Akhutina & Pylaeva. Overcoming Learning Disabilities - A Vygotskian-Lurian Neuropsychological Approach PDF

overcoming learning disabilities
Based on the ideas of Russian psychologists Lev Vygotsky and Alexander Luria,
this book explores methods of preventing or overcoming learning disabili-
ties. Tatiana V. Akhutina and Natalia M. Pylaeva follow Vygotsky and Luria’s
sociocultural theory and their principles of a systemic structure and dynamic
organization of higher mental functions, building on their theoretical founda-
tion by focusing on the interactive scaffolding of the weak components of the
child’s functional systems, the transition from joint child–adult co-actions, and
the emotional involvement of the child.
The authors discuss effective methods of remediation of attention, executive
functions (working memory and cognitive control), and spatial and visual-
verbal functions. Overcoming Learning Disabilities translates complex problems
into easily understandable concepts that will be appreciated by school psychol-
ogists, special and general education teachers, and parents of children with
learning disabilities.
Tatiana V. Akhutina is the head of the Laboratory of Neuropsychology at

Lomonosov Moscow State University and of the Laboratory of Learning Dis-
abilities at Moscow State University of Psychology and Education. She has
published in Russian, English, Spanish, Finnish, and German. In 2003 the Jour-
nal of Russian and East European Psychology dedicated a special issue to her
research on psychology of language and neuropsychology.
Natalia M. Pylaeva is a neuropsychologist at Lomonosov Moscow State Univer-

sity. She is a coauthor with Tatiana V. Akhutina of five books on methods of
remediation of learning disabilities. Her articles and books have been translated
into English, Finnish, Slovak, and Spanish.
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Cambridge Books Online © Cambridge University Press, 2012
Overcoming Learning Disabilities
a vygotskian-lurian neuropsychological
approach
Tatiana V. Akhutina
Lomonosov Moscow State University and
Moscow State University of Psychology and Education
Natalia M. Pylaeva
Lomonosov Moscow State University
cambridge university press
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C Tatiana V. Akhutina and Natalia M. Pylaeva 2008, 2012
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no reproduction of any part may take place without the written
permission of Cambridge University Press.
First English edition published 2012

First published in Russian as Preodolenie trudnostey
ucheniya: neyropsikhologicheskiy podkhod, 2008
A catalog record for this publication is available from the British Library.
Library of Congress Cataloging in Publication data

Akhutina, T. V. (Tat’iana Vasil’evna)
[Preodolenie trudnostey ucheniya. English]
Overcoming learning disabilities : a Vygotskian-Lurian neuropsychological approach /
T. Akhutina, N. Pylaeva.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-107-01388-9 (hardback)
I. Pylaeva, N. (Natalia M.), 1948– II. Title.
[DNLM: 1. Learning Disorders – therapy. 2. Child. 3. Neuropsychology – methods.
WS 110]
616.85889–dc23 2011040835
ISBN 978-1-107-01388-9 Hardback
Cambridge University Press has no responsibility for the persistence or accuracy of URLs for
external or third-party Internet Web sites referred to in this publication and does not guarantee
that any content on such Web sites is, or will remain, accurate or appropriate.
contents
Preface page ix
Introduction to the Russian-Language Edition: Contemporary

Research in Child Psychological Development and
Remediation: An Overview 1
Introduction to the English-Language Edition:
Vygotskian-Lurian Approach to Neuropsychology 11
part i. general issues in development and

remediation of higher mental functions
1. Neuropsychology of Individual Differences in Children as the
Foundation for the Application of Neuropsychological
Methods in School 29
2. Methodology of Neuropsychological Intervention in Children
with Uneven Development of Mental Functions 40
3. What Psychologists, Teachers, and Parents Need to Know
About Children with Learning Disabilities 48
4. Neuropsychological Support of Remedial-Developmental
Education 65
5. Neuropsychological Approach to the Development of
Health-Preserving Educational Techniques 73
vi Contents
part ii. methods of development and remediation of

executive functions
6. Organization of Joint Activity 89
7. The School of Attention and a Pilot Study of Its Effectiveness 93
8. Modified Psychological Methods to Facilitate Development of
the Executive Functions 115
9. Numerical Rows in Remedial Work with Fourth Graders 128
10. The Role of the Analysis of the Zone of Proximal Development
in the Course of Remediation of Executive Functions: An
Example 136
part iii. methods of developing visual-verbal

functions
11. Remediation of Visual-Verbal Functions in 5- to 7-Year-Old
Children 153
12. Perceptual Modeling in the Development of Visual-Verbal
Functions 164
part iv. methods of developing visual-spatial

functions
13. Development of Visual-Spatial Functions 179
14. “Construct the Figure” Methods in Assessment and
Remediation of Visual-Spatial Functions 182
15. The Use of Construction Methods to Develop Spatial Functions 193
16. Table and Computer Games to Improve Spatial Functions in
Children with Cerebral Palsy 205
17. Directions of Intervention for Developing Visual-Spatial
Functions to Prepare Children for School 215
18. Neuropsychologist–Teacher Collaboration in Designing a
“Numbers Composition” Manual 229
19. On Visual-Spatial Dysgraphia: Neuropsychological Analysis
and Methods of Remediation 236
Contents vii
part v. neuropsychological interventions in

children with severe developmental delay
20. “Tracking Diagnostics” Methods 245
21. Case 1: Predominant Delay in the Development of
Programming and Control Functions (Unit III) 251
Information-Processing Functions (Unit II) 258
Energy-Support Functions (Unit I) 265
References 275
Recommended Reading: Authors’ Selected Publications 297
Index 299
Cambridge Books Online
http://ebooks.cambridge.org/
Tatiana V. Akhutina, Natalia M. Pylaeva
Book DOI: http://dx.doi.org/10.1017/CBO9781139012799
Online ISBN: 9781139012799
Hardback ISBN: 9781107013889
Chapter
Preface pp. ix-xii
Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.001

preface
Alexander Romanovich Luria was our teacher. We feel that it is our duty to
share our understanding of Luria’s ideas, as well as those of his friend and
mentor, Lev Vygotsky, about whom Luria always spoke with great respect
and love. We feel that it is also our personal obligation to give an account
of how we put their ideas to work. Therefore, the purpose of this book is
to introduce our methods of overcoming learning disabilities based on the
Vygotsky-Luria neuropsychological approach.
The Vygotsky-Luria neuropsychological theory is systemic and dynamic
and emphasizes the role of social interaction between a child and adult in
the development of higher mental functions (HMFs). From this point of
view, learning difficulties (the term used in Russia), or learning disabilities
(the more widespread term internationally) in children are the result of the
interplay of flawed neurobiological and social factors and their interactions
during different stages of development in school-aged children that appear
as a partial disturbance or delay in the development of their HMFs. Therefore
learning disabilities (LDs) can be explained not only as an insufficient
adaptation of children to their social requirements but also as an effect of the
increasing social demands and standard teaching methods in contemporary
education. Such a lack of mutual adaptation accounts for the disturbing
tendency that has been reported in all industrial countries, namely, that the
number of children with LDs is constantly growing.
When speaking about the mechanisms of LDs it is important to have
in mind that negative social and neurobiological factors can interact and
intensify each other. For example, neurobiological problems resulting from
low birthweight might be compensated for if a child’s development occurs in
a favorable social situation; alternatively those problems may be significantly
exacerbated if a child does not receive sufficient early parental or adult
attention.
ix
http://dx.doi.org/10.1017/CBO9781139012799.001
x Preface
Often child development in today’s world is unbalanced: a social situation

might enhance development of some functions at the expense of others, or
the situation might be unfavorable for the successful development of certain
functions. For example, adults might actively stimulate speech and verbal
thinking and pay little attention to the development of movement dexterity,
visual-motor coordination, drawing, and self-regulatory skills. It has been
found that children who grow up in an urban environment as compared
to those growing up in the country have worse scores in visual-spatial tasks
(Polyakov, 2004), and one of the reasons for it is that they spend less time
playing active games, games that require orientation in space like “hide-and-
seek.” In a different scenario, some children have been left alone at an early
age, with very little interaction with adults such as reading and discussing
books together. All of these circumstances, when combined with genetic
predispositions, can cause pronounced unevenness in the development of
HMFs that is impossible to offset in the highly demanding environment of
modern learning institutions and that consequently leads to the develop-
ment of LDs.
This book presents methods of preventing and overcoming learning
disabilities. In the first introductory chapter (from the Russian edition)
we discuss the context of our work; present an overview of contempo-
rary research in neurobiology, neuropsychology, and economics dedicated
to a child’s mental development; and analyze the effectiveness of reme-
dial programs. The second introductory chapter, added to the English
edition, includes a discussion of the theoretical bases of Vygotskian and
Luria’s approach to neuropsychology and the understanding of LDs derived
from it.
Part I considers general problems in the neuropsychological approach
to learning and LDs. In the first chapter we focus on the new branch of
neuropsychology – the neuropsychology of individual differences – that
serves as a foundation for the practical application of neuropsychological
knowledge in a school setting. The basic notion of the uneven development of
higher mental functions is introduced here. Chapter 2 continues the discus-
sion of these general methodological questions in school neuropsychology
and presents the Vygotskian-Lurian approach to the diagnosis and reme-
diation of LDs. The following chapter provides an overview of the main
types of LDs. Chapter 4 deals with practical applications of our approach
to remedial-developmental education. Whereas Chapters 2–4 are devoted
to LD remediation, in the last chapter in this part we return to concerns
common to all children. Chapter 5 focuses on the psychoeducational per-
spective of the prevention of deterioration in the physical health of students
during the course of the educational process. We argue that taking into
Preface xi
consideration the general neuropsychological characteristics of early school-

aged children as well as the specific characteristics of individual students can
facilitate the resolution of the problem; that is, it can optimize interaction
between pupils and teachers and increase students’ learning potential.
In Part II we present methods for the development and remediation
of executive functions. We initially present data on the trials of our most
well-known method of numerical sequences called the School of Atten-
tion (Akhutina, 1997; Akhutina & Pylajeva, 1995; Pylaeva & Akhutina,
1997/2008 R [Russian-language publications are designated by the letter
R following the date]). We also discuss remedial adaptations of popular
psychological tests (sorting of colored shapes, Link’s cube, etc.), as well
as methods and techniques based on more complicated number sequences
(what we call the School of Multiplication; Pylaeva & Akhutina, 1999/2006 R).
We describe both the process of remediation of programming and control
functions and the technique of conducting the qualitative analysis of the
“zone of proximal development” in the process of intervention. Using con-
crete examples we show how neuropsychologists deal with the following
issues:
r How to determine the component of a functional system that needs to
be remediated in a particular task to achieve maximum results
r How to provide help to the child
r How to withdraw this help gradually (cf. “scaffolding”; Bodrova &
Leong, 2007; Chaiklin, 2003; Daniels, 2007)
Thus, the focus of Part II is on the core aspects of the developmental work
conducted by a neuropsychologist, who provides an intervention aimed at
the weak link in the development of HMFs and gradually decreases the
intensity of the assistance depending on the child’s progress.
Part III is dedicated to methods for the remediation of visual-verbal
functions. Chapter 11 provides a general overview of the sequence of stages
in the remediation work, and Chapter 12 describes specific methods used
during one of the key stages.
Part IV focuses on methods of development and remediation of visual-
spatial and quasi-spatial functions. Here we present specific methods and
describe clinical trials. This part ends with an excerpt from our introductory
math textbook, Composition of Numbers, and includes a case study of a boy
with weaknesses in visual-spatial functions and visual-spatial dysgraphia.
The fifth and final part of the book presents three cases with severe devel-
opmental delays in HMFs in which interventions based on the Vygotsky-
Luria theory were applied. Each child had multiple disabilities, but each
one’s neuropsychological profiles were considerably different: one child had
xii Preface
significant delays in programming and control functions (Unit III according

to Luria), the second child had delays in processing of sensory information
(Unit II), and the third showed delays in the arousal system (Unit I).
In writing this book, our intent is to offer readers the choice of either
reading the whole book chapter by chapter or selecting the parts of particular
interest for them. As a result, readers might come across some repetition.
Portions of the data presented in the book have already been published in
a number of articles, although all of this material has been updated for this
book. The rest of the data discussed have never been published.
We want to express our sincere gratitude to all our Russian and Amer-
ican colleagues and students who helped in preparing this publication,
particularly Anastasia Agris, Tatiana Grabar, and Gary Shereshevsky. The
manuscript was translated from Russian with the support of the Spencer
Foundation (Chicago) within the framework of the program “Promoting
Social Studies of Education in Russia.” We are grateful to the Spencer Foun-
dation and to Daniil Alexandrov, director of the program, for their support.
Special thanks goes to our translator, Julia Linkova – without her highly
professional help, the English edition of this book would not have been
possible. The authors also have the pleasant task of expressing their sin-
cere thanks to the project manager of this edition, Brigitte Coulton, and
copy editor, Gail Naron Chalew; their numerous questions helped to make
the text more clear and readable for an English-speaking audience.
Online ISBN: 9781139012799
Chapter
Introduction to the Russian-Language Edition: Contemporary Research in
Child Psychological Development and Remediation: An Overview pp. 1-10

Introduction to the Russian-Language Edition:
Contemporary Research in Child Psychological
Development and Remediation: An Overview
Our book is dedicated to the neuropsychological remediation of learning

disabilities and, in a broader sense, to developing health-preserving learning
methods based on neuropsychological methodology. In this introduction
we discuss the multidisciplinary framework of our work.
Numerous publications – articles, books, and textbooks on the topic of
school neuropsychology (the term introduced in 1981 by George Hynd, the
prominent American researcher and expert in the field of development and
learning) – are available today. Among them are one textbook 940 pages
long (Handbook of School Neuropsychology [Amato, et al., 2005]) and the
other 340 pages long (Hale & Fiorello, 2004).
The number of trained school neuropsychologists is increasing steadily,
because graduate students with master’s degrees in school psychology
now have an option of taking a two-year certification program in school
neuropsychology. This training program includes four to six internships/
seminars in the educational and clinical environment (Hynd & Reynolds,
2006). The increase in the number of school neuropsychologists reflects
the growing demand for professionals who combine knowledge of the
educational system with expertise in neurobiologically and neuropsy-
chologically based educational interventions. The thorough training that
school neuropsychologists receive is evident in the highly professional level
of neuropsychology websites compared to the ones dedicated to neuro-
pedagogy that often trivialize neurobiological and neuropsychological data
and contain simplistic recipes for learning and self-learning that have not
undergone appropriate clinical trials.
In Russia, only Moscow and Leningrad State Universities offered training
in neuropsychology in the 1990s. Today, many universities and educational
and medical colleges have departments of clinical (medical) psychology.
2 Overcoming Learning Disabilities
As far as we know, in Moscow the majority of neuropsychologists work-

ing with children receive appropriate training in their undergraduate and
graduate research work conducted in various children’s agencies under the
guidance of experts in the field. In other cities there are also centers for the
psychological, medical, and social support of children and adolescents, and
neuropsychologists often are part of a team of psychologists there, although
the level of their professional training may vary.
Legislation guaranteeing all children the right to an appropriate edu-
cation and advances in research into the neurobiological foundations of
learning and developmental disabilities have facilitated the rapid expan-
sion of the neuropsychological approach to a large number of countries. In
contrast to the simplistic interpretation of learning disabilities as problems
caused by “minimal brain dysfunction” (MBD; the overly broad umbrella
term that explains little), there has emerged a new, more specific theoretical
and practical understanding of mechanisms of normal development as well
as developmental disorders in children.
For example, the diffuse perspective offered by the MBD approach has
been superseded by our current, more nuanced understanding of Attention
Deficit Hyperactivity Disorder (ADHD). Using the methods of neurovi-
sualization, researchers were able to show special characteristics of brain
organization in children diagnosed with ADHD. In addition pharmaco-
logical methods that provided temporary alleviation of the majority of
symptoms, as well as methods of psychoeducational help, became available
(Barkley, 1998; Hynd et al., 1990).
A substantial body of research has been dedicated to the study of mech-
anisms of learning disabilities on different levels. For example, researchers
were able to show the connection between severe dyslexia and the distur-
bance in neuronal migration during fetal development (Galaburda et al.,
1985). That disturbance can cause the atypical development of speech cen-
ters in the brain (Hynd et al., 1990) and, consequently, deficiencies in
auditory memory and speech disorders (Kibby et al., 2004) that in turn can
lead to the development of reading disabilities.
Psychogenetic studies conducted in the last 15 years have shown a con-
nection between reading disabilities and genetic chromosomal mutations:
phonological processes and analytical reading are connected to chromo-
some 6, whereas word recognition (predominantly holistic) is connected
to chromosome 15. Research data are also available that connect reading
disabilities and chromosome 18 (Fisher et al., 2007; Gayan & Olson, 2001;
Grigorenko et al., 1997; Pennington, 1999). Analysis of reading disabilities
in monozygotic and dizygotic twins showed that the heritability indicator
Introduction to the Russian-Language Edition 3
(h2g) of the state of phonological operations and analytical reading capacity

that highly correlates with those disabilities equals 0.56. The h2g indicator
of precise orthographic word recognition (in which the holistic reading
strategy plays a significant role equals 0.6–0.7 (DeFries & Alarcon, 1996;
Gayan & Olson, 2001).
Analysis of the causes of reading deficits, based on comparison of group
data, has shown the effect of both general and specific genetic factors on
individual differences – both in the control group and in the group of
children with reading disabilities (Gayan & Olson, 2001). This data coincide
with the idea of unevenness in the development of functions or components
of functions that we elaborate on in Chapters 1 and 2 (Akhutina & Pylaeva
R, 2003a), as well as the multi-deficit (polyfactor) model of developmental
disorders in children suggested by Pennington (2006).
As established in a number of studies, only 50% of learning disabilities
are defined by genetic factors – this finding suggests that the environment
plays an important role in child psychological development. Nor does the
presence of genetic or structural deficiencies necessarily mean that they will
translate into deficiencies in psychological development. Environmental
influences and the ability of functional systems to self-organize explain
numerous observations of the same pathogenic factor causing different
problems in children.
Thus, children with low birthweight often have problems with spatial
and executive functions. However, as the analysis of the results of the Block
Design Test (part of the Wechsler Intelligence Scale sensitive to these func-
tions) shows, adolescents whose birthweight was either less than 750 g or
750 g to 1.5 kg showed a broad spectrum of results, ranging from low to
high normal with only some tendency to the lower results (Taylor et al.,
2004).
Thus, the connection between brain organization and functional charac-
teristics is not strictly deterministic. This repeatedly observed phenomenon
is consistent with the modern understanding of the neurobiological founda-
tions of child mental development that recognizes the complex and closely
interconnected interactions of environmental and genetic influences, con-
structive self-organization of structural-functional systems, and the impor-
tance of early stages in child development (Gottlieb, 1992; Johnson, 1997).
Vygotsky’s views on that subject were very similar (for an overview, see
Akhutina, 1997, and also the introduction to the English-language edition
of this book).
In the last quarter of the 20th century a substantial body of data
emerged illustrating the primary importance of early experiences in the
development of structural-functional systems of the brain and their effec-

tive performance. The research summarized by Knudsen, Heckman, and
their colleagues showed that the “brain structure-function” relationship
can be described as a two-directional process of interaction: not only
does function depend on the structure but brain architecture changes
depending on the experience (Knudsen et al., 2006; compare to Gottlieb,
1992).
The most evident and well-researched example of this two-directional
process is the development of brain circuitry between the thalamus and
the primary visual cortex. In cases where vision in one eye is significantly
weaker than in the other, axons that transmit information from the weaker
eye separate from the neurons of the visual cortex, and the growth of the
majority of extensions in these axons is interrupted. In contrast, axons that
are connected to the stronger eye develop multiple extensions and numerous
connections with cortical neurons, exceeding the amount typical for the
norm. This change in the anatomy of brain structures leads to fundamental
differences in the function of the part of the visual cortex that becomes
dominant because of its connections to the stronger eye. However, these
changes in brain organization are only possible during the brief sensitive
period in the development of this particular brain circuit; as soon as this
period has ended, the main effects are irreversible, and it is impossible for
the brain circuitry connected with the eye that was deprived at an early age
to fully recover (Hensch, 2005; Hubel et al., 1977).
In addition, research studies have shown that mental functions are orga-
nized in a hierarchical manner, with critical periods of development occur-
ring at different times for different parts and levels of the hierarchy. The
sensitive periods of the base-level circuits end earlier than those of the higher
levels. For example, the sensitive period for the brain circuits that support
the synthesis of visual information from both eyes ends earlier than that for
the circular connections responsible for the recognition of biologically sig-
nificant objects (Daw, 1997). Such a developmental sequence signifies that
the ability of higher levels to fully function depends on early experiences,
which are needed for the lower levels to develop properly (this is also very
close to Vygotsky’s understanding).
Research advances have also made it possible to show that early expe-
riences affect not only the development of brain structures but also
gene expression and neurochemistry. The brain circuit activation that
occurs as a result of different experiences can create noticeable changes
in genes that become expressed in these circuits (Tagawa et al., 2005). The
protein products of these genes can cause changes in neuron chemistry and,
consequently, in their structure and excitability. In turn these changes can
significantly affect the characteristics of brain circuits and the behavior they
mediate. Some genes can turn off and on or change their level of expression
depending on the individual’s experience, but only within the time-limited
critical period of brain circuit maturation (Tagawa et al., 2005).
The following example illustrates the dependence of gene expression
and brain biochemistry on early experiences. Rats that were cared for by
careful “mothers” that provided easy access to milk during the first week
after birth grew up to become more active and less prone to stress compared
to those animals whose “mothers” were not so careful. Because the “moth-
ers” used in these experiments were either biological or adoptive, these
differences in behaviors in the two groups cannot be explained by genetic
influences but rather occurred as a result of early experiences. The early expe-
rience (decreased access to milk) causes the release of the stress hormones
(glucocorticoids) that create permanent change in genes expression for the
glucocorticoid receptors in key areas of the brain. Early social interactions
modify the expressiveness of the gene, thus changing the critical starting
point of the brain circuit. That, in turn, affects the animal’s temperament
for the rest of its life (Meaney, 2001).
We presented just a few examples, but more are available to illustrate
the importance of early experience. Advances in research enable us to view
early childhood development in general and the problem of social neglect
in particular in a new light. When the classes of remedial education was first
implemented in mainstream schools in Russia in the 1990s, the majority
of teachers working in these classrooms had extensive experience in the
educational field but did not have any special training in remediation. It was
assumed that these instructors could not work with children with “organic
deficiencies,” but that they would be qualified to work with children who had
what were considered functional difficulties as a result of neglect. However,
modern scientific data allow us to conclude with certainty that early social
neglect causes not only functional but organic-functional problems as well
and that the course of psychological development in these children can be
significantly altered.
The research conducted by Martha Farah and colleagues on the effects
of poverty on children’s mental development showed not only the gen-
eral decrease in their performance of cognitive tasks but also pronounced
unevenness in development of their functions; the authors use the term
“neurocognitive profile of childhood poverty.” In these studies, Farah and
colleagues (2006) assessed the functioning of five main neurocognitive sys-

