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Child Neuropsychology: A Journal on

Normal and Abnormal Development in
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The Development of Sustained Attention

in Children: The Effect of Age and Task
Load
a a d a b c
Jennifer Betts , Jenny Mckay , Paul Maruff & Vicki Anderson
a
University of Melbourne, Melbourne, Australia
b
Royal Children's Hospital, Melbourne, Melbourne, Australia
c
Murdoch Children's Research Institute, Melbourne, Australia
d
CogState, Pty. Ltd, Melbourne, Australia
Published online: 03 Feb 2007.

To cite this article: Jennifer Betts , Jenny Mckay , Paul Maruff & Vicki Anderson (2006) The
Development of Sustained Attention in Children: The Effect of Age and Task Load, Child
Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence,
12:3, 205-221

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Child Neuropsychology 2006.12:205-221.
 Child Neuropsychology, 12: 205–221, 2006
Copyright © Taylor & Francis Group, LLC
ISSN: 0929-7049 print / 1744-4136 online
DOI: 10.1080/09297040500488522

THE DEVELOPMENT OF SUSTAINED ATTENTION IN

CHILDREN: THE EFFECT OF AGE AND TASK LOAD

Jennifer Betts,1 Jenny Mckay,1 Paul Maruff,4 and

Vicki Anderson1,2,3
1
University of Melbourne, Melbourne, Australia, 2Royal Children’s Hospital,
Melbourne, Melbourne, Australia, 3Murdoch Children’s Research Institute,
Melbourne, Australia, and 4CogState, Pty. Ltd, Melbourne, Australia

This study explored how children’s sustained attention develops and the effect of manipulat-
ing task parameters on sustained attention. The sample comprised 57 children (5–12 years)
who completed CogState and Score! (Test of Everyday Attention for Children). Novel vari-
Child Neuropsychology 2006.12:205-221.

ability and traditional indices indicated rapid development from 5–6 to 8–9 years on all
measures and a developmental plateau from 8–9 to 11–12, with growth evident on some
measures. Findings suggest that sustained attention improves to age 10, then plateaus with
only minor improvements. Further, performance was generally poorer on high load tasks
compared to low load, with the same developmental pattern uncovered.

Keywords: sustained attention child development variability

Sustained attention, or vigilance, refers to the ability to maintain attention over an

extended period of time. Brain-behavior models propose that this component of attention
is mediated to a large extent by the reticular formation and brain stem structures (Mirsky,
Anthony, Duncan, Ahearn, & Kellam, 1991; Mirsky, 1996; van Zomeren & Brouwer,
1994), with some involvement of frontal regions (Stuss, Shallice, Alexander & Picton,
1995). The capacity to sustain attention plays a key role in children’s school performance,
determining the child’s capacity to maintain concentration over long periods in order to
understand and integrate large amounts of information (Catroppa & Anderson, 1999).
Impairments in sustained attention, therefore, may potentially impact on the child’s ability
to acquire and integrate new skills and knowledge. Despite this, only limited research has
been conducted into the normal development of sustained attention.
While there is a large body of knowledge concerning theoretical models of sustained
attention and its underlying neural basis within the adult literature, the child literature is less
developed. One of the earliest studies to address these issues was conducted by McKay,
Halperin, Schwartz, and Sharman (1994). These researchers employed a cross-sectional
design to describe developmental trajectories for healthy children aged 7 to 11 years, and
they compared these to an adult sample, using a continuous performance paradigm (CPT)

Address correspondence to Vicki Anderson Ph.D., Professor/Director, Psychology, Royal Children’s

Hospital, Parkville Victoria 3052, Australia. Tel: +61 3 9345 5524. Fax: +61 3 9345 6002. E-mail: vaa@
unimelb.edu.au

205
 206 J. BETTS ET AL.

to measure sustained attention. As might be expected, CPT performances, or the capacity

to sustain attention, deteriorated over time, regardless of age, suggesting lower levels of
efficiency with time on task. Results indicated stable but less efficient performances for
children aged between 7 and 11 years in comparison to adults, with a significant improve-
ment in children’s performances around 11 years of age, suggesting relatively little devel-
opmental progress in sustained attention skills through middle childhood.
While McKay et al.’s (1994) research made an important contribution to the field,
its methodology has been questioned. Using a rigorous longitudinal design, Rebok et al.
(1997) reported on the development of attention skills in 435 children assessed at ages 8,
10, and 13 years. A CPT paradigm was also employed in this study, with outcome mea-
sures of reaction time (RT), accuracy (correct responses and correct omissions), and omis-
sion errors. Rebok and colleagues detected significant age effects on all measures.
Reaction times improved between 8 to 10 years and again from 10 to 13 years. Accuracy
dramatically improved from 8 to 10 years then showed gradual improvement from 10 to
13 years. Errors declined by about half from 8 to 10 years with more gradual declines from
10 to 13 years. Contrary to McKay et al. (1994), Rebok et al. (1997) concluded that sus-
tained attention develops rapidly from 8 to 10 years then plateaus from 10 to 13 years,
Child Neuropsychology 2006.12:205-221.

with only gradual improvements during that period. More recent cross-sectional research
has supported Rebok et al.’s (1997) findings, suggesting that, regardless of the outcome
measure employed, there is continued improvement in sustained attention skills from 8 to
16 years, but with the magnitude of gains reducing from around 10 to 11 years (Klenberg,
Korkman, & Lahti-Nuuttila, 2001; Manly et al., 2001). While these studies provide a bet-
ter understanding of attentional development for children aged eight years and older, there
is ongoing debate regarding the relative sustained attention capacities of younger children,
particularly those in their first years of schooling.

