to just submit this work
with ink’s note of thanks and graciousness for the help I was provided over the years
of my research. Firstly I would like to thank God almighty for always blessing me
throughout my life.

My profound and hearty thanks to our founder Dr. S. Peter, Chairman,

Madha Group of Academic Institutions for providing his support, encouragement
and inspiring me to carry out this study in this institution.

I convey my deep and sincere thanks to Dr. Mrs. Tamilarasi. B, R.N., R.M.,
M.Sc.(N)., M.Phil., Ph.D., Principal, Madha College of Nursing, who has been a
great inspiration for me throughout my studies in this college. Her meticulous
attention and thoroughness provides a careful presentation of any project initiated.
She is the pillar beyond every wall of accomplishment.

I also express my heartfelt gratitude to Prof. Mrs. Grace Samuel, R.N.,

R.M., M.Sc.(N)., Vice Principal, Madha College of Nursing for her excellent
guidance and golden suggestion for this study.

I also thank Mrs. Vathana. V, R.N., R.M., M.Sc.(N)., Associate Professor,

Department of Medical Surgical Nursing for her constructive and innovative views
and advice.

I must also pay my heartfelt word of thanks to Mrs. Kanagavalli. P, R.N.,

R.M., M.Sc. (N)., Reader, Department of Obstetrics and Gynecology Nursing for
her guidance and infinite words of inspiration and encouragement throughout my
research work. Half of this work couldn’t have come to fruition without her help.

I am immensely grateful to Mr. K.S.P. Sundar, M.Sc., M. Phil, M.Ed.,

Principal, Madha Matriculation School for giving permission to conduct my
research study.
 I extend my respect to Mr. Venkatesan, M.Sc., MBA, Ph.D., statistician for
his expert guidance in data analysis.

I am grateful to all experts for validating the instrument and I am thankful to

the Faculty, Classmates, Madha College of Nursing, Chennai for their support and
encouragement.

I wish to acknowledge my heartfelt gratitude to Librarian, Madha College of

nursing, Chennai for providing facility.

I also thank the students of Madha Matriculation School for their valuable
time and space in the sampling work.

A precious bouquet of colorful thanks to my friends Nithya Krithika,

Vadivambigai and Suganya for their love, support and prayer.

Finally, I am deeply grateful to my loving father Mr. G. Gee Varghese and

my family members for their constant support and encouragement throughout my
research work.
 TABLE OF CONTENTS

CHAPTER PAGE
CONTENTS
No. No.
I INTRODUCTION 1-8
Need for the study 4
Statement of the problem 7
Objectives 7
Hypothesis 7
Operational definitions 7
Delimitations 8
II REVIEW OF LITERATURE 9-25
Review of related literature 10
Conceptual framework 22
III METHODOLOGY 26-32
Research approach 26
Research design 26
Research variables 26
Setting of the study 27
Population 27
Sample 27
Sample size 27
Sampling technique 27
Criteria for sample selection 27
Description of the instrument 28
Validity 29
Reliability 29
Ethical consideration 29
Pilot study 30
Data collection procedure 30
Data analysis 31
IV DATA ANALYSIS AND INTERPRETATION 33-66
V DISCUSSION 67-71
VI SUMMARY, CONCLUSION, NURSING
IMPLICATIONS, RECOMMENDATIONS
72-76
AND LIMITATIONS
REFERENCES 77-82
APPENDICES I-vi
 TAB
PAGE
LE n TITLE
No.
No.
34
Frequency and percentage distribution of demographic
1
variables of school age children.

46
Frequency and percentage distribution of pre test level of
2
attention among school age children.

48
Frequency and percentage distribution of post test level of
3
attention among school age children.

Frequency and percentage distribution of pre test level of 50

4 concentration among school age children.

Frequency and percentage distribution of post test level of 52

5 concentration among school age children.

Comparison of frequency and percentage of pre test and 54

6 post test level of attention among school age children.

Comparison of frequency and percentage of pre test and 56

7 post test level of concentration among school age children.

Comparison of mean and standard deviation of pre test and 58

8 post test level of attention among school age children.

Comparison of mean and standard deviation of pre test and 60

9 post test level of concentration among school age children.

Correlation between post test level of attention and 62

10 concentration among school age children.

Association of post test level of attention among school age 63

11 children with their demographic variables

Association of post test level of concentration among 65

12 school age children with their demographic variables.
 LIST OF FIGURES

FIGURE TITLE PAGE

No. No.
1 Conceptual framework 25
2 Schematic representation of research methodology 32
3 Percentage distribution of sex of the child among school 36
age children
4 Percentage distribution of type of family among school 37
age children
5 Percentage distribution of religion among school age 38
children
6 Percentage distribution of monthly income of family 39
7 Percentage distribution of structure of family among 40
school age children
8 Percentage distribution of educational status of mother 41
9 Percentage distribution of educational status of father 42
10 Percentage distribution of type of diet among school age 43
children
11 Percentage distribution of type of hobby among school 44
age children
12 Percentage distribution of previous exposure to 45
meditation among school age children
13 Percentage distribution of pre test level of attention 47
among school age children
14 Percentage distribution of post test level of attention 49
among school age children
15 Percentage distribution of pre test level of concentration 51
among school age children
16 Percentage distribution of post test level of concentration 53
among school age children
17 Percentage distribution of pre test and post test level of 55
attention among school age children
18 Percentage distribution of pre test and post test level of 57
concentration among school age children
19 Mean and standard deviation of pre test and post test 59
level of attention among school age children
20 Mean and standard deviation of pre test and post test 61
level of attention among school age children
 LIST OF APPENDICES

APPENDIX PAGE
TITLE
No. No.
A Instruments i
B Certificate of ethical clearance ii
C Certificate for content validity iii
D Permission letter iv
E Certificate for editing v
F Activity module vi
 ABSTRACT
Attention is the concentrated direction of the mind, especially to a problem or
task. Concentration is the ability to keep one’s attention on a particular object or
domain. We use our attention and concentration skills every day, often with little
effort and without really noticing them. Attention and concentration cause problems
with everything from maths test to social relationships to motivation for learning. In
order to function effectively, one needs to be able to concentrate on and pay attention
to the task at hand.
A study was conducted to assess the effectiveness of concentration
enhancement activity on attention and concentration among school age children. The
hypothesis formulated was that there is a significant association between
concentration enhancement activity on attention and concentration among school age
children. The review of literature included studies which provided a strong foundation
for the study including the basis for conceptual framework and formation of tool.

The research design used for this study was pre experimental one group pre
test post test design. It was carried out with 30 samples those who fulfilled the
inclusion criteria. Purposive sampling technique was used to select the sample. A
modified attention profile and card game was used to assess the pre test and post test
level of attention and concentration. Concentration enhancement activity was
conducted for the duration of 30 minutes for six days. The post test was assessed on
seventh day by using same tool.

The analysis revealed that the pre test level of attention mean score was
29.83 with the standard deviation of 6.73 and the post test level of attention mean
score was 18.53 with standard deviation of 5.14. The pre test level of concentration
mean score was 21.57 with standard deviation of 4.78 and post test level of
concentration mean score was 13.83 with standard deviation of 3.60. The paired‘t’
test value of attention was 9.72 and concentration was 6.71 which showed very high
significant at the level of p<0.001. The Karl Pearson correlation coefficient value of
r = 0.56 at the level of p<0.01 which showed moderate correlation between post test
level of attention and concentration among school age children. Hence it indicates the
effectiveness of concentration enhancement activity on attention and concentration
among school age children. So the research hypothesis was accepted for the study.
 1

CHAPTER I
INTRODUCTION

“Success in any endeavor requires single minded attention to detail and

total concentration”

-Willie Sutton

Attention is taking possession of the mind, in clear and vivid form, of one out
of what may seem several simultaneously possible objects or trains of thoughts. It
implies withdrawal from some things in order to deal effectively with others (James,
1890). Concentration is the ability to keep one’s attention on a particular object or
domain. Moreover, concentration is a prerequisite for common daily behavior such as
reading and listening. Whether an individual reads the newspaper or listens to the
news, he or she needs to stay focused in order to understand the information around
them.

Attention allows tuning out information, sensations and perceptions that are
not relevant at the moment and instead helps to focus energy on the information that
is important. Concentration is a behavior of the mind that selects and constructs the
contents of the mind. In other words, concentration is the mechanism that manipulates
the focus in a desired way and can be seen as a meta cognition. Moreover,
concentration involves not only focusing on an object but also avoiding those stimuli
that are not part of the focus. Mikulas (2002) stated that the individuals shift attention
in more complex ways and usually without conscious control. A person can learn to
refocus when one’s attention drifts away, one can learn to sustain the focus in the
presence of less salient stimuli, and can learn to skillfully shift one’s attention from
one object to another without getting stuck or caught up in irrelevant objects.

Children who have attention difficulties immediately compromise their ability

to learn, as they are not focused on the information presented. Children are facing the
havoc of low concentration these days. Because of so many activities surrounding
them, so many distractions, children find it difficult to concentrate on one single
thought or activity. This in turn affects their life and ability to perform. Concentration
 2

is a high attribute in an individual’s personality. It helps in observing things around us

sharply and enhances the memory.

A good concentration level is needed in all the spheres of life. An individual

with low concentration problem suffers from bad memory, which leads to under
performance. The capacity to understand, pick up from the environment, retain facts,
everything is affected, which ultimately leads to below average results. Concentration
levels can be improved from the childhood if the problem is identified earlier. If the
child is involved in different kinds of activities that enhances concentration, then he
will grow up to be sharp and quick.

Every individual use attention and concentration skills, often with little effort
and without really noticing them. These skills help us to select and focus on what is
important as to what the teacher is saying, ignore irrelevant or distracting things that
is not needed to pay attention, for example what is happening outside the classroom
window, and maintain or sustain our effort or attention over time such as concentrate
for the whole period. Sometimes we need to pay attention to two or more important
things at the one time, and may need to switch back and forth between activities
quickly like copy work from the board while the teacher goes through the information
and explains it.

Having good attention and concentration helps children to learn. Most skills in
life need to be learnt through repeated practice, things like tying shoelaces, writing,
using scissors, riding a bike. Children need to be able to focus on a task and practice
an activity to improve their skills. Learning to concentrate and complete activities
helps reduce impulsive behavior and can lower activity levels.

Attention and concentration are greatest in short activities. Frequent and brief
drills or lessons covering small chunks of information will result in greater learning.
Attention may flag on the second presentation of a task. Attention can be maximized
by presenting the material in slightly different ways or with different applications or
resources. A consistent routine, with an organized format to complete activities is
ideal for learning. Well planned activities and smooth transitions from one activity to
the next should enhance the learning environment.
 3

Attention and concentration cause problems with everything from maths test
to social relationships to motivation for learning. While basic attention abilities may
be inborn, the good news is that many attention skills can be learned. These core
abilities are rooted in the physiology of the brain, but home and school environments
have a great deal to do with how a child learns to use his particular attention
mechanisms. These days children are distracted because of the presence of a lot of
technology around them. They play games on information pads and tablets, instead of
actually going out and playing in the parks. They prefer to sit and watch kids
television than playing the solitary games with blocks.

Although, this technology and highly educational television is good for them
in more than one way but, there are no doubts in the fact that it is killing their natural
instinct to observe and practice concentration. Everything is readily available for
them, they do not have to work for it, is just a click away, which means that there is
absolutely no need for their minds to work hard or think hard over anything.

This leads to the mind losing its capacity to comprehend and come up with
solutions. This is why scientists and psychologists say that, spending more time on
television and computers leads to a dumb child. It also makes children non social and
lethargic. Parents are very concerned about this situation with their children. It is an
important concern as it affects the quality of rest of their life.

Poor concentration skills may lead to difficulties in studying, falling asleep,

control over disturbing and intruding thoughts, poor listening skills and disobedience.
Children who have attention difficulties immediately compromise their ability to
learn, as they are not focused on the information presented. They may also have a
language difficulty and cannot understand complex verbal information or they may
have a memory difficulty and cannot store and hold onto information.