tems:
1. executive/prefrontal system
2. language/left perisylvian system
3. memory/medial temporal system (for example, the system that sup-
ports memorization on the first attempt)
4. spatial/parietal system
5. visual/occipitotemporal system
The first system, which encapsulates executive functions (known as func-
tions of programming and control in the Russian scientific tradition), can
be further divided into three subsystems:
1. working memory/lateral prefrontal system
2. cognitive control/anterior cingulate system (capacity to inhibit inad-
equate stereotypical reactions)
3. reward processing/ventromedial prefrontal system (ability to reject
an immediate reinforcement in favor of a delayed but larger one)
Pronounced differences between children who grew up in middle-class
families and those in families with low socioeconomic status were identified
in tests that tax the functioning of systems needed for language, memory,
working memory and cognitive control, and borderline significant dispari-
ties were found in processing of visual and spatial information (Farah et al.,
2006). It is not the financial situation per se that caused the disruption of
the developmental process but rather the lack of cognitive and noncognitive
stimuli, as well as the high possibility of “toxic stress” (significant, frequent,
or prolonged stress) in the absence of supportive adults (Shonkoff, 2006).
In the context of remediation, it is particularly important to emphasize
that, in the critical period of development, brain complexes display marked
sensitivity to both negative and positive influences. Functional magnetic
resonance imaging (fMRI) reveals that the results of remedial intervention in
children can be seen not only in the display of behaviors and characteristics
of the learning process but also in metabolic changes in the brain (Shaywitz
et al., 2004).
Magnetic electroencephalography (MEG), or magnetic source imaging
(MSI), has also been used to obtain data on changes in time and spatial
parameters of brain activation in the process of reading in children with
severe dyslexia who have undergone remedial procedures. The findings of
this research on children in Grades 1 and 3–5 are summarized in Simos et al.
(2006).
Children undergoing MEG wear a helmet that registers magnetic signals

from electrical activity of the brain. When a child starts reading words,
brain neurons send signals that can be registered as electrical activity of
the brain. This method is more precise than EEG and evoked potential
methods because it registers the magnetic field created by electricity that
generates waves (flux) spreading from neuronal sources and reaching the
surface of the head. The helmet catches these signals and reconstructs the
spread of the magnetic field over the head’s surface. The extent of the spread
is processed in the frequency of milliseconds, which allows researchers to
track the unfolding of neurophysiological activity in real time while a subject
completes a task; for example, word reading.
When given the task of reading words silently, children in the normal
group displayed the following sequence in activation of brain areas:
r primary visual cortex in the occipital area
r secondary associative visual cortex under the surface of temporal lobes,
bilaterally
r three areas of temporal parietal zones (angular, supramarginal, and
superior temporal gyri) predominantly in the left hemisphere
When subjects were reading aloud, prefrontal and premotor areas of frontal
lobes, including Broca’s area, were activated as well.
In students with reading disabilities, frontal lobe activation preceded the
activation of temporal parietal zones, and activation occurred more on the
right side than on the left.
After conducting interventions during the summer break with students
in Grades 3–5 – two sessions daily for a period of 8 weeks – and with first-
grade students during the 8-month school year every day for 40 minutes,
the quality of reading in the majority of students increased (in the younger
group in 13 of 16 students). MEG analysis revealed a strong tendency for
normalization of activation processes in both groups:
r The latent period of activation decreased.
r The activity in the temporal parietal zones of the left hemisphere
increased.
r At the same time the activity in the similar areas of the right hemisphere
revealed interindividual variations.
r The activation of frontal lobes no longer preceded that of the temporal
parietal zone and was widely variable in length.
These results are very interesting. They confirm the idea of a systemic
organization of higher mental functions (HMFs) and help explain the
sequence of events. Additionally, they demonstrate the plasticity of the func-

tional structure of the reading system in elementary school students and
the possibility of altering it through interventions. However, this otherwise
outstanding research did not make sufficient use of the neuropsychologi-
cal approach: it did not consider individual neuropsychological differences
in either the control or the reading disabilities group. Although five cor-
rectional methods of reading disabilities were used at different stages with
different students, the analysis of their impact from a neuropsychological
perspective was not conducted, and the neuropsychological characteristics
of children were not considered in selecting these methods. Our experience
in conducting remedial-developmental education demonstrates that tak-
ing into consideration each child’s strengths and weaknesses, promoting an
environment appropriate for development, and starting interventions early
maximally increase the effectiveness of these procedures. The analysis of
remedial-developmental education following these guidelines is the subject
of this book.
Yet additional data are essential for designing interventions. Sophisti-
cated economic, neurobiological, and psychological research studies con-
ducted in collaboration with James Heckman, winner of the Nobel Prize in
economics, have shown the economic effectiveness of early remedial work
with cognitively and emotionally at-risk children (due to the low socio-
economic and educational level of their families, genetic compromise, etc.).
In other words, the early interventions are cost-effective because they save
money in the long run by increasing salaries that participants later earn and
reducing rates of dropout, prison, and children born out of wedlock. The
trajectory of economic effectiveness of these interventions shows a sharp
decline in the period from early preschool to the start of the grade school
years, crosses the zero line in the middle of the grade school years, and
continues to slowly decline. Remedial procedures during middle school and
job training, although certainly producing some impact, prove to be less
cost-effective (Cunha et al., 2006; Knudsen et al., 2006).
Many publications are dedicated to the study of the effectiveness of
intervention programs. Here we present data on the cost effectiveness of
two early intervention programs.
The Perry Preschool Program provided morning group classes and after-
noon teachers’ visits to students’ homes for problem children ages 3–4 for
a period of 2 years. Longitudinal studies showed that, at 10 years old, the
subjects’ IQs were no higher than those of the control group, but they
had higher results in academic achievement tests (due to higher learning
motivation). By 40 years of age, in comparison to the control group, the
percentage of those who received a college education, had a higher salary,

and owned a home was higher, whereas the percentage of those who were
receiving unemployment assistance, had children out of wedlock, and were
arrested was lower (Heckman, 2006; Schweinhart et al., 2005).
The second program, the Abecederian Program, also focused on at-risk
children, but participation started at the age of 4 months. Children were
engaged in different activities for 6–8 hours a day, 5 days a week, while
attending kindergarten and preschool; families of children in the control
group received food assistance, social services, and medical assistance. Chil-
dren who participated in the program consistently showed higher cognitive
(IQ) and noncognitive results than children in the control group. However,
it remained unclear whether the higher results were caused by the early start
of the program or its intensity (Heckman, 2006; Ramey & Ramey, 2000).
In 2000 the Institute of Medicine and National Research Council pub-
lished the report, From Neurons to Neighborhoods: The Science of Early
Childhood Development (Shonkoff & Phillips, 2006). In 2006 the National
Scientific Council on the Developing Child was established. It consists of
12 prominent scientists in the areas of neuroscience, child psychology, eco-
nomics, and communication. The studies produced by J. Heckman, E.
Knudsen, and colleagues (Heckman, 2006; Knudsen et al., 2006) examine
the interaction of economics, neurobiology, and the psychology of early
childhood development. The design and implementation of such studies
reflect society and the state’s acknowledgment of the need to optimize the
process of raising and educating children, including different groups of
at-risk children. Without knowledge of contemporary neurobiology and
neuropsychology, this optimization is scarcely likely to achieve. The Rus-
sian scientists Vygotsky and Luria achieved worldwide recognition for their
contribution to the development of psychological and neuropsychological
diagnostic methods and remedial education; their ideas are widely used in
the practice of education and remediation.
When the Russian edition of this book was in the publication pro-
cess, the journal Science printed an article by the well-known specialist in
cognitive developmental neuroscience, Canadian scientist Adele Diamond
(Diamond et al., 2007) titled “Pre-School Program Improves Cognitive
Control.” This article reported on a study that, using a carefully selected
control group, showed the effectiveness of the remedial-developmental pro-
gram for preschoolers 3–5 years of age designed by Elena Bodrova and
Deborah Leong (Bodrova & Leong, 2007) based on the ideas of Vygot-
sky. The data showed that children in the experimental group after 1 year,
and especially after 2 years, showed statistically significant improvements
in executive functions as compared to those in the control group. The

Bodrova-Leong program (development of self-regulation in children dur-
ing playtime, the use of materialized signs for action programming) is very
similar to the authors’ approach and also uses the principles of Vygotsky as its
foundation.
In this book we share our experience of helping children that is based on
the ideas of our teachers as well as the contemporary data obtained in child
developmental research.
Online ISBN: 9781139012799
Chapter
Introduction to the English-Language Edition: Vygotskian-Lurian Approa
ch to Neuropsychology pp. 11-26

Introduction to the English-Language Edition:
Vygotskian-Lurian Approach to Neuropsychology
The goal of our introduction to the Russian-language edition was to acquaint

the reader with the contemporary, mostly western interdisciplinary research
on child’s development that has provided the context for our studies. The
goal of this second introduction is to review the foundations of the Vygotsky-
Lurian neuropsychological approach and the interpretation of learning dif-
ficulties derived from it. This review will prepare us to answer the main
question posed in this book: How has the Vygotsky-Lurian approach con-
tributed to the elaboration of remedial methods for helping children with
learning disabilities?
Lev Vygotsky was a founder of cultural-historical psychology. He is com-
monly associated with general and developmental psychology, educational
psychology, special education, and the psychology of art, but his contribu-
tion to the development of neuropsychology is not so well known. On the
contrary, Alexander Luria’s contribution to this field is widely recognized.
According to a survey of neuropsychologists conducted by Charles Long in
the 1980s, Luria was named to the top spot among the ten founders of neu-
ropsychology (Puente R, 1998). His influence is strong even today, and the
editors of the Handbook of School Neuropsychology in the preface called him
“the most famous of all neuropsychologists” (D’Amato, Fletcher-Janzen,
& Reynolds, 2005, p. ix). Why then do we call the approach that we have
developed the Vygotsky-Lurian approach? There are two reasons. First, both
scientists created the theoretical foundations of neuropsychology – its main
principles – on the basis of cultural-historic concepts suggested by Vygot-
sky (Luria, 1965, 1980; see also Khomskaya, 1996R; Akhutina, 2003, 2004a,
2004b; Glozman, 2002R). Second, Vygotsky made significant contributions
to our understanding of both normal and pathological child psycholog-
ical development, and consequently, a number of advancements in child
neuropsychology are particularly closely connected with his ideas.
11
Yet it was the joint efforts of both researchers that laid the foundation
of neuropsychology. In 1925–26, Lev Vygotsky joined Alexander Luria in
the Clinic of Nervous Diseases of Moscow University, which today is a part
of the I. M. Sechenov Medical University of Moscow. There Luria headed
a small laboratory where he investigated neuroses with the help of the
combined motor method. Vygotsky had another – more fundamental –
aim: he wanted to discover the foundations for a new natural-scientific
psychology that could explain not only elementary but also higher mental
functions in normal adults, in pathology, and in child development. He set
himself to the task of combining the paradigms of “Naturwissenschaften”
and “Geisteswissenschaften,” as he described in 1924: “This new psychology
will be a branch of the general biology and at the same time the basis of all
sociological sciences. It will be the knot that ties the science of nature and
the science of man together” (Vygotsky, 1997a, p. 61).
On October 9, 1930, in the same clinic at a conference of Vygotsky’s
research group and medical colleagues, Vygotsky presented the report, “On
Psychological Systems,” in which he summarized the results of both genetic
and pathological lines of his research as a basis for the idea of systemic struc-
ture of higher mental functions (HMFs), the key principle of contemporary
neuropsychology; he connected this systemic structural principle with the
principle of the social genesis of HMF (Vygotsky, 1997a, pp. 91–107).
In 1931 Vygotsky and Luria resumed their medical studies (Vygotsky had
dropped out of medical school in 1913 and Luria in 1923), when they were
both accepted to the Kharkov Medical Institute. They studied together for
the exams and discussed clinical cases that Vygotsky had seen in Moscow
(there are notes in his archive on a number of patients, some of which are
presented in Zavershneva, 2010) and Luria had in Kharkov. In his letter
(June 26, 1933) written from Kharkov to L. P. Linchina, his future wife,
Luria wrote the following:
I am completing my studies of aphasia patients and trying to convince

them that the brother of the father is not the same as the father of the
brother. . . . Currently we came across lots of very interesting material:
cases of agnosia, agraphia, postnatal psychosis with aphasia. . . . We are
drowning in an abundance of the rarest cases. I am thoroughly enjoying
medicine: I am spending time with Vygotsky to study pathophysiology,
and, of course, thinking about you (E. A. Luria, 1994 R, pp. 80–1).
The progress they were making in intensive research in the field of

neuropsychology is clear from Vygotsky’s letter, written on November 21,
1933. Replying to Luria’s question concerning the possibility of publishing
Introduction to the English-Language Edition 13
a series of articles on the “investigation of higher psychological functions in

their development and disintegration,” Vygotsky answered,
At last, about the series. If they are going to actually publish it and pub-
lish regularly (from issue to issue without fail), it is necessary to take it
with all responsibility. I have [the articles] 1). The classification of apha-
sia; 2). Birenbaum and Vygotsky. Aphasia and dementia; 3). Birenbaum
and Zeigarnik. Agnosia; 4). Vygotsky – written speech in cases of brain
lesions; 5). Vygotsky – grammar disorders – “ohne Zahl” [without num-
ber, numberless] as our patient answers the question “How many fingers
are there on one hand?” – I will submit one article by mid-December,
and we will prepare 3–4 articles to keep in reserve (Vygotsky, 2004 R; this
letter in English was published in Akhutina, 2003).
Vygotsky never wrote the articles he mentioned, although items 2

and 3 were partially completed together with G. V. Birenbaum and B. V.
Zeigarnik – proponents of Vygotsky’s ideas and former students of Kurt
Lewin (Samukhin, Birenbaum, & Vygotsky, 1934 R; Zeigarnik & Biren-
baum, 1935 R). Nevertheless, in many of Vygotsky’s writings and lectures
delivered in 1932–34, especially the ones from 1934, he outlined the ideas
that formed a foundation for the science of neuropsychology (see for
example, Vygotsky, 1995 R; 1997a, pp. 139–44; 1998, pp. 128–36, 284–302).
A. R. Luria then incorporated these ideas into the integral theory and
practice of neuropsychology.
The science of neuropsychology established by Vygotsky and Luria stud-
ies the functional structure and brain organization of higher mental func-
tions (HMFs). Vgotsky developed the basic concept of neuropsychology –
higher mental functions (also known as higher psychological functions) – and
Luria elaborated on their definition: “the higher human mental functions
are complex self-regulated processes, social in origin, mediated through
structure and conscious and voluntary in their mode of function” (Luria,
1980, p. 30), and they “have a social genesis, a systemic structure, a dynamic
development” (Luria, 1967, p. 55). Vygotsky also revised the basis for distin-
guishing between higher and lower mental functions as he came to embrace
a systemic understanding of higher mental functions: “Higher mental func-
tions are not built up as a second story over elementary processes, but are
new psychological systems that include a complex merging of elementary
functions that will be included in the new system, and themselves begin to
act according to the new laws” (Vygotsky, 1999, p. 43; see also his notes to
himself published in Zavershneva, 2010).
Thus, the three main principles of Vygotsky-Lurian neuropsychology are

as follows:
1. social genesis of higher mental functions (HMFs)

2. systemic structure of HMFs
3. dynamic organization and localization of HMFs
social genesis of higher mental functions

The principle of the social genesis of HMF is well known: “every function in
a child’s cultural development appears on the stage twice, in two planes,
first – social, then – psychological; first between people as an inter-mental
category, then within a child as an intra-mental category” (Vygotsky, 1997b,
p. 106; cf. translation, Wertsch, 1985, p. 60). The transition from joint
social functioning to an individual’s mental function – in other words, the
process of internalization – is at the same time, according to Vygotsky, a
transition from external to internal: “Every higher mental function was
external because it was social before it became an internal, strictly mental
function” (Vygotsky, 1997b, p. 105).
Vygotsky describes the stages of internalization using the example of
voluntary actions: “First, an inter-psychological stage – I order, you execute.
Then an extra-psychological stage – I begin to speak to myself. Then an
intra-psychological stage – two points of the brain that are excited from
the outside (that are externally stimulated – T. A.) develop a tendency to
work as a unified system and eventually form an intracortical point” (1997a,
p. 106). The stages of transition from external actions to speech and finally
to internal action, identified by Vygotsky, are very similar to the stages of
voluntary action development described by P. Y. Galperin (1969). These
stages form the main path of developmental or remedial interventions.
We follow Vygotsky’s idea that “objectification of a disturbed function, i.e.
taking it outside and changing it into an external activity, is one of the basic
ways to compensate for the deficiencies” (Vygotsky, 1997a, p. 143). This
theoretical platform became the basis for creating the remedial methods
presented in this book.
Vygotsky’s ideas on the sociogenesis of HMFs and his diagnosis of the
zone of proximal development and learning are more familiar to the west-
ern scientific community than his understanding of the principles of sys-
temic and dynamic organization of functions. The first principle is used
in both developmental education and rehabilitation and the correction
(prophylactic) of learning difficulties (Bodrova & Leong, 2007; Braga et al.,

2005; Сole, 1985, 1996; Daniels, Cole, & Wertsch, 2007; Kozulin & Gindis,
2007; Kozulin et al., 2003; Ylvisaker & Feeney, 2008).
systemic structure of higher mental functions

Vygotsky postulated the principle of the systemic structure of HMFs, but
A. R. Luria developed it. In his book, Higher Cortical Functions in Man,
Luria wrote, “We are indebted to Vygotsky for his detailed substantiation
of the thesis that higher mental functions may exist only as a result of
interaction between the highly differentiated brain structures and that each
of these structures makes its own specific contribution to the dynamic
whole” (Luria, 1980, p. 34). Here is what Vygotsky wrote on this topic
in his last work: “It [research] demonstrates . . . that no specific function
is ever connected with the activity of one single brain center. It is always
the product of the integral activity of strictly differentiated, hierarchically
interconnected centers” (1997a, p. 140).
The understanding of the systemic structure of HMFs made it possi-
ble to determine their localization in the brain and thus opened the door
to the analysis of their components. A contemporary cognitive neurosci-
entist has noted that the main contribution of clinical neuropsychology
is not the discovery of the brain substratum of mental functions but
rather the analysis of their components, which A. R. Luria completed
so brilliantly (Luria, 1973, 1980). In Essays on the Psychophysiology of
Writing (1950 R), A. R. Luria pioneered the task of describing the struc-
ture of a complex functional system of writing using neuropsychological
methodology.
Advancements in clinical neuropsychology, including analysis of the
components of HMFs, would have been impossible without the new diag-
nostic approach suggested by Vygotsky and developed by Luria. Based on
the systemic character of HMFs, Vygotsky identified the primary impaired
component (primary defect1 ), the secondary systemic consequences of the
primary defect, and tertiary compensatory reorganizations as parts of the
brain lesion syndrome in adult patients (or of abnormal development in
1
Although the term “deficit” is frequently used in English-language literature, the word
“defect” is more appropriate because it implies a disturbed process that is not necessarily
a deficit. Deficit often implies that a patient is lacking something, but a defect is not
necessarily a lack of something but may be a process that results in a psychological function
that is not optimal for a given task.
children). We have used the exact same approach to address learning difficul-
ties. For example, in the very common dysexecutive syndrome of learning
disabilities, the primary defect is the underdevelopment of programming
and control functions (executive functions). Operations such as orienta-
tion within a task, planning, switching to other actions, and inhibitory
control are disturbed as parts of this syndrome. All of these symptoms are
the examples of the manifestation of a primary defect. The problems with
all gnostic and mnestic processes that require concentration of attention,
checking and reviewing perceived information, and active memorization
constitute the secondary defects. Furthermore, children with this syndrome
can develop compensatory reorganization: both positive adaptive and nega-
tive maladaptive. Self-talk, self-commands, and self-discussions of the task
(i.e., a transition from the intra-psychological level of a voluntary action
to the extra-psychological level) are examples of a positive reorganization.
Adopting the role of a class clown (to attract attention, to withdraw from
the situation of failure, and to increase self-appraisal) is an example of a
negative compensation.
To help children with learning disabilities we use the methods for devel-
oping programming and control functions described in this book. As part
of their curriculum, Tools of the Mind (Bodrova & Leong, 2007; see also
Diamond et al., 2007 – we mention these publications in the first intro-
duction), Elena Bodrova and Debora Leong use very similar methods that
also implement Vygotsky’s and Luria’s ideas on the development of self-
regulation/executive functions in young children (see also Bodrova, Leong,
& Akhutina, 2011).
dynamic organization and localization of higher

mental functions
The principle of dynamic organization and localization of the HMFs suggests
a variability of each function’s structure and localization. Vygotsky spoke
about this concept in his 1931 publication (p. 133) and in more detail in his
last report, written in 1934, The Problem of Development and Disintegration
of Higher Mental Functions (Vygotsky, 1995 R – unfortunately this report
was not included in his collected works). Luria also wrote about this prin-
ciple (Luria, 1973, 1980; Luria, Simernitskaya, & Tybulevich, 1973 R). The
dynamic localization occurs because of (1) modification of the structure of
functions through ontogenesis, (2) modification of the functional structure
depending on the level of automatization, and (3) the possibility of using
different means to achieve the same result; for example, different strategies
of information processing: holistic vs. analytic.
The Vygotsky-Lurian principles of systemic and dynamic organization of
functions in their ontogenesis serve as a framework for interpreting varying
effects of similar brain lesions, depending on the stage of the development
of a given function. This framework has important implications for clinical
assessment and intervention and for research into localization of function,
because variables such as age at brain insult, type of compensatory pro-
cesses after insult (Frampton, 2004; Kolb & Fantie, 1997; Nass, 2002; Spreen
et al., 1995), time elapsed after insult (Anderson et al., 2001; Simernitskaya,
1985 R), focus of brain lesion (Kolb & Fantie, 1997; Nass, 2002; Simer-
nitskaya, 1985 R), and level of automatization of function (Segalowitz &
Hiscock, 2002) need to be considered. Debora Waber describes in detail
the modification of the functional structure and localization depending on
the level of automatization (Waber, 2010, pp. 105–20). In Russian literature
this concept is widely known from the works of Nikolay Bernstein (1967,
1996).
The possibility of using different means to achieve similar results on a
given cognitive task has been described in developmental neuropsychology
(e.g., Gottlieb, 2001; Temple, 1997), which has emphasized the need to assess
the means by which a normal result on a given task has been achieved to
uncover hidden deficits or compensatory processes (Johnson & Karmiloff-
Smith, 2004; Karmiloff-Smith, 1997). Furthermore, the well-known process
approach to neuropsychological assessment in adults emphasizes task anal-
ysis and discovery of the means by which a result is achieved to determine
lesion localization and to create a profile of impaired and preserved func-
tions (Kaplan, 1988; Milberg et al., 1986; Poreh, 2000; Shear, 2007; White &
Rose, 1997).
A good illustration of the Vygotsky-Lurian principles of systemic and
dynamic organization of functions is provided by the data on language dis-
orders in children with right- and left-hemisphere lesions. Infants (10–18
months) with right-hemisphere lesions demonstrate more delayed devel-
opment of both language comprehension and production, whereas toddlers
(19–31 months) show more delayed development of word production and
near normal comprehension in cases of left temporal lobe lesions (Stiles
et al., 1998; Thal et al., 1991; Wulfeck et al., 1991). The finding of the
role of right-hemisphere lesions (in light of widely known left-hemisphere
dominance for most language functions) confirms the dynamism of the
organization and localization of language functions. The interpretation of
the finding in the toddlers is more complicated. Could we conclude that in