Sustained Attention and Load

A wealth of literature exists concerning the impact of variations in task parameters on
sustained attention performance in adults. In contrast, very few studies have addressed the
presence of such effects on children’s sustained attention performance. In adults, instruc-
tions to participants, feedback, task duration and complexity, stimulus presentation times,
and interstimulus intervals have all been found to influence performance (Ballard, 1996b;
van der Meere & Sergeant, 1988). Manipulating task parameters varies the processing
demands and level of sustained attention necessary to complete the task, and performance
alters accordingly (Corkum & Siegel, 1993). When the requirements are greater, the task is
considered one of high load and when requirements are simpler, the task is one of low load.
While similar patterns may emerge in children, given the rapid cognitive and neurologi-
cal development occurring throughout childhood, it is inappropriate to simply extrapolate from
adult findings. For example, adult studies have traditionally found that performance is
poorer when event rate and signal probability are high (eg. Parasuraman, 1979; Warm,
Howe, Fishbein, Dember, & Sprague, 1984), however, in a study of 7- and 8-year-olds,
Laurie-Rose, Bennett-Murphy, Schickedantz, and Tucci (2001) found that children were
significantly faster and more accurate when event rate and signal probability were high. They
hypothesized that a low event rate might be “under-arousing” for children, placing greater
demands on children’s sustained attention resources and resulting in poorer performance.
Using adult samples, researchers have consistently identified performance
differences associated with task load or complexity. Noonan, Ash, Loeb, and Warm
 DEVELOPMENT OF SUSTAINED ATTENTION 207

(1984) varied target criteria in four conditions of a CPT task that presented pairs of num-
bers on a screen every three seconds for 1.5 seconds duration. Participants were asked to
respond by pressing a button when target criterion was satisfied. In Condition 1, target cri-
teria comprised a pair of numbers that differed by no more than one. Condition 2 added
the requirement that the summed number pair fall within a specified range (eg. 4–14)
placed above the pair. The complexity increased further in Condition 3, with two ranges
and two number pairs presented, and continued to increase in Condition 4, where four
number pairs and ranges were presented. In Conditions 2–4, the ranges changed at 30, 60,
or 90 second intervals (averaging a change every 60 seconds). Sustained attention perfor-
mance was measured via RT and correct responses at ten-minute intervals over the 50-
minute task duration. As expected, correct responses decreased and RT increased as the
target criteria became more complex, supporting the presence of “task load” effect.
Similar results were reported by Lysaght, Warm, Dember, and Loeb (1984) who
used just two conditions (Condition 1 and Condition 2 from the aforementioned study),
which they nominated as the “low” and “high” load tasks respectively. Sustained attention
was reflected in the percentage of correct responses, which was assessed at 20-minute
intervals over a 60-minute period. Again, participants were less accurate on the task with
Child Neuropsychology 2006.12:205-221.

complex target criteria than the task with simple target criteria.
As far as we are aware, only a handful of studies have been conducted with children
to determine whether similar task complexity effects exist. These have generally been
restricted to clinical populations, such as traumatic brain injury or Attention deficit/hyper-
activity disorder (Catroppa & Anderson, 2003; van der Meere & Sergeant, 1988).

The Measurement of Sustained Attention

One of the challenges within the field of attention is the identification of appropriate
and reliable assessment tools. A wide range of tasks and performance indices has been
employed in the literature, leading to difficulties in comparisons across studies and proto-
cols. Traditionally, sustained attention has been operationalized via tasks of long duration,
such as signal detection tasks, that tap the continuity of performance. Performances on
such tasks are usually characterized by a gradual fall-off with time-on-task. Signal detec-
tion tasks have been used extensively in adult research but have also been employed in
childhood studies. In the child and adult literature, the length of tasks have varied greatly
from a few minutes to over an hour, with tasks of 10 to 15 minutes typically employed in
developmental research. More recently, however, within the developmental literature, a
number of studies have demonstrated sustained attention deficits using much shorter pro-
tocols (e.g. Catroppa & Anderson, 2003; Manly et al., 2001). The current research utilizes
a computer-based visual continuous performance task paradigm of 3–4 minutes duration,
dispersed amongst a battery of attention and executive function tasks. The duration of the
total test protocol is approximately 20 minutes. In addition, a 6-minute auditory-based
continuous performance task was administered. Historically, a characteristic of tasks pur-
porting to measure sustained attention has been the inclusion of monotonous stimuli, with
minimal demands on participants, (e.g. signal detection), so as to tap and to exhaust inter-
nal resources of attention and concentration. The tasks utilized in the current study are
consistent with these principles.
Many researchers endorse the use of multiple tests to improve the validity of conclusions
(Fletcher, 1998; Shapiro, Morris, Morris, Flowers, & Jones, 1998). An extension of this princi-
ple is the recording of multiple performance indices on multiple tests. Conventionally,
 208 J. BETTS ET AL.

