Visual attention in the first years: typical development and developmental disorders.

The development of attention is critical for the young child's competence in dealing with the demands of everyday life. Here we review evidence from infants and preschool children regarding the development of three neural subsystems of attention: selective attention, sustained attention, and attentional (executive) control. These systems overlap with dorsal cortical visual streams and their disorders are related to the general hypothesis of 'dorsal stream vulnerability'. Infants' ability to control spatial selective attention can be measured using the 'Fixation Shift' task. From around 4 months of age, infants start to show cortical control in disengaging to switch between competing targets. Fixation shifts have proved to be an effective early indicator of attentional disorders associated with perinatal brain damage. Executive function emerges slowly, starting around 1 year of age. The new Early Childhood Attention Battery has identified the three attention subsystems as distinct before 5 years of age in typical development and allows assessment of individual attention profiles across these subsystems. The Early Childhood Attention Battery is now being used to identify specific profiles associated with developmental syndromes such as Williams, Down, and fragile X. These new methods offer the possibility of very early identification of attention disorders, raising the challenge of effective remediation and treatment at an early age. © The Authors. Developmental Medicine & Child Neurology