Concentration enhancement activity is essential for school going children to

improve the lack of attention and concentration in all their activities. It would help
them to perform better in academics as well as in other extracurricular activities. As
nurses we should identify the lack of concentration among children and use the
required skill to improve the attention span, and thereby help them to improve their
future career.
 4

NEED FOR THE STUDY

“Concentrate all the thoughts on the task at hand. The sun’s rays do not burn until
brought to a focus.”

-Alexander Graham Bell

Attention is a term given to a perceptual process that selects certain inputs for
inclusion into our conscious experience or awareness in a given period of time
(Mishra, 2008). From the external environment, some information is selected, filtered
and taken into the centre of consciousness while other information remains in the
background. Attention develops over one’s lifespan and assists a person to regulate
his or her behavior and adapt to environmental demands. Attention processes improve
with age and develop rapidly during infancy and early childhood. Infants and young
children remember information and consciously try to attend to tasks, especially those
that are novel in nature.

Children in middle childhood from 6 to 12 years are more in control of their

attention processes and hence are able to sustain it well (Lee, 2005). Concentration is
the cognitive process of selectively paying attention to one thing to the exclusion of
others over a period of time. Concentration difficulty is a decreased ability to focus
the thoughts on something. It can be related to difficulty staying awake,
impulsiveness, intrusive thoughts, over activity or inattention.

Attention and concentration problems are one of the most prevalent and
widely recognized problems in children. Worldwide about 140 millions of students
are affected by attention and concentration. The possible causes in children are lack of
sleep, personal circumstances, motivation and interest, surrounding conditions like
school environment, distracted teens, teacher trouble, health problems, lack of
exercise, family environment, diet, neglected children and ineffective child rearing
practices.

Attention changes with age such as a normal lack of inhibition in a four year
old become a serious problem in a ten year old. Moreover, a regularly bumptious
child usually a boy may seem very much out of place in an overly restrictive and
stressful classroom. When normally active youngsters are condemned to desks and
 5

routine pencil and paper tasks all day, we should not be surprised if they show up with
problems. Many schools are increasingly restricting children's free play time, children
who need to work off physical energy don't have much of a chance. Moreover, many
of today's children are so heavily scheduled that they are actually sleep deprived. All
these factors may masquerade as an attention problem.

Attention difficulties are also found in many children with language or reading
problems, sometimes treating the underlying condition makes it easier to focus on
learning. Too much time with television and video games also exacerbates attention
difficulties. A recent study linked that the amount of preschool television exposure
enhanced later symptoms of attention deficit hyperactivity disorder. It was found that
violent entertainment doubled the possibility of development of attention problem five
years later.

Most children suffer with poor memory and attention difficulty almost every
day. This affects many areas of their life. It is difficult for them to do well in school,
perform required activities and even participate in normal conversations due to their
attention and concentration problems. Students are particularly in need of good
attention skills. They must be able to attend to instructions, focus on the details of
assignments, and stay on task until an assignment is completed. Children with
attention difficulties frequently experience problems in studies and with their peers.

They may be seen as flighty, disorganized and irresponsible. They don’t pay
attention to details, make careless mistakes, have trouble staying focused, are easily
distracted, experience difficulty in remembering things and following instructions,
have trouble staying organized, get bored with a task before it gets completed, get
frustrated easily, have mood swings, find it difficult to complete assignments and
frequently tend to lose or misplace homework, books, toys, or other items (Fowler,
2004). Issues such as enthusiasm and skill for task in hand, motivation, emotional and
physical state and surrounding environment affect the child’s ability to concentrate
(Blerkom, 2009).

Peck. et al., (2005) reviewed that intervention can help students with attention
and concentration problems by improving their ability to concentrate and also to
reduce anxiety, headaches, general tension and stress symptoms, and development of
 6

positive attitude towards oneself. The incidences in 2004 at India reported that about
68% of children with lack of attention and concentration don’t pay attention to details
and they often accompany academic skill disorder and can seriously interfere with
academic performance.

The result of a study in 2006 stated that regular habit of eating breakfast had
beneficial influence of attention and concentration, memory and school achievement.
Children are often unmotivated to pay attention in class, as they find the lessons
uninteresting and dull. The way the teacher manages the class and school environment
have significant impact on attention and concentration ability of children. In order to
function effectively, one needs to be able to concentrate on and pay attention to the
task at hand.

Prot. et al., (2012) has conducted a study on correlations between attention

problems in childhood and video game play. High excitement and rapid changes of
focus that occur in many video games may weaken children’s abilities to maintain
focus on less exciting tasks such as schoolwork and shorten their attention spans.

In a longitudinal study on video game use and attention problems, video game
play predicted children’s attention problems 13 months later, even while controlling
for other relevant variables such as earlier attention problems, television viewing, and
gender. A 3-year longitudinal study of more than 3000 children found evidence of a
bidirectional relation between attention problems and videogame playing, and found a
stronger relation between the amount of gaming and later attention problems than for
the content of gaming.

Children suffering from attention and concentration problem have to face

hardships on a daily basis. Their difficulties need to be understood by parents and
those around them so that they do not become victims of unreasonably high
expectations. Familiarizing parents with the causal factors of this problem can help
them in taking preventive steps so that further development of the problem among
children may be curbed. It is important to focus on the problems faced by such
children so that they may be provided with proper interventions.

Among children with attention problems, there is excessive brain activity

which makes it difficult for these children to focus. Thus concentration enhancement
 7

activities are essential like letter cancellation, storytelling, dots joining, missing
numbers, tongue twisters etc to improve the attention and concentration in children.

When the investigator noticed the children in the neighborhood and also
during school visit, she observed lack of attention and concentration among school
children due to various reasons and thus leading to poor performance in academics
and in extracurricular activities. Considering these facts, the investigator felt it as a
strong need to provide concentration enhancement activity to improve the attention
and concentration among school children.

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of concentration enhancement activity on

attention and concentration among school age children in Madha Matriculation
School at Chennai.

OBJECTIVES

1. To assess the pretest level of attention and concentration among school age
children.
2. To assess the post test level of attention and concentration among school age
children.
3. To determine the effectiveness of concentration enhancement activity
regarding attention and concentration among school age children.
4. To correlate the post test level of attention and concentration among school
age children
5. To associate the post test level of attention and concentration among school
age children with their selected demographic variables.

HYPOTHESIS

There is a significant association between concentration enhancement activity

on attention and concentration among school age children.

OPERATIONAL DEFINITIONS

Effectiveness: Refers to the outcome of concentration enhancement activity in

improving attention and concentration among school age children.
 8

Concentration Enhancement Activity: Refers to set of activities which include

letter cancellation, color cancellation, dots joining, missing numbers, puzzle solving,
and tongue twisters in improving attention and concentration among school age
children.

Attention: Refers to the concentrated direction of the mind, especially to a problem

or task.

Concentration: Refers to enhancing the mind to focus on a single task for a while.

School Age Children: Refers to children who are in the age of 10 years in Madha
Matriculation School.

DELIMITATIONS

• The data collection period was delimited to 4 weeks.

• The sample size was delimited to 30 children who are in the age group of
10years.
 9

CHAPTER II
REVIEW OF LITERATURE

The review of literature is an essential aspect of the scientific research. It is a

systemic identification, location, scrutiny and summary of written material that
contains information related to the problem under study. The investigator gained
insight in selected problem from an extensive review. This chapter is designed to
include the review of literature and the conceptual frame work adopted for the study.

PART I- REVIEW OF RELATED LITERATURE

Attention is the act or state of applying the mind to an object of sense or

thought. Concentrate refers to series of mental effort focused on a particular object or
activity. The warning signs of concern due lack of attention and concentration are
distraction, restlessness, boredom, difficulty or anxiety, nervousness in making
decisions, difficulty paying or sustaining attention, easily frustrated, makes careless
mistakes, makes critical remarks about self, preoccupied mind and day dreaming. The
various benefits of attention and concentration include better studying, enables faster
comprehension, improves the memory, helps in focusing on a task, job or goal, and
therefore, achieving them more easily and efficiently.

The purpose of concentration enhancement activity is to improve attention and

concentration among school age children. It helps to improve poor performance in
academics and in extracurricular activities. The recommendations describe that these
measures help to lessen the attention and concentration problems in children and helps
them to follow the particular task in a directed way.

This chapter is organized systematically and classified in the following

manner

• Literature related to attention.

• Literature related to concentration.

• Literature related to concentration enhancement activity.

PART II - CONCEPTUAL FRAMEWORK

 10

PART I
REVIEW OF RELATED LITERATURE

Attention and concentration issues in children have parents and educators

concerned. The ability to attend with focus, clarity, and purpose is a skill everyone
needs. Students are particularly in need of good attention skills. They must be able to
attend to instructions, focus on the details of assignments, and stay on task until an
assignment is completed. Attention abilities are not just behavioral patterns but they
are also cognitive skills.

The student's cognitive skills development, which includes attention training,

not only provides the tools for strong learning, but improves the student's ability to
perform in other academic areas. In addition, the training frequently improves the
child's self-esteem. Strengthened attention skills frequently lead to greater success and
much less frustration.

In order to improve the level of attention and concentration in children, they

have to be periodically trained in certain enhancement activities and improve their
focus on education. Some evidence suggested that the concentration enhancement
activity must be implemented in schools to help inattentive and poor concentrated
children to achieve maximum potential during their learning period in schools.

Literature related to Attention

Mocan. O., et al., (2014) had conducted a study on relating individual

differences in internalizing symptoms to emotional attention set shifting in children.
The study investigated attention shifting in a sample of 108 school age children aged
7 to 11 years using a task switching paradigm which required participants to alternate
between emotional and non emotional judgements. The results indicated that higher
levels of internalizing symptoms had a detrimental effect on performance efficiency
but not on response accuracy. The results concluded that individual differences in
internalizing symptoms play a role in children’s ability to flexibly alternate between
emotional and non emotional judgements.

Natasha. K., et al., (2014) had conducted a study to investigate the

association and directionality between attention deficit symptoms and obesity from
 11

childhood to adolescence in the general population. The study was conducted from 7
and 8 years to 16 years where the teacher reported attention deficit symptoms and
parents reported body mass index via clinical examination and physically active play.
The results showed that childhood attention deficit symptoms significantly predicted
adolescent inattention. The study concluded that child attention deficit symptoms are
at increased risk of becoming obese and physically inactive adolescents.

Silveria. A. A., et al., (2014) conducted a study on relationship between

learning problems and attention deficit in childhood. The samples included in the
study were 774 children from selected elementary schools. The child was assessed by
his teacher using a standardized scale. The attention deficit hyperactivity disorder
scale- teacher’s version was used to evaluate attention deficit hyperactive disorder
symptoms and learning problems. The result indicated that a very strong association
was found between attention deficit and learning problems. The result concluded that
attention deficit leads to learning problems.

Becker. K., et al., (2013) conducted a study on age, task complexity, and sex
as potential moderators of attention focus effects. The study tested whether age, sex,
or task complexity moderate the effect of attention focus on motor learning. Children
were assigned to an internal or external attention focus and were timed while riding
either a double pedalo with handles or without handles over a distance of seven
meters. The study result showed that for simpler task, no time difference due to
attention focus emerge but with the complex task an external focus resulted in faster
times in retention than an internal focus, but only for males. The study suggested that
attention focus affects children but task complexity and sex moderate these effects.

Dodge. K. A., et al., (2013) has conducted a study on attention problems and
academic achievement. The study examined a negative association between children’s
attention difficulties and their academic functioning. The study was classified into
four attention problem groups based on the presence versus absence of attention
problems in first and second grade. The study result showed that those
with attention problems in both grades showed a decline in reading and math
achievement during the K-5 interval relative to children with attention problems in
first grade only. Both groups of inattentive first graders also performed worse than
comparison children. In contrast, children whose attention problems emerged in
 12

second grade did not differ from comparison children on any achievement outcome
performed significantly better than inattentive first graders.