performance indices on tasks of sustained attention comprise mean RT, accuracy, and
errors (both inaccurate responses and omissions). It has been proposed that measuring per-
formance variability, in addition to traditional indices, provides a more complete picture
of sustained attention (van Zomeren & Brouwer, 1994). Although variability has not been
applied in this context before, it has advantages over some of the traditional measures.
Psychological research primarily deals with latent phenomena, however, it is preferable to
observe and measure phenomena directly wherever possible (Castellanos & Tannock,
2002). That is, it is better to infer sustained attention processes from variables such as
mean RT or variability in RT, rather than from a missed response, as is the case in errors
of omission. Further, measures such as errors or accuracy often produce data that have a
skewed distribution and are subject to floor or ceiling effects. This is especially common
in normative samples and for traditional neuropsychological tests that typically have a
small number of trials (Ballard, 1996a). These types of data are more appropriately treated
as ordinal, or nonparametric, as the difference between an individual with two errors com-
pared to four errors suggests that, while the individual with fewer errors is better, he/she is
not necessarily twice as good. The advent of computers has facilitated the use of RTs and
variability in RTs, which do not suffer the measurement problems associated with floor or
Child Neuropsychology 2006.12:205-221.

ceiling effects. They are normally distributed (or become normal with transformation) and
are a true interval scale of measurement. In addition to these psychometric advantages,
variability measurement has provided insight into the process of cognitive change (Miller,
2002) and has been advocated in the fields of head trauma and focal brain lesions
(Bleiberg, Garmoe, Halpern, Reeves, & Nadler, 1997; Stuss et al., 1989) and has also been
employed to study ADHD (Hynd, Nieves, Connor, & Stone, 1989).
There are three main sources of variability (see Figure 1). First, when an individual
responds to an item in a task, the RT to that item is recorded. Over an entire task, an indi-
vidual’s mean RT can be calculated. The fluctuations of RTs around the mean reflect the

Figure 1 A visual display of the sources of variability.

 DEVELOPMENT OF SUSTAINED ATTENTION 209

participant’s intraindividual variability (Makdissi et al., 2001). Second, when a participant

completes the same task several times, their performance on each task can be compared. A
change in a person’s intraindividual variability from one task to the next reflects their con-
sistency (Hultsh, MacDonald, & Dixon, 2002). Third, when different groups of individu-
als complete tasks, the average intraindividual variability and average consistency can be
compared between the groups.
The use of variability as a tool for understanding sustained attention is in its infancy,
with no established research tradition advocating specific statistical procedures. Two pos-
sible techniques that may be used to measure variability include an established measure—
standard deviation (SD), and a newer technique, the mean absolute deviation from the
median (MAD). The MAD involves identifying the median RT and computing the differ-
ence between the RT of each item and the median. The mean of these difference scores is
the MAD. The MAD is argued to be a robust measure of variability, but unlike SD, outliers
do not unduly affect it (Garret & Nash, 2001). Both MAD and SD will be employed in the
current study.

The Current Study

Child Neuropsychology 2006.12:205-221.

The present study aimed to extend current understanding of the development of sus-
tained attention skills in children aged 5–12 years, employing both traditional and novel
performance indices. With regard to the novel index, it was predicted that variability in
performance would be greater for younger participants. In line with previous research it
was expected that, regardless of age, participants’ performance over time would evidence
greater variability as sustained attention resources become depleted, with traditional indi-
ces showing evidence of development of sustained attention throughout the 5–12-year
period, but with greatest progress occurring before age 10 years. It was predicted that a
similar developmental pattern would be demonstrated for the novel variability index.
The second aim of the study was to explore the effect of task load on children’s sus-
tained attention performance using both novel and traditional indices. The task parameters
of target complexity and display size were manipulated to create a task of low load and a
task of high load. Although these parameters have not previously been explored with child
samples, in line with the adult literature, it was predicted that traditional indices would
demonstrate poorer performance on the high load task compared to those for the low load
task. It was expected that as the high load task places greater sustained attention demands
on participants, their performance on the high load task would comprise greater variability
than on the low load task.

METHOD
Participants
The sample comprised 57 participants (28 males and 29 females) aged between 5 and 12
years, recruited from public and private primary schools in metropolitan Melbourne,
Australia. Availability sampling techniques were employed whereby all children who
returned consent forms and met the inclusion criteria were tested. Inclusion criteria were:
attending mainstream school with no additional educational support; no history of diag-
nosed ADHD (indicated by a score less than two standard deviations from the age-mean
on the Rowe Behavioural Rating Inventory: RBRI: Rowe & Rowe, 1995, a parent-based
 210 J. BETTS ET AL.

Table 1 Demographic characteristics of sample

Socioeconomic
Age (months) Gender Status

Group Mean (SD) Range Males Females Mean (SD) Range

5–6 years 65.95 (4.52) 62–77 10 9 3.38 (0.98) 1.8–6.1

8–9 years 106.05 (3.34) 101–13 10 9 3.23 (0.68) 1.8–4
11–12 years 141.84 (4.21) 134–48 8 11 3.24 (1.11) 1.8–5.3

measure of attentional function); and no diagnosed neurological, developmental or psychi-

atric disorder, based on parental responses provided via an information questionnaire.
Participants were divided into three age groups: 5–6 years (n = 19), 8–9 years (n = 19),
11–12 years (n = 19). Group characteristics are presented in Table 1. The socio-economic
status (SES) of each child’s family was determined using Daniel’s Scale of Occupational
Prestige (Daniel, 1983), which rates parental occupation from 1 to 7, with 1 reflecting high
SES and 7 representing low. There was no significant difference in SES between the
Child Neuropsychology 2006.12:205-221.

groups (F (2,54) = 0.163, p = .85).