2-year-old children language production is supported by brain structures
of the left temporal lobe? The answer is no: delayed development of word
production is a secondary defect of imperfect phonological perception. The
almost normal results in comprehension tasks could be explained by use
of a compensatory strategy of relying on different (not phonological but
global) features of words, as processed by the intact right hemisphere (cf.
Bates et al., 1997; Dick et al., 2005).
The study of the dynamic organization and localization of functions led
Vygotsky (1995 R) to a very important conclusion. He compared the con-
sequences of lesions with the same localization in children and adults and
found that they differed. Subordinate, underlying operations suffer more
in adults, but the defect is compensated by the higher mental functions.
In children, by contrast, overlying operations that require the participation
of the affected component in their development suffer more. For example,
in the cases of underdevelopment of visual perception the acquisition of
vocabulary and speech as a whole is affected, which, in turn, causes prob-
lems in the development of verbal thinking and, at the same time, delay
in the development of visual thinking (i.e., partial defects can cause the
significant underdevelopment of several HMFs in children; Vygotsky, 1995
R; cf. Dobbing, 1968, 1975). In contemporary neuroscience the concept
of a “developmental cascade” (Karmiloff-Smith, 2002) reflects very similar
ideas.
However, in the course of a child’s development, this negative tendency
is confronted by the tendency to substitute, go around, and create new
“interfunctional connections.” Vygotsky wrote that “the formations which
emerge much later and that are less connected with the primary derivative
factor are more easy to eliminate with the help of pedagogical influences”
(Vygotsky, 1993, pp. 133–4). These tendencies (cascading effect vs. plasticity,
with greater plasticity of new formations) constantly compete in the process
of a child’s development. The understanding of development as a continuous
struggle between various tendencies is very characteristic of Vygotsky and
is in accord with contemporary ideas of neurobiology.
According to this understanding, development of a function and of
functional systems is a probabilistic self-organizing process. Vygotsky con-
stantly uses the “drama” metaphor when describing it (see, for example,
Vygotsky, 1993, pp. 241–91). He joins A. Gesell (1930 R) in characterizing
development as “an uninterrupted, self-conditioned process,” in which “the
developmental stages in normal and abnormal children flow continuously
and organically from one another, as the action does in a well-ordered
drama” (Vygotsky, 1993, p. 253; see also Vygotsky, 1988, p. 147). He states
further, “The fundamental methodological issue in pedological research is
to discover the internal logic in the drama of child development, to discover
the dynamic links among its various crises and events” (1988, p. 253). Vygot-
sky calls his point of view “causal dynamic” in contrast to “phenotypical.”
This approach moves away from the simplistic, mechanical cause-and-effect
understanding of the developmental process and its deviations. It is very
similar to the modern “constructivist” view of development that includes
the ideas of probabilistic epigenesis, relational causality, and the extreme
importance of dynamic interplay (= “drama”) of various factors in the
process of development (Gottlieb, 1992; Johnson, 1997; Karmiloff-Smith,
2002).
Genes, the organism, and the environment (most importantly, the social
environment) constitute the “coactive” developmental factors. Genes bring
their biases into the system and thus define not a specific skill, such as read-
ing, but “domain-relevant” functions: those that are genetically connected,
for example by belonging to the same type of input (Karmiloff-Smith, 2002).
Similarly the condition of certain brain structures brings their biases into a
system and defines not a specific skill but domain-relevant functions, such
as successful development of motor or auditory functions.
Let us consider this concept in more detail. Vygotsky and Luria, along
with the famous Russian physiologist N. A. Bernstein, believed that the his-
tory of behavioral organization in phylogenesis is reflected in the structure
of the brain: “the brain preserves in itself in a spatial form the documented
temporal sequence of development of behavior” (Vygotsky, 1988, p. 123)
and that “the development of [the] brain proceeds according to laws of strat-
ification and superstructure of new stories over the old” (Vygotsky, 1997b,
p. 102); new structures are built on top of the old while preserving the prin-
cipal relatedness, the same working style, the “common factor” (Luria, 1970,
p. 370, see also pp. 101–3). This is why, when describing the aphasia syn-
dromes, Luria not only wrote about speech itself but also considered related
nonverbal deficiencies. This approach is very similar to the modern concept
of “embodied cognition,” in which “language (as well as other abstract or
higher order skills) emerges from, and is intimately linked to, the more
evolutionarily entrenched sensorimotor substrates that allow us to compre-
hend (auditory/visual) and produce (motor) it” (Dick et al., 2005, p. 238).
Because of their common morphogenesis and close functional connections,
certain brain structures are more closely associated with each other, and the
disturbance in the functioning of one will, with high probability, cause
the dysfunction of the other. These “domain-relevant” connections need
to be considered when analyzing symptom complexes of developmental

deviations (this is the approach that A. R. Luria called “factor analysis” or
“syndrome analysis”).
To better understand this approach to interpreting syndromes as
domain-relevant, let us consider one of the most studied types of learn-
ing difficulties in the contemporary body of research on learning disabili-
ties: problems with reading and writing caused by a “phonological deficit.”
According to Shaywitz and Shaywitz (2005), “the phonological deficit is
domain-specific; that is, it is independent of other non-phonological abilities.
In particular, the higher order cognitive and linguistic functions . . . such as
general intelligence and reasoning, vocabulary and syntax are generally
intact” (p. 1032, emphasis added). We strongly disagree. According to our
data, the phonological deficit is domain-relevant, which means that the syn-
drome usually also involves a decline in short-term auditory-verbal mem-
ory, poor vocabulary, and a secondary decline in the variability of syntactic
structures; these deficiencies are accompanied by difficulties in perception
of nonverbal information, specifically, rhythms that occur with a higher
than incidental probability (Akhutina, 2004; Velichenkova, Akhutina, &
Inshakova, 2001 R). It is worthwhile to remember that Luria’s tests aimed at
the analysis of temporal lobe functions include both verbal and nonverbal
rhythm tasks.
Our understanding of the syndrome of a phonological deficit is compat-
ible with the data obtained in psychogenetic research. Several members of
the now well-known KE family diagnosed with SLI (severe articulation dif-
ficulties accompanied by a grammatical impairment), caused by an allelic
variation in the FOXP2 gene, also experienced difficulties in production
of rhythmic movements of the hand as well as the perception of rhythm
(Karmiloff-Smith, 2005, cf. Konopka et al., 2009). Difficulties in processing
of nonlinguistic auditory stimuli (e.g., rapidly occurring tones) were also
noted in the study conducted by P. Tallal (1980); however, in contrast to that
study, we do not suggest the direct strict causal relationship between difficul-
ties in the processing of nonlinguistic auditory stimuli and the phonological
deficit.
Let us return to the topic of “coactive” developmental factors. We have
yet to consider the role of the environment in developmental processes.
Although they acknowledge the important role of environment, modern
“constructivists” do not pay sufficient attention to the differences between
the biological and social environment. In contrast, Vygotsky, although he
draws a close analogy between the child’s development and the evolution
of species, also emphasizes the differences between the child’s development

and the development of animals and human ancestors:
The history of the child cultural development must be considered as anal-

ogous to the living process of biological evolution, to how new species
of animals developed gradually, how in the process of the struggle for
existence, the old species became extinct, how catastrophically adapta-
tion of the living organisms to nature proceeded. . . . Introduced into the
history of child development at the same time is the concept of conflict,
that is, contradiction or clash between the natural and the historical, the
primitive and the cultural, the organic and the social (Vygotsky, 1997b,
p. 221).
Explaining this idea of Vygotsky, B. Meshcheryakov writes that “it is

exactly in the factor of ideal form that the development of higher men-
tal functions is sharply different from the processes of biological evolu-
tion and cultural development through history” (Meshcheryakov, 1998 R,
p. 46).
In the course of human life a prolonged period of time is dedicated to
the development of vitally important social forms of behavior and learning,
and this period has no analogs in the animal world. The child’s development
includes the process of internalization of social forms of behavior (thus, we
return to the first principle). Vygotsky’s famous statement – “Learning leads
development” – emphasizes the role of the social environment; however,
although the environment is the main actor, it is not the only character in
the “developmental drama.”
It is very important to consider this postulate when creating educational
and remedial methods. Unfortunately, many theoretical and practical stud-
ies of education and remediation largely ignore the presence of “characters”
in the developmental drama other than the social environment. The neu-
ropsychological approach to development and correction of HMFs consid-
ers both the biological and social developmental factors.
Following Vygotsky, we consider the developmental syndrome (in nor-
mal or abnormal development) a biosocial unity that envelops not only
the social situation of development – a form of adult–child interaction that
is specific to each age group – but also the state of a child’s HMFs: their
weak and strong components, their systemic consequences, and compen-
satory rearrangements (see also Kirk, 1972; Venger, 1994 R). Consideration
of every child’s particular characteristics and the organization of adequate
child–adult interactions are required if the remediation process is to be
successful. How to realize these requirements is the question that our book
attempts to answer.
Learning difficulties (LDs) are defined in Russian psychology according
to the ICD-10 and DSM-4. The argument that LDs occur as a result of
disturbances in cognitive information processing largely due to a biological
dysfunction (see ICD-10 F81) typically is elucidated in (Russian) neuropsy-
chological literature as follows: LDs are caused by the partial delay in the
development of higher mental functions or, more precisely, the delay of
certain components of the HMFs. However the presence of relatively strong
and weak structural-functional components of mental functions can be
seen in the population as a whole (in adults as well as children) and occurs
as a result of interactions between the individual genetic program, individ-
ual anatomic and functional organization of brain structures, individual
experience, and the subject’s own activity.
We call this phenomenon the uneven development of HMFs in children
and adults (Akhutina, 1998a R) and characterize it based on the detailed
neuropsychological analysis of the state of HMFs in adults and children
(Akhutina, 1998b R; Akhutina et al., 2000 R; Fotekova, 2004 R; Melikyan &
Akhutina, 2002 R). The same phenomenon is described in Schretlen et al.
(2003). In the course of normal development it is possible to compensate for
weak components by implementing various strategies using the strong com-
ponents of HMF. If the compensation does not occur, the lack of adaptation
to social norms is perceived as a deviation in the developmental process,
and these students might be diagnosed with learning disabilities. The level
of compensation may vary, creating a continuum with high-functioning
children with certain individual characteristics on one end, children who
have both above and below the norm of abilities in the middle, and children
whose strong and weak components are below the norm on the oppo-
site end. The idea of the continuous nature of deviations in development
accords well with the dimensional nature of learning disabilities and with
psychogenetic research data (DeFries & Alarcon, 1996; Pennington, 2002;
Plomin et al., 1994; Plomin & Price, 2001 R).
The uneven development of higher mental functions can be clearly seen
in the most widely used assessment measure of mental functioning; namely,
the Wechsler intelligence tests. The factor analysis of data on Wechsler tests
(WISC-R) has shown three stable factors: (1) language comprehension,
(2) perceptual organization, and (3) freedom from distractibility (working
memory; Kaufman, Long, & O’Neal, 1986). The presence of the stable fac-
tor groups (see Tulsky et al., 2003) shows that in the general population
strong and weak mental processes are not distributed in a mosaic pattern,
and it confirms the presence of stable groups of symptoms. Most likely,

left posterior zone functions support the functions of language compre-
hension, right-hemisphere functions support perceptual organization, and
left frontal functions support working memory. Thus, the factor structure
revealed by the WISC-R could be interpreted as the evidence of relative
independence of left posterior zone functions, right-hemisphere functions,
and left frontal functions. We became aware of this data only at the end
of the 1990s after we had completed our initial studies in the neuropsy-
chology of the norm that showed that normal subjects (both adults and
children) can be divided into three groups depending on the presence of
relative weaknesses in various components of their HMFs (Akhutina, 1998b
R; Yablokova, 1998 R). We were very pleasantly surprised to find out that
our division based on neuropsychological characteristics coincided with the
one derived from the factor structure of Wechsler’s test data. It was all the
more surprising considering that we had used very different methods. We
later found out that a fourth stable factor – speed of information process-
ing – was identified by combining Wechsler Adult Intelligence Scale, Third
Edition (WAIS-III), and Wechsler Memory Scale, Third Edition (WMS-III),
data (Tulsky et al., 2003); this factor could be correlated with the state of the
Lurian Unit I functions. Further studies of learning difficulties conducted
with T. V. Akhutina as the advisor (Akhutina et al., 2000 R; Fotekova, 2004
R; Melikyan & Akhutina, 2002 R) yielded the same results, which was to be
expected considering the continuous character of the transition from the
norm to learning disabilities.
Thus, neuropsychological methods can distinguish three main types of
learning disabilities:
1. Difficulties in developing academic skills in children with predomi-

nant weakness in programming and control of actions and serial orga-
nization of movements: because of difficulties switching between
tasks and the small volume of programming (working memory),
these children experience problems with problem solving, and count-
ing, reading, writing, discourse (the so-called compositional skills)
(Akhutina, 2004; Akhutina, Obukhova, & Obukhova, 2001; Akhutina,
Pylaeva, & Kamardina, in press R; Khotyleva et al., 2006; Polonskaya,
2002 R).
2. Difficulties in developing academic skills in children with predomi-
nant weakness in the analytical (left-hemispheric) strategy of process-
ing auditory and kinesthetic information (and in some cases also visual
information): their primary defect is in phonological processing in
writing and reading and in the tasks of vocabulary and short-term

verbal memory.
3. Difficulties in developing academic skills in children with weakness
in the holistic (right-hemispheric) strategy of processing visual, visual-
spatial, and auditory information: children with an extensive vocabu-
lary and syntax suffer difficulties in the semantic-pragmatic aspect of
verbal functions, in writing (surface/spatial dysgraphia), in counting,
and in math problem solving.
All three types of difficulties in developing learning skills may be combined

with the difficulty in maintaining an optimal level of cortical tone while
performing school tasks. These children may have ADHD or attention deficit
disorder (ADD) with hypoactivation (underaroused state), thus having
a sluggish cognitive tempo (see, for example, Morris et al., 1998; Waber
et al., 2000; Weiler et al., 2002). It is important to keep in mind that the
weakness of any component in the functional systems of academic skills
delays the process of their automatization, which is why performing school
tasks remains effortful and energy demanding. When performance of the
function overexerts the processing resources, the whole functional system
is overloaded and loses (or does not acquire) the necessary selectivity (see
the interaction of Units I and III [Luria, 1973, 1980; cf. “the automatization
hypothesis in developmental context”; Waber, 2010, pp. 110–20; Waber
et al., 2000]).
These three types of learning difficulties are widely known. The most
extensively researched type is the second type involving phonological pro-
cessing. The third type of learning difficulties, which are caused by weakness
in right-hemisphere functions, is very similar to the “syndrome of nonver-
bal learning disabilities” described by Byron Rourke (Rourke & Finlayson,
1978; Rourke, 1995), to surface and constructional (spatial) dysgraphia
(Chittooran & Tait, 2005). The first type that can be called the dysexecutive
syndrome, although not typically mentioned in the literature on learn-
ing difficulties, is often found in publications on ADHD and recently was
described by Adele Diamond as one of the variants of ADD as opposed to
ADHD (Diamond, 2005).
However, the methods used to distinguish syndromes and the under-
standing of their mechanisms based on the neuropsychological principles
of Vygotsky-Luria differ from the predominant understanding. Even in cases
where psychologists share the systemic and dynamic understanding of neu-
ropsychology, they usually do not carry out the analysis of the components
of complex functional systems of academic skills and do not differentiate
primary and secondary symptoms in their syndrome analysis of learning

disabilities.
For example, each of the types of learning difficulties described earlier
includes writing problems, but each type carries with it specific problems.
Therefore only a neuropsychological analysis that identifies primary and sec-
ondary defects and compensatory reorganization would be able to diagnose
the syndrome and understand its mechanisms. Neuropsychological testing
of the child’s HMFs is the first step, but it does not permit the full assessment
of the possible compensatory changes in the functional systems underlying
academic skills. Thus the second step – analysis of the manifestations of
learning difficulties – becomes necessary. The methods of neuropsycholog-
ical analysis of students’ behavior in school and of the mistakes they make
in their school assignments (the so-called methods of tracking diagnostics,
which we created) supplement the data obtained through testing and qual-
itative estimations of learning difficulties (Akhutina, 2004; Pylaeva, 1995
R). The specific strategy and tactics of remedial education are then created
based on these data. For more detailed discussion of different types of learn-
ing difficulties and their connections to other characteristics of HMFs, see
Chapters 3 and 18. Methods of working with students from different groups
are described in Parts II–IV.
conclusion
Vygotsky-Lurian neuropsychology is dynamic and systemic. Its opposite,
“static neuropsychology” (the term of M. Johnson, 1997) is losing pop-
ularity, as evident from a large number of studies of learning difficulties
(Berninger, 2004, Berninger & Winn, 2006; Fisher, Bernstein, & Immordino-
Yang, 2007; Grigorenko, 2008; Pennington, 1999, 2006; Waber, 2010) and in
publications on motor control and developmental motor disorders that are
highly influenced by the ideas of N. A. Bernstein (Dewey & Tupper, 2004;
Thelen, 1995, 2000, 2002).
If similar ideas can be found in contemporary publications, why then
do we turn to the ideas of Vygotsky and Luria? First, their works embody
a single integral approach to understanding the development, functioning,
and disintegration of mental functions in children and adults. The systemic
structure of HMFs is necessarily derived from the principle of the social ori-
gin of mental functions, whereas functional systems develop (and change)
in the course of child development based on interactions between biological
factors and social environment, which brings us back to the principle of the
social genesis of HMFs. Modern ideas, many of which have been mentioned
here, are not so unified as a rule and often require alignment with a more
holistic framework. Second, Vygotsky and Luria’s texts on the development
and disintegration of higher mental functions and on normal and deviant
development delve into the essence of these processes; the richness of details
helps modern researchers better understand the newly discovered facts and
create new methods to effectively help children with developmental and
part i
GENERAL ISSUES IN DEVELOPMENT AND

REMEDIATION OF HIGHER MENTAL
FUNCTIONS
Online ISBN: 9781139012799
Chapter
1 - Neuropsychology of Individual Differences in Children as the Found
ation for the Application of Neuropsychological Methods in School pp.
29-39