Julia. D. I., et al., (2013) has conducted a study to evaluate whether the
perceptual learning requires consciousness or attention. A textured figure ground
stimuli and manipulated report ability either by masking or inattention was presented.
24 hours later, learning was assessed visually and behaviorally via differences in
figure ground and detection task. The results suggested that learning requires
consciousness and not attention, and further strengthens the idea that consciousness is
separate from attention.

Lynda. M., et al., (2013) has conducted a study to examine whether age and
developmental differences in selective attention influence young children’s
differential responses to interactive and passive distractions. Totally 65 three to six
year old children were assessed by a test of selective attention and parents completed
ratings of attention. The results showed that children benefited more from interactive
distraction than from passive distraction. The study concluded that younger
preschoolers can benefit from interactive distraction, provided that the distraction
activity is developmentally appropriate

Oosterlaan. J., et al., (2013) had conducted a study on executive function and
intelligent quotient mathematical and attention problems in very preterm children.
The participants included 200 preterm and 230 term children without severe
disabilities. Mathematics was assessed with Dutch pupil monitoring system, parents
and teachers rated attention problems using standardized behavior questionnaires.
Interactions with group were examined. The analysis was conducted separately for
two subsamples for children in preschool and primary school. The results revealed
that preterm children performed poorer on tests for mathematics and had more parent
teacher rated attention problems than controls (p<0.01). The result concluded that
impaired executive function is over and above impaired intelligent quotient is an
important predictor for poor mathematics and attention problems following preterm
birth.

Venkata. J. A., et al., (2013) conducted a study on prevalence of attention

deficit hyperactive disorder in primary school children. Totally 770 children aged
 13

between 6 and 11 years were selected from four schools in Coimbatore district and
were assessed by using Conner’s abbreviated rating scale given to parents and
teachers. The children identified as attention deficit were assessed for the presence of
any co morbid factors by administering children’s behavioral questionnaire to
teachers and personal information questionnaire to the parents. The prevalence was
found to be 11.32% and was found to be higher among the males 66.7% as compared
to that of females 33.3%, also highest in the age group of 9 and 10 years. The study
showed a high prevalence of attention deficit among primary school children
especially among males than in females.

Giovanna. P., et al., (2012) has conducted a study on level of sustainability

on the rehabilitative training of preterm children’s attention. The samples included
were a group of 55 healthy preterm children at mean age of 5.2 years, 55 mothers, 15
pediatricians, 5 neonatologists and 10 teachers. Specific questionnaires were
administered to parents and teachers before and after training session and the trainer
used techniques of narrative and descriptive observation. The results showed good
levels of sustainability.

Linda. S., et al., (2012) has conducted a study to evaluate whether words cue
children’s attention in a visual search task. The children were assessed using a
computer touch screen and tested the prediction that words can cue children’s
attention to the shape of objects. The result suggests that nouns rapidly cue attention
to shape in children, providing a stepping stone to mechanic account of how words
organize attention and early word learning.

Nowakowski. M. E., et al., (2012) conducted a study on joint attention in

toddlerhood predicts internalizing problems at early school age. Fifty eight mothers
and their children were observed in the home of laboratory engaging in one
unstructured and four semi structured tasks designed to assess joint attention episodes
when the children were toddlers. Then four years later, mother and child dyads were
contacted again and mothers completed the child behavior check list as a measure of
their children’s socio emotional outcome at the early school years. The results showed
that lower frequencies of joint attention episodes at toddlerhood predicted higher
internalizing behaviors at early school age.
 14

Richard. M., et al., (2012) has conducted a cohort study to evaluate the
influence of relative age on diagnosis and treatment of attention deficit children. A
total of 9, 37,943 children in the age group of 6 to 12 years were included in the
study. The absolute and relative risk of receiving a diagnosis of attention deficit was
evaluated. The results showed that boys were 30% and girls were 70% more likely to
receive a diagnosis of attention deficit. The results interpreted that there was a relative
age effect in diagnosis and treatment of attention deficit. The findings also raised
concerns about the potential harms which include sleep, appetite and growth.

Shrensen. L., et al., (2012) had conducted a study on the impact of inattention
and emotional problems on cognitive control in primary school children. The samples
were 241 children from primary school. The cognitive control was measured by
functions of set shifting and working memory was assessed by behavior rating
inventory of executive function and performance based tests. Inattention and
emotional problems were measured with parent and teacher reports on Swanson
Nolan and Pelham questionnaire, strengths and difficulties questionnaire respectively.
The result showed that clinical symptoms of inattention and emotional problems
explained the child’s performance on test measures, however symptoms of inattention
made a significant contribution on all the selected measures of cognitive control. The
result concluded that valid information on cognitive control function in primary
school children should include information concerning problems of inattention and
emotion.

Trautmann. M., et al., (2012) had conducted a study on attention

performance, age and scholastic achievement in healthy children. An extensive testing
battery was used to assess a wide range of attention dimension. A principal
component analysis revealed three factors that are related to attention performance.
The result revealed that age was negatively associated with distractibility, lapses of
attention and cognitive speed, indicating that distractibility and lapses of attention
decreased with age in healthy children and resulted in lower cognitive speed. The
study concluded that attention processes in healthy children should be measured in
relation to distractibility, lapses of attention and cognitive speed.

Ferguson. C. J., et al., (2011) conducted a study on the influence of television

and video game use on attention and school problems. The samples included were
 15

Hispanic population of 603 children aged 10 to14 years. The tool used for attention
behavior problems was child behavior checklist and poor school performance was
measured by grade point average. The result found that internal factors such as male
gender, antisocial traits, family environment and anxiety best predicted attention
problems. Television and video game use whether total time spent using or exposure
to violent content specifically, did not predict attention problems. The result
concluded that television and video game use do not appear to be significant
predictors of childhood attention problems.

Murray. D. W., et al., (2011) conducted a study on teacher management

practices for first graders with attention problems. The sample included a total of 36
teachers who completed the teacher management questionnaire for 92 students in five
predominantly low income minority schools. Additional teacher and student
background data were collected on the inattentive sample, including behavior ratings
and academic test. The result indicated that teachers reported variable implementation
of different management strategies, with more frequent use of class wide structure and
organizational interventions, and less frequent assignment modifications and
individual behavior plans. The study concluded that teachers appear to differentiate
some management strategies based on the presence of attention problem.

Swanson. H., et al., (2011) has conducted a study to examine the role of
working memory in children’s growth in mathematical problem solving. Totally 127
elementary school children were assessed by a battery of tests that included problem
solving, achievement, working memory and cognitive processing in grade 1, 2 and 3.
The results showed that grade 1 predictors contributed unique variance to grade 3
problem solving performance. The study concluded that growth in the executive
system of working memory is an important predictor of growth in children’s problem
solving beyond the contribution of cognitive measures of inattention, inhibition and
processing speed.

Lundervold. A. J., et al., (2007) conducted a study on the emotional

symptoms in inattentive primary school children. The samples included teacher and
parent reports of inattention and emotional symptoms in 6,229 primary school
children. The tool used was the emotional symptoms subscale and impact scale from
strengths and difficulties questionnaire, inattention items from Swanson, Nolan and
 16

Pelham questionnaire. The result showed that children defined as inattentive showed a
high risk of being defined as high scores on emotional symptom subscale, a high
score on both inattention and emotional symptoms subscale was associated with a
high impact score.

Tanya. E., et al., (2007) had conducted a cross sectional study to determine
the United States national prevalence of attention deficit and whether prevalence,
recognition and treatment vary by socio economic group. The samples included 3,082
eight to fifteen year old children from national health and nutrition examination
survey. The children were assessed by diagnostic and statistical manual of mental
disorders criteria. The results showed that 8.7% of children met the criteria for
attention deficit. The results concluded that half of the children meeting the criteria
reported receiving a diagnosis of attention deficit.

Kinsey. K., et al., (2004) conducted a study on magno cellular mediated

visual spatial attention and reading ability. The study included reading ability in a
group of primary school children compared to performance on a visual cued coherent
motion detection task. The results showed that a brief spatial cue was more effective
in drawing attention either away or towards a visual target in the group of readers
ranked in the upper 25% of the sample compared to lower ranked readers. The result
concluded a strong relationship between visual attention and non word reading
compared to irregular word reading.

Literature related to Concentration

Courtney. H., et al., (2011) has conducted a study to evaluate the effect of
cartoons on children’s concentration and memory. The samples included 10 children.
They were assessed by cognitive capability test that included counting backwards and
solving puzzles. The results showed that watching cartoons had an immediate effect
on kids.

Ong. L.C., et al., (2010) had conducted a cross sectional study on factors
associated with poor academic achievement among urban primary school children in
Malaysia. Socio demographic and medical data were obtained from questionnaires
and interviews. All students underwent raven’s standard progressive matrices test as a
general measure of cognitive ability. The results showed that out of 1470 eligible
 17

children, 206 had poor achievement. Out of 919 children who participated in the
study, 111 had poor achievement compared with 95 of the 551 non participants and
the factors were found to be independently associated with poor academic
achievement (p<0.001). The study concluded that cognitive ability, gender,
prematurity and social factors contributed to poor academic achievement during the
early school years.

Andrea. F., et al., (2009) has conducted a study to evaluate the concentration
level of children after the effect of walk in the park. A total of seventeen children
aged 7 to 10 years old experienced each of three events like a city park and two other
well kept urban settings via individually guided 20 minute walks. The concentration
level was measured using digit span backwards. The result showed that children
concentrated better after walk in the park than after the downtown walk or the
neighborhood walk, p=0.229. The study concluded that twenty minutes in a park
setting was sufficient to evaluate concentration performance relative to the same
amount of time in other settings.

Roebers. C. M., et al., (2009) conducted a study on metacognitive monitoring

and control processes involved in primary school children’s test performance. A total
of 133 participants from third to fifth grade did a test about a previously learned
science topic, gave confidence judgements for every answer, and were then allowed to
cross out answers if they wished. Two different mock scoring schemes for test
performance were compared with a control group. The results revealed well
developed monitoring skills indicating that by the age of 9, children can reliably
distinguish between correct and incorrect answers. As for control skills, 11 and 12
year olds proved to be better able to improve their test performance by selectively
withdrawing answers that would have been incorrect than the 9 to 10 year olds. The
study concluded that the impact of meta cognitive processes in student’s learning
outcomes documented strategic behavior during test taking.

Gajre. N. S., et al., (2008) conducted a study on breakfast eating habit and its
influence on attention and concentration, immediate memory and school achievement.
The samples were 379 urban 11 to 13 year old school children. Data was collected
using letter cancellation test, immediate memory from PGI memory scale, school
marks of the previous year and nutritional status. The result showed a significant
 18

difference in the letter cancellation total score with the regular breakfast group
achieving the highest mean scores compared to the no breakfast group, p<0.05. The
results concluded that regular habit of eating breakfast as opposed to irregular
consumption or skipping breakfast altogether had beneficial influence on attention
and concentration, memory and school achievement.

Literature related to Concentration Enhancement Activity

Steiner. N. J., et al., (2014) conducted a study on neuro feedback and

cognitive attention training for children with attention deficit hyperactive disorder in
schools. Children in second and fourth grade with diagnosis of attention deficit
hyperactive disorder were randomly assigned to neuro feedback and cognitive
training. A two point growth model assessed change from pre post intervention on
parent reports, teacher reports and systematic classroom observations were evaluated.
The results concluded that neuro feedback is a promising attention training treatment
intervention for children.

Alice. W., et al., (2013) has conducted a study to evaluate the effects of
mindfulness training and children’s attention skills. Totally 24 children aged 9 to 12
years were selected for the study. The child was assessed on the attention network
task interference and attention control task, executive function was rated by parents
filled in questionnaires. The measurement was assessed before and immediately after
five to six week training. The results showed that the performance on the attention
network task interference and on the attention control task showed a significant main
effect for training group. The results concluded that mindfulness training in children
enhanced their attention control.

