A student's ability to attend in the classroom is an important factor in determining academic success. This systematic review examined the effects of an alternative seating system on improving attention in students with attention difficulties. Databases searched included CINAHL, Medline, PsycINFO, OTSeeker, Cochrane Library, and Google Scholar. Articles were critically appraised using a format based on the American Occupational Therapy Association's Evidence-Based Literature Review Project. The results of this review suggest that the use of alternative seating devices generally improves attention for students with attention difficulty.