1
Neuropsychology of Individual Differences in Children

as the Foundation for the Application of
Neuropsychological Methods in School
The main task of psychologists working in a school setting is to facilitate the

development of students’ abilities to the fullest extent. According to A. G.
Asmolov (1996 R), a school psychologist accomplishes this task by doing
the following:
r Organizing a milieu that is conducive for the students’ development
and creating developmental programs
r Assessing the developmental process and helping students find their
individual developmental paths
r Providing psychotherapy and offering expertise in conflict resolution
Interactions between psychologists and teachers help turn teaching into

developmental teaching, which influences student development and, in
turn, becomes a powerful psychotherapeutic tool for both students and
teachers.
The experience of the staff at the laboratory of neuropsychology, Moscow
State University Department of Psychology, has shown that a neuropsychol-
ogist can effectively implement diagnostic procedures in a school setting.
We gained this experience in collaboration with the staff of the Moscow
Child and Adolescent Center for Psychological, Medical and Social Support
and with the specialists from the Center for Curative Pedagogics (under the
supervision of Anna Bitova and Roman Dimenstein).
The theoretical foundation developed by A. R. Luria and his teacher L. S.
Vygotsky guides the work conducted by neuropsychologists in schools and
is built on three principles: (1) the social genesis of higher mental functions
(HMFs), (2) the systemic structure of HMFs, and (3) HMFs’ dynamic orga-
nization and localization. Russian educational psychologists acknowledge
and use the first principle in their work, whereas only neuropsychologists
put into practice the second and third principles.
29
One of the fastest growing areas in neuropsychology is the neuropsy-

chology of the norm or the neuropsychology of individual differences. The
corresponding area in child neuropsychology provides the foundation for
the application of neuropsychological methods in school.
What are the hypotheses that create a basis for developmental neuropsychology
of individual differences and remedial-developmental education?
We argue that the typical heterochronic maturation of brain structures
that is defined by the genetic program of the species varies because of
the influence of the individual genetic program, social (environmental)
factors, and the individual’s activity (cf. Egorova & Maryutina, 1992 R).
The structural-functional self-organization of HMFs is determined by the
probabilistic interaction among these factors. In the course of this interac-
tion some functional groups undergo faster development, whereas others
develop in a less favorable way, which results in the uneven development of
separate components of HMFs. As the well-known neurophysiologist Natalia
Dubrovinskaya (1996 R, p. 26) asserted, “Significant intra-individual vari-
ability represents not the accidental and undesirable deviation from the
average norm but a natural phenomenon beneficial for the population as
a whole. These are different not ‘bad’ or ‘good’ variations of the norm.”
The concept of uneven development leads to the first set of interconnected
hypotheses:
r Hypothesis 1: The norm is characterized by uneven development in
HMFs, which is particularly prominent during childhood.
r Hypothesis 2: The observed functional dissociations occur along the
seams (joints) of normal mechanisms and reflect their component struc-
ture.
r Hypothesis 3: The potential ability to compensate for functional weak-
nesses can be used as an indicator that separates normal from abnor-
mal: if a child can compensate for his or her weaknesses, that child
will undergo normal development; those who cannot compensate for
their weaknesses will deviate from normal development (i.e., without
good adaptation to social demands).
We further argue that the delay in the development of a functional com-
ponent results in its partial dropout. The primary delay causes secondary
modifications and compensatory changes – both real positive adaptive and
fictitious negative maladaptive changes. Such a complex picture of actual
development creates the need for syndrome analysis that is very similar to
the clinical analysis used in cases of focal brain damage.
Neuropsychology of Individual Differences in Children 31
The second set of hypotheses derived from this argument are as follows:
r Hypothesis 4: Neuropsychological diagnostic methods can be used to
identify the strong and the weak components of functional systems.
r Hypothesis 5: The tracking of developmental dynamics (analysis of the
zone of proximal development, repeated assessments during remedia-
tion, and “tracking diagnostics”) enables identification of the primary
and secondary compromised processes, because the secondary defects
are more amenable to restoration and remediation (Vygotsky, 1993).
Hypotheses 4 and 5 require additional explanation. In the clinical treat-
ment of focal brain damage in adults, neuropsychological assessment deter-
mines the strong and weak components of mental functions, identifies
primary and secondary compromised processes, and provides the topical
diagnosis – the localization of brain lesions. In children the problem is more
complicated.
Because of the vast array of possibilities for reorganization of developing
functional systems in children, the organic defect can be compensated for in
the presence of favorable environmental conditions and successful unfold-
ing of the self-organization process of brain systems. However, if internal
self-organization or interactions with the environment are unfavorable then
the defect does not get compensated. Pronounced environmental and, con-
sequently, functional deprivation can even cause an organic defect. In other
words, in children the relationships between organic problems and func-
tional disturbances are less straightforward than in adults.
The matters are made even more complicated by the fact that later the
initial deficiency – as noted by Vygotsky and Luria (Luria, 1980; Vygot-
sky, 1995 R) – leads to the dysfunction in the mechanisms that have to
build on it, which in turn leads to new secondary systemic dysfunctions.
As a result, on the level of HMFs, neuropsychological assessment methods
are able to reveal a significantly “spread out” dysfunction (“developmental
cascade”). In the dynamic process of learning, the systemic dysfunctions
diminish, being more pliable, whereas the primary defect with its vertical
consequences – the deficiencies of overlying operations that were built with
the participation of the affected component – is harder to remediate. Thus,
analysis of learning dynamics can reveal the functional structure of a defect.
At the same time, vertical topical diagnosis (inside the “functional module”)
is generally difficult to conduct. Some authors argue that mapping from cog-
nitive to neural defects (topical diagnosis) in children is on principle hardly
possible (see, e.g., Johnson, 1997). Thus, the main task that neuropsycho-
logical diagnostics in children competently accomplishes is the assessment
of the state/condition of the functional systems’ components that support

HMFs; in other words, it is a functional diagnosis.
What degree of detail of functional systems’ components is optimal to achieve
the goals and capabilities of child neuropsychological assessment?
The functional analysis of a HMF – for example, writing a dictation – can
be conducted in operational terms: the writing process engages the processes
of primary auditory perception, short-term auditory memory, phonolog-
ical analysis, etc. However, the same analysis can also be conducted using
units of a larger scale. Thus, one can say that the process of writing con-
sists of processing auditory information, as well as kinesthetic, visual, and
visual-spatial information; serial movement organization, programming,
and control; and selective activation and its maintenance. In this approach
operations that are close in neural and functional genesis and localization
and that function according to the same principle (“factor,” according to
Luria) belong to the same functional component.
In adult neuropsychology the accuracy of the identification of particular
functional components has been confirmed with syndrome analysis of focal
lesions, topical diagnostics, and rehabilitation practice (Luria, 1980). How-
ever, functional division into components (“factors”) in children requires
prolonged and thorough scientific investigation. It can begin with the analy-
sis of the success of operations that belong to the same or different functional
components, using as the initial working hypothesis the functional division
that has been described in adults. The use of this functional division is
justified because it is relatively stable in adults, and developing functional
systems in children strive to achieve it. The detailed comparison and its
discussion are beyond the scope of this book. We limit ourselves to verifying
the hypotheses presented earlier and showing the principal validity of the
suggested approach.
Diagnosis presented in terms of functional components rather than
operations is consistent with the task of remedial-developmental education.
To verify the five hypotheses we chose three approaches:
1. Analysis of the data obtained through complete neuropsychological

assessment
2. Comparison of the results of the neuropsychological assessment with
the results of computerized tests that register the timing and quality
of responses
3. Analysis of the success of remedial-developmental education designed
on the basis of neuropsychological functional diagnosis
Table 1.1. Tests battery for the assessment of children 6- to 9-years-old
Unit III. Programming, Regulation, and Control

Serial organization of movements and Palm-First-Edge Test; Reciprocal Coordination;
speech Graphomotor Sequences Test; Reproduction of
Rhythms (after verbal instruction); Sentence
Completion; Creating a Story based on the
series of pictures
Programming and control of voluntary Go-no-go tasks; Schulte’s tables; Counting;
actions (executive functions) Problem Solving; Verbal Fluency Tests; “Odd
one out”; Arranging series of pictures
Unit II. Information Perception, Processing, and Storage
Processing of kinesthetic information Finger Position Test; Oral Praxis
Processing of auditory information Rhythm Reproduction and Evaluation;
Understanding of Similar Sounding Words;
Understanding of Words Similar in Meaning;
Verbal Memory Test
Processing of visual information Perception of Superimposed, Crossed out, and
Unfinished Images; Design Fluency Tests (free
drawings, drawings of plants)
Processing of visual-spatial information Head’s Test (reproduction of hand position);
Constructional Test (mental rotation of design);
Three-Dimensional Drawings; Block Design
Test; Visual Spatial Memory; Understanding of
Logical Grammatical Constructions
Unit I. Energy Unit and Subcortical-Brainstem Structures
The functions of this unit can be assessed in the process of completing the whole test battery,
in particular movement trials and Schulte’s tables. The fluctuations of attention,
exhaustion, micro- and macrography, muscle hypo- and hypertension, speed, and pauses
are considered.
For the purposes of this research we needed to conduct a complete

neuropsychological assessment (as opposed to a screening assessment). In
our laboratory we adapted the battery of tests created by A. R. Luria: we
selected the tasks to be analyzed, standardized the procedures, and selected
and verified assessment criteria (Akhutina et al., 1996 R, 2008 R). In Table 1.1
we classify the battery of tests according to the main functional goal of the
trials (we use Luria’s proposed division of functional organization of the
brain into three parts that are called “units” or “blocks”).
analysis of neuropsychological assessment data

The first approach was to analyze the neuropsychological assessment data.
In the 1990s members of the laboratory staff conducted two longitudinal
studies of the development of HMFs in 75 first- and second-grade stu-

dents and 46 students from Grades 1 through 4 from two Moscow schools
(Akhutina et al., 1996 R; Polonskaya, 2007 R; Polonskaya et al., 1997 R).
We verified Hypothesis 1 on the basis of the analysis of peculiarities
of neuropsychological profiles in different subjects. The different (posi-
tive and negative) directions of deviations below and above the average in
each subject confirmed Hypothesis 1: the norm is characterized by uneven
development in HMFs.
The work of Schretlen et al. (2003) has confirmed Hypothesis 1 as well.
They examined the range of intra-individual variability in neuropsycholog-
ical test performance of 197 healthy subjects (aged 20 to 92). The authors
used 15 neuropsychological tests (with 32 parameters) and measured the
difference between the highest and lowest results in each subject. They found
that the difference varied from 1.6 to 6.1 standard deviations (mean of 3.4).
Only 2% of subjects had a difference less than 2 standard deviations.
The next step was to answer this question: Were the identified changes
completely random (mosaic), or did they reflect the component structure of
functional systems – as stated in Hypothesis 2? If this hypothesis is correct,
the results of the testing would be able to distinguish different groups of
children with relative underdevelopment of certain components of HMFs.
Turning to the proofs of Hypothesis 2, we would like to comment on
the perception of the notion of uneven development of HMF components.
Usually psychologists and teachers who hear about this concept for the first
time agree that children who do not do well in school could have weak and
strong components of HMFs, but they do not accept that successful children
are also characterized by the uneven development of mental processes. The
results of the first longitudinal study are relevant to answering that objection.
In that study, of the 75 students in their classes teachers selected 44 who
had achieved success in school. After quantitative and qualitative analy-
sis of their neuropsychological test performance, these 44 children were
classified into three groups: (1) those with relative underdevelopment of
left-hemisphere functions – 18; (2) those with relative underdevelopment
of right-hemisphere functions – 10; and (3) those with relative under-
development of both hemisphere functions – 16 pupils. Among the 18
children in the first group, 6 had relative weakness of programming and
control functions and serial organization of movements and speech, 8 had
relative weakness mainly of acoustic verbal information processing, and 4
pupils had both the left-hemisphere weaknesses. Both verbal and nonver-
bal tests showed these weaknesses to be congruent, which argues against
their mosaic character. We did not distinguish subgroups in the second
group of children, who had relative underdevelopment of right-hemisphere

functions, because of more diffuse functional-structural organization of this
hemisphere, especially in children. The children in the third subgroup were
easy to divide by severity of problems: 13 pupils had mild problems of
executive functions and visual and visual-spatial information processing
(holistic and/or analytic strategies), and 3 pupils had more severe complex
problems. The verbal test results of the three groups – left frontal, left pos-
terior, and right hemisphere functions underdeveloped – are presented in
Akhutina (1998a R).
It is important to note that this division into three groups with rela-
tive underdevelopment of left frontal, left posterior, and right-hemisphere
functions was replicated by our colleagues and us in subsequent studies
(Akhutina et al., 2000 R; Fotekova, 2004 R; Melikyan & Akhutina, 2002 R).
As noted in the introduction to this book’s English-language edition, we
argue that it is not by chance that the factor analysis of the huge amount
of Wechsler test data (WISC-R) has shown three stable factors: (1) lan-
guage comprehension, (2) perceptual organization, and (3) freedom from
distractibility (working memory; Kaufman, Long, & O’Neal, 1986). These
three factors could be interpreted as evidence of the relative independence
of left posterior zone functions, right-hemisphere functions, and left frontal
functions. Later, by combining WAIS-III and WMS-III data, the fourth sta-
ble factor – speed of information processing – was distinguished (Tulsky
et al., 2003); it could be correlated with the state of Lurian Unit I functions.
use of computerized methods

Now let us turn to computerized methods that allow registration of the time
and quality of response in a precise manner.
We consider the results of a study of structural rhythmic tapping that
enables analysis of the serial organization of movements (Kurgansky &
Akhutina, 1996 R). The data presented in Table 1.2 clearly demonstrate
that the lengths of the intervals in serial tapping – for example, in triads
conducted by right (RRR) and left (LLL) hands or in bimanual complex
rhythms (LRR, RLL) – have higher statistically significant correlations with
the quality of performance in the dynamic praxis trial (all correlations are
positive from .203 to .590∗∗ ) than with the finger praxis trial and indicators
of problems in activation maintenance (micrographia, incomplete fulfill-
ment because of fatigue) in the graphic trial (for information on methods
and subjects, see Kurgansky & Akhutina, 1996 R). Especially high corre-
lations (from .287∗ to .590∗∗ ) are seen in cases of between-triad intervals,
Table 1.2. Coefficients of linear correlations between the intertap intervals and the
neuropsychological indexes of the I, II, and III units (R- right hand; L – left hand;
I – interval)
Graphic trial Finger praxis Dynamic praxis

Serial movements Unit I Unit II Unit III
R .047 .140 .260

L −.110 .148 .355∗
RL .035 −.055 .224
RRR I1 −.142 .054 .287∗
I2 −.084 −.015 .230
I3 −.106 .009 .247
LLL I1 −.093 .202 .323∗
I2 −.105 −.016 .320∗
I3 −.173 .009 .284∗
LRR I1 .362∗∗ .217 .322∗
I2 .143 .233 .292∗
I3 .070 .272∗ .203
RLL I1 .295∗ .397∗ .590∗∗
I2 .307∗ .188 .319∗
I3 .208 .205 .315∗
designated in Table 1.2 as I1; these intervals reflect the time needed for
organization of the next group of taps, and that is why they are very good
indicators of the serial organization of movements.
Thus, data show that the neuropsychological assessment indicators in
normal students reflect individual differences in the functioning of different
components of HMF, which is consistent with our second hypothesis.
Based on our third hypothesis that normal children differ from non-
normal children by their ability to compensate for relative functional weak-
nesses, we suggested that in cases where the deficiencies have been compen-
sated (in other words, they can be detected with the help of specialized tests,
but have minimal effect on general productivity, including school grades)
very few low indicators will be obtained, the rest of the trials will be suc-
cessfully completed, and as a whole the summary results of the neuropsy-
chological testing will be comparatively high; in contrast, in cases where
difficulties were not compensated more low indicators will be obtained,
and as a whole these students will show lower summary results. Thus, the
group as a whole will show correlations between summary results of test
performance and the degree of learning success. Our results did confirm
these three suggestions as well as showed that straight “A” students at times
Table 1.3. Results of trials in the groups of students with good and poor success in school
Groups of children
Marks/
Trials Number With good success With poor success
Choice reaction (two tasks) Number of errors 0.8 2.3

Fluency tests: free associations; Number of words 18.6 19.0
actions plants 8.3 8.3
8.4 8.4
Reciprocal coordination (0 – 0 45% 25%
best results, 3 – worst results) 1 28% 25%
2 18% 31%
3 9% 19%
Dynamic praxis 0 73% 14%
(Palm-First-Edge Test): 1 9% 43%
performance 2 9% 21%
quality (0 – best results, 3 – 3 9% 22%
worst results)
Graphic 0 33% 15%
trial 1 42% 23%
performance 2 17% 39%
quality (0 – best results, 4 – 3 8% 15%
worst results); time of 4 0% 8%
performance of one series mean time (sec) 7.8 8.3
Source: Polonskaya, 2007 R.
(in some tests) achieved lower results. Because these data have been pre-
sented in several publications (Akhutina et al., 1996R; Polonskaya, 2003 R,
2007 R; Polonskaya, Yablokova, & Akhutina, 1997 R;) we give only a few
examples here.
First let us consider the results of the programming and control trials
in 46 pupils of the two first-grade classes mentioned earlier. The teach-
ers evaluated success in school in 12 pupils as “good,” in 21 students
as “average,” and in 13 as “weak.” Table 1.3 presents the results of the
pupils in the “good” and “weak” groups. The “0” mark designates the
best (errorless) performance; the “3” or “4” marks mean the worst per-
formance. The number of associations and errors are presented where
appropriate.
As Table 1.3 shows, the children with poor success in school performed
worse on almost all tests; only on one fluency test did they show the same
Table 1.4. Value of neuropsychological indexes in first-grade

children with varying success in school
Success in school
Index Good Average Poor
Frontal 0.39 0.25 −0.69

Posterior 0.47 0.02 −0.44
Left 0.53 0.02 −0.49
Right 0.28 −0.09 −0.12
Source: Polonskaya, 2003R.
results as the “good” students. If all results relating to one neuropsycholog-

ical component are combined, the differences between the groups become
more evident. Comparison of four indexes that summarize the estimation
of frontal and posterior functions of both hemispheres and the functions
of left and right hemispheres highlights these differences, as presented in
Table 1.4.
The indexes of first-graders with good success in school are not sta-
tistically significantly different from the indexes of the “average” group.
However, the indexes of children with poor success in school are statistically
significantly different from the indexes of children in the good and average
groups: the left index (p = .017 and .06), the frontal index (p = .021 and
.004), and the posterior index (p = .022 and .01), respectively. It is inter-
esting that the difference in the right indexes appeared the following year.
The difference between the right index of second-graders with good success
in school from the same indexes of “average” and “poor” groups (p = .002
and .004, respectively) was statistically significant (Polonskaya, 2003 R).
Therefore comparisons of neuropsychological testing of students with
different success in school demonstrate that the groups as a whole show
correlations between test performance and the degree of learning success;
however, in any group there are children with some strong and some weak
components of HMFs.
remedial-developmental education
The third method of verifying the hypothesis is through the results of
remedial-developmental education (RDE). If the specifically directed RDE
interventions that were designed based on the data obtained in neuropsy-
chological assessment are more successful than extra lessons with a teacher
or a general psychologist, then that would verify our hypothesis. The remain-
der of this book is devoted to verifying this hypothesis. Recent studies with
control groups of subjects show the effectiveness of the methods described
in this book (Akhutina & Kamardina, 2008 R, 2008; Skityaeva, 2010 R;
Skityaeva & Akhutina, 2011 R; see also Akhutina & Cole, 2008).
Online ISBN: 9781139012799
Chapter
2 - Methodology of Neuropsychological Intervention in Children with Un
even Development of Mental Functions pp. 40-47

2
Methodology of Neuropsychological Intervention

in Children with Uneven Development of Mental
Functions
Neuropsychological methods of helping children are gaining more and more

popularity among school psychologists. The following groups of students
particularly benefit from these methods:
r students with learning disabilities or at risk for developing learning
disabilities
r poorly performing students
r gifted children, including those who experience school problems
r children with psychosomatic problems
r students who succeed in school at the expense of their physical health
All these groups share one feature that we discussed in the first chapter:
a pronounced unevenness in the development of higher mental functions
(HMFs) caused by partial delay in the development of some functions when
they are not sufficiently compensated for by more advanced functions. In
this chapter we explore the concept of “unevenness.”
We all know from experience that some adults and children have bet-
ter developed visual perception and memory, whereas others have more
developed auditory or tactile processes. These differences are not acciden-
tal. Development of brain systems and functional groups is a long process
contingent on interactions between biological (organic) and social (envi-
ronmental) factors, as well as the probability mechanisms of brain systems’
self-organization. As a result, the development of some groups of functions
occurs faster than others, which causes unevenness in the development of
certain components of HMFs. The individual genetic program, environ-
ment, and the individual’s activity determine this process.
Unevenness in the development of structural-functional components of
HMFs in itself is not an abnormal phenomenon. It has a significant adaptive
40
Methodology of Neuropsychological Intervention in Children 41
effect because when different people have different abilities the population
as a whole benefits. The presence of the relatively independent subsystems
in the genetic program (evident in the uneven development) creates a more
stable system as a whole (Marr, 1976).
When the environment (the social environment in particular) places
demands on the person that are within his or her adaptive capabilities,
unevenness in the development of HMFs does not have negative con-
sequences for the individual or the society. However, in industrial soci-
eties with their rapid development of new technologies, demands on the
quality of education and learning consistently increase. At the same time,
in all industrial countries ecological problems, the highly stressful lives
of parents, and other biological and social factors, such as the decrease
in recreational opportunities, cause the worsening of children’s psycho-
physiological health. Both these trends lead to the situation in which children
in today’s world, already weaker and less prepared physically and psycho-
logically, are faced with greater demands. In these conditions, unevenness
in the development of higher mental functions creates a situation in which
relatively weak components become obstacles to further development and
successful learning.
In Russia and in the United States, of children with all types of deviations
in mental development, the only group that is greatly increasing in size are
those with partial delay in the development of HMFs (in Russian statistics,
these are the children with mild delays in mental development and students
in compensatory and remedial education; in the United States these are the
children with specific learning disabilities). For example, in 1977 only 1.8%
of American children were diagnosed with learning disabilities, in contrast
to 5.4% in 1993 (U.S. Department of Education, 1993).
In the previous chapter and in the introduction to this chapter, we
presented arguments that the norm is characterized by an unevenness in
development of structural-functional components and that this uneven-
ness is particularly pronounced in children. However, the functions of the
weak components can be compensated for by adaptation of the functional
systems. This compensation can be more or less successful, and thus in the
norm there can be a wide range of abilities to learn.
Unevenness in the development of higher mental functions occurs along
the whole continuum from highly functioning children to those with pro-
nounced abnormal development. Different cognitive profiles can even be
identified among developmentally disabled children; for example, between
children with Down syndrome with more pronounced left-hemisphere
symptomatology and children with Williams syndrome with more pro-