Anthony. D., et al., (2013) had conducted a comparative study which

examined the effect of a single bout of exercise on measures of attention and
impulsivity in children with attention deficit and children without attention deficit. A
total of 21 children were selected and assessed by Connor’s continuous performance
test, immediately before and after 20 minutes of intermittent exercise. The data were
analyzed with a three way multiple analysis of variance. The result indicated that the
children without attention deficit had improved academic performance and behavior
when compared to children with attention deficit.
 19

Hovik. K. T., et al., (2013) conducted a study on working memory training in

attention deficit children. Sixty seven children aged 10 to 12 years were randomly
assigned to training or control group. The trainees participated in a 25 day training
program at school, while the control group received treatment as usual. Participants
were tested one week before intervention, immediately after and eight months later.
The results showed that the training group had significant long term differential gains
compared to the control group on all outcome measures.

Ramon. M., et al., (2013) has conducted a study on randomized clinical trial
of cogmed working memory training in school age children with attention deficit
hyperactive disorder. A total of eighty five seven to eight year school age children
were randomized to memory training and evaluated before and after three weeks of
treatment. The result showed that active participants demonstrated significantly
greater improvements in verbal and non verbal working memory stage. The results
concluded that cogmed memory training can be considered as a viable treatment for
children with attention deficit.

Brian. J., et al., (2012) had conducted a study to examine the effect of a
single bout of moderate intensity aerobic exercise on preadolescent children with
attention deficit. The task performance and event related brain potentials were
assessed while participants performed on attention control task following a bout of
exercise or seated during two separate, counter balanced sessions. The results showed
that children exhibited greater response accuracy and performance in the areas of
reading and arithmetics. The study concluded that single bouts of moderately intense
aerobic exercise may have positive implications for aspects of inhibitory control in
children with attention deficit.

Saskia. O., et al., (2012) had conducted a study to evaluate the effectiveness
of eight week mindfulness training for children with attention deficit and mindful
parenting for their parents. Parents were assessed by questionnaires including their
own attention deficit symptoms, parenting stress, parental overacting, permissiveness
and mindful awareness before, immediately after the eight week training and at eight
week follow up. The teachers reported attention deficit behavior of the child. The
results showed the effectiveness of mindfulness for children with attention deficit and
their parents.
 20

Dion. E., et al., (2011) conducted a study on improving attention and

preventing reading difficulties among low income first graders. In this study 58 first
grade classrooms located in 30 schools were assigned to a control condition or to one
of two intervention conditions. In the last two conditions, peer tutoring activities were
conducted to improve classroom reading instruction. In one of the intervention
condition, the good behavior game was also implemented to maximize student
attention during reading lessons. The results indicated that interventions were
effective, peer tutoring activities helped students improve their reading skills and
attention was generally higher when the good behavior game was implemented.

Mahar. M. T., et al ., (2011) had conducted a study on impact of short bouts

of physical activity on attention to task in elementary school children. Attentions to
task in elementary school students following physical activity breaks were reviewed.
The results revealed that direct measurement of attention to task is intensive and
demanding on observers. Teachers can be trained in a relatively short time to
effectively lead classroom based physical activities. Students who participated in class
room based physical activities that incorporate academic concepts demonstrated
significantly better improvements in attention to task than control group participants.

Hill. L., et al., (2010) conducted a study on exercising attention within the
classroom. A cross over design trial was conducted in six main stream primary
schools of age 8 to 11 years. Children received a teacher directed, classroom based
programme of physical exercise, delivered approximately 30 minutes after lunch for
15 minutes during one week and no exercise programme during the other. At the end
of each school day, they completed one of five psychometric tests so that each test
was delivered once after exercise and once after no exercise. The results demonstrated
a significant interaction between intervention and counter balance group (p<0.001),
showing that exercise benefited cognitive performance.

Pfeiffer. B., et al., (2008) conducted a study on effectiveness of disc ‘o’ sit
cushions on attention to task in second grade students with attention difficulties.63
second grade students participated in the study with 31 in treatment group and 32 in
control group. The treatment group used disc ‘o’ sit cushion throughout the school
day for a two week period. The teachers completed the behavior rating inventory of
executive functioning for each participant before and after intervention. The study
 21

result showed a statistically significant difference in the attention to task before and
after the intervention for the treatment group. The study provided preliminary
evidence for the use of this intervention to improve attention in school setting.

Alvarez. L., et al., (2007) conducted a study on multimodal intervention

program to improve attention deficits. Two groups of age 5 to 19 years participated in
the study, one with difficulties in selective attention made up of 102 students with 59
in experimental and 43 in control group and other with sustained attention with 58 in
experimental group and 48 in control group. The results indicated that this kind of
intervention combined with visual therapy, cortical activation, and training with
activity banks is effective to improve attention deficits, both at the level of selective
attention and sustained attention.

Edward. H., et al., (2006) had conducted a study on neuro feedback of two
children with learning, attention, mood, social and developmental deficits. The
samples were administered twenty minute session of neuro feedback training for
approximately six months. The samples were assessed by a parent rating scale and
symptom assessment questionnaire. The results showed that both the boys improved
in all tracked symptoms without adverse effects and also in academic functioning,
home behavior and peer relationships. The results concluded that neuro feedback was
successful treatment for the multi symptomatic diagnosed boys.

Piek. J.P., et al., (2004) conducted a study on the relationship between motor
co-ordination, executive functioning and attention in school aged children. The study
included samples of 238 children, 121 girls and 117 boys, aged between 6 and 15
years. Motor ability was assessed using the McCarron assessment of neuromuscular
development, level of inattention using the child behavior checklist, and verbal
intelligent quotient was estimated using subtests of Wechsler intelligence scale for
children. A reaction time task measuring response inhibition, working memory and
the ability to plan and respond to goal directed tasks were administered. The results
revealed that motor ability significantly accounted for variance in tasks measuring
speed of performance, whereas inattention appeared to influence performance
variability.
 22

PART II
CONCEPTUAL FRAMEWORK

The conceptual framework for this study is based on Imogen King’s goal
attainment model (1971). Conceptual models deal with concepts that are used as
building blocks and provide a conceptual perspective regarding interrelated
phenomena which are closely structured.

The central focus of Imogen King’s frame work is man as a dynamic human
being whose perception of objects, persons and events influence his behavior, social
interaction, and health. Imogene King’s conceptual frame work includes three
interacting systems which each system having its own distinct group of concepts and
characteristics. These systems include personal systems, interpersonal systems, and
social systems.

The personal system refers to the individual. The concepts within the personal
system in understanding human beings are perception, self, body image, growth and
development, time and space. Imogen King (1981) viewed perception as the most
important variable because perception influences behavior. An individual’s perception
of self, body image, time and space influence the way he or she responds to persons,
objects and events in his or her life. As individuals grow and develop through the life
span, experience with changes in structure and function of their bodies over time
influence their perception of self and interpersonal systems involve individuals
interacting with one another. King refers to two individuals as small or large groups.

The theory is based on the concepts of the personal and interpersonal systems
including interaction, perception, transaction and action. A basic theory for
conceptual framework, which is aimed to assess the effectiveness of concentration
enhancement activity on attention and concentration among school age children in
Madha Matriculation School at Chennai. This involves interaction between the
researcher and the school children, the seven major concepts are described as follows.

Perception

Perception is the person’s representation of the reality. It influences all other

behavior of a person and it is more subjective and unique to each person. The
 23

researcher perceives that the school children have lack of attention and concentration
due to their age and playful mind, so they need to improve the level of attention and
concentration.

Judgment

The judgment is a decision made by the researcher and the school children.
Here the researcher judges that the school children have lack of attention and
concentration. So, the investigator planned to provide concentration enhancement
activity to improve the level of attention and concentration. The school children judge
to utilize the enhancement activity to increase the level of attention and concentration.

Action

This refers to the changes that have to be achieved. The researcher’s action is
to implement concentration enhancement activity in order to improve attention and
concentration and the children were ready to increase their level of attention and
concentration.

Goal setting

Here the researcher plans to provide enhancement activity like letter

cancellation, color cancellation, dots joining, missing numbers, puzzle solving, and
tongue twisters to improve attention and concentration among school age children.

Reaction

Reaction means decision to act. In this study the researcher developed a tool
such as modified attention profile and card game to assess the level of attention and
concentration among school children.

Interaction

Interaction is a process of perception and communication between person and

environment and between person and person, represented by verbal and nonverbal
behaviors that are goal directed. Here the researcher gave concentration enhancement
activity like letter cancellation, color cancellation, dots joining, missing numbers,
puzzle solving, and tongue twisters to school children.
 24

Transaction

The transaction is purposeful interaction that leads to goal attainment between

the researcher and the school children. Here, the researcher assessed the effectiveness
of concentration enhancement activity on attention and concentration among school
age children by post test using modified attention profile and card game.

Positive outcome is rarely inattentive and good concentration which has to be

reinforced further. Negative outcome is sometimes inattentive, often inattentive, fair
and poor concentration which needs to be reassessed for further learning.

King’s conceptual framework and theory of goal attainment provides a useful

structure for the current researcher by using a concentration enhancement activity to
improve the level of attention and concentration. King’s theory provides direction for
nursing practice by emphasizing the processes of communication, interaction,
transaction and the use of critical thinking.
 25

Reinforcement
Perception: School children have lack of Reaction: (pre test)
attention and concentration. The investigator develops the tool
to assess the level of attention and Rarely inattentive and
concentration by using modified good concentration
attention profile and card game. (Goal Attained)
Judgment: Concentration enhancement
Investigator activity can improve the level of attention
and concentration

Action: Implement concentration Interaction: Concentration Sometimes inattentive

enhancement activity in orderMutual
to improveGoal setting: enhancement activity like and fair concentration
The investigator plan to provide activity like letter letter cancellation, color
the level of attention and concentration. (Goal Not Attained)
cancellation, dots joining,
cancellation, color cancellation, dots joining, missingmissing
numbers,
numbers, puzzle
puzzle solving and tongue twisters to improve the level of and tongue twisters.
solving
attention and concentration among school children.
Perception: Need to improve the level of
attention and concentration.

School Often inattentive and

Judgment: Utilization of concentration poor concentration
children enhancement activity to improve the level
Transaction: (post test) (Goal Not Attained)
of attention and concentration.
The effectiveness of enhancement
activity was assessed by post test
level of attention and concentration
Action: Readiness to increase the level of by using modified attention profile
attention and concentration. and card game.

Reassessment

25
Fig 1: MODIFIED KING'S GOAL ATTAINMENT THEORY (1971).
25
 26

CHAPTER III
METHODOLOGY

The methodology is the back bone for any investigation. It is a guideline system
for solving a problem with specific components such as phases, tasks, methods, 25
techniques and tools. The successes of any research depend largely upon the suitability of
the tools and the technique that the investigator follows to gather adequate data. This
design was used to assess the effectiveness of concentration enhancement activity on
attention and concentration among school children in Madha Matriculation School at
Chennai.

This chapter deals with a research design, setting of the study, population, sample,
sample size, sampling techniques, criteria for sample selection, description of tools and
data collection procedure.

RESEARCH APPROACH

Quantitative research approach was used to assess the effectiveness of

concentration enhancement activity on attention and concentration among school age
children in Madha Matriculation School.

RESEARCH DESIGN

The design selected for study was pre experimental one group pre test post test
design.

RESEARCH VARIABLES

Independent variables: It refers to concentration enhancement activity on attention and

concentration.

Dependent variables: It refers to attention and concentration among school age

children.
 27

SETTING OF THE STUDY

The study was conducted in Madha Matriculation School in Kundrathur at

Chennai. The school is well developed with excellent infrastructure facilities in
permanent building. The main building is a three storeyed framed structure with practical
labs, play ground and library. The school has spacious number of class room that
accommodates 50 students per class. The class rooms are well furnished, ventilated and
have conclusive atmosphere which stimulate good academic learning. The school is
equipped with sufficient number of equipments and accessories for the students. The total
strength of school is 590 students. I have selected students from IV to V standard for
study.

POPULATION

The population consists of school age children in the age group of 10 years in
Madha Matriculation School.

SAMPLE

The sample consists of school age children who fulfilled the inclusion criteria.

SAMPLE SIZE

The sample size comprises of 30 school age children in Madha Matriculation

School at Chennai.

SAMPLING TECHNIQUE

Purposive sampling technique was used to select the samples.