Materials
Demographic and Background Information. Parents were required to com-
plete a questionnaire eliciting demographic details, children’s medical and educational
history, and parental occupation. They also completed the Rowe Behavioural Rating
Inventory (RBRI: Rowe & Rowe, 1995), a 16-item scale measuring children’s everyday
symptoms of inattentiveness, normed on an Australian sample. Parents responded to
behavioral statements, such as “restless; fidgety; can’t sit still” versus “relaxed; can sit
still,” by marking a five-point ordinal scale. A total score was calculated by summing
results on the attentive-inattentive and restless-settled dimensions, as described in the test
manual.
(i) CogState, Version 2.1.0 (CogState Ltd, 2002). Participants completed
CogState, a computer-administered battery of nine neuropsychological subtests designed
to tap aspects of attention and information processing, and reported to be sensitive to sub-
tle changes in performance. Although completing the entire battery, participant’s perfor-
mances on five subtests were of interest in the current study (refer to Table 2).

Table 2 CogState: Task composition, order of presentation, duataion of task, and variable labels

Approximate Analysed in Variable

Subtest Order Task Duration Current Study Label

1 Simple Reaction Time task 2 minutes ✓ SRT1

2 Choice Reaction Time task 2 minutes
3 Congruent Reaction Time task 2 minutes ✓ Low Load
4 Dynamic Monitoring task 2 minutes
5 Working Memory task 2 minutes
6 Simple Reaction Time task 2 minutes ✓ SRT2
7 Matching Task 3 minutes ✓ High Load
8 Memory task 4 minutes
9 Simple Reaction Time task 2 minutes ✓ SRT3
 DEVELOPMENT OF SUSTAINED ATTENTION 211

Attention Over Time. To capture sustained attentional processes, participants

completed three identical Simple Reaction Time tasks presented as the first, sixth, and
ninth tasks in the battery. Participants were asked to monitor the presence of a playing
card and to press a response key on the keyboard as soon as the card turned face up. The
interstimulus interval was varied randomly between 1000 and 1500 msec, with each stim-
ulus present for a maximum of five seconds.
These tasks required participants to call on internal resources to maintain concentra-
tion on the monotonous stimuli. The repeated administration of the task at three intervals
during the test battery captured any change in participant’s performance over time, an
essential component of any measure of sustained attention. For the purposes of the present
study, the three Simple Reaction Time tasks will be referred to as SRT1, SRT2, and SRT3,
respectively. Performance was measured by speed (mean RTs), errors (number of
responses occurring before a card’s face was displayed), accuracy (number of correct
responses), variability of RT (SD and MAD), and max outs (failure to respond to an item
within five seconds).
(ii) Score! (Manly et al., 1999). Participants completed Score!, a subtest from
the Test of Everyday Attention for Children. Participants were asked to listen to a tape
Child Neuropsychology 2006.12:205-221.

recording of 10 “games” and silently count the scoring sounds (without using their fin-
gers). Sounds were presented at varied intervals, with between 9 and 15 per game. At the
end of each game the participant’s response represented the number of scoring sounds
they counted. Taking approximately six minutes to complete, Score! reflects the subjects’
ability to maintain alertness over time in order to monitor and count the sounds. Number
of correct responses was the outcome measure used in analysis.
Attention Under Differing Loads. This study also examined participants’ per-
formance on two other subtests from the CogState battery, the Congruent Reaction Time
Task, and the Matching Task, administered as the third and seventh tasks. Each of these
tasks employs the same basic task characteristics (i.e. computer presentation, playing card
stimulus) as the simple reaction time tasks described above. The outcome measures on
both tasks included speed (mean log10 RT), errors (number of responses that reported
matching cards when they were incongruent, or nonmatching cards when they were con-
gruent), variability (MAD log10 RT and SD log10 RT), and max outs. The Congruent
Reaction Time Task asks participants to judge whether two playing cards are the same
color, thus requiring them to scan two cards and focus on color as the important feature.
With its simple target criterion (color) and a small display size, the Congruent Reaction
Time Task is the designated “low load” task and will herein be referred to as such. The
Matching Task asks participants to determine if playing cards match, but it broadens the
target criteria to include suit and number as well as color (refer to Figure 2). Further,
instead of examining individual cards, the target is a pair of cards and six possible matches
are presented. Hence, the Matching Task has been designated the “high load” task. Again,
the interstimulus interval was randomly varied from between 1000 and 1500 msec, with a
maximum stimulus duration of five seconds.
Both of these tasks capture participants’ sustained attention capabilities by requiring
them to maintain concentration and monitor the playing card stimuli over time, making
decisions regarding the match between playing cards. The low and high load tasks there-
fore involve participants engaging in analogous mental processes, however the high load
task has greater sustained attention demands due to the larger display size and the com-
plexity of target criteria.
 212 J. BETTS ET AL.
Child Neuropsychology 2006.12:205-221.

Figure 2 The Matching Task (the keyboard and instructions disappear after the practice trials).