nounced right-hemisphere deficiencies (Bellugi et al., 1988; Bihrle et al.,
1989).
On this continuum the transitional part that goes from normal to abnor-
mal development is wide and includes children with partial underdevelop-
ment of mental functions that was not compensated or compensated insuffi-
ciently in the process of education and training. These are the students in par-
ticular need of neuropsychological help because neuropsychologists do not
limit themselves to ascertaining HMF weakness (e.g., reading or calculation
abilities), but also determine exactly which one of the structural-functional
components has suffered primarily and caused the underdevelopment of
this function as a whole. Then on the basis of this analysis neuropsycholo-
gists can develop individual strategies and tactics of remedial-developmental
interventions.
The methodology of diagnosis with children has been covered in Russian
publications in detail (Akhutina et al., 1996 R, 2008 R; Korsakova et al.,
1997 R; Mikadze, 2002 R; Polonskaya, 2007 R; Semenovich, 2002 R, 2005
R; Tsvetkova, 2001 R). All these authors, following A. R. Luria, emphasize
the need for a systemic or syndrome approach that identifies the primary
affected component of the functional system, the secondary systemic con-
sequences, and compensatory adjustments and reorganizations. According
to Vygotsky, such an analysis should enable psychologists to “a) explain
the plus and minus symptoms observed in a certain disorder using a single
principle; b) reduce all symptoms, even those which are most remote from
each other, to a unity, to the lawfully built structure; and c) outline the
path leading from focal disorders of a certain type to a specific alteration of
the whole personality and his way of life” (Vygotsky, 1997a, p. 143). Luria
called this kind of analysis a “factor analysis” (the “convergence profile anal-
ysis” proposed by I. S. Baron [2004, pp. 13–15] is also close to Vygotsky’s
conception).
These experts agree that a neuropsychological analysis can produce both
a functional and topical diagnosis in adults. However, they do not agree on
whether it can produce a reliable topical diagnosis in children. Those who
believe that the only reliable diagnosis in children is a functional diagno-
sis (Akhutina, 1998a R; Johnson, 1997) base their opinion on the princi-
ple of dynamic (“chronogenic”) organization and localization of functions
(Luria, 1980; Vygotsky, 1996 R) or the ideas of “probabilistic epigenesis”
and “chronotopic nativism” (Elman et al., 1996; Gottlieb, 1992). There
are several reasons why a neuropsychological assessment enables identifi-
cation of the affected functional component, but that component’s topical
characteristic can only be determined based on probability. Among these

reasons are the following:
r continuous process of mental functions’ corticalization

r age diffuseness and plasticity of functional organs in children
r the possibility of organization of a particular mental process along
different levels of the brain hierarchy
r the presence of circular functional connections in different brain struc-
tures
The variance in vertical direction is particularly wide both because of

the dynamics of developmental processes and the hierarchical organization
of mental processes: symptoms at a certain level can be caused by a deficit
in this level or by the negative influences from the levels above or below.
The more definitive topical diagnosis can be formulated along the axes
“anterior–posterior areas of the brain” and “right–left brain hemisphere”
(Akhutina et al., 2000 R; Polonskaya, 2007 R).
Despite certain disagreements, Russian neuropsychologists share the
opinion of N. K. Korsakova that topical diagnostics in children is diffi-
cult and that “in any case (except cases of obvious neuropsychological
disturbances that require thorough medical assessment) psychologists or
teachers can use the functional diagnosis alone when providing assistance
for a student and design remedial interventions based on weak and strong
components of child cognitive activity” (Korsakova et al., 1997 R, p. 21).
As described in Chapter 1, the methodology of remedial-developmental
interventions is based on the principle of the social genesis of mental func-
tions, their systemic structure, and dynamic organization and localization
(Luria, 1980; Vygotsky, 1997a). L. S. Tsvetkova (1972b R, 2001 R) has also
made a significant contribution to the theories and methods of neuropsy-
chological rehabilitation and remediation.
Two main approaches have emerged in remedial work with children:
1. development of basic foundations: “prerequisites” of cognitive func-

tions
2. development and remediation of cognitive functions and their com-
ponents
These approaches are complementary. The first one focuses on the senso-
rimotor level on the assumption that such help activates the development
of all the HMFs (Semenovich, 1998 R, 2002 R). The second one focuses on
the development and remediation of cognitive functions and the compo-

nents (links) of these functions, implementing the ideas of Vygotsky on the
process of internalization.
In his thesis “Psychology and the Theory of Localization of Mental
Functions,” Vygotsky wrote,
[I]nitially all these functions [higher forms of speech, cognition, and
action – T.A.] function in intimate connections with external activity
and only later on, as it were, disappear inward and change into the inner
activity. Research into the compensatory functions which develop in
these disorders also shows that objectification of a disturbed function,
i.e. bringing it outside and changing it into external activity, is one of the
basic roads in the compensation of disorders (Vygotsky, 1997a, p. 143).
Before we consider this approach in detail, it is worth discussing several
strategies of the remediation of cognitive functions that have been described
in literature, particularly, analytical and interactive approaches. Analytical
approaches are based on the identification of the weak and strong aspects
of a child’s development and include the following:
r “attack of weakness” (Alfano & Finlayson, 1987; Kirk, 1972; Reitan,
1980)
r remediation using intact links (Flynn, 1987; Simernitskaya & Matyu-
gin, 1991 R)
r mixed approach (Rourke et al., 1983, 2002)
Interactive approaches focus on supporting learning motivation and

involving children in active interaction with adults.
Both approaches have their disadvantages and strengths. The disadvan-
tage of “attack of weakness” approach, which is quite popular in educa-
tional settings, is its excessive load on the weak components (“try again!”)
and insufficient help given to students (they are not given the means and
methods of overcoming difficulties that they experience). With remediation
using the intact links approach the student is being adapted to the defect (an
advantage), but the development of the weak link is neglected (a disadvan-
tage). In the mixed approach it is clear how to unite the first two approaches
to cure some specific problems, but not clear how to do so in general.
Interactive approaches focus on students’ activity (an advantage), but
students are treated as an idealized subject of the creative process. As a
result their weaknesses and difficulties are not taken into consideration,
and the development of the weak components of student’s functional
system is neglected. Students are encouraged to adapt to their defects (a
disadvantage).
Based on the theory of the development of the child’s mental functions

development (L. S. Vygotsky and P. Y. Galperin) and the theory of the sys-
temic dynamic organization of functions (L. S. Vygotsky and A. R. Luria),
we have developed a complex approach to remedial-developmental educa-
tion that incorporates the advantages of both the analytical and interactive
strategies. It addresses the development of the HMF’s weak component by
using the strong components in the course of targeted interactions between
a child and an adult. These interactions are constructed by taking the fol-
lowing elements into account:
r dynamics of the process of internalization
r weak component of the child’s functional systems
r child’s emotional involvement in the interactive process
The dynamics of the process of internalization (L. S. Vygotsky and P.

Y. Galperin) are incorporated by sequencing tasks from simple to more
complicated based on three parameters: joint/independent action, use of
external supports/interiorized action, and step-by-step/fluent automatized
action.
To address the weak component of the child’s functional systems in the
process of interaction, an adult first fulfills the functions of the weak compo-
nent and then gradually transfers them to the child (“scaffolded,” “errorless”
learning). The adult sequences the tasks from simple to more complex as
they relate to the weak component. The child is presented with the task, and
the adult helps complete it, decreasing or increasing help depending on the
child’s success (i.e., the help is interactive in nature). Thus the psychologist
or the teacher works within the zone of proximal development, according
to L. S. Vygotsky, conducting a qualitative analysis of the difficulties experi-
enced by the child and the help needed. Identifying the appropriate quality
and level of complexity of tasks, arranging them in the right sequence,
determining the optimal amount of help, and constantly decreasing it are
the necessary conditions of effective remediation as well as indicators of the
level of professionalism of the teacher-psychologist.
Work with the weak component occurs not only within the frames of
the isolated function – for example, writing – but also with all the verbal
and nonverbal functions that involve this component. Identification of the
weak component does not occur only in the process of neuropsychological
assessment before the start of the remedial work; rather the functional
diagnosis is refined through dynamic tracking in the process of that work.
The methods of “tracking diagnostics” are developed to analyze all the
peculiarities of the student’s behaviors, learning activities, way of solving
problems, and typical mistakes from the neuropsychological point of view.

A reduction in the number of mistakes as the amount of help is decreased
and the assignments become more complex is a good indicator of effective
remedial intervention.
The emotional involvement of a child in the process of social interaction is
a prerequisite for his or her cognitive development. If the emotional sphere
is among the child’s strengths, it can be used in the process of remedial work;
if it is not sufficiently developed, the development of this sphere should be
the first priority. When the child is not an object but one of the subjects of
learning, when he or she is emotionally involved in the learning process and
is successful in completing the assignments, then the “affective-volitional
basis” (Vygotsky, 1988, p. 282) of the learning process emerges and supports
the natural increase in productivity and effective brain functioning without
adversely affecting physical health.
Based on these theoretical foundations, several remedial-developmental
methods have been created in the neuropsychology laboratory of Moscow
State University: the central one is the School of Attention method
developed by N. M. Pylaeva and T. V. Akhutina (Pylaeva & Akhutina,
1997/2008 R).
The School of Attention method is used to remediate learning disabil-
ities caused by weaknesses in programming and control functions (func-
tional Unit III; Luria, 1973). It helps unfold to a maximum degree the
programming process, supporting the transition from the actions in the
external materialized plane to the internalization of the student’s actions.
This method is conducted in an interactive way: from the joint actions of
the student and the psychologist aimed at the creation and realization of the
program in the external plane, to the student working with the help of the
psychologist in case of difficulties, and finally to the student’s independent
completion of assignments.
This system of methods offers a wide variation in the complexity of the
materials, which enables tasks to be individualized depending on the age,
needs, and abilities of the child. The repertoire of methods for developing
interventions is also quite diverse. In addition to the School of Attention
method, V. M. Kogan’s classification method, the Link’s cube (Chapters
6–8), attention and memory games, and different types of ciphers adapted
for the purposes of remedial-developmental education are also available.
Providing different types of motivation such as play, cognitive, and com-
petitive motivations increases children’s ability to work and improves the
processing characteristics of their activity.
Different methods are available to assist in developing Unit II functions:

visual-verbal functions (Pylaeva & Akhutina, 2008 R; see Chapter11) and
visual-spatial functions (Pylaeva & Akhutina, 2000 R; see Chapter 14).
It is important to emphasize that the externalization of the program and
“dosing” of tasks are particularly important in the system of developing and
remediating Unit III functions. To remediate Unit II functions, simplicity of
selection is required: from choosing among dissimilar elements to choosing
among similar ones. This choice is based on Luria’s (1973, 1976) under-
standing of the mechanism of mistakes in Unit III and II dysfunctions:
deficit of Unit III functions is characterized by such mistakes as simpli-
fication of the program and lack of inhibition, whereas deficit of Unit II
functions features difficulties in the differentiation of similar elements.
Online ISBN: 9781139012799
Chapter
3 - What Psychologists, Teachers, and Parents Need to Know About Child
ren with Learning Disabilities pp. 48-64

3
What Psychologists, Teachers, and Parents Need to

Know About Children with Learning Disabilities
A large number of children experience difficulties in school, but for some

students, these problems are more severe and persistent.
who are these children?

They are found in both regular and remedial classrooms; they may be
successful in some subjects (mostly oral), but have problems with writing,
reading, or math. Some push themselves hard and have passing grades in all
the classes, but their health– both physical and mental– suffers as a result.
These are the children with learning difficulties or learning disabilities (in
an extended sense of the term), and this book is about how to help them
succeed.
Psychological studies of mechanisms of learning disabilities show that
the majority of these students experience partial delay in the development of
higher mental functions. Neuropsychological methods can assess the state of
these functions.
From the point of view of neuropsychology, reading, writing, solving
math problems, as well as oral speech and its understanding, are com-
plex functional systems that have a number of components, each of which
is supported by a particular area of the brain and provides very specific
contributions to the functioning of the system as a whole. The same com-
ponent can belong to several different functional systems. For example,
phonemic hearing and phonological analysis (the ability to distinguish the
sounds of speech involuntarily and voluntarily) are necessary for under-
standing oral speech and mastering writing and reading; however, they play
a minimal role in math problem solving. Visual analysis, recognition, and
48
What Psychologists, Teachers, and Parents Need to Know About Children 49
memorization of visual images of letters and words play important roles in

the process of reading.
Neuropsychologists identify strong and weak components of higher
mental functions (HMFs) by comparing the results of different tasks com-
pleted by the child and thus determining the mechanisms of his or her
Analysis of the structure of HMFs and their brain localization conducted
by A. R. Luria (1973) showed that any HMF, such as reading or writing,
requires action programming, information processing, and maintenance of
the brain’s working condition. Deep and medial parts of the brain help
maintain the state of arousal, allowing retention of the capacity to work
(functional Unit I according to Luria’s terminology); posterior areas of
the cortex support information processing (Unit II); and frontal cortical
areas are responsible for programming and control functions (≈ executive
functions; Unit III).
Development of HMFs in children is an extended process: some functions
develop early, and others do not develop until later. For every human being,
this “schedule” undergoes “corrections” caused by the individual genetic
program and environmental influences (Egorova & Maryutina, 1992 R).
As a result of such variations, as was already noted earlier, HMFs develop
unevenly: for example, some children have a better developed auditory
perception, whereas others have more advanced visual perception or spatial
orientation.
When the unevenness is pronounced and students are not able to com-
pensate for weak components by using strong ones, they are not able to meet
social demands, and that failure translates into and gets noticed through
What Types of Learning Disabilities (LDs) Are We Referring to Here?
delays in the development of

programming and control functions
Every teacher has probably encountered students in the classroom who have
difficulty focusing on the task at hand. They are easily distracted and do
not concentrate on the content of the tasks; they often answer the teacher’s
questions without thinking and do not seem to notice the obvious absurdity
of their answers. These children experience difficulties in making plans and
acting according to the plan. This type of behavior is typical of delays
in the development of programming and control functions (≈ executive
functions).
Comprehensive observations of such children’s behavior during task

completion reveal the following:
r These children have difficulty initiating tasks.
r Their orienting activity is chaotic and incomplete.
r Their plans are simplified and unstable, and the children tend “to slide”
to the more simplistic version of the task completion, often failing to
carry the task through to the end.
r They repeat the parts of the program or the whole program and fail to
inhibit inappropriate answers (e.g., when writing a sentence they may
repeat an element of the letter, a whole letter, a syllable, or the whole
word).
r They are impulsive and get easily distracted by outside stimuli.
r They do not compare results with the model of task performance or
the plan.
r They find it difficult to switch from one task to the other, stop the
activity that they are engaged in, and move to a different activity that
they consider a chore.
The main causes of their mistakes are simplifying the tasks and persever-
ations; in other words, they have problems in executive functions: inhibitory
control, working memory, and cognitive flexibility (see, for example,
Diamond et al., 2007). These students need help to become organized
because organizational skills are their most vulnerable area. Weak self-
regulation and low motivation lead to failures in school and behavior prob-
lems. Problems in school and at home decrease these students’ motivation
to learn even more, which leads to more problems in school and increased
behavioral problems. From that point it is relatively easy to develop negative
compensation in the form of bravado or adopting the role of a class clown
and later engaging in antisocial behaviors.
Difficulties in programming and control can become evident in all school
assignments that require voluntary attention, but they are especially obvious
when the student attempts to complete cognitive tasks such as solving logical
or math problems, as seen in the following example:
A 7 1/2-year-old first grader is working on a problem where he needs

to identify one object out of the group of five objects that does not
fit (“odd one out” test). He is presented with the following words: hen,
rooster, eagle, goose, and turkey and is asked which of these words does not
belong. Typically the list is presented to the student twice. Immediately
after the first presentation he answers that “turkey” does not fit. The list
is presented again, and the child again repeats that “turkey” does not fit.
When asked to explain his answer, the student says, “They are all farm
animals and the eagle is not.” Yet even though he knows the difference
between an eagle and the farm animals, when asked the same question,
he still repeats his mistake. The student is capable of conducting the
formal logical operation of dividing animals in two groups – wild and
farm animals – but he does not use it either to formulate his answer or
check it: his actions are not guided by an integral program.
G. M. Kapustina (1989 R), in her publication on how 6-year-old chil-
dren with partial delays in mental development (the Russian term roughly
equivalent to LDs) learn math, gave an accurate description of the difficul-
ties that these children experience in the process. One of the examples from
her article follows.
Children were presented with three problems to solve:
1. Three birds were sitting on a tree. Then two more birds came. How
many birds are now sitting on the tree?
2. Five birds were sitting on a tree. Two birds flew away. How many birds
were left on the tree?
3. First, two birds flew away from the tree and then three more left. How
many birds flew away from the tree?
At the beginning of the school year all the 6-year-olds from the first grade
of a regular school (N = 50) and 80% of their peers with LDs (N = 73)
were able to solve the first problem. In the second task there was a wider gap
in the two groups’ performance results: all the children without LDs and
45% of the LD children were able to solve it. The third problem presented
difficulties to 50% of the non-LD students and to 90% of the students
with LDs. What were the reasons for the difficulties in correctly answering
the third problem? Students associated words like “flew away” and “took
away” with a decrease in quantity and, consequently, subtraction. Thus,
this task presented “a conflict” between the lexical meaning of the word and
the type of the math operation required; this problem could not be solved
in the stereotypical manner, but required analysis and creation of a new
program. This was a difficult programming and control task, and therefore
only children with well-developed executive functions were able to solve it.
We use such “conflict” math problems in our evaluation of programming
and control functions in children who are entering school.
Let us look at another example described by G. M. Kapustina: counting
in direct and reverse order and selective counting (we also include these
tasks in the evaluation of executive functions in children 6- to 7-years-old).
All the students from the regular school, without exception, were able
to count in direct order from 1 to 10, 90% of them could count to 20, and
52% could count higher than 20. Among students with LDs, 81% could
count to 10, but only 10% could count to 20. Of the non-LD students,
90% were able to count in reverse order from 10 to zero and 20% from 20
to zero. In contrast, only 10% of students in the LD group knew how to
count in reverse order from 10 to zero and none were able to count from 20
to zero. However, because direct and reverse counting can be significantly
affected by the amount of practice students have, the most interesting results
were obtained in the trials on selective counting (i.e., count from 2 to 6),
which students did not practice at all. Eighty percent of children from the
regular school were able to complete that task, whereas only one student
with LDs was able to do that. Only 70% of the students in the first group
were able to successfully complete the task involving selective counting
in the reverse order, “count from 7 to 4,” in contrast to none of the LD
students. Selective counting requires the creation of a new program and the
inhibition of the stereotypical pattern, which is why children with relative
weakness in programming and control functions from the first group and
those in the LD group with pronounced difficulties in this area were unable
to complete these tasks. We use direct, reverse, and selective counting tasks
in our evaluation of programming and control functions in children who
are entering school.
Language and writing also demand adequately developed functions of
serial organization of speech and language as well as programming and
control functions. When a child enters school, language problems become
evident through simplification of syntax and difficulties in creating a text in
school assignments. These students use only simple syntax structures and
sometimes have grammatical mistakes (agrammatisms) in their sentences
(which can be clearly seen in Russian when children substitute the indirect
case for the nominative case or put the verb at the end of the sentence or
omit it). While creating a story based on series of pictures, they experience
difficulties in creating (programming) a coherent utterance (when telling
a story): the text is short and abrupt, they miss important content links,
and require additional questioning to fully describe the content of the series
of pictures. They either do not use the words that keep the text together
(conjunctions and linking words; for example, at first, because, though) or
substitute for them by repeating the conjunctions and or then.
Let us illustrate this difficulty in creating (programming) a coherent
utterance with the following story created by a first grader with deficiencies
in serial organization of speech/language and programming and control
functions. It is based on the series of pictures, “Garbage” (this task is part

of our neuropsychological assessment). The series consists of four pictures
showing a man taking out the garbage. When he tries to dump the trash,
the wind blows the garbage in the man’s face, and he ends up being covered
with dirt. The words in italics are the psychologist’s prompts.
And here the man is going to the dumpster, and here he dumped it
out. And here. . . . as well. . . . and here . . . coal (14-sec pause). Why. . . .
Because what? Wind.
The syntactic structures of this text are very simple, and some are incomplete
(“coal,” “wind”). The story itself is short and also incomplete, and its parts
are combined by the repetition of words “and here.” The psychologist’s
question is needed to help the child finish the story.
Now let us look at writing, which also demands adequately developed
functions of programming and control. The following mistakes in written
assignments are typical for children with delays in the development of these
functions:
r Omitting or adding extra elements of letters, extra letters, syllables,
and words (simplification or distortion of the program)
r Inert repetition (perseveration) of preceding elements of letters, letters,
syllables, and words (see Fig. 3.1)
r Anticipation of the following letters (with all children → will all
children)
r “Gluing” together (contamination) of two words; for example, bunch
of flowers → bunch oflowers; the blue earrings → the bluarings
r Mistakes of language analysis (lack of orientation activity leads to
mistakes in determining the boundaries of sentences and words, which
leads to mistakes such as having no capital letter at the beginning of
the sentence or no period at the end the sentence, or writing two words
as one)
r Spelling mistakes despite knowing the correct spelling (taking orthog-
raphy into account requires a more complicated writing program; a
student might not be using the rule, even though he or she knows it,
thus simplifying the program). Such spelling mistakes could also be
explained in terms of the low capacity of working memory.
Difficulties in programming and control might be of various degrees

(Figs. 3.1 and 3.2) and often are accompanied by difficulties in maintaining
the normal working state of the brain (see the later discussion).
Figure 3.1. Writing problems caused by a slight delay in the development of execu-
tive functions: the repetition of an element l (line 1), letter ш (line 2), and a word
(line 7).
Students in elementary school make writing mistakes in all kinds of

assignments: dictation, copying, and summarizing. In middle school the
total number of mistakes (except the orthographical mistakes that students
make despite knowing the rules) decreases, and difficulties in written speech
come to the forefront. Difficulties in creating text that were present in oral
Figure 3.2. Writing mistakes caused by a more pronounced delay in the develop-
ment of executive functions: writing a preposition and a noun as one word (line 1),
the perseveration of letters (line 2), the perseveration of words and the omission of
syllables (line 5), the perseveration of letters ox (line 8), and the contamination все
еще → всеще (line 9).
speech are now clearly seen in written compositions or summaries. Many

researchers have noted the difficulties in composing a text (Hooper et al.,
2002; Luria, 1950 R; Swanson & Berninger, 1996).
In the following written exposition by a sixth-grader, the student is
retelling the short story, “The Village,” by the famous 19th-century Russian
writer I. S. Turgenev. It describes a landscape, which makes the reten-
tion/creation of text composition more difficult, because the text has no
sequence of events or story milestones that could help create the order
(program) of retelling.
Here is the first part of Turgenev’s short story:
The last day of June; for the thousand miles around is Russia, the native
land. The sky is lit with the even blue; only one cloud is in the sky–
floating or may be melting. Not a hint of wind, warmth . . .
The larks are jingling; the pigeons are cooing; swallows soar silently;
horses are snorting and chewing; dogs don’t bark and just stand there
peacefully wagging their tails . . .
This is the student’s exposition of those lines:
The last day of June, the larks flew in. The swallows are flying quietly.
Horses are quietly chewing on the straw. Dogs are quietly wagering their
tails. Pigeons are quietly cooing to themselves.
The exposition ends here and fails to recount the remaining two-thirds
of the story. The syntactic constructions are very simple and repetitive. The
word “quietly” is repeated numerous times because of perseverations.
What Kind of Help Can We Offer These Children?