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria

¾ Children who belong to the age group of 10 years.

¾ Children include both boys and girls.
¾ Children who can understand and speak English.
 28

¾ Children who scored 50% or below during their previous academic performance.

Exclusion Criteria

¾ Children who have chronic illness.

¾ Children who were not available during study period.
¾ Children who were absent in school for a long duration.
¾ Children who practice meditation and other concentration enhancement activity.

DESCRIPTION OF THE INSTRUMENT

Extensive review of literature, discussion and guidance from experts enhance the
development of tools. The tool consists of four parts:

Part I

It consists of demographic variables like sex of the child, type of family, religion,
family income, family structure, educational status of mother, educational status of
father, type of diet, type of hobby and previous exposure to meditation.

Part II

ASSESSMENT OF ATTENTION

MODIFIED JAMES.B.SNYDER’S ATTENTION PROFILE was used to

assess the level of attention among school age children. The scale consists of 20 items
with three options, score 0 for rarely true, score 1 for sometimes true, score 2 for very or
often true.

The scoring was interpreted as follows

0-20 : rarely inattentive

21-30 : sometimes inattentive
31-40 : often inattentive

ASSESSMENT OF CONCENTRATION
 29

A game developed by ERIC HARSH BARGER was used to assess the level of
concentration among school age children.

The scoring was interpreted as follows

9-14 attempts : Good concentration

15-20 attempts : Fair concentration
21-26 attempts : Poor concentration

Part – III

It consists of concentration enhancement activity which included letter

cancellation, color cancellation, dots joining, missing numbers, puzzle solving, and
tongue twisters in improving attention and concentration among school age children.

VALIDITY

Validity of the tool was assessed using content validity. Content validity was
determined by experts from nursing and medical field. They suggested certain
modifications in the tool. After the modifications they agreed this tool for assessing
effectiveness of concentration enhancement activity on attention and concentration
among school age children.

RELIABILITY

The reliability of the tool was assessed by using inter rater method, its correlation
coefficients r values was 0.83 and 0.88. The correlation coefficient was high, so the tool
was appropriate and used to assess the effectiveness of concentration enhancement
activity on attention and concentration among school children.

ETHICAL CONSIDERATION

The study was conducted after the approval of dissertation committee. Formal
written permission was obtained from the Chairman of Madha group of Academic
Institution and the Principal of Madha Matriculation School. The school children were
 30

clearly explained about the study purpose and procedures. The formal oral consent was
obtained from the subjects. The usual assurance of anonymity and confidentiality was
obtained.

PILOT STUDY

The refined tool was used for pilot study to test the feasibility, appropriateness
and practicability. The pilot study was conducted in Madha Matriculation School at
Chennai from the duration of 01.11.2013 to 09.11.2013. A formal permission from higher
authorities and oral consent from the students was obtained. The pilot study was carried
out with 3 children who fulfilled the inclusion criteria. The samples were selected by
purposive sampling technique.

The brief self introduction was given by the investigator and explained the
purpose of the study to the children to gain their co-operation. The tool was explained in
detail to the participants. On the first day modified attention tool and card game was used
to assess the pre test level of attention and concentration. On next day concentration
enhancement activity was given to the children for duration of 30 minutes for six days.
The post test was conducted by using the same tool on the seventh day.

DATA COLLECTION PROCEDURE

A formal written permission was obtained from the Chairman of Madha group of
Academic Institutions and the Principal of Madha Matriculation School, Chennai. The
data was collected over a period of 4 weeks duration from 15.11.2013 to 15.12.2013. The
study was carried out among 30 school children who fulfilled the inclusion criteria. An
oral informed consent was obtained from each participant. Self introduction was followed
by adequate explanation about the purpose of the study to ensure better cooperation.

Every week the investigator selected 10 school children by using purposive

sampling technique. A modified attention profile and card game was used to the samples
to assess their pre test level of attention and concentration. After conducting pre test,
concentration enhancement activity was given to the children for duration of 30 minutes
 31

for six days. Then the investigator conducted the post test on seventh day by using same
tool.

DATA ANALYSIS

The data was analyzed in term of the objectives of the study by using both
descriptive and inferential statistics. Demographic variables of school children were
analyzed in terms of frequency and percentage. Mean and standard deviation was used to
determine the level of attention and concentration among school age children. Paired‘t’
test was used to assess the effectiveness of concentration enhancement activity on
attention and concentration among school age children. Karl Pearson correlation
coefficient was used to correlate between the post test level of attention and concentration
among school age children. Chi square test was used to associate the post level of
attention and concentration among school age children with their selected demographic
variables.
 32

A STUDY TO ASSESS THE EFFECTIVENESS OF CONCENTRATION

ENHANCEMENT ACTIVITY ON ATTENTION AND
CONCENTRATION AMONG SCHOOL AGE
CHILDREN IN MADHA MATRICULATION
SCHOOL AT CHENNAI

Pre experimental one group pre test and post test design
Research design

School age children of 10 years studying in Madha Matriculation Scho

Target population

The children who fulfilled the inclusion criteria.

Sample

30 children studying in Madha Matriculation School.

Sample size

Purposive sampling technique

Sampling technique

Modified attention profile and card game

Tool for data collection

Oral consent, pre test, concentration enhancement activity and post test as
Data collection procedure

Descriptive and inferential statistics

Analysis and interpretation

R
e
s
Fig. 2: Schematic representation
ul
of research methodology
t
 33

CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

Data analysis is the categorizing, ordering, manipulating and summarizing of data

to reduce the intelligible and interpretable so that the research problem can be studied and
tested including the relationship between variables. (Kerlinger 1976).

The findings are based on the descriptive and inferential statistics analyzed and
presented under the following sections.

Section A : Frequency and percentage distribution of demographic variables of school

age children.

Section B : Frequency and percentage distribution of pre test level of attention and
concentration among school age children.

Section C : Frequency and percentage distribution of post test level of attention and
concentration among school age children.

Section D : Comparison of frequency and percentage distribution of pre test and post
level of attention and concentration among school age children.

Section E : Comparison of mean and standard deviation of pre test and post test level
of attention and concentration among school age children.

Section F : Correlation between post test level of attention and concentration among
school age children.

Section G: Association of post test level of attention and concentration among school
age children with their demographic variables.
 34

SECTION – A

Table 1: Frequency and percentage distribution of demographic variables of

S. No Demographic Variables Frequency Percentage
1 Sex of the child
Boy 18 60.0
Girl 12 40.0
2 Type of family
Nuclear family 29 96.7
Joint family 1 3.3
3 Religion
Hindu 26 86.7
Christian 3 10.0
Muslim 1 3.3
4 Family income per month
Below Rs.5,000 10 33.3
Rs.5,000-10,000 20 66.7
5 Family structure
Parents living together 30 100.0
6 Educational status of mother
Non-formal education 1 3.3
Primary school 2 6.7
Higher secondary 25 83.3
Graduate 2 6.7
7 Educational status of father
Primary school 1 3.3
Higher secondary 24 80.0
Graduate 5 16.7
8 Type of diet
Vegetarian 4 13.3
Non-vegetarian 26 86.7
9 Type of hobby
Listening to music 3 10.0
Sports 10 33.3
Watching TV 7 23.3
Playing video games 10 33.3
10 Previous exposure to meditation
Yes 5 16.3
No 25 83.7
school age children.

N=30
 35

Table 1 depicts the distribution of demographic variables of school age children.

With respect to sex, the majority of children 18 (60.0%) were boys and 12 (40.0%) were
girls. With respect to type of family, 29 (96.7%) were in nuclear family and 1 (3.3%)
were in joint family. Regarding religion majority of the children 26 (86.7%) were Hindus,
3 (10.0%) were Christians, 1 (3.3%) was Muslim. Considering the monthly income,
10 (33.3%) were within family income of less than Rs.5, 000 and 20 (66.7%) were within
family income of Rs. 5, 000- 10,000.

With regard to their family structure all 30 (100%) children were living with their
parents. With regard to educational status of mother, 1 (3.3%) had non formal education,
2 (6.7%) went to primary school, 25 (83.3%) has completed school and 2 (6.7%) were
graduates. With regard to educational status of father, 1 (3.3%) went to primary school,
24 (80.0%) has completed school and 5 (16.7%) were graduates. In relation to the type of
diet, 4 (13.3%) were vegetarian and 26 (86.7%) were non vegetarian.

With regard to type of hobby 3 (10.0%) children listens to music, 10 (33.3%)

plays sports, 7 (23.3%) watches TV and 10 (33.3%) plays video games. In relation to
previous exposure to meditation 5 (16.3%) had no exposure to meditation and 25 (83.7%)
had exposure to meditation.
 36

Sex of the child

Male
Female

40%

60%

Fig 3: Percentage distribution of sex of the child among school children

36
 37

Fig 4: Percentage distribution of type of family among school children

37
 38

Fig 5: Percentage distribution of religion among school children

38
 39

Fig 6: Percentage distribution of monthly income of family

39
 40

Fig 7: Percentage distribution of structure of family among school children

40
 40

41

Fig 8: Percentage distribution of educational status of mother.

41
 42

Fig 9: Percentage distribution of educational status of father

42
 43

Type of diet
Vegetarian
Non vegetarian
13%

87%

Fig 10: Percentage distribution of type of diet among school children

43

43
 44

Fig 11: Percentage distribution of type of hobby among school children

44
 45

Previous exposure to meditation

Yes
No
16%

84%

45
Fig 12: Percentage distribution of previous exposure to meditation among school children
 46

SECTION - B

Table 2: Frequency and percentage distribution of pre test level of attention

among school age children
N=30

Pre test
Level of attention
Frequency Percentage
Rarely inattentive 3 10
Sometimes inattentive 6 20
Often inattentive 21 70

Table 2 depicts the frequency and percentage distribution of pre test level of
attention among school age children. It reveals that 3 (10%) children were rarely
inattentive, 6 (20%) children were sometimes inattentive and 21 (70%) children were
often inattentive.
 47

Fig. 13: Percentage distribution of pre test level of attention among school age children 47
 48

Table 3: Frequency and percentage distribution of post test level of attention

among school age children.

N=30

Post test
Level of attention
Frequency Percentage
Rarely inattentive 18 60
Sometimes inattentive 12 40
Often inattentive 0 0

Table 3 depicts the frequency and percentage distribution of post test level of
attention among school age children. It reveals that 18 (60%) children were rarely
inattentive, 12 (40%) children were sometimes inattentive and none of the children
were often inattentive.
 49

Fig. 14: Percentage distribution of post test level of attention among school age children 49
 50

SECTION - C

Table 4: Frequency and percentage distribution of pre test level of

concentration among school age children.

N=30

Pre test
Level of concentration
Frequency Percentage
Good 4 13.3
Fair 7 23.3
Poor 19 63.4

Table 4 depicts the frequency and percentage distribution of pre test level of
concentration among school age children. It reveals that 4 (13.3%) children had good
concentration, 7 (23.3%) children had fair concentration and 19 (63.4%) children had
poor concentration.
 51

Fig. 15: Percentage distribution of pre test level of concentration among school age children
51
 52

Table 5: Frequency and percentage distribution of post test level of

concentration among school age children.
N=30

Post test
Level of concentration
Frequency Percentage
Good 19 63.3
Fair 11 36.7
Poor 0 0.0

Table 5 depicts the frequency and percentage distribution of post test level of
concentration among school age children. It reveals that 19 (63.3%) children had good
concentration, 11 (36.7%) children had fair concentration and none of them had poor
concentration.
 53

Fig. 16: Percentage distribution of post test level of concentration among school age children

53
 54

SECTION - D

Table 6: Comparison of frequency and percentage of pre test and post test level
of attention among school age children.
N=30

Pre test Post test

Level of attention
Frequency Percentage Frequency Percentage
Rarely inattentive 3 10 18 60
Sometimes inattentive 6 20 12 40
Often inattentive 21 70 0 0

Table 6 shows the comparison of frequency and percentage distribution of pre

test and post test level of attention among school age children. In pre test level of
attention 3 (10%) children were rarely inattentive, 6 (20%) children were sometimes
inattentive and 21 (70%) children were often inattentive. In post test level of attention
18 (60%) children were rarely inattentive, 12 (40%) children were sometimes
inattentive and none of the children were often inattentive.
 55

Fig 17: Percentage distribution of pre test and post test level of attention among school children

55
 56

Table 7: Comparison of frequency and percentage of pre test and post test level
of concentration among school age children.
N=30

Pre test Post test

Level of concentration
Frequency Percentage Frequency Percentage
Good 4 13.3 19 63.3
Fair 7 23.3 11 36.7
Poor 19 63.4 0 0.0

Table 7 shows the comparison of frequency and percentage distribution of pre

test and post test level of concentration among school children. In pre test level of
concentration 4 (13.3%) children had good concentration, 7 (23.3%) children had fair
concentration and 19 (63.4%) children had poor concentration. In post test level of
concentration 19 (63.3%) children had good concentration, 11 (36.7%) children had
fair concentration and none of them had poor concentration
 57

Fig 18: Percentage distribution of pre test and post test level of concentration among school children

57
 58

SECTION – E

Table 8: Comparison of mean and standard deviation of pre test and post test
level of attention among school age children.

