BEHAVIORAL TREATMENT OF ATTENTIONAL DYSFUNCTION IN CHRONIC, TREATMENT-REFRACTORY SCHIZOPHRENIA Steven M. Silverstein, Ph.D., Debra L. Pierce, Ph.D., Mari Saytes, B.S.O.T., Lisa Hems, M.A., Lindsay Schenkel, B.A., and Nancy Streaker, B.P.S. Attentional impairment is both a core characteristic of schizophrenia and a fac- tor in producing poor outcomes in rehabilitative treatment. While cognitive re- habilitation interventions have demonstrated some success, the severity of some patients' attentional impairment is such that they cannot attend to material in these treatments, leading to unsatisfactory outcomes. In this paper, we report on the results of a behavioral intervention designed to increase attention span in the lowest functioning group of schizophrenia patients on a long-term inpa- tient unit. The treatment is based on social-learning procedures, especially the principle of shaping. Results indicate that chronic, treatment refractory patients with severe attentional impairment, including those with IQs near or within the mentally retarded range, can improve their attention spans to over 45 min- utes with this treatment. The authors are affilitated with the University of Rochester Medical Center and Rochester Psychiatric Center, Rochester, NY. Address correspondence to Steven M. Silverstein, Ph.D., University Services Psychiatric Rehabilitation Program, Rochester Psychiatric Center, 1111 Elmwood Avenue, Rochester, NY 14620. Electronic mail may be sent via internet to sslv@cvs.rochester.edu. PSYCHIATRIC QUARTERLY, Vol. 69, No. 2, Summer 1998 0033-2720/98/0600-0095$15.00/0 © 1998 Human Sciences Press, Inc. 95