The program of action can be “externalized” so that students can start by
using the program that is “materialized” through external supports, with
a gradual transition from mutual unfolded (by elements) external action
to independent, folded internal action (L. S. Vygotsky and P. Y. Galperin).
The methods presented in the manuals, School of Attention and School of
Multiplication (Pylaeva & Akhutina, 1997/2008 R; 2006 R), which are based
on number sequences, have proven to be effective in remediation of the
delays in the development of executive functions (see Part II of this book).
The syndrome of delay of programming and control functions could be
an isolated disorder (dysexecutive syndrome or a subgroup of ADD; Dia-
mond, 2005). However, it is often accompanied by difficulties in maintain-
ing the normal working state of the brain (Unit I functions of the brain).
It is possible to differentiate two types of a syndrome combining delays

in programming and control functions and difficulties in maintaining the
brain’s normal working state. In the first type, children with problems of
programming and control are also hyperactive and impulsive: they are fid-
gety, need to constantly move around, jump from their seats, and raise their
hands before the teacher finishes asking a question. In the second type of
combined syndrome, they are hypoactive: slow, inert, and lacking initiative.
The first group is often diagnosed with ADHD (Barkley, 1998) and the sec-
ond with one of the subgroups of ADD: attention deficit disorder without
hyperactivity-impulsivity. In both types, delay in the development of the
frontal lobes (Unit III of the brain) is accompanied by different combina-
tions of weaknesses in the functioning of deep and subcortical structures of
the brain (Unit I per Luria); specifically, difficulties in maintaining an opti-
mal level of activity (cf. Brown, 2005; Casey et al., 2002; Casey & Durston,
2006; McBurnett et al., 2001). Because ADHD has been described in detail
in multiple publications, in this book we look more closely at the second
type of combined functional weaknesses in Units I and III.
Hypoactive children (also described as children with sluggish cognitive
tempo) have a difficult time initiating a task and, having started work,
become easily fatigued; their work capacity tends to fluctuate and diminishes
rapidly (cf. McBurnett et al., 2001). In experimental studies they show
a disproportionate vulnerability to processing load (Waber, 2010; Weiler
et al., 2000, 2002). In the classroom, during the first half of the class they
try to follow the teacher’s explanations; in the second, they often “shut
down” and put their faces down on their desks. Their written assignments
are incomplete or display an increasing number of mistakes toward the
end of the assignment. Analysis of the types of mistakes reveals a broad
spectrum, especially those that are similar to the mistakes made by children
with problems in programming and control functions that were described
earlier.
These students need increased motivation, an emotional “warm-up”
before starting a task, and proper task rationing by presenting the tasks in
small portions. Alternating between different types of activities also helps.
Their long-term memory might function on a higher level than their short-
term memory in different modalities: visual, auditory, and motor. This
means that if students are asked a question right after the presentation of
new material they will be more likely to make a mistake than if asked that
question later, after the new information has been processed.
Figure 3.3 presents an example of completion of two tasks by a first grader
who was almost 7 years old. In the first task the student was asked to copy
Figure 3.3. Task completion by the first grader with deficiencies in the energy unit –
decrease in the processes of activation.
a geometric design (“a fence”) and to continue to the end of the line. The
student’s drawings were almost half the size of the original drawing (micro-
graphia). Then because of the child’s increasing fatigue, the elements of the
design became progressively smaller, and eventually the student was unable
to continue the task. Pronounced micrographia was also present in his
school notebooks. It took more than 2 minutes (125 sec) to draw the “fence.”
In the second task the student was asked to draw four images from
memory after each of three presentations of the model. After the first,
second, and third presentations the child drew less images than after he was
given a three- to five-minute pause in the test procedure; this pause was
filled by other tests (i.e., during the delayed recall condition).
We would like to make two additional points before moving on to the dis-
cussion of learning difficulties caused by delays in Unit II functions. First,
weakness in the functioning of Unit I can also be combined with weak-
ness in Unit II, as well as with the more diffuse deficit in the functions of
Units II and III (for more detailed description of these complex syndromes
please refer to Chapters 22 and 23). In addition, hyperactivity is not always

accompanied by attention problems or problems in the programming and
control functions. Hyperactive children without attention difficulties strug-
gle with maintaining discipline at school and at home, but do not necessarily
have learning disabilities; in fact, there are many gifted children in this group.
delays in the development of

information-processing functions
Learning disabilities can also be caused by delays in the development of
information-processing functions: auditory, kinesthetic (sensations from
moving organs), visual, and visual-spatial (Unit II, per Luria). Traditionally
these are the types of learning difficulties that are discussed in the literature,
whereas the connection between learning difficulties and weaknesses in the
frontal and deep areas of the brain has been rarely addressed in English-
language publications.
When the development of auditory and kinesthetic information-
processing functions is delayed, both reading and writing are affected, and
that leads to the development of phonological dyslexia and dysgraphia. In
the process of reading or writing students might confuse sounds that are
similar in pronunciation and phonation; they are slow in correlating a letter
with its sound, and reading and writing skills do not become automatic.
Students compensate for reading difficulties by trying to guess the words.
When writing, they might mix up similar sounds or similar graphemes
(see Figure 3.4 for a writing sample of a student with difficulties in audi-
tory information processing). These types of dyslexia and dysgraphia have
been thoroughly researched, and numerous publications are available on
the topic of their remedial techniques (Castles & Coltheart, 1993; Shaywitz
& Shaywitz, 2005; Temple & Marshall, 1983; see also reviews by Chittooran
& Tait, 2005; Grigorenko & Naples, 2008; Kornev, 1997 R; Lalaeva, 1989 R;
Polonskaya, 1999 R; Sadovnikova, 1995 R; Semrud-Clikeman et al., 2005;
and Triger, 1999 R).
What Kind of Help Can We Offer These Children?

In Russia, traditionally the main method of remediation has been to conduct
very detailed training to enable the child to develop phonological processing
and phonemic awareness with the help of external supports and using the
functions that have not been compromised. This training starts with the
very simple task of comparing words that differ by omission or inclusion
Figure 3.4. Writing difficulties caused by the weakness of auditory information

processing functions: substitutions of voiced and unvoiced consonants (b → p in
the second word; t → d in the fourth word).
of one sound (box – ox, pace – space, pay – play, and so on). Later, children
learn to differentiate words that differ by sound and pronunciation (mug –
rug, boy – toy, dog – log), and only after that do they differentiate words
with similar sounds that differ by one phonological feature e.g., pairs of
voiced/unvoiced consonants; (duck – tuck, vine – fine, crow – grow, time -
dime). We also teach children to recognize a word as a whole (global, holistic
reading strategy), using words that they may encounter in typical house-
hold and community settings (tea, milk, coffee, bread), as well as those used
in the discrimination task (boy, dog, box). In developing the individualized
educational program for such children it is also important to remember
that delays in phonological processing and phonemic awareness are accom-
panied as a rule by poor vocabulary and poor short-term verbal memory,
which are also caused by difficulties in processing auditory information
(cf. Snowling, 2000, who showed that problems of short-term memory and
naming in adults with dyslexia could be more permanent than problems in
phonological processing). Thus remedial work with these children cannot
be limited only to reading and writing skills; it is also critical to develop
their vocabulary and verbal memory.
Difficulties in visual-spatial information processing present a very dif-
ferent picture. Experienced teachers may encounter students with well-
developed speech who are emotionally sensitive and easily hurt. When
listening to such students, one might assume that they should be making
good grades, but teachers who check their notebooks will find a significant
number of serious mistakes. Even after having been in school for 3 years,
such students can mix or omit letters in the words they write everyday (e.g.,
classwork, exercise) and may write the same word differently every time (see
Fig. 3.5).
Such students may write letters and numbers with different spaces
between them, which makes it impossible for them to add or subtract multi-
digit numbers, because figures from the same array end up in different posi-
tions (these problems are described in detail in Chapter 19).
Figure 3.5. Writing mistakes caused by the weak holistic (right-hemisphere) strat-
egy of visual-spatial information processing: Классная работа → Нлассная
родота [classwork] (line 1); Упр. → Чпр. (line 2). Further, the whole phrase
(came to [the] village) is written as one word.
Analysis of these students’ writing mistakes reveals the following:
r Difficulties in orienting on the sheet of paper, identifying where the

line starts, and following the line; sometimes the symptom of left-sided
neglect is manifested in left margin that increases in size as the student
continues writing (Fig. 3.6)
r Variations in the size and slant of letters; letters that belong to the same
word are written separately (Fig. 3.7)
r Difficulties in remembering letters, inability to write them correctly,
replacing italic with print letters, replacing the correct letters with
similar looking ones (K-H)
r Writing pattern that is characterized by mirror images; for example,
mixing up letters “b” and “d” or rotating letters and numbers in the
opposite direction (for example, p → q, e → ə, u → n)
r Difficulties in remembering images of words, even the ones that they
encounter frequently (Fig. 3.5)
r Omitting and replacing vowels, including the accented ones
r Incorrect letter order in words
r A tendency for phonetic (transcription) writing; for example, in
English “money” → muny; “comb” → koum; cp. Temple, 1998; in
Russian: ручьи → ручйи
r Writing several words as one (Fig. 3.5)
These mistakes are mentioned in descriptions of surface dysgraphia

and constructional agraphia/dysgraphia (Benson & Ardila, 1996; Castles &
Figure 3.6. Writing problems of a first-grade pupil caused by the weak holistic
(right-hemisphere) strategy of visual-spatial information processing: symptoms of
left-sided neglect. Left: On April 7 the teacher indicated with the arrows that the
indentation is supposed to be 10, 4, and 2 squares. Right: on May 5 the student was
counting the squares and marking them with dots but he started counting from the
edge of the active visual field.
Coltheart, 1996; Chittooran & Tait, 2005; Lorch, 1995; Temple, 1998). Let us
emphasize that all these mistakes can be explained as having the same root
cause: weakness in the right hemisphere holistic (global) strategy of visual,
visual-spatial, and auditory information processing.
Figure 3.7. Writing problems of a second-grade pupil caused by the weak holistic
(right-hemisphere) strategy of visual-spatial information processing: variations in
the size of letters; difficulties in remembering how to write 8, mirror writing of
figure 3.
These children struggle with reading by words (global reading). They

learn how to read by using analytical methods because the left hemisphere
analytical strategy of perception is easier for them.
At times the difficulties in holistic perception also prevent these children
from being able to use the “connect-the-dots” method when learning how
to write numbers and letters; this method has proved to be helpful for
students without learning disabilities of this kind. For example, the first
grader described earlier, when learning how to write the number “1,” after
tracing it, connected the three dots correctly the first two times, but then
started to connect them from the top down and did not even notice that he
drew a symbol “lesser” (<) instead of a number 1.
How We Can Help These Children?

The main method of remediation in children with visual-spatial problems
remains the same: increase their motivation (using interesting games, com-
petition), spatial actions using external programs, and talking the student
through them; for example, to find “the treasure” first go straight, then turn
left, look under the . . . A more detailed description of remedial work with
children with visual-spatial problems is presented in Part IV. Along with
techniques to address these specific problems, it is also necessary to work on
all the processes that can potentially suffer as a result of the delays in devel-
opment of the spatial component of HMFs, particularly the understanding
of spatial and quasi-spatial syntactic structures; for example, circle under the
square, magazine under the book, A is shorter than B, greater by . . . , smaller
by. . . .
Difficulties in understanding logical grammar constructions that, among
other things, are important for solving math problems can be present also
when the analytical left hemisphere strategy of visual-spatial orientation is
weak. In addition, students with right or left functional deficit have diffi-
culties learning multiplication tables and can make mistakes in assigning
place value in multi-digit numbers (1,052 →152) or in solving problems in
which they have to switch to a different array; for example, 23 − 5 = 22:
the logic here is “23 − 3 = 20, 2 is in mind; what should I do with 2? Maybe
I should add, so 20 + 2 = 22.”
In Figure 3.8, the logic of the decision was, “I cannot subtract 5 from
0, so I borrow 1 from 10 and write it down.” Then the pupil forgot about
borrowing, and so he wrote the answer as 525; later he remembered about
it and added 1 to the previous result and that is why the new result is 35. At
last he decided to subtract 1 and obtained the correct answer: 515.
Figure 3.8. Solution of an arithmetic problem by a student with

a weakness in visual-spatial functions.
The difficulties in understanding logical grammatical constructions and

solving math problems when switching to a different array have a common
feature: the performance of quasi-spatial operations. When presented with
the information that “A is shorter than B,” students struggle to understand
which one of the two (A or B) is described as “shorter.” Similarly, when
trying to solve the math problem 22 − 5, they are not sure whether to add
or subtract the number “5.” Luria (1980, 1987) discussed these types of
difficulties in detail.
Children who have difficulties in processing visual information struggle
with developing distinct, stable images of objects; these difficulties in turn
lead to problems in expanding vocabulary and then a delay in learning
letters and mastering reading skills. Figure 3.9 shows the sample writings of
the 7-year-old first-grade girl’s drawings and methods of remedial work for
these particular problems are presented in Part III.
Figure 3.9. Difficulties in drawing and writing letters and numbers of the first grader
with problems in visual information processing. The girl signed the drawings of an
eagle and a deer. Next, there is an example of the student writing the number “2.”
Note that repetition does not strengthen the image of the number, but in fact it
becomes blurry.
conclusion
Let us share one of our memories of an incident that occurred about 15
years ago when an elementary school for children with learning disabilities
opened in Moscow as part of the Child and Adolescent Social Help Complex.
Experienced and creative teachers from general education schools were
invited to join the staff, but after several months of working with “difficult”
children, many wanted to return to their regular schools, because students
there were more creative. Later as they learned how to help their students
with LDs, they learned to notice and appreciate their small victories. With
this increase in success came the joy of overcoming difficulties together.
A teacher is the most important person in a school, and both the chil-
dren’s successes and the psychological climate of the school depend on
teachers’ understanding of difficulties experienced by their students, their
ability to identify the students’ strengths, and their ability to offer help.
Teachers, in turn, also need help, and the most important help is getting
children ready for school. Prevention, after all, is the best treatment.
Online ISBN: 9781139012799
Chapter
4 - Neuropsychological Support of Remedial-Developmental Education pp.
65-72

4
Neuropsychological Support of
Remedial-Developmental Education
Neuropsychologists working in elementary schools – in remedial-

developmental education (RDE) classrooms in particular – have two pri-
mary tasks: assessment and remedial development. They fulfill these tasks
by designing a strategy of remedial interventions and interactions with
teachers (i.e., remedial-developmental work).
As we noted earlier, our experience confirms the effectiveness of diag-
nostic and remedial work that is based on the theoretical postulates and
practical implementations of the Vygotsky-Lurian school. Our data were
obtained in the course of the work we conducted together with the teachers
of the Center of Curative Pedagogics and the Moscow Center of Psycho-
logical, Medical and Social Support of Children and Adolescents. In this
chapter we discuss this experience in detail.
how does this process work?

As neuropsychologists, we attend classes and conduct observations to iden-
tify what kinds of tasks are difficult for different students and, most impor-
tant, why did these tasks cause problems; that is, we conduct a qualita-
tive analysis of difficulties students experience in the process of learning
(Pylaeva, 2004). For example, let us look at the situation when the child
does not start working on writing assignments when instructed to do so.
By observing the child’s behavior and his or her reactions to the teacher’s
assistance, we can determine whether this pause is caused by difficulties in
initiating the task (symptoms of delay in Unit III) or in orienting on the
piece of paper (delays in the processing of visual-spatial information).
In the process of analyzing educational and creative assignments we
use the results of the significant body of work conducted by the staff
of the laboratory of neuropsychology, Moscow State University, aimed at
65
identifying those characteristics of speech, reading, writing, and math prob-

lem solving that are connected with neuropsychological profiles of children’s
HMFs (Akhutina, 1998b R, 2004; Akhutina & Pylaeva, 2003b R; Akhutina,
Pylaeva, & Kamardina R, in press; Akhutina, Velichenkova, & Inshakova,
2004 R; Polonskaya, 1999 R).
As neuropsychologists we do not just observe from the sidelines, but in
certain situations offer help to students, thus creating an opportunity to
determine which type of help is effective. For example, having discovered
that a student does not start the task immediately, we may offer motivational
or organizational help, based on the hypothesis that the child’s programming
capacities are not sufficient. In other cases, if the delays are attributed to
spatial difficulties, we can provide help in orienting the student on the sheet
of paper.
By discovering which kind of help works and comparing it with the data
obtained through the analysis of students’ notebooks, drawings, and crafts,
we test our hypotheses about the nature of the difficulties experienced by
students and compare results with the data of primary assessment. Having
thus specified the students’ weak and strong characteristics in real-life situ-
ations, we share these insights with the teacher and together we design the
tactics of remedial interventions.
On that basis the teacher, equipped with the wide range of different
methods and techniques of developmental education, uses them to design
the system that allows each student to find a way to master school subjects
that he or she finds difficult. Examples of such programs include programs
for the introductory (propedevtic) period of learning grammar and learning
how to count created by E. V. Zolotareva (1997 R) and T. Y. Khotyleva
(1998 R, 2006 R) in close cooperation with neuropsychologists (see, e.g.,
Chapter 18).
Let us take a closer look at different kinds of our work.
diagnostics
The goals of primary assessment are well known: identifying the strong and
weak components of a child’s HMFs and determining the prognosis of the
developmental process (its course and possible outcome) that allow creation
of the strategy of remedial-developmental interventions.
In the course of working with the child, we conduct repeated, partial
assessments and do a full assessment on completion of the work. We need
to emphasize the important role played by the partial “check up” that
analyzes only some processes and may be repeated as often as every 2 to
Neuropsychological Support of Remedial-Developmental Education 67
3 months, usually coinciding with the beginning, middle, and end of the
remedial course during the school year. The repeated, partial assessments
include both similar and dissimilar tasks to the ones being completed in the
course of remediation.
In addition to assessment we also use these methods of tracking diagnos-
tics:
r Observe the student’s behavior in situations of learning, playing, or

relaxing.
r Analyze the completion of educational and creative tasks.
Tracking diagnostics enables the development of a common language

and helps maintain a dialogue between the neuropsychologist, teachers,
and parents. This dialogue is important because the main task of the neu-
ropsychologist in school is to help students learn and teachers teach. We
certainly view teachers as the most important contributors to the educa-
tional process, and a successful outcome depends on their understanding
of the strong and weak components of the HMFs of a particular student.
It is important to emphasize the role of tracking diagnostics in both
ongoing control of the remedial-developmental work and in the results
of the work. Ongoing control – based on analysis of the dynamics of the
required depth and the quality of the help provided to the student, as well as
identification of the zone of proximal development in the situations where
different types of help are offered – is an integral part of the remedial process
(see Chapter 10).
The results of the work are evaluated not only through the final assess-
ment but also by using the tracking diagnostics of the student’s behavior
and successes at home and in school. Many studies are currently investi-
gating the ecological approach to assessment and remediation, which takes
into account the environment and social surroundings; they suggest that
psychologists should be mindful of the everyday problems encountered by a
child or an adult (Gioia, Isquith, 2004; Tupper & Cicerone, 1991; Ylvisaker,
2003). We believe that the most effective way to understand these problems
is through tracking diagnostics.
The experience of dynamic diagnostic tracking that we gained in RDE
classrooms shows that students display the following difficulties (in order
of frequency):
1. decreased work ability, attention fluctuations, weakness of mnemonic

processes (i.e., symptoms of “energy” unit weakness and also
insufficient language and speech development; see also Lebedinskiy

et al., 1982 R)
2. insufficient development of executive functions
3. visual-spatial and quasi-spatial difficulties
4 & 5. difficulties in processing auditory and visual information.
Insufficient development can occur in one of these areas or, more often, in
more than one, which causes a significant decrease in the ability to learn.
Let us look at some examples.
Among the first-grade students we observed was a student with sig-
nificant weakness of the energy unit. Periods of successful work, when
he displayed high intellectual competence, were quickly replaced by peri-
ods when his performance resembled that of a developmentally disabled
student. The success of learning in this case depended on our designing
the educational process in such a way as to increase learning motivation
as well as distributing activities in time, rationing them according to the
child’s abilities at any particular time. Indeed, strong emotional engage-
ment and the rationing of the workload are significant elements in all RDE
classrooms.
Another student whom we observed experienced difficulties primarily in
visual information processing, which, when she was under pressure, looked
like problems observed in cases of visual agnosia. The girl made mistakes
even when presented with simple realistic pictures; the mistakes became
even more severe in cases of perceptually complicated images. During class
when she was presented with the visual materials that normally would be
used as a support for students, she experienced additional problems. These
difficulties could be overcome when the visual images were included in a
speech context – when visual support was rationed/limited and there was
active use of other modalities and speech.
types of remedial-developmental work