N=30

Assessment of
Mean Standard Deviation Paired ‘t’ test
attention
Pre test 29.83 6.73
9.72***
Post test 18.53 5.14
*** p<0.001

Table 8 shows the comparison of mean and standard deviation between pre
test and post test level of attention. Analysis reveals that the pre test level of attention
mean score was 29.83 with the standard deviation of 6.73 and the post test level of
attention mean score was 18.53 with the standard deviation of 5.14. The paired’ test
value of 9.72 was very high significant at the level of p<0.001. The difference
between pre test and post test level of attention score is high and it is statistically very
high significant. Thus, it indicates the effectiveness of concentration enhancement
activity.
 59

Fig 19: Mean and Standard deviation of pre test and post test level of attention among school age children.
59
 60

Table 9: Comparison of mean and standard deviation of pre test and post test
level of concentration among school age children.

N=30

Assessment of
Mean Standard Deviation Paired ‘t’ test
concentration
Pre test 21.57 4.78
6.71***
Post test 13.83 3.60
*** p<0.001

Table 9 shows the comparison of mean and standard deviation between pre
test and post test level of concentration regarding among school age children.
Analysis reveals that the pre test level of concentration mean score was 21.57 with the
standard deviation of 4.78 and the post test level of concentration mean score was
13.83 with the standard deviation of 3.60. The paired’ test value of 6.71 was very high
significant at the level of p<0.001. The difference between pre test and post test level
of concentration score is high and it is statistically very high significant. Thus, it
indicates the effectiveness of concentration enhancement activity.
 61

Fig 20: Mean and Standard deviation of pre test and post test level of concentration among school age children. 61
 62

SECTION – F

Table 10: Correlation between post test level of attention and concentration
64
among school age children.
N=30

Karl Pearson
Standard Correlation
Assessment Mean score
deviation Coefficient
r
Attention 18.53 5.14 r =0.56
Concentration 13.83 3.60 S**
** p<0.01

Table 10 depicts the correlation between post test level attention and
concentration among school age children. The analysis reveals that the correlation
between post test level of attention and concentration were moderately correlated at
the level of p<0.01.

.
 63

SECTION – G

Table 11: Association of post test level of attention among school age children
64
with their demographic variables.
N=30

Post test level of attention

Rarely Sometimes Chi square
Demographic χ2
S.No
variables n % n %

Sex χ2 =4.54
1 Boy 8 44.4 10 55.6 df= 1
Girl 10 83.3 2 16.7 S*
2 Type of family χ2 =0.69
Nuclear family 17 58.6 12 41.4 df= 1
Joint family 1 100.0 0 0.0 NS
3 Religion
Hindu 17 65.4 9 34.6 χ2 = 5.48
Christian 0 0.0 3 100.0 df= 2
Muslim 1 100.0 0 0.0 NS
4 Monthly income χ2 = 0.62
<Rs.5,000 7 70.0 3 30.0 df= 1
Rs.5,000-10,000 11 55.0 9 45.0 NS
5 Family structure χ2 =0.0
df= 0
Parents living together 18 60.0 12 40.0 NS
Educational status of
6
mother χ2 =0.83
Non formal 1 100.0 0 0.0 df= 3
Primary school 1 50.0 1 50.0 NS
Higher secondary 15 60.0 10 40.0
Graduate 1 50.0 1 50.0
Educational status of
7
father χ2 =1.56
Primary school 0 0 1 100.0 df= 2
Higher secondary 15 62.5 9 37.5 NS
Graduate 3 60.0 2 40.0
8 Type of diet χ2 =0.43
Vegetarian 3 75 1 25 df= 1
No Non vegetarian 15 57.7 11 42.3 NS
9 Type of hobby χ2 =3.69
Listening to music 3 100.0 0 0.0 df= 1
Sports 5 50.0 5 50.0 NS
Watching TV 3 42.9 4 57.1
Playing video games 7 50.0 3 30.0
Previous exposure to χ2 =5.00
10 meditation df= 1
6 100.0 0 0.0
Yes S*
12 50.0 12 50.0
No
NS- Non significant, S- statistically significant, *p<0.05
 64

Table 11 shows the association of post test level of attention regarding

concentration enhancement activity among school children with their selected
demographic variables.

The chi square value of 4.54 showed that there was a significant association
between the sex of school children and post test level of attention after concentration
enhancement activity at the level of p<0.05. The chi square value of 5.00 showed that
there was a significant association between previous exposure to meditation and post
test level of attention after concentration enhancement activity at the level of p<0.05.
 65

Table 12: Association of post test level of concentration among school age
children with their demographic variables.
N=30

Post test level of concentration

Good Fair Chi square
χ2
S.No Demographic variables
n % n %

Sex χ2 =6.91
1 Boy 8 44.4 10 55.6 df= 1
Girl 11 91.7 1 8.3 S*
2 Type of family χ2 =0.59
Nuclear family 18 62.1 11 37.9 df= 1
Joint family 1 100.0 0 0.0 NS
3 Religion
Hindu 17 65.4 9 34.6 χ2 = 1.78
df= 2
Christian 2 66.7 1 33.3
NS
Muslim 0 0.0 1 100.0
4 Monthly income χ2 = 1.12
<Rs.5,000 5 50.0 5 50.0 df= 1
Rs.5,000-10,000 14 70.0 6 30.0 NS
5 Family structure χ2 =0.0
df= 0
Parents living together 19 63.3 11 36.7 NS
Educational status of
6
mother χ2 =0.89
Non formal 1 100.0 0 0.0 df= 3
Primary school 1 50.0 1 50.0 NS
Higher secondary 16 64.0 9 36.0
Graduate 1 50.0 1 50.0
Educational status of
7
father χ2 =1.43
Primary school 1 100.0 0 0.0 df= 2
Higher secondary 14 58.3 10 41.7 NS
Graduate 4 80.0 1 20.0
8 Type of diet χ2 =2.67
Vegetarian 4 100.0 0 0.0 df= 1
No Non vegetarian 15 57.7 11 42.3 NS
9 Type of hobby 33.3 χ2 =2.33
Listening to music 2 66.7 1
40.0 df= 1
Sports 6 60.0 4 NS
14.3
Watching TV 6 85.7 1
50.0
Playing video games 5 50.0 5
Previous exposure to χ2 =4.34
10 meditation 6 100.0 0 0.0 df= 1
Yes 13 54.2 11 45.8 S*
No
NS- Non significant, S- statistically significant, *p<0.05
 66

Table 12 shows the association of post test level of concentration among

school children with their selected demographic variables.

The chi square value of 6.91 showed that there was a significant association
between the sex of school children and post test level of concentration after
concentration enhancement activity at the level of p<0.05. The chi square value of
4.34 showed that there was a significant association between previous exposure to
meditation and post test level of concentration after concentration enhancement
activity at the level of p<0.05.
 67

CHAPTER V
DISCUSSION

This chapter deals with discussion of the result obtained from the statistical
analysis. This study aimed to assess the effectiveness of concentration enhancement
activity on attention and concentration among school age children in Madha
Matriculation School at Chennai.

The hypothesis formulated was that there was a significant association

between concentration enhancement activity on attention and concentration among
school age children. The review of literature included related studies which provided
a strong foundation for the study including the basis for conceptual frame work and
formation of tool.

The conceptual framework for this study was developed based on Imogen
King’s goal attainment theory. The research design used in the study was pre
experimental one group pre test and post test design. It was carried out with 30
participants who fulfilled the inclusion criteria. Purposive sampling technique was
used to select the sample.

A modified attention profile and concentration test was used to assess the pre
test level of attention and concentration among school age children. Concentration
enhancement activity was conducted to the participants for the duration of 30 minutes
for six days. The post test was conducted on seventh day by using the same tool.

The collected data was analyzed using descriptive and inferential statistics.
The distribution of demographic variables of study showed that the majority of
children 18 (60.0%) were boys and 12 (40.0%) were girls. With respect to type of
family, 29 (96.7%) were in nuclear family and 1(3.3%) were in joint family.
Regarding religion the majority of the children, 26 (86.7%) were Hindus, 3 (10.0%)
were Christians, 1(3.3%) was Muslim. Considering the monthly income, 10 (33.3%)
were within the family income of less than Rs.5, 000 and 20 (66.7%) were within the
family income of Rs. 5, 000- 10,000.

With regard to their family structure all 30 (100%) children were living with
their parents. With regard to educational status of mother, 1 (3.3%) had non formal
 68

education, 2 (6.7%) went to primary school, 25 (83.3%) has completed school and
2 (6.7%) were graduates. With regard to educational status of father, 1 (3.3%) went to
primary school, 24 (80.0%) has completed school and 5 (16.7%) were graduates. In
relation to the type of diet, 4 (13.3%) were vegetarian and 26 (86.7%) were non
vegetarian.

With regard to the type of hobby, 3 (10.0%) children listens to music,

10 (33.3%) plays sports, 7 (23.3%) watches TV and 10 (33.3%) plays video games. In
relation to previous exposure to meditation 5 (16.3%) had no exposure to meditation
and 25 (83.7%) had exposure to meditation.

The first objective was to assess the pre test level of attention and concentration
among school age children.

In pre test, 3 (10%) children were rarely inattentive, 6 (20%) children were
sometimes inattentive and 21 (70%) children were often inattentive, with regard to
concentration, it reveals that 4 (13.3%) children had good concentration, 7 (23.3%)
children had fair concentration and 19 (63.4%) children had poor concentration.

The study correlates with Ong. L. C., et al., (2010) who conducted a study on
factors associated with poor academic achievement among urban primary school
children in Malaysia. Socio demographic and medical data were obtained from
questionnaires and interviews. All students underwent raven’s standard progressive
matrices test as a general measure of cognitive ability. The results showed that out of
1470 eligible children, 206 had poor achievement. Out of 919 children who
participated in the study, 111 had poor achievement compared with 95 of the 551 non
participants and the factors were found to be independently associated with poor
academic achievement (p<0.001). The study concluded that cognitive ability, gender,
prematurity and social factors contributed to poor academic achievement during the
early school years.

The study correlates with Silveria. A., et al., (2014) who conducted a study on
relationship between learning problems and attention deficit in childhood. The
samples included in the study were 774 children from selected elementary schools.
The child was assessed by his teacher using a standardized scale. The attention deficit
hyperactivity disorder scale of teacher’s version was used to evaluate attention deficit
 69

hyperactive disorder symptoms and learning problems. The result indicated that a
very strong association was found between attention deficit and learning problems.

The second objective was to assess the post test level of attention and concentration
among school age children.

In post test level of attention 18 (60%) children were rarely inattentive,

12 (40%) children were sometimes inattentive and none of the children were often
inattentive. In the post test level of concentration 19 (63.3%) children had good
concentration, 11 (36.7%) children had fair concentration and none of them had poor
concentration.