Procedure
Ethics approval was granted by the University of Melbourne’s Human Ethics Com-
mittee. The cooperation of primary schools was sought via letter. Upon gaining permis-
sion to conduct research within a school, information packages were forwarded to all
parents, inviting participation. Written consent was obtained from both parents and chil-
dren. Parents completed the RBRI and an information questionnaire.
Children were tested in a quiet room at school, on an individual basis. Each child
was seen for one testing session, taking approximately one hour. Tasks were administered
without breaks, in a set order to control for any learning effects common in neuropsycho-
logical research.
CogState was administered on colored IBM laptops. The researcher gave a brief
description of CogState and prior to each task, specific written instructions appeared on
the screen. These were read aloud and elaborated by the researcher if necessary. Partici-
pants had to demonstrate that they comprehended the task and that their perceptual and
motor skills were adequate by completing practice trials. The assessment began once three
successive practice trials were successfully completed.
Score! was administered using a portable cassette player. Verbal instructions were
given according to the administration manual. Before beginning the test, participants were
asked to demonstrate that they could count to fifteen and were required to respond cor-
rectly (by accurately counting the stimuli sounds) to the two practice trials. If practice tri-
als were failed, instructions were explained further and the practice trials repeated until
comprehension was demonstrated.
 DEVELOPMENT OF SUSTAINED ATTENTION 213

Statistical Analysis
The first independent variable was age, with three groups comprising 5–6-year-
olds, 8–9-year-olds, and 11–12-year-olds. The dependent variable was sustained
attention as measured by speed (mean RT), errors (total number incorrect), variabil-
ity (SD and MAD), and accuracy (total number correct). The second independent
variable was load (high or low), with the dependent variable, sustained attention,
measured by speed (mean RT), errors (percent incorrect), max outs, and variability
(SD and MAD).
All statistical analyses were performed with Statistical Packages for Social
Sciences (SPSS) Version 9.05. Exploratory data analysis was conducted, with alpha
level set at .01. Boxplots and matrix scatterplots illustrated score distributions. As the
RTs were skewed, a log10 transformation was performed on each participant’s RT
before calculating descriptive statistics. These transformations helped to reduce the
influence of outliers, which may have affected variability statistics (Luce, 1986).
Box’s M test was employed to identify problems with homogeneity of the variance-
covariance matrices, influential outliers were uncovered by Cook’s distance, and
sphericity was examined using Mauchly’s test.
Child Neuropsychology 2006.12:205-221.

When test assumptions were satisfied, repeated measures multivariate ANOVAs

were performed on i) age vs. time and ii) age vs. load, with an alpha level set at .05 for
these inferential tests. When a significant age vs. time interaction occurred, planned t-tests
were undertaken to compare adjacent levels of the time variable for each age, with a Bon-
ferroni adjusted alpha level being employed to control Type 1 error. Variables that were
skewed to an extent that transformation was inappropriate were analyzed using nonparametric
statistics (Kruskal Wallace, Mann-Whitney U and Chi-square). There were some missing
data due to computer malfunction. Only participants with complete data for the hypothesis
under investigation were included in the analysis, e.g., only participants with complete
data for the Simple Reaction Time tasks (SRT1, SRT2, SRT3) were included when exam-
ining performance change over time.

RESULTS
Development of Sustained Attention
Speed. A significant interaction was identified between group (5–6, 8–9, and 11–
12-year-olds) and performance on the repeated administration of the Simple Reaction
Time task (SRT1, SRT2, SRT3), F (4,92) = 2.74, p = .03 (see Figure 3).
Planned comparisons revealed that the responses of the 5–6-year olds became sig-
nificantly slower from SRT1 to SRT2, t (12) = −5.05, p < .001, then plateaued, with no
significant change from SRT2 to SRT3, t (12) = .73, p = 0.48. The 8–9 and 11–12-year-
olds’ performance was unaffected by time, with no significant change between SRT1 and
SRT2, t (18) = −2.40, p = .03, and t (17) = .40, p = .69 respectively, or SRT2 and SRT3, t
(18) = .77, p = .45, and t (17) = .73, p = .48, respectively.
Errors. There were no systematic differences in the number of errors occurring
over time, x2 (2, N = 50) = 2.11, p = .35. The observed slowing of RTs over the duration of
the tasks could therefore not be explained in terms of a speed-accuracy trade-off, as error
rates remained constant. There were significant differences in median errors committed by
each group, x2 (2, N = 150) = 16.2, p < .001. The 5–6-year-olds (Mdn = 2, Range 0–27)
committed more errors than 8–9-year-olds (Mdn = 1, Range = 1–8), U = 757.50, p = .01,
 214 J. BETTS ET AL.

3.5

3
Mean Log10 Reaction Time

2.5
(milliseconds)

2 5-6 years
8-9 years
11-12 years
1.5

1
Child Neuropsychology 2006.12:205-221.

0.5

0
SRT1 SRT2 SRT3
Time

Figure 3 The mean log10 reaction time across age and time.

and 8–9-year-olds committed more errors than 11–12-year-olds (Mdn = 0, Range = 0–6),
U = 1090.00, p = .01. The 5–6-year-olds were therefore slower and less accurate than 8–9-
year-olds, who in turn were slower and less accurate than 11–12-year-olds.
Variability—SD. There was no significant change in consistency over time, F
(2,46) = .36, p = .70. However, a significant difference across age groups was detected, F
(2,47) = 9.82, p < .001. The 8–9-year-olds were not significantly less variable than 5–6-year-
olds, t (30) = 1.52, p = .14. The 8–9-year olds were significantly more variable than the 11–
12-year-old participants, t (35) = 3.25, p = .003. Refer to Table 3 for descriptive data.
Variability—MAD. A significant difference in consistency, F (2,46) = 6.73, p <
.001 and a significant group difference, F (2,47) = 4.90, p = .01 were identified. Overall,

Table 3 Variability across age groups for the three simple reaction time tasks (SRT1, SRT2, SRT3)

SRT1 SRT2 SRT3

SD MAD SD MAD SD MAD

Age M SD M SD M SD M SD M SD M SD

5–6 0.20 7.290E-02 0.11 4.772E-02 0.22 6.526E-02 0.16 7.503E-02 0.19 8.645E-02 0.17 7.735E-02
8–9 0.17 8.701E-02 0.11 5.024E-02 0.18 4.917E-02 0.14 7.160E-02 0.19 5.917E-02 0.13 6.961E-02
11–12 0.14 5.761E-02 0.08 2.925E-02 0.14 4.787E-02 0.1 3.690E-02 0.14 6.061E-02 0.11 6.119E-02

Note: M = mean and SD = standard deviation, MAD = mean absolute deviation.