RDE can be conducted on the group, microgroup, and individual levels,
each of which is described in detail in this section.
Group work with all the students in the classroom (“getting ready for
school” group) includes the complex of methods aimed at remediation
of frequently observed difficulties – primarily problems in programming
and control functions, spatial and quasi-spatial functions, memory, and
speech. Microgroups (each made up of two to four students) can be used for
conducting interventions with children who have delays in the development
of similar higher mental functions (HMFs); for example, visual or auditory

gnosis. Individual work is most effective when focused on the “weakest”
mental functions, which enables the shift from unfolded to folded action,
from external to internal, from joint to independent to be achieved in the
most complete manner.
As an example of group work let us consider the work performed in
class using the School of Attention method of programming and control
functions development (Pylaeva & Akhutina, 1997/2008 R). It is used with
developmentally disabled children (Pylaeva, 1996 R) and in RDE classes,
“getting ready for school” groups, and other types of preparatory classes. The
more than 50 tasks included in this method can be used for practicing not
only programming and control functions but also visual-spatial functions,
developing writing skills, and supporting the formation of digital images.
These tasks are divided into five cycles: number sequence in established
situations, number sequence in forward order, quantity sequence in forward
order, number sequence in backward order, and parallel rows. This method
uses number sequences because learning these sequences is one of the major
tasks in the early school years.
The School of Attention method is very convenient for group work because
assignments are completed using standardized forms (worksheets) and it
incorporates tasks at various levels of complexity that can be adjusted to
students’ individual needs. The degree of teacher assistance can also be
modified based on students’ needs. For example, using the same worksheets
the students can be given such assignments as forward, discrete (e.g., 1–3–
5 . . . ), backward, and parallel sequences. Some students might get the full
program how to do the task, others get just part of it, and still others are
expected to completed the program independently.
As we noted earlier, for RDE to be successful and productive, students
must have a high level of motivation to compete the tasks. In group work this
motivation can be achieved by creating a continuous game context for the
tasks. For example, during the entire first–grade year, students worked in the
city called “Attention” where Pinocchio and the Blue Fairy lived. Pinocchio
created tasks for students to complete, sent them letters and awards, and
asked for their help; students looked forward to receiving new assignments
from him.
RDE is also most effective when conducted in a group of students who
interact well with each other. Therefore, it is advisable that, in a group
consisting of 6–10 children, there be no more than one hyperactive child
and no more than one child with disorders of autistic spectrum because both
of these types of children have weak social skills and need a comfortable
Figure 4.1. Examples of tasks: extraction figure from background.
environment in which to develop them; moreover, the presence of two

hyperactive children can be very disruptive to the group.
Work in microgroups is particularly effective when dealing with children
with similar developmental delays; for example, delays in visual object gnosis
and verbal perceptual processes. The partial assessment, conducted before
the group work, includes a detailed analysis of visual gnosis, as well as verbal
and nonverbal fluency tests (free associations, naming or drawing plants),
finishing the drawing, and completing the image.
The following two cycles of methods can be included in the battery of
assignments for developing visual gnosis. The tasks are arranged from the
most simple to the more complicated actions, which together form a system.
First cycle – identification tasks. These tasks include identification of two
realistic images, realistic and contour or shadow, and complete and partial
images. These images belong to the same and different semantic groups.
The students’ work on identification is reinforced through a series of
subtasks on recognition, recall of order of images, drawing the images,
and oral or written naming. A gradual increase in complexity is achieved
through methods of overlapping and crossing the image that are well known
in neuropsychology (Figs. 4.1 and 4.2).
Second cycle – construction of visual images of object or perceptual
modeling. These tasks include model building, creating whole images from
parts, and visual graphic work using worksheets (Fig. 4.3).
In this cycle we tend to give tasks that require different strategies – global
as well as analytical – thus presenting students with opportunities to find for
Figure 4.2. Examples of tasks: identification of overlapping images.
themselves the optimal ways of visual information processing. We borrow

tasks from children’s literature that stimulate development and adjust them
to our specific goals.
The composition of microgroups changes so that students can obtain
help from more advanced students in the group, but are also given an
Figure 4.3. Examples of tasks: completion of images.
opportunity at other times to be in the position of being the advanced

student helping other children.
Finally, individual lessons are most appropriate when dealing with the
weakest components of mental functions because they allow for the most
effective work with their basic components. They incorporate well-known
classical psychological methods modified for the purposes of RDE; for
example, methods created by Kogan, Kohs, and Schulte (see Parts II and
IV). We use a series of emotionally significant tasks of varying degrees
of complexity aimed at developing and remediation of different processes.
Our experience shows that methods of diagnosis and development of HMFs
built on the neuropsychological principles developed by Vygotsky and Luria
facilitate the development of children’s capacities to the fullest.
Online ISBN: 9781139012799
Chapter
5 - Neuropsychological Approach to the Development of Health-Preservin
g Educational Techniques pp. 73-86

5
Neuropsychological Approach to the Development

of Health-Preserving Educational Techniques
In recent years an increase in health problems in children has been noted

in the context of an unfavorable ecological and social situation and an
intensified educational process. Many children are not sufficiently healthy,
either physically or mentally, to handle the challenges of school. Unable
to handle the consistent overload of schoolwork, they either become poor
students or succeed at the expense of their own health. A chronic state of
failure or anxious anticipation of failure deepens their behavioral and/or
cognitive deficiencies and often triggers the development of antisocial types
of behavior. The implementation of health-preserving learning techniques
is needed to break this cycle.
can psychology and, in particular, neuropsychology,

help resolve this critical problem?
Contemporary child neuropsychology, founded on principles developed
by L. S. Vygotsky and A. R. Luria, has accumulated significant theoretical
knowledge and empirical data on which to develop health-preserving learn-
ing techniques. The purpose of this chapter is to discuss the implications of
theoretical postulates in neuropsychology for such learning techniques.
Because the science of neuropsychology started with the study of focal
brain lesions, one comes across the assumption even today that experts
in this area of psychological science deal only with the pathology of brain
systems. However, this is far from the truth. Initially, research in neu-
ropsychology was focused on the study of cognitive mechanisms of higher
mental functions (HMFs) both in norm and pathology – through the study
of pathology, neuropsychologists arrived at the understanding of normal
brain functioning. However, within the science of neuropsychology a new
orientation has emerged – neuropsychology of the norm or neuropsychology
73
of individual differences (Akhutina 1998a, 1998b R; Khomskaya, 1998 R;

Khomskaya et al., 1997 R).
Neuropsychology is based on these principles: the social genesis of higher
mental functions, their systemic structure, and their dynamic (chronogenic)
localization and organization (Luria, 1980; Vygotsky, 1997a). Although all
Russian psychologists subscribe to these principles, only in neuropsychology
has there been a thorough study of the structure, dynamic organization, and
localization of functions that are crucial in learning, such as speech, writing,
reading, and counting (Akhutina, 2001 R, 2004; Luria, 1950 R, 1980; Luria
& Tsvetkova, 1990, 1996 R).
systemic organization of hmfs and potential

applications for the development
of learning techniques
In creating techniques of teaching basic learning functions (reading, writing,
counting), it is important for the teacher to take into account all the compo-
nents of a certain function and children’s readiness to form a new function.
According to the neuropsychological data, the following components are
important in learning writing skills:
r Readiness to process auditory, kinesthetic, visual, and visual-spatial

information (functional Unit II; Luria, 1973)
r Sufficient level of development of programming and control (execu-
tive) functions of voluntary activity and maturity of serial organization
of movements and actions (functional Unit III)
r Ability to maintain working capacity (functional Unit I)
Along with these structural components the entire vertical hierarchi-

cal structure of functions should be taken into account. In particular, it
is important to consider the readiness of the “background,” unconscious
levels of movement structure – ability to maintain working posture (pos-
tural control), avoid muscle tension, etc. (Bernstein, 1967; Dewer & Tup-
per, 2004). Initial lessons in writing should focus on the development of
both the higher and background components of the function that is being
learned.
This list of the functional components of writing includes only operations
that are necessary for the development of the highly automatic writing skills,
but not for written speech. Written speech is a particularly complex type of
monologue speech that includes not only the components of writing but
also all operations of language production.
Neuropsychological Approach 75
Analysis of thinking and speech/language disorders has confirmed the

stages of moving from thought to word described by Vygotsky in his book,
Thinking and Speech (for overviews, see Akhutina, 1975/2002 R, 1989/2008
R; Luria, 1976; Ryabova (Akhutina), 1967 R/2003). To help children ade-
quately translate thoughts into a verbal form, one needs not only to improve
their vocabulary and grammar but also to develop their ability to create
coherent text; in other words, the ability to organize text in a certain way. This
can be achieved through the joint development of an external text program
and consequent internalization of the process of program creation (here,
the principle of the social genesis of HMFs is involved). However, one can
ask, What is the connection between the development of coherent speech
and health? The connection is straightforward because in middle school
most students are faced with tasks of answering questions in subject-matter
classes and writing summaries and compositions. A chronic state of failure
or anxious anticipation of failure deepens the students’ behavioral and/or
cognitive deficiencies and problems with health. And the cycle repeats.
However, this may not be the most important information that a teacher
can extract from studies of verbal thinking. The main idea is that our
voluntary action (verbal or nonverbal) is organized by the guidance of an
inner program, created with the help of inner speech, which, according to
Vygotsky, is “a dynamic, unstable, fluid phenomenon” (Vygotsky, 1988, p.
280) between a word and a thought. Inner words and, later, a selected set of
keywords allow fixating of that whole which is a thought. Vygotsky writes,
The units of thought and speech do not coincide. . . . Thought does not
consist of individual words – like speech. . . . Thought is always some-
thing whole, something with significantly greater extent and volume than
the individual word. . . . What is contained simultaneously in thought
unfolds sequentially in speech. Thought can be compared to a hovering
cloud which gushes a shower of words (Vygotsky, 1988, pp. 280–1).
For the thoughts “to pour out“ in logically correct forms of speech,
students need to master the conceptual apparatus and be able to translate
concepts into a meaning of the word. However, these questions arise:
1. Is the conceptual apparatus enough for the development of thinking,

and when should we form it? The answer to the first question is “no.”
Vygotsky wrote that “thought does not correspond with the word,
it doesn’t even correspond with the word meanings in which it is
expressed” (Vygotsky, 1993, p. 281). Only from the raindrops of a
proper shape can the rain be formed, but that does not solve the
problem of creating a cloud.
2. When should concepts be formed – before starting the work on the

“cloud,” in parallel to this work, or after it? This question is far from
irrelevant as is evident from the argument presented by the advocates
of the school of “developmental teaching”: according to P. Y. Galperin,
D. B. Elkonin, and V. V. Davydov the process of learning begins with
forming a concept. The author of Another Math, Alexander Lobok
(1998 R) suggests that this process should start with the forming of
pseudo-concepts and eye-mindedness (thinking in images).
Both schools are supported by solid theoretical foundations. The advo-

cates of the Elkonin-Davydov school base their argument on the social genesis
of HMFs and conduct learning accordingly. Alexander Lobok argues against
the early formation of concepts based on the principle of the dynamic
organization of mental functions. He argues that 6–10 years of age is the
critical period for developing pseudo-concepts and that only later, in the
adolescent years, does the critical period for concept development start. His
educational experiences confirm that children can occupy themselves to the
point of self-oblivion with graphical modeling and search for answers to the
provocative questions that lead to the exploration of the most fundamental
problems in math. During this process the ideal images of mathematical
concepts are being formed, as are pseudo-concepts that are functionally
close to concepts and are personally appropriated by a child. Development
of speech occurs at the same time: “the break-through written speech of first
graders – speech that is saturated with the surprisingly powerful images and
that is noticeably different from the dispirited and ordinary writing style
that is typical for that age, was, in a way, the flip side of the method of teach-
ing math suggested by us” (Lobok, 1998 R, p. 7). Most importantly, children
become used to drawing a mental picture of the math problem that they
are trying to solve. (In the context of the discussion of health-preserving
learning techniques, it is important to point out that one of the possible
titles of the book by A. Lobok was Math Therapy).
Certainly, in this controversy over whether to start with concepts or
pseudo-concepts, the positions of both sides are exaggerated. In reality
advocates for both types of developmental learning, consistent with the
Vygotsky and Galperin model, agree that children in the learning process in
class make a transition
r from joint to independent actions

r from materialized actions to their verbal and mental formats
r from extended element-by-element actions to ones that are abbrevi-
ated and automatic
In the process of learning that is based on Elkonin-Davydov methods,

students, presented with a material object, first form pseudo-concepts and
then concepts. It is possible to arrange this process in such a way that
the discovery of a rule is experienced as a personal discovery. Similarly, in
Lobok’s methods the internalization of joint mental activity is taking place.
To paraphrase Vygotsky, in both models, objectification of the function that
is being developed (i.e., bringing it outside and changing it into external
activity) is one of the basic learning processes (Vygotsky, 1997a, p. 143).
The resolution of this controversy is an empirical problem, which
depends on answers to the following questions:
r Which higher mental functions and to what extent are developed as a
result of each approach?
r What are the social demands of our society in regard to education?
If the answer to the second question is more high school graduates, then
to answer the first question we need longitudinal researches about “good
and various” (with good quality of education and various skills) HMFs in
students who attended different schools. This research work is only now
starting; in particular, a study of different approaches to teaching writing
skills is currently being conducted (Korneev et al., 2002 R). Nevertheless,
we already have some data to consider.
The research conducted on children in urban and rural areas of Siberia
showed that verbal logical functions are significantly more advanced in chil-
dren from urban areas as compared to children from rural regions and that
visual-spatial functions are more developed in children from rural regions
(Polyakov, 2004). The findings of J. D. Babaeva, a well-known specialist in
the education of gifted children, confirm this data: it is relatively easy to find
students in Moscow with a significantly high verbal coefficient, but there
are very few with a high nonverbal coefficient (oral message). Thus, one can
make a conclusion that contemporary education primarily helps develop
verbal-logical functions. Our findings confirm that conclusion.
In this context, important data were obtained by N. V. Perezhigina
(1999 R) in her neuropsychological analysis of HMFs in preschool chil-
dren. Her research showed that compared to children in the control group,
who attended classes that were based on a traditional kindergarten curricu-
lum, children in two experimental groups, where image or language-speech
programs were used, showed significant but different dynamics in develop-
ing speech, visual-spatial functions, and generative imagination. The most
noticeable development of generative imagination – in both verbal and
nonverbal trials – was in children who participated in the program where
the image program was used.
The expansion of the visual image experience also led to the development
of generative imagination of a “simultaneously anticipated internal plan,
used by a child as a frame, within which he could easily develop the plot
without the danger of losing the sight of the end goal” (Perezhigina, 1999
R, p. 19). Thus, the data obtained by Perezhigina confirm the findings of
Lobok that development of eye-mindedness (thinking in images) and visual-
spatial functions leads to further improvement in the deeper levels of verbal
thinking. According to data obtained by Perezhigina, unlike image exercises,
“verbal assignments naturally influence the image experience by conserving
and fixating it and, at the same time, developing various (synonymous)
means of its verbal presentation” (Perezhigina, 1999 R, p. 20).
The thesis research conducted by T. S. Valentovich (2002 R) under our
guidance showed the influence of education in the humanities on develop-
ment of the verbal sphere (predominantly or exclusively).
In a series of research studies summarized in the book, Diagnostics of
Development of Visual Verbal Functions (Akhutina & Pylaeva, 2003a R), we
discovered that a significant percentage of preschool children and children
in the early grades in Moscow possessed sufficiently varied vocabulary but
rather poor visual images (these are children with stronger left-hemisphere
functions and weaker right-hemisphere functions). For example, when
asked to name plants in pictures, they called a pine tree an apple tree,
an oak, a palm tree, a burdock, an aspen, a maple tree, and they called an
aster a chrysanthemum, a tulip, violet, and pansy. When asked to draw sev-
eral pictures of different plants (our nonverbal fluency test), they repeatedly
drew the same simplistic picture and called each one by a different name;
for example, blueberry, cherry tree, oak tree, or spurge-flax.
Another group of children (with weaker left- than right-hemisphere
functions), when naming the pictures, used mostly generalized categories,
like flower, tree, vegetable, or popular prototypical names (daisy, rose or
apple, onion). The speech deficits of children in the second group are widely
recognized, and both speech therapists and teachers work on expanding
their vocabulary, whereas very few specialists in the field focus on devel-
oping the image realm, on expanding visual and visual-spatial concepts,
and on making them more accurate. In the absence of interventions of this
kind, visual-spatial dysgraphia (see Chapter 19) and other learning disabil-
ities caused by the insufficient development of right-hemispheric functions
become widespread.
Such data need to be taken into consideration when developing early
childhood educational strategies. In particular, authors of textbooks and
program developers need to have a very clear understanding of the type
of mental processes their programs strive to develop. They must also be

familiar with different types of learning disabilities because, according to
the most modest estimates, children with learning disabilities who struggle
in school constitute 20–30% of the entire population.
Learning disabilities are caused by partial weakness of a number of
mental functions or their components. As we discussed in the previous
chapters, modern research in neuropsychology of the norm has found the
presence of relatively strong alongside relatively weak mental functions or
their components; in other words, their uneven development is a natu-
ral phenomenon rather than a developmental deviation (Akhutina, 1998a,
1998b R; Khomskaya, 1998 R; Khomskaya et al., 1997 R). This unevenness
in the development of HMFs is genetically determined by the individual’s
genetic program (for information on two functions of the genotype – real-
ization of the genetic program of a particular species and the individual’s
genetic program – see Egorova & Maryutina, 1992 R); unevenness is also
determined by environmental factors. There is no clear boundary between
so-called normal children and children with learning disabilities. In the
normal group, children’s relatively weak processes become evident when
they are fatigued. In the group of children with learning disabilities the
unevenness of functions is more prominent at all times: these children are
unable to use their strengths to compensate for their weak processes, they
begin to deviate from social norms, and thus they attract attention of a
teacher or an instructor.
what are the problems seen most frequently

in children?
As presented in Chapter 4, learning disabilities can be caused by the follow-
ing factors, listed in order of frequency:
1. The weakness of functional Unit I (energy unit), which manifests in
decreased productivity, fluctuations of attention, weak memory pro-
cesses, and insufficient speech development (as the function requiring
the most energy)
2. Underdevelopment of functions of programming and control
3. Visual-spatial and quasi-spatial difficulties
4. & 5. Difficulties in processing auditory and visual (visual-verbal)
information
It is quite evident from this list that the most frequently observed problems
are those connected to deficiencies in the supply of energy: increased fatigue,
exhaustion that causes fluctuations in attention, and eventually the complete

deterioration of attention.
How can a teacher help combat the fatigue? It can be done by increas-
ing motivation, proper rationing (“dosing”) of assignments in class, and
assuring that the student has proper rest.
Providing Motivation
If a child is treated as one of the subjects of the learning process (as opposed to
its object), is emotionally involved in this process, and is able to successfully
complete the assignments, the “affective-volitional basis” of the learning
process develops. It results in a natural increase in the ability to perform
and in efficiency of brain functioning and thus provides necessary resources
that otherwise would have been obtained at the expense of the child’s health.
To secure motivation, learning “by units, not by elements” – making
the material meaningful (making sense for a child) – is important. When
a child learns how to speak, his or her first words can be considered as
both sentences and statements at the same time; such meaningful actions
are reinforced by external reactions and become anchored in memory. This
holistic principle is applicable to school-aged children as well: elementary
actions that are meaningful are better learned and memorized. Therefore
it is best to avoid purely technical assignments (for example, writing the
elements of a letter repeatedly) and instead to offer appropriate creative
assignments. For example, when teaching how to write the letter “e,” instead
of assigning the student to write an entire line of “e’s,” a teacher might ask
the child to write the sound that a phone makes when the line is busy and
when the line is free (e-e-e or eee-eee-eee). Or the child may be asked to
draw an object that contains elements of a letter. However, such assignments
are unlikely to be very effective if a child considers them silly, childish, or
below his or her newly acquired status of school pupil.
To support the proper psychological climate in school, assignments
should be presented in such a way as not to facilitate (provoke) mistakes,
not to create difficulties that can potentially be avoided. Let us look at some
examples.
Many children, when they begin to tire, exhibit difficulties in program-
ming and control or visual-spatial functions (these difficulties can also be
chronic; see items 1 and 2 in the earlier list). For example, when one teacher
noticed that a student confused the Cyrillic letters “î” and “W” by omitting
one element (a little tail) in “î” she suggested that the child had to write two
lines of “Wî” as a way of correcting the problem. The child, who typically
tended to simplify the writing scheme – which is obvious from the type of
mistakes – wrote the correct letters the first two times and then started
writing pairs of the same letter without a tail. This assignment was counter-
productive and even harmful both for maintaining learning motivation
and preserving health.
Here is another example. In one Russian textbook, the first assignment
of the school year is to copy the sentence: Машины шинами шуршат по
мокрой мостовой (it is similar to the sentence, The miners mine many
minerals in mines). This sentence can be used to test the difficulties in
switching over from one element to next elements in series (like a written
word or a sentence). Surely at least one of the students will add an extra stroke
to one of the letters or will miss one. Why make this difficult assignment
the first one in the school year?
Finally, let us consider diagram reading. Some authors believe that if
something can be visualized (i.e., it has visual representation), it becomes
easier to understand. However, significant number of students might expe-
rience difficulties reading diagrams, especially when they look at them days
after learning the material contained in them; by that time, the content of a
diagram may be partly or completely erased from their memory. Assisting a
child in reading diagrams by giving him or her verbal clues – that is, dividing
the task in such a way as to include processing of both visual and verbal
information – is a way to help, but authors of developmental programs
often overlook that.
Students’ emotional engagement in the process of learning facilitates last-
ing memorization. Information that is emotionally significant is processed
on a deeper level and thus is remembered better (Velichkovskiy, 1999 R).
However, based on what we know about the dynamics of memorization and
forgetting, teachers still need to find time in class to review new material
so that information is transferred from short-term to long-term memory,
both semantic and procedural. Here the mechanisms of trace fading should
be taken into account. Frequent reinforcement is needed at the beginning of
the process, but gradually it should occur less often. In addition, the traces of
only one modality – for example, visual or auditory – are not remembered
as well as poly-modal traces, in which visual, auditory, motor, and tactile
images are memorized at the same time. A system of reviewing new material
that is based on data obtained in scientific research is a necessary condition of
making a learning process accessible and safeguarding learning motivation.
Supporting Appropriate Energy Restoration

A change in type of activity – regularly alternating between periods of intense
active work and relaxation, between voluntary and emotional activation – is
necessary to prevent overexertion in children. Here, it is important to

remember that simply sitting behind a desk without actively moving around
might be tiresome for children, particularly for 5- to 6-year-olds. Problems
in posture and the locomotor system that lead to problems in internal
organs’ innervations are frequently the result of excessive demands of an
authoritarian teacher who does not allow for regular breaks during the
school day.
To safeguard motivation and the capacity to perform, it is very important
for students to experience the learning process as successful. When a teacher
points out students’ successes to them, the result is almost therapeutic. To
do so, a teacher does not need to make false statements, because it is always
possible to highlight some part or aspect of a student’s work or praise his or
her efforts. If a child fails often, then the assignments given to this student
should be the “one-skill” assignments that allow focus on a single issue. The
ability to choose assignments of adequate complexity is one measure of the
level of effectiveness of teachers and psychologists. It is important to note
that teachers themselves need this therapeutic intervention – the ability to
see students’ success favorably affects teachers’ health as well.
Rhythmical work is preferable to help properly distribute energy and
fight fatigue. It is always helpful to create stages in tasks: preparing to start
work, completion of a task, and, finally, reinforcement. These micro-cycles
are present, for example, in the writing classes of a well-known teacher,
V.A. Ilukhina: she first gives the preparatory set, students complete the
assignment, and always they receive praise afterward. Then they are ready for
the next challenge. The scope of the assignment that needs to be completed
to receive the positive reinforcement is small at first, but then increases.
All children experience an “energy supply” problem to some degree.
The rest of the problems from the earlier list are more specific and thus
require an individualized approach that is based first on the student’s per-
sonality and social developmental factors and second on the state of his or
her higher mental functions. In the contemporary psychological and edu-
cational literature the personality-oriented approach is widely popular; it
focuses on maintaining motivation and awareness of successes in learning.
We emphasize the importance of the second approach.
Assessing the state of students’ HMFs requires a neuropsychological anal-
ysis that identifies strengths and weaknesses in their development. From the
point of view of neuropsychology, the main strategy of developmental edu-
cation (or remedial-developmental education if necessary) is to “stimulate
the growth” of the weaker components while relying on the stronger com-
ponents in completion of specially designed joint activity of the student
and the educator. In other words, as formulated by Vygotsky, the principle

of working in the zone of proximal development is supplemented by the
principle of taking the weak components into account. A teacher presents a
student with an assignment, motivates its completion, and takes part in that
process: at first the teacher takes over the functions of weaker components
and later gradually transfers them to the student. To achieve that the teacher
needs (1) to design school assignments that target the weak components
based on the principle “from simple to complex” and (2) to offer support
(give hints) to the student that would allow him or her to complete the
task by using the functions of the weak component (see Chapter 2). The
individual approach to remedial-developmental education (RDE) can only
be realized if the teacher works with a psychologist who is familiar with neu-
ropsychological diagnostic methods of the state of higher mental functions
and with methods of their development and remediation in the process of
learning.
what are the stages of this approach?