The study correlates with Shrensen. L., et al., (2012) who conducted a study
on the impact of inattention and emotional problems on cognitive control in primary
school children. The samples were 241 children from primary school. The cognitive
control was measured by functions of set shifting and working memory as assessed by
behavior rating inventory of executive function and performance based tests.
Inattention and emotional problems were measured with parent and teacher reports on
Swanson Nolan and Pelham questionnaire, strengths and difficulties questionnaire
respectively. The result showed that clinical symptoms of inattention and emotional
problems explained the child’s performance on test measures, however symptoms of
inattention made a significant contribution on all the selected measures of cognitive
control, whereas reports concerning emotional problems uniquely explained the
variance on the shift scale.

The study correlates with Murray. D. W., et al., (2011) who reviewed a study
on teacher management practices for first graders with attention problems. The
sample included a total of 36 teachers who completed the teacher management
questionnaire for 92 students in five predominantly low income, minority schools.
Additional teacher and student background data were collected on the inattentive
sample, including behavior ratings and academic test. The result indicated that
teachers reported variable implementation of different management strategies, with
more frequent use of class wide structure and organizational interventions, and less
frequent assignment modifications and individual behavior plans.
 70

The third objective was to assess the effectiveness of concentration enhancement

activity regarding attention and concentration among school age children.

In comparison of mean and standard deviation between pre test and post test
level of attention among school age children. Analysis reveals that the pre test level of
attention mean score was 29.83 with the standard deviation of 6.73 and the post test
level of attention mean score was 18.53 with the standard deviation of 5.14. The
paired ‘t’ test value of 9.72 was very high significant at the level of p<0.001. The
difference between pre test and post test level of attention score is high and it is
statistically very high significant.

In comparison of mean and standard deviation between pre test and post test
level of concentration among school age children. Analysis reveals that the pre test
level of concentration mean score was 21.57 with the standard deviation of 4.78 and
the post test level of concentration mean score was 13.83 with the standard deviation
of 3.60. The paired ‘t’ test value of 6.71 was very high significant at the level of
p<0.001. The difference between pre test and post test level of concentration score is
high and it is statistically very high significant. Thus, it indicates the effectiveness of
concentration enhancement activity among school age children.

The study correlates with Saskia. O., et al., (2012) who had conducted a study
to evaluate the effectiveness of eight week mindfulness training for children with
attention deficit and mindful parenting for their parents. Parents were assessed by
questionnaires including their own attention deficit symptoms, parenting stress,
parental overacting, permissiveness and mindful awareness before, immediately after
the eight week training and at eight week follow up. The teachers reported attention
deficit behavior of the child. The results showed the effectiveness of mindfulness for
children with attention deficit and their parents.

The fourth objective was to correlate the post test level of attention and
concentration among school age children

The Karl Pearson correlation coefficient value of r = 0.56 at the level of

p<0.01 showed moderate correlation between post test level of attention and
concentration among school age children.
 71

The study correlates with Gajre. N. S., et al., (2008) who has conducted a
study on breakfast eating habit and its influence on attention and concentration,
immediate memory and school achievement. The samples were 379 urban 11 to 13
year old school children. Data was collected using letter cancellation test, immediate
memory from PGI memory scale, school marks of the previous year and nutritional
status. The result showed a significant difference in the letter cancellation total score
with the regular breakfast group achieving the highest mean scores compared to the
no breakfast group, p<0.05. The results concluded that regular habit of eating
breakfast as opposed to irregular consumption or skipping breakfast altogether had
beneficial influence on attention and concentration, memory and school achievement.

The fifth objective was to associate the post test level of attention and concentration
among school age children with their selected demographic variables.

In association with the post test level of attention, there was a significant
association found with their demographic variables. The chi square value of 4.54
showed that there was a significant association between the sex of child and post test
level of attention after the conduction of concentration enhancement activity at the
level of p<0.05. The chi square value of 5.00 showed that there was a significant
association between previous exposure to meditation and post test level of attention
after the conduction of concentration enhancement activity at the level of p<0.05.

In association with the post level of concentration, there was a significant

association found with their demographic variables. The chi square value of 6.91
showed that there was a significant association between the sex of child and post test
level of concentration after the conduction of concentration enhancement activity at
the level of p<0.05. The chi square value of 4.34 showed that there was a significant
association between previous exposure to meditation and post test level of
concentration after the conduction of the concentration enhancement activity at the
level of p<0.05.
 72

CHAPTER VI
SUMMARY, CONCLUSION, NURSING IMPLICATIONS,
RECOMMENDATIONS AND LIMITATIONS.

The heart of the research lies in reporting the finding of the study. This is most
creative and demanding part of study. This chapter gives a brief account of the present
study including the conclusion drawn from the finding, recommendations, limitation
of the study, suggestions for the study and nursing implications. The present study
was to assess the effectiveness of concentration enhancement activity on attention and
concentration among school children in Madha Matriculation School at Chennai.

SUMMARY

Attention and concentration is needed in all spheres of life. Concentration

levels can be improved from the childhood if the problem is identified earlier. If the
child is involved in different kinds of activities that enhances concentration, then he
will grow up to be sharp and quick. Thus concentration enhancement activity helps to
improve the skills and to perform better in academics and extracurricular activities
and helps to face the competitive world in a challenged manner.

The objectives of the study were as follows

1. To assess the pretest level of attention and concentration among school age
children.
2. To assess the post test level of attention and concentration among school age
children.
3. To determine the effectiveness of concentration enhancement activity
regarding attention and concentration among school age children.
4. To correlate the post test level of attention and concentration among school
age children
5. To associate the post test level of attention and concentration among school
age children with their selected demographic variables.

The hypothesis formulated was that there is a significant association between

concentration enhancement activity on attention and concentration among school age
children. The review of literature included the related studies which provided a strong
 73

foundation for the study including the basis for conceptual frame work and formation
of tool.

The conceptual framework for this study was developed based on Imogen
King’s goal attainment theory. The research design used in the study was pre
experimental one group pre test and post test design. It was carried out with
30 participants who fulfilled the inclusive criteria. Purposive sampling technique was
used to select the subjects.

A modified attention profile and card game was used to assess the pre test
level of attention and concentration among school age children. Concentration
enhancement activity was conducted to the participants for the duration of
30 minutes for six days. The post test was conducted on seventh day by using the
same tool.

The collected data was analyzed using descriptive and inferential statistics.
The distribution of demographic variables of study showed that the majority of
children 18 (60.0%) were boys and 12 (40.0%) were girls. With respect to type of
family, 29 (96.7%) were in nuclear family and 1(3.3%) were in joint family.
Regarding religion the majority of the children, 26 (86.7%) were Hindus, 3 (10.0%)
were Christians, 1(3.3%) was Muslim. Considering the monthly income, 10 (33.3%)
were within family income of less than Rs.5, 000 and 20 (66.7%) were within family
income of Rs. 5, 000- 10,000.

With regard to their family structure all 30 (100%) children were living with
their parents. With regard to educational status of mother, 1 (3.3%) had non formal
education, 2 (6.7%) went to primary school, 25 (83.3%) has completed school and
2 (6.7%) were graduates. With regard to educational status of father, 1 (3.3%) went to
primary school, 24 (80.0%) has completed school and 5 (16.7%) were graduates. In
relation to the type of diet, 4 (13.3%) were vegetarian and 26 (86.7%) were non
vegetarian.

With regard to the type of hobby, 3 (10.0%) children listens to music,

10 (33.3%) plays sports, 7 (23.3%) watches TV and 10 (33.3%) plays video games. In
relation to previous exposure to meditation 5 (16.3%) had no exposure to meditation
and 25 (83.7%) had exposure to meditation.
 74

In comparison of mean and standard deviation between pre test and post test
level of attention and concentration among school age children, the pre test level of
attention mean score was 29.83 with the standard deviation of 6.73 and the post test
level of attention mean score was 18.53 with the standard deviation of 5.14. The
paired‘t’ test value of 9.72 was very high significant at the level of p<0.001. The
difference between pre test and post test level of attention score is high and it is
statistically very high significant. In comparison of mean and standard deviation
between pre test and post test level of concentration among school age children, the
pre test level of concentration mean score was 21.57 with the standard deviation of
4.78 and the post test level of concentration mean score was 13.83 with the standard
deviation of 3.60. The paired‘t’ test value of 6.71 was very high significant at the
level of p<0.001. The difference between pre test and post test level is high and it is
statistically very high significant. Thus, it indicates the effectiveness of concentration
enhancement activity among school age children.

The correlation between post test level of student’s attention and concentration
were moderately correlated at the level of p<0.01. Hence it indicates the effectiveness
of concentration enhancement activity among school age children.

CONCLUSION

Attention and concentration is very essential for all students in order to control
the disturbing and intruding thoughts. Most children suffer with poor memory and
attention difficulty almost every day. This affects many areas of their life. Through
this enhancement activity students can learn and focus better in their academics and
prevent the problems from maths test to social relationships to motivation for
learning. Hence the investigator found that there was a significant difference in the
level of attention and concentration after giving concentration enhancement activity
among school age children.
 75

NURSING IMPLICATIONS

The findings of the study have implications in various areas of nursing service,
nursing education, nursing administration and nursing research.

Nursing Practice

An education can be provided to the children in orphanages and also in special

schools about concentration enhancement activity and its effectiveness which will
benefit them to develop their skills in future career. The nurse can conduct this
activity not only to school students but also to the children in both urban and rural
areas. She can conduct home visit and provide various practical techniques and
methods to enhance attention and concentration in the community.

Nursing Education

Nurse educators have a role to educate the children and parents regarding
various methods to improve attention and concentration. The educational institution
should include various concentration enhancement activity in the curriculum to
educate the nurses and identify the needs of the children regarding lack of attention
and concentration. Various continuing nursing education and in service education
regarding methods to improve attention and concentration should be explained to
nurses to help them to become aware of attention and concentration problems in
children.

Nursing Administration

Nurse administrator should encourage and monitor the nurses while

performing their role in an efficient manner. The nurse administrator can formulate a
standard protocol regarding concentration enhancement activity. The administrator
should motivate the parents to observe and monitor the level of attention and
concentration in children. She should plan and implement collaborative training
involving parents and their children.
 76

Nursing Research

Nursing research helps to broaden the boundaries of our knowledge regarding

attention and concentration. Nursing students and nursing practitioners should be
encouraged to conduct nursing research related to attention and concentration. Nurse
researcher should be motivated to conduct more studies to identify the strategies of
improving attention and concentration. She should focus on identifying the needs of
lack of attention and concentration among school students.

She should publish the study findings and communicate the findings regarding
the concentration enhancement activity to enhance evidence based practice. She
should encourage and conduct further researches to create awareness of concentration
enhancement activity.

RECOMMENDATIONS

¾ The same study can be conducted in large samples to generalize the finding.
¾ The similar study can be conducted with control group.
¾ A comparative study can be done between rural and urban school children.
¾ A similar study can be conducted among adolescent children.
¾ A descriptive study on assessing the level of attention and concentration among
school children can be done.

LIMITATIONS

During the period of study the investigator faced the difficulties of lack of
attention from the students while conducting activity and the study sample was small
and sample were selected by purposive sampling method limiting the generalize
ability.
 77

REFERENCES

BOOKS

¾ Achar (1969). Textbook of pediatrics. (2nd ed). Philadelphia: Orient Longman

publishers.

¾ Bhaita. et al., (2006). Problems of behavior in children and adolescents. (3rd ed).
New Delhi: CBS publishers and distributors.

¾ Charles. S, (2006). Introduction to psychology. (6th ed). New Delhi: Lippincott

publication.

¾ Edward. T, (1991). Interpersonal process in psychotherapy: A relational

approach. (2nd ed). New Delhi: Jaswant publishers.

¾ Elizabeth. M, (2007). General psychology. (4th ed). New York: Ateneo University
Press.

¾ Chellappa. J. M, (1995). Pediatric nursing. (1st ed). Bangladesh: Gajana book

publishers and distributors.

¾ Datta. P, (2007). Pediatric nursing. (1st ed). New Delhi: Jaypee publishers.

¾ Ghai. O. P, (2004). Essential pediatrics. (5th ed). USA: Mosby publishers.