 DEVELOPMENT OF SUSTAINED ATTENTION 215

the intraindividual variability significantly increased between SRT1 and SRT2, t (49) =
–3.22, p < = .001, then plateaued with no significant change present between SRT2 and
SRT3, t (49) = .02, p = .98. The 5–6-and 8–9-year-olds were not significantly different, t
(94) = 1.54, p = .13, while the 11–12-year-olds were significantly less variable, t (109) =
2.65, p = .01. Refer to Table 3 for descriptive data.
Accuracy. For Score!, a significant group difference for number of correct
responses was detected, Kruskal-Wallis x2 (2, N = 50) = 17.88, p < .001. The 5–6-year-
olds (Mdn = 6, Range = 1–8) were significantly less accurate than 8–9-year-olds (Mdn = 9,
Range = 4–10), U = 47, p < .001. The accuracy of the 8–9- and 11–12-year-olds (Mdn =
10, Range = 6–10) was not significantly different, U = 113.5, p = .07.

Sustained Attention and Load

Speed. There was a significant interaction between group and load, F (2,51) =
4.37, p = .02, refer to Figure 4.
The high load task yielded significantly slower RT performance than the low load
task for each of the age groups: 5–6-year-olds, t (16) = –3.90, p < .001; 8–9-year-olds, t
Child Neuropsychology 2006.12:205-221.

(18) = –13.66, p < .001; 11–12-year-olds, t (17) = –10.14, p < .001. On the low load task,
5–6-year-olds and 8–9-year-olds and 8–9-year-olds and 11–12-year-olds were signifi-
cantly different, t (34) = 3.02, p = .01 and, t (36) = 2.11, p = .04. On the high load task, 5–
6-and 8–9-year-olds’ performances were similar, t (34) = .100, p = .33. The 11–12-year-
olds recorded significantly faster RTs than the other groups, t (36) = 2.54, p < .001.
Errors. Load was found to have a significant effect on percentage of errors, Fried-
man x2 (1, N = 54) = 28.70, p < .001. The 5–6-and 8–9-year-olds committed more errors

3.5
Mean Log10 Reaction Time

3
(milliseconds)

2.5
5-6 years
2 8-9 years
11-12 years
1.5

0.5

0
Low Load Task High Load Task
Load

Figure 4 Mean log10 reaction time across age and task load.
 216 J. BETTS ET AL.

Table 4 Variability data across age group fro low and high load tasks.

Low Load High Load

Mean Absolute Mean Absolute

Standard Deviation Deviation Standard Deviation Deviation

Age M SD M SD M SD M SD

5–6 0.1776 5.802E-02 0.1682 5.829E-02 0.1366 7.758E-02 0.1162 8.927E-02

8–9 0.1257 4.109E-02 0.1189 4.793E-02 0.1170 5.724E-02 0.1229 6.353E-02
11–12 0.1238 6.965E-02 0.1114 0.1142 0.1119 2.581E-02 0.1080 3.680E-02

Note: M = mean and SD = standard deviation.

on the high (Mdn = 61.11%, Range = 23.53%–92.86% and Mdn = 28.57%, Range =
4.76%–66.67% respectively) than the low load task (Mdn = 15.79%, Range = 0–38.89%
and Mdn = 11.11%, Range = 0–43.75% respectively), t (16) = 10.23, p < .001 and t (18)
4.16, p < .001. The 11–12-year-olds did not differ significantly in number of errors com-
mitted across the low (Mdn = 9.76%, Range = 0–28.57%) and high load (Mdn = 14.29%,
Child Neuropsychology 2006.12:205-221.

Range = 0–42.1%) tasks, t (17) = 2.44, p = .03. On the low load task, there were no age
differences for errors, Kruskal Wallace x2 (2, N = 54) = 2.73, p = .26. The observed differ-
ences in speed on the low load task were therefore not translated into differences in accu-
racy. On the high load task, there were significant age differences in errors, Kruskal-
Wallis, x2 (2, N = 54) = 25.22, p < .001. The 5–6-year-olds committed significantly more
errors than the 8–9-year-olds, U = 52.00, p < .001. The 8–9-year-olds and 11–12-year-olds
were not significantly different, U = 113.50, p = .08. Thus, 11–12-year-olds were the fast-
est and most accurate, 5–6-year-olds were the slowest and least accurate, while 8–9-year-
olds were as accurate as 11–12-year-olds but as slow as 5–6-year-olds.
Max Outs. On the low load task, each age group had a median number of max outs
of 0 with a range of 0–0. On the high load task, group was found to have a significant effect
on max outs, Kruskal-Wallis x2 (2, N = 54) = 29.88, p < .001. The 5–6-year-olds (Mdn = 8,
Range = 3–11) committed significantly more max outs than the 8–9-year-olds (Mdn = 2,
Range = 0–9), U = 33, p < .001. The 8–9-year-olds were significantly different from the 11–
12-year-olds (Mdn = 0, Range = 0–7) in number of max outs, U = 95.5, p = .016.
Variability—SD. There was no effect of load as intraindividual variability did not
change significantly between tasks, F = 3.03, p = .09. There was a significant group effect,
F (2,51) = 5.94, p = .01, with 5–6-year-olds having significantly greater variability than 8–
9-year-olds, t (34) = 2.83, p = .008. The variability of 8–9-year-olds and 11–12-year olds
did not differ significantly, t (35) = .30, p = .75. Refer to Table 4 for descriptive data.
Variability—MAD. Intraindividual consistency did not change from the low to
high load task, Friedman x2 (1, N = 54) = .07, p = .79. A significant effect of group was
present, Kruskal-Wallis x2 (2, N = 54) = 8.35, p = .02. This difference however did not
occur between the 5–6-and 8–9-year-olds, U = 112, p = .117, nor the 8–9-and 11–12-year-
olds, U = 110, p = .064. Refer to Table 4 for descriptive data.