¾ Gupta (1995). The short textbook of pediatrics. (7th ed). New Delhi: Medical
publishers.

¾ Hamrick. et al., (1986). Health. (1st ed). USA: Merril publishers.

¾ Kyle. T, Essentials of pediatric nursing. (1st ed). New Delhi: W.K pvt Ltd.

¾ Marlow (1971). Textbook of pediatrics. (15th ed). Philadelphia: W.B Saunders

Company.

¾ Polit, (1996). Principles and methods of nursing research. (6th ed). Philadelphia:
Lippincott Company.

¾ Santrock. J. W, (1998). Child Development. (8th ed). North America: Mc Graw

Hills publishers.
 78

¾ Sharma. R, (1993). Methodology of education research. (3rd ed.). New Delhi: Vera
publishers.

¾ Sundar. et al., (1981). Introduction to biostatistics, a manual for students in health

science. (3rd ed). Vellore: M C publishers.

¾ Wesley (1994). Theories and models. (2nd ed). Pennsylvania: Spring house
corporation Ltd.

¾ William (2001). Current pediatric diagnosis and treatments. (5th ed). USA: Mc
Graw publishers.
 79

JOURNALS

¾ Alice. W., et al., (2013). The effects of mindfulness training on children’s

attention skills. Maastricht student journal of psychology and neuroscience.
2(1), 44.

¾ Andrea. F., et al., (2009). Children with attention deficits concentrate better after
walk in the park. Journal of attention disorders. 12(5), 402-409.

¾ Anthony. D., et al., (2013). Acute exercise effects on measures of attention and
impulsivity in children with attention deficit. Journal of educational and
developmental psychology. 3(2), 65.

¾ Asberg. J., et al., (2012). Behavioral, psycholinguistic, cognitive and graphomotor

correlates of spelling difficulties in school age children with attention deficit.
Journal of learning disability. 2(3), 22

¾ Carrig. M., et al., (2013). Does academic achievement and attention problems
have more adverse long term effects. Journal of attention disorder. 3(1), 33.

¾ Catarina. V. et al., (2012). Words cue children’s attention in a visual search task.
Journal of vision. 12(9), 482.

¾ Chacko. A., et al., (2013). A randomized clinical trial of cogmed working training
memory in school aged children with attention deficit. Journal of child
psychology. 4(3), 22-56.

¾ Hinshaw. P., et al., (1997). Comprehensive assessment of childhood attention

deficit in the context of a multisite, multimodal clinical trial. Journal of attention
disorders. 1(4). 217-234.

¾ Jacobs. et al., (2008). Neurofeedback treatment of two children with learning,

attention, mood, social, and developmental deficits. Journal of neuropathy. 9(4),
55-70.

¾ Lanphear. et al., (2007). Prevalence, recognition and treatment of attention deficit

in a national sample of US children. Journal of JAMA pediatrics. 161(9), 857-864.
 80

¾ Leima. M., et al., (2013). Comparison of child self reports and parent proxy
reports on quality of life of children with attention deficit. Journal of health and
quality life outcome. 1(1), 186.

¾ Mathew. B., et al., (2013). Exercises improve behavioral, neurocognitive and

scholastic performance in children. The journal of pediatrics. 162(3), 543-551.

¾ Melissa. L. et al., (2014). Trends in the parent report of health care provider in
children with attention problems. Journal of the American association of child
and adolescent psychology. 53(1), 34-46.

¾ Merwese. et al., (2013). Does perceptual learning require consciousness or

attention. Journal of cognitive neuroscience. 25(10), 1579-1596.

¾ Natasha. K., et al., (2014). Childhood attention deficit symptoms are risk factors
for obesity and physical inactivity in adolescence. Journal of the American
academy of child and adolescent psychiatry.53 (4), 425-436.

¾ Rapport. D., et al., (2013). Do programs design to train working memory and
attention benefit children with attention deficit. Journal of child psychology.
4(13), 502-543.

¾ Regina. M. et al., (2012). Rehabilitative training of preterm children’s attention.

Journal of pediatric and neonatal individualized medicine. 1(1), 177-181.

¾ Richard. M., et al., (2012). Influence of relative age on diagnosis and treatment of
attention deficit. Journal of Canadian medical association. 18(1), 73-81.

¾ Saval. K., et al., (2013). Attention deficit and transition to adulthood. Journal of
child care health development. 2(1), 223.

¾ Simon. et al., (2014). Common and specific impairments in girls with attention
deficit. Journal of neurodevelopment disorders. 6(5), 1866-1955.

¾ Susan. M., et al., (2012). Effectiveness of mindfulness training for children with
attention deficit and mindful parenting for their parents. Journal of child and
family services. 21(1), 139-147.

¾ Swanson. H. et al., (2011). Working memory, attention, and mathematical

problem solving: A longitudinal study of elementary school children. Journal of
Educational Psychology. 103(4), 821-837.
 81

¾ Wohlheiter. et al., (2013). Interactive versus passive distraction for selective

attention in young children. Journal of pediatric psychology. 38(2), 202-212.
 82

NET REFERENCE

• www. pubmed. com

• www. medline.com

• www.royal free. nhs. uk

• http://www.attentionpsychology.com

• http://www.articlesbase.com

• http://www.amazines.com

• http://www.lack of concentration in children.com

55
 i

APPENDIX – A
PART I

DEMOGRAPHIC VARIABLES

1. Sex of the child

a) Boy
b) Girl

2. Type of family
a) Nuclear family
b) Joint family

3. Religion
a) Hindu
b) Christian
c) Muslim
d) Others

4. Family income per month

a) Below Rs.5000
b) Rs.5000-10000
c) Above Rs. 10000

5. Family structure
a) Single parent
b) Parents living together
c) Divorced parents
d) No parents
e) Step mother/step father

6. Educational status of mother

a) Non- formal education
b) Primary school
c) Higher secondary
d) Graduate

7. Educational status of father

a) Non- formal education
b) Primary school
c) Higher secondary
d) Graduate
8. Type of diet
a) Vegetarian
b) Non-vegetarian

9. Type of hobby
a) Listening to music
b) Sports
c) Watching TV
d) Browsing

10. Previous exposure to meditation

a) Yes
b) No
 PART II

MODIFIED JAMES.B. SNYDER ATTENTION PROFILE

√ (Tick) the response that best describes how you feel

Rarely Somet Very/

S. Questions true -imes often
No true true
(0) (1) (2)
1. Trouble completing assignments

2. Too active, often out of seat, driven by a motor

3. Fidgets with hands, squirms in seat

4. Day dreams excessively

5. Impulsive, acts without thinking

6. Difficulty listening or following directions

7. Argumentative or stubborn

8. Messy work, poor handwriting

9. Inattentive, easily distracted

10. Talks excessively

11. Avoids or refuses to do work

12. Blurts out answers, has trouble waiting turn

13. Acts silly ‘class clown’, disrupts class

14. Easily frustrated or annoyed

15. Annoys or alienates peers

16. Forgetful, loses things

17. Rushes through, careless mistakes

18. Disorganized

19. Requires excessive prompting and redirection to start or

complete work

20. Easily depressed for little things

SCORING INTERPRETATION

0-20 : rarely inattentive

21-30 : sometimes inattentive

31-40 : often inattentive

 PART II

CONCENTRATION TEST

A game developed by Eric Harsh Barger to improve concentration is used for

children with English as second language. It will help to increase concentration and
language skills of the students.

There are 9 pairs of cards given for children. In each pair, name of any occupation
is given. These cards are shuffled and spread on the table as upside down. The child has
to take two cards at a time and check whether the occupation is same for both cards. If
not, keep both cards upside down and take any other two cards. The cards can be taken
out if both are same. The number of attempts to finish the game is considered as the
score. The child who completes the game with less attempts is considered as having more
concentration.

SCORING KEY:

¾ 9-14 attempts : Good concentration

¾ 15-20 attempts : Fair concentration
¾ 21-26 attempts : Poor concentration

HUNTER FISHERMAN DOCTOR

ENGINEER BARBER HUNTER

PILOT TEACHER FISHERMAN

NURSE MERCHANT ENGINEER

BARBER TEACHER PILOT

NURSE DOCTOR MERCHANT

 iii

APPENDIX - C
LIST OF EXPERTS FOR CONTENT VALIDITY

DR. SHRINIVAS V.C

MD, DCH (Senior Consultant Pediatrician),

Miot International,

Mount Poonamallee road,

Chennai – 600 089.

DR. ANITHA RAJENDRAN,

R.N., R.M., M.Sc.(N). Phd,

Principal,

Rajalakshmi College of Nursing,

Thandalam, Chennai- 602105

Mrs. EDNA SWEENIE.J,

R.N., R.M., M.Sc.(N).,

Professor & HOD,

Department of child health nursing

Miot College Of Nursing,

Chennai-600089
 vi
APPENDIX-F

ACTIVITY MODULE
ON
CONCENTRATION
ENHANCEMENT ACTIVITY
Task I

Cancel small letter ‘a’ within 2 minutes

EVery chiLD is blESsed With A

special Gift. TheRe is sOmethinG He iS goOd
at. CHildreN Have particulAr interests. IT may
Be singinG, playing a muSical iNstrUment,
dRawing, matH or SporTS. They hAve an iNner
Drive to explore and leaRN.

AS Parents It is Your dutY to

reCogniZE tHeiR iNteresTS and EncoURage
theM. It iS a gOod PRactice to eXpose yoUR
child to a widE ranGE Of INterests. allow him
TO takE Part In DIfferenT ACtivitiES. I Have
alwAYS been FascinateD BY MathematiCS. IN
My spare time, I likE to do MatheMatical
calCulations. I lovE readiNG boOKs veRy
MUCh.
Task II

Cancel all capital letters from the paragraph within 2 minutes

EveRY chilD iS blEssed With A

speCial gift. THere is sOmething he Is good aT.
CHildren Ha ParTIcular IntereSts. It maY be
singing, PlayinG a MUsical instruVEment,
drawING, math or SPorts. THey have an inner
drive to exPlore and LEarn.

AS ParEnts it iS yOur Duty To

RecognizE theiR interEsts anD Encourage theM.
It is a Good pRactice tO expOse youR Child to a
wide RaNge Of iNterests. Allow HIm tO take
PART in DiFferent activities. I hAve alwAys
beeN fascINated by MAtheMatics. IN mY spare
timE, I like to do MatheMatical cAlculations. I
loVE rEadinG books. I FInd it quiTE enjOYable
To reAD BoOKs.
Task III

Cancel both capital and small letter ‘a’ from the paragraph within 2 minutes

Every child iS blesseD With a special

gift. THere is soMEthing He IS good at.
ChildreN havE parTIcular intereSts. It May be
sinGing, playIng a muSical instrument, drawing,
Math or SPorts. ThEY hAve an inNer drivE to
exploRE and learN.

As PARents It is Your DutY TO

RECognize THeir interests anD eNcourage
tHem. it is a Good Practice to ExpoSE Your
chiLD to a wiDe RANGE of InteRests. AlloW
him TO take pArt in DIfferent aCtiVities. I
hAve always BEen faScinated by MatHeMatics.
In mY sPare time, I lIke TO Do mAthematical
caLculations. I loVe reaDing Books vERY
mUCh.
COLOUR CANCELLATION

A. Cancel all black stars within 1 minute

B. Cancel all blue circles within 1 minute
C. Cancel all black star and blue circles within 1 minute
PUZZLE SOLVING

Solve the puzzle within 3 minutes

MISSING NUMBERS

Solve this within 2 minutes

TONGUE TWISTERS

i. Choppers chop
Droppers chop

ii. Blue lorry

Red lorry
 iv
APPENDIX-D
APPENDIX-B ii
INTRODUCTION
METHODOLOGY
 DATA ANALYSIS
AND
INTERPRETATION
DISCUSSION
 SUMMARY,
CONCLUSION,
NURSING
IMPLICATIONS,
RECOMMENDATIONS
AND LIMITATIONS
ABSTRACT
REFERENCES
 REVIEW
OF
LITERATURE
APPENDICES