DISCUSSION
The aim of this study was to employ both traditional and novel indices to investigate
the development of sustained attention and the effect of task load on children’s perfor-
mance. As predicted, sustained attention was found to develop throughout childhood.
 DEVELOPMENT OF SUSTAINED ATTENTION 217

Rapid growth occurred from 5–6 to 8–9 years, and then a developmental plateau was evi-
dent from 8–9 to 11–12 years with only minor improvement. As expected, the task param-
eters of target complexity and display size influenced children’s sustained attention, with
performance poorer on the high load task than the low load task. The same developmental
pattern was evident on the load tasks.
As predicted, sustained attention showed development from 5–6 to 11–12 years. For
every index (speed, errors, accuracy, and variability), performance was in the expected
direction with increasing age associated with improved performance. On some indices,
evidence for a plateau in development was present. For example, on indices of speed and
accuracy, the 8–9-year-olds’ performance was significantly better than that of 5–6-year-olds,
but similar to that of 11–12-year-olds. In contrast, more consistent growth of sustained
attention across the age range was identified on other indices. For example, the 5–6-year-
olds committed significantly more errors than the 8–9-year-olds who committed signifi-
cantly more errors than the 11–12-year-olds. Both measures of variability — SD and MAD
— showed the 5–6-year-olds to be significantly more variable than the 8–9-year-olds, who
in turn, were significantly more variable than the 11–12-year-olds. These differential find-
ings suggest that the skills underpinning performance on measures of sustained attention
Child Neuropsychology 2006.12:205-221.

may display varying developmental trajectories. Specifically, the 8–9-year-old group

recorded response speeds as short as the 11–12-year-old group, but with less accuracy.
This pattern of less accurate performance may reflect emerging but not yet established
sustained attention skills in the 8–9-year-old children.
Although MAD indicated a change in consistency over time, this change was not
identified by SD. According to MAD, performances initially became more variable before
plateuing and remaining consistent. As SD is vulnerable to the influence of outlying data,
the conflicting results produced using the MAD statistic versus the SD statistic suggest that
in this case, outliers may have been present that masked the change in variability, possibly
when concentration lapsed creating unusually slow responses (Garret & Nash, 2001).
The mixed developmental evidence after 8–9 years is consistent with the literature
on development of other cognitive skills (Anderson, Anderson, & Lajoie, 1996; Kirk,
1985). Kirk (1985) found that when skills were approaching a new level of competence
there were clear differences on some indices but not others, due to a “reorganization of
function.” The mixed evidence is also consistent with the 8–9-year-olds having one or two
years of rapid development left before they reach 10, the age at which the plateau is evi-
dent in most studies (Klenberg et al., 2001; Manly et al., 2001; Rebok et al., 1997). Results
from the present study are consistent with previous research showing that sustained atten-
tion develops throughout childhood, with rapid improvements to age 10, then gradual
improvements thereafter (Klenberg et al., 2001; Manly et al., 2001; Rebok et al., 1997).
While Rebok et al. (1997) and Klenberg et al. (2001) found the decline in errors to
plateau at age 10, the current study did not support this developmental pattern. Rebok
et al. (1997) divided errors into two types—errors of omission and commission, and
Klenberg et al. (2001) worked with a performance “total score” involving subtracting
errors from correct responses. As errors rates were very low, the current study examined
errors of omission, commission, and anticipation together. A more detailed analysis of
each type of error may have revealed the previously described developmental plateau.
As expected, performance was poorer on the high load task than the low load task,
regardless of age. The parameters of target criteria and display size were successfully
manipulated to increase the sustained attention resources required to complete the tasks.
When participants matched a pair of cards for color, suit, and number with one of six pairs
 218 J. BETTS ET AL.

of cards (high load), their speed was slower and more errors and max outs were committed
than when they matched a single card for color with one other card (low load). The results
suggest that participants were not engaging in a speed-accuracy trade-off because both
errors and speed increased. Variability, as measured by both SD and MAD, did not change
from the low load to high load task, indicating that the slowing speed was not a function of
fluctuations in performance unduly influencing the mean or median, but it was due to
greater sustained attention demands of the high load task.
The current findings are consistent with the adult literature. When target criteria
were manipulated, Noonan et al. (1984) and Lysaght et al. (1984) observed a decrease in
correct responses and an increase in RT on the high load task. These studies demonstrate
that when task demands become too great, participants are unable to cope and perfor-
mance deteriorates (Corkum & Siegel, 1993). This study has shown that increasing target
criteria and display size places greater demands on children’s sustained attention system.
Subsequently, these parameters may now be added to the small, but growing, list of fac-
tors that affect children’s sustained attention, along with display time, target probability,
and event rate (Chee et al., 1989; Laurie-Rose et al., 2001).
As these tasks place differing demands on participants’ sustained attention, the perfor-
Child Neuropsychology 2006.12:205-221.

mance of each age group provides further insight into development. As expected, the develop-
ment of sustained attention from 5–6 to 11–12 years was evident on all indices (speed,
variability, errors, and max outs). In addition, the gradual improvements characterizing the pla-
teau in development from 8–9 to 11–12 years was evident on some indices (speed-accuracy
trade-off, variability), while continued improvements were evident on others (max outs). Con-
tinued rapid growth was evident on the max out index, with groups not differing at low load
but the 5–6-year-olds committing significantly more max outs than the 8–9-year-olds at high
load, who in turn committed significantly more max outs than the 11–12-year-old group.
The plateau in development was evident on measures of speed, accuracy, and vari-
ability. As a speed-accuracy trade-off was identified, these measures will be interpreted
collectively. At low load there were no age differences in speed or error rate. At high load,
the speed of the 5–6-year-olds was not significantly different from the 8–9-year-olds,
while the 8–9-year-olds were significantly slower than the 11–12-year-olds. The 5–6-
year-olds committed significantly more errors than the 8–9-year-olds, while number of
errors did not differ for the two older groups. Thus, 8–9-year-old children were as accurate
as 11–12-year-olds, but they took longer to produce these accurate responses.
With both MAD and SD, the variability of the 8–9-year-olds was similar to that dis-
played by the 11–12-year-olds, providing evidence for the plateau in sustained attention.
While the MAD found the 5–6- and 8–9-year-olds to be performing similarly, SD showed
them to be significantly different. The influence of outliers on SD is likely to be responsi-
ble for this discrepancy (Garret & Nash, 2001). The 5–6-year-olds may have suffered
lapses in attention that resulted in unusually slow responses and increased their variability.
The current findings are consistent with the developmental literature that has investi-
gated sustained attention with tasks of the same load. In accordance with Klenberg et al.
(2001), Manly et al. (2001), and Rebok et al. (1997), sustained attention was found to develop
from 5–6 to 11–12 years, with a plateau in development after 8–9 years evident on some indi-
ces. Finding a plateau on only some indices is consistent with Kirk’s (1985) “reorganization of
function” and is reasonable, considering the 8–9-year-olds still have one or two years of rapid
development left before they reach the age at which the plateau becomes clearly evident.
Methodologically, the development of sustained attention was successfully captured
by traditional indices. While errors and accuracy are often subject to ceiling or floor
 DEVELOPMENT OF SUSTAINED ATTENTION 219

effects, this was not the case in the present study as only 29% of participants responded
without error on Score!, 11% on the low load task and a single person on the high load
task (Ballard, 1996a; Manly et al. 2001). Error and accuracy measures, however, produced
skewed data that required nonparametric tests to be employed.
This research demonstrated that the novel index of variability can be successfully
applied in the context of normative research. Variability was found to be a useful tool,
providing a more direct observation of sustained attention from response performance,
rather than from missed response performance (Castellanos & Tannock, 2002). The use of
this index is in accordance with the principle of multiple measures, whereby utilizing a
range of indices provides a more comprehensive picture. The similarities between results
obtained in this study using variability and the more traditional indices, gives greater
weight to the validity of the findings. The variability data was not subject to floor or ceil-
ing effects and, unlike the traditional indices, was normally distributed (Ballard, 1996a).
These results suggest that variability should be included as an index in future sustained
attention research and, with its advantages over more traditional indices, may become one
of the primary indices of sustained attention.
The results obtained with SD and MAD were sometimes inconsistent, possibly due
Child Neuropsychology 2006.12:205-221.

to the sensitivity of these measures to nonsignificant outliers (Garret & Nash, 2001). In the
future, studies of variability may need to employ a more lenient definition of an outlier to
address this. Further research is also required to explain the underlying mechanisms
responsible for the performance variability. For example, the variability could be the
result of unusually slow responses caused by lapses in attention, unusually fast responses
caused by disinhibition and impulsiveness, or a combination of both.
This study was subject to the usual problems associated with testing attention,
namely, that attention cannot be measured directly but must be inferred from task perfor-
mance (van Zomeren & Brouwer, 1992). The current study therefore used two different
tests of attention (CogState and TEA-Ch), and several outcome indices (speed, errors,
accuracy, and variability). This reduced the influence of extraneous factors and improved
the validity of conclusions (Fletcher, 1998). For example, even though CogState requires
motor responses and Score! verbal responses, both tests produced comparable results,
indicating that method of response was not influencing the findings.
The current research has applications in educational settings, where the knowledge can
be employed to design schedules that most effectively use the limited hours in a school day.
For example, the research indicates that younger students require more breaks and that 8–9-
and 11–12-year-olds could follow a similar study-break schedule. In addition, the research
provides insight into how to present information most efficiently to children. This is especially
relevant as computers and games are now common classroom learning tools. This study has
also demonstrated that children can attend best when small amounts of information are
displayed. These findings have important implications in clinical settings where a sound under-
standing of normal sustained attention and its developmental trajectory may aid in the diagno-
sis and treatment of attentional problems, such as Attention deficit/hyperactivity disorder.

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