Based on the results of neuropsychological assessment and tracking diag-
nostics (observing the child’s behavior in class and during breaks, analyzing
work on school assignments), the psychologist and the teacher determine
strong and weak components of the student’s HMFs and the direction of
developmental interventions; for example, development of programming
and control functions, voluntary attention, or visual-spatial functions.
Having determined the focus of the interventions, the teacher and the
psychologist design the methods of conducting this work. In cases where
the student experiences significant difficulties, this intervention can be the
joint work of both professionals. When the difficulties are relatively insignif-
icant, the teacher may conduct the developmental work in the process of
teaching.
It is important for both the teacher and the psychologist to determine
the level of complexity of the tasks appropriate for a particular student.
Tasks that are either too easy or too difficult are equally useless. Ideally the
student should be able to complete the task without making mistakes but
by putting forth effort. The psychologist, who works either with a group
of children (two to four students) experiencing similar difficulties or with
each student individually, designs these tasks based on the knowledge of
the developmental mechanisms of a particular function. He or she ranks
the content and context of tasks from the easiest to the more complex ones
accordingly.
Here the School of Attention (Pylaeva & Akhutina, 1997/2008 R) manual

can be useful because it provides examples of assignments aimed at learning
numerical sequences in order of difficulty in regard to programming and
control of actions; in other words, difficulties in performing voluntary
actions. The first assignments include actions in familiar situations using
the full, materialized program; later assignments require verbal support
with consequent folding (internalization) of the program.
In the manual both the content and the context of assignments become
more complex. In addition, each task can be carried out on different levels
of complexity of programming. For example, one worksheet with Schulte
tables (with a random distribution of numbers) allows such possible tasks
as laying out the cards with numbers 1–9 to table cells 1–9, outlining the
numbers in the table cells, or searching for numbers there in a particular
order (from 1–9 or from 9–1). When the assignment switches from laying
out numbers in a particular order to searching for numbers in that same
order, the materialized action based on a materialized program changes to
an action, in which such support is optional but is available for students if
they start experiencing difficulties.
To determine the level of difficulty appropriate for a particular student,
the psychologist presents a trial task of medium difficulty and registers the
amount of help a student needs. The subsequent assignments are then based
on these results.
Thus, a psychologist working in developmental education classes
arranges tasks based on the logic of the development of particular func-
tions. A teacher might use this assignment sequence at the initial (prope-
devtic) stage of learning, but generally the sequence is coordinated with
the curriculum. The curriculum can be analyzed from the point of view of
difficulties that it presents to individual students and could be rated from
easy to more difficult for different functions. This analysis not only allows
the identification of those children who might potentially experience dif-
ficulties but also determines what kind of problems they may experience
in completing different assignments; this, in turn, enables the development
of helping strategies and assigning tasks that gradually increase in level of
difficulty. A teacher might use the strategy of using hints that can be adjusted
in terms of quality or quantity for students with different problems.
When using the individual approach, the process of completing assign-
ments is interactional – the teacher provides support when the student
experiences difficulties and changes the quality of hints depending on the
hypothesis that he or she has built together with the psychologist in regard to
the mechanisms of these difficulties. For example, if a child does not initiate
working on the assignment, the teacher, based on the hypothesis of delayed

executive functions development, offers support aimed at stimulating the
student or helping him or her become organized; if the hypothesis is that
the weakness is in visual-spatial functions, the teacher would help a student
orient him- or herself in regard to the page of the notebook.
In addition to correctly assessing the nature of the hint that is being
offered, it is also important that the teacher accurately determine the amount
of support needed. This determination occurs on the spot and is based on
feedback; the amount of help given increases or decreases depending on the
student’s actions. Consequently, developmental tasks should be designed in
such a way as to allow different variations of hints depending on student
actions. For example, in the School of Attention manual, in tasks of laying
out and searching for numbers in Schulte tables, two rows of numbers are
used: one row for the teacher and one for the student. When a student is
laying out cards from his row of numbers to the cells of the Shulte table,
the teacher might, if necessary, point to her own row to correct or prevent a
mistake. The teacher can either simply point to the corresponding number
of the row/sequence or remind the student of the sequence; further the
teacher might continue giving hints, moving her finger along the row, or
take away her finger while still reminding the student about the sequence.
Another way for a teacher to help students with different strengths and
weaknesses comprehend study materials is to use multiple (multichan-
nel) modalities of lesson presentation. If, when introducing a new letter,
the teacher presents visual, tactile, and motor images of the letter while
explaining the key elements of its writing, then students can use the channel
of receiving and processing information that works best for them. Thus
students use their strengths but at the same time receive an opportunity to
work on their weaknesses.
how successful is developmental work? How many times

does a particular student need to repeat tasks
of the same type?
To answer these questions one needs to be able to exercise control over
the dynamics of assignment completion. This control can be achieved by
monitoring the number of mistakes made, the number and quality of hints,
and the length of time required to complete assignments of essentially sim-
ilar types presented in different formats. If results are improving for all
parameters or if the first two measurements improve and then the comple-
tion time becomes shorter, one can say that developmental work has been
successful and it is now possible to move on to more complex tasks. Yet this
data on dynamics can be used to motivate a child: it can and should create
competition, and it can and should have a therapeutic effect.
Constant monitoring of dynamics is also necessary for portioning (“dos-
ing”) the assignments during a lesson: for example, the increase in the num-
ber of mistakes or the decrease of work speed are warning that it is time to
change activities.
Besides monitoring of task fulfillment the use of tests or partial neu-
ropsychological assessment is also helpful.
On completion of the developmental program it is useful to repeat the
trial assignment and to have the student complete new assignments aimed
at the same function to check the transference of learned skills (see, for
example, Akhutina, Pylaeva, & Yablokova, 1995 R, and Chapter 7).
The last thing to keep in mind is the alterations of motivations from
extrinsic emotional to intrinsic more cognitive. As long as the assignment
presents certain difficulties for students, they need an “emotional warm-
up” to successfully complete the task. For example, a teacher might ask
students to “help Pinocchio,” who cannot solve the problem by himself.
Another warm-up technique is to introduce an element of competition.
After the task has been learned, the student needs to be presented with
an educational (control) task that presupposes more cognitive intrinsic
motivation. According to this principle, every cycle of the School of Attention
ends with control tasks in which strictly formal worksheets are used.
The individual approach to developing education based on neuropsycho-
logical knowledge can be used with all children, but is particularly effective
with children with partial delays in psychological development that lead to
learning disabilities. It can be just as useful for the so-called unsuccessful
gifted students who make up, according to the data obtained by different
authors, more than one-third of all children (see Shcheblanova, 1999 R).
This approach has been successfully applied in developmental classes to
prepare children for school. We describe specific methods used in these
classes in the following parts of the book.
part ii
METHODS OF DEVELOPMENT AND

REMEDIATION OF EXECUTIVE FUNCTIONS
Online ISBN: 9781139012799
Chapter
6 - Organization of Joint Activity pp. 89-92

6
Organization of Joint Activity
The development of programming and control functions (executive func-

tions) is a long process that is completed significantly later than the devel-
opment of other mental functions – either in late adolescence or the early
twenties. This process has several stages, but the most significant restruc-
turing occurs around 7 years of age. This period is associated with the
development of voluntary regulation of activity as well as with changes in
psychological and physiological mechanisms of attention.
In child and educational psychology it is known that the ability to plan
actions and perform them voluntarily develops in grade school through the
process of learning. As learning activity becomes the leading activity at this
age, all mental processes undergo reorganization, because thinking moves
to the center of the child’s consciousness and starts to define other mental
functions. These changes lead to the development of voluntary mental
processes and internal planning and control (Davydov, 1990 R; Vygotsky,
1997b).
Neuropsychological research has found that the development of the
ability to create a program (plan) of action and regulate and control its
execution is supported by structural-functional mechanisms of the pro-
gramming, regulation, and control of current activity (Unit III) located in
the frontal lobes. Owing to the connections with the “energy” block (Unit
I), Unit III is responsible for the regulation of different states of activity
(selective attention in particular) and of voluntary behavior (Luria, 1973).
These findings are supported by data obtained in research conducted
on children diagnosed with ADD or ADHD. As both neuropsychological
analysis and neurovisualization data show, a significant percentage of these
children suffer from the underdevelopment of programming and control
functions; in particular, the ability to inhibit an incorrect answer or retain
a complicated plan of actions in “working memory.” This deficiency is
89
attributed to problems in the frontal striatal and/or frontal parietal circular

connections (Casey et al., 1997; Diamond, 2005; Hale et al., 2000; Osipova &
Pankratova, 1997 R; Zavadenko, 2005 R).
Psychophysiological research shows that, at the age of 6 to 7 years, the
leading role of the elementary emotional system of brain activation is being
replaced by a new system that is based on a voluntary verbal regulation of
activity. At the same time, frontal areas of the brain (especially in the left
hemisphere) gradually begin to assume the role of the “conductor of the
brain ensemble” (Farber, 1990 R).
Thus the age of 7 years is a critical period for both social psychological
and psychophysiological aspects of development. That explains why, in the
early school years, the lack of voluntary regulation of activity is observed
particularly frequently and is identified as the prevalent cause of learning
difficulties.
Difficulties in programming and control can present as a diverse behav-
ioral picture. Some children are hyperactive and fidgety, lack self-control,
and act impulsively, without thinking; others, on the contrary, are slow,
apathetic, not active enough, and unfocused. The common features of both
of these groups is the inability to organize their activity and difficulties in
focusing attention on the task at hand, switching from one task to the next,
and following the rules.
These difficulties are not particularly noticeable at home, before children
start school; however, they become evident in kindergarten when these chil-
dren start to experience difficulties following teachers’ directions, are not
able to listen to complete verbal instructions, and get distracted and con-
fused in the process of completing tasks. These deficits negatively affect
learning motivation, and as a result children become consistently unsuc-
cessful.
Programming and control functions could be developed by organizing
joint activity between a teacher and a student. The action plan, owned
initially by the teacher, should change consistently in such a way that it
becomes an internalized property of a student. For this to happen it is
necessary to create the following conditions that allow the student to “get”
the program and assume increasing control of this process:
r Presenting the program externally and materializing it (through visual
representation)
r Organizing the joint student-teacher activity in a way that allows the
student to move from the unfolded “element by element” action and
its control to its folded forms (i.e., more compact, efficient, and inter-
nalized; Galperin, 1969; Vygotsky, 1997b)
Organization of Joint Activity 91
Five stages of scaffolding can be identified in the joint student-teacher

(psychologist) activity of mastering the program:
1. Joint element-by-element completion of actions according to verbal

directions from the teacher, with element-by-element control pro-
vided by the teacher. Both the plan of action and the control are the
teacher’s responsibility.
2. Joint step-by-step completion of actions according to the visual program.
The teacher makes sure that the student is following the plan of actions
and completes a control activity that consists of comparing this plan
to the results obtained. The teacher and student share programming
and control.
3. Joint action completion using the visual plan of actions and transitioning
from step-by-step completion to more abbreviated forms of completion.
For example, if the student has to write the succession of numbers 1, 2,
3 . . . , he or she can write some numbers looking at the pattern (plan)
and some numbers from memory. At this stage, the programming
and control functions that are shared by the teacher and the student
become more compact, efficient, and internalized, and the teacher’s
role in the programming and control decreases.
4. Independent completion of action using internalized (internal) program
and returning to the visual program when difficulties arise. At this stage
the student both completes the action independently and controls
that process. The teacher observes the student and monitors whether
the student turns to the visual program if he or she starts to experience
difficulties. The teacher reminds the student to do so if necessary.
5. Independent completion of actions based on internal programming and
transferring the program to new material. Here the student transfers
the learned modus operandi to a new material while the teacher
monitors this ability to transfer.
Based on our experience, such detailed and thorough management of

the process of internalization of the plan of actions and its control leads to
students’ active absorption of new material. As Dubrovina notes, “Initially,
the teacher explicitly directs the student’s activity, monitoring every step,
even the smallest one, but gradually the monitoring decreases and only the
general result is monitored” (1991 R, p. 81). Yet some authors have expressed
concerns that using step-by-step control to monitor a student’s attention and
performance can potentially have a negative effect on the development of his
or her ability for voluntary, independent actions. Indeed this negative effect
can occur if the transition from step-by-step to independent completion of
tasks is not arranged properly. At first the student needs to obtain external
support (external materialized program) to be able to master the plan of
action, but later the support may be decreased. If that initial support is
not provided, it can result in the situation described by A. M. Prichozhan:
“Children seem to resist the new stage: they need an adult to explicitly and
specifically identify the point of completing one stage and transitioning to
the next. They experience particular difficulties when they perform tasks
independently: having completed one part, they can’t transition to the
next, they get distracted and thus seem disorganized, absent-minded, etc.”
(Dubrovina, 1991 R, p. 82).
To prevent that from happening it is necessary to make the program
external and to arrange the process of its becoming more internalized. Sys-
tems of methods that have been created to develop the functions of planning,
control of actions, and voluntary attention include the School of Attention
(Pylaeva & Akhutina, 1997/2008 R; for Finnish, Spanish, and Slovak trans-
lations see the Recommended Reading) and the School of Multiplication
(Pylaeva & Akhutina, 2006 R). The tasks that promote the development of
programming and control functions have been included as part of an all-
encompassing neuropsychological remedial-developmental method, School
Is Near. Traveling with Bim and Bom in the Country of Mathematics (Akhutina
et al., 1999/2006 R), that teaches children how to learn effectively.
Online ISBN: 9781139012799
Chapter
7 - The School of Attention and a Pilot Study of Its Effectiveness pp.
93-114

7
The School of Attention and a Pilot Study

of Its Effectiveness
In this chapter we present the data of our study of the effectiveness of

remedial-developmental education (RDE) using the School of Attention
method, with students whose learning difficulties were caused by delay in
the development of programming and control functions; this delay has been
identified as one of the leading causes of learning disabilities (Akhutina &
Pylaeva, 1995 R; see also Pennington, 1993).
The remedial work was conducted with a group of six first-grade students
of School #109 in Moscow (principal, E. A. Yamburg; classroom teacher, A.
P. Filina). Hour-long lessons were conducted twice a week over 2 months
(March–May) and included interventions to remediate difficulties in pro-
gramming and control and to help develop visual-spatial functions. Two
main methods, the School of Attention (Pylaeva & Akhutina, 1997/2008) and
Perceptual Modeling (see Chapters 13 and 14), were used. The first method
focuses on developing programming skills, whereas the second targets both
programming and control skills and visual-spatial abilities. In this chapter
we describe our experience with the School of Attention method.
subjects
The course of remedial interventions was conducted with the first-grade
students who participated in the “first- to fourth-grade” program begin-
ning in kindergarten (the goal of this program is to facilitate a smooth
transition to a school setting). Based on the teacher’s and psychologist’s
observations of students’ learning activities during class and results of the
neuropsychological testing of all the students in the class (n = 24), we
identified six students (five females and one male) with more pronounced
This study was conducted together with L.V. Yablokova.
93
Table 7.1. General data on students in the remedial group
Wechsler test results

Students Gender Age Verbal IQ PIQ Full-Scale IQ
A F 7.5 90 90 89
B F 7.5 79 110 93
C F 6.7 85 108 96
D F 6.8 95 97 96
E F 7.3 90 122 106
F M 7.3 100 119 111
learning disabilities caused predominantly by delay in the programming

and control of voluntary activity (see Table 7.1 for data on the students).
These difficulties manifested themselves in an inability to understand
tasks as quickly as other children did and to follow instructions for com-
pleting them. These six children were impulsive, not fully oriented to the
conditions of the task, and tended to give hasty responses. In addition, they
often failed to compare their results with the model provided. One student’s
behavior (Student A) was characterized by hyperactivity and increased dis-
tractibility; her actions were often inconsistent and chaotic. In contrast,
the other five students were slow and relatively inactive, and they lacked
interest in completing tasks. Neuropsychological testing revealed that pro-
gramming and control difficulties were accompanied by a partial delay in
the development of other higher mental functions.
Whereas in Student A programming and control difficulties were com-
bined with hyperactivity, in Student F they were accompanied by increased
exhaustion and fluctuations in his ability to work caused by deficiencies in
the energy unit of the brain (Luria, 1973). The rest of the students (B, C,
D, E), in addition to having difficulties in programming and control, also
exhibited problems associated with the information-receiving and process-
ing unit: all showed delays in the development of phonological analysis and
auditory memory, and three of the four (B, C, and especially D) had spatial
difficulties as well as deficiencies in visual perception and memory.
Comparison of the neuropsychological assessment results of all these
children with their Wechsler test scores showed that weakness of executive
functions and the slight delay in processing of auditory information corre-
sponded with a decrease in verbal IQ (VIQ): in all children VIQ ≤ PIQ. The
IQ test does not differentiate secondary (as in Student A) and primary (as
in Student D) defects of processing of visual and visual-spatial information
(see Table 7.1).
The School of Attention and a Pilot Study of Its Effectiveness 95
Figure 7.1. Completion of the coding task “numbers – dots” by Student F.
control tasks
To identify the students’ baseline functioning and to assess the effectiveness
of remedial interventions, they were asked to complete a number of control
tasks at the beginning and at the end of the remedial intervention series.
The analysis of baseline abilities was necessary to determine the appropriate
difficulty level of programming and control tasks for each child. In addition,
because we planned to use numerical rows in our remedial interventions,
we needed to establish the baseline level of students’ understanding of this
concept.
To assess programming and control abilities we used two tasks: coding
and V. M. Kogan’s technique (Kogan & Korobkova, 1967 R). Coding is a
widely used task in which, using certain rules presented in a table, every
symbol from the upper row is coded by a different symbol and recorded
in the lower row. Typically the correspondence between the two symbols is
not defined by either their form or content; the rule is arbitrary and is not
based on any specific rationale. However, we modified this task by creating
a rule of coding that could be explained rationally.
In the first task a circle with a dot in the middle was supposed to be
coded as “1,” a long rectangle with two dots on both sides as “2,” a triangle
with three dots as “3,” and a square and a five-pointed star as “4” and “5,”
respectively.
In the second coding task, numbers 1–5 were used to code the number of
dots that together formed a particular spatial design (almost like a domino –
see Figure 7.1).
Performance of coding tasks reflects students’ abilities to independently
understand a plan of action, learn it, use it to complete the task, and to find
mistakes made during the process. These specific coding tasks were chosen
because their plan of action is presented in a visual format and could be
easily understood. To perform the tasks successfully, students needed to

understand the relationship between quantity and number, using a visual
model. The coding tasks were not used during the remedial course, but
could be used to assess the students’ ability to transfer the skills acquired in
the process of remedial interventions onto the proximal tasks.
V. M. Kogan’s technique involves sorting figures by matching two of their
characteristics: color and shape. It consists of a table in which the colors
are presented vertically and different geometric figures (circle, square, etc.)
are shown horizontally. The goal is to find an appropriate cell for every
card with a colored geometrical figure on it. The modified version of this
technique with four shapes and four colors was used to assess the students’
ability to switch from joint actions with a teacher using verbal instructions to
independent actions. The need to consider two indicators (color and shape)
requires that students orient themselves to them before starting the task
and then be able to resist the tendency to sort on the basis of one indicator
only. This technique does not require counting and does not use numbers.
In addition because it was not used in the course of remedial interventions,
it could be applied to situations where the ability of students to transfer
programming and control skills to new activities had to be assessed.
To determine the students’ mastery of the numerical sequence the following
methods were used: (1) counting forward and backward to 10, (2) writing
numbers 1–10 in direct order, (3) arranging numbers 1–10 in direct order,
and (4) searching for numbers 1–10 in tables with randomly arranged num-
bers (Schulte’s tables, 16 and 25 fields). These tasks required actions based
on the internalized program of a numerical row. It is exactly such actions
that students master through the series of remedial interventions. The com-
parison of students’ performance on these tasks at the beginning and the
end of the course of remedial interventions determined the interventions’
direct effects on students’ performance.
Control tasks (coding, Kogan’s technique, and Schulte’s table) form a
continuum from less to more complex, which allows one to determine the
direct and indirect (transfer) effects of RDE.
initial performance of control tasks

In coding tasks students correctly used numbers to mark the number of dots
in various shapes. That meant that they had developed the basic understand-
ing of quantity and its numerical equivalents. However, the performance of
all students was slow: the first version took from 3 min, 10 sec to 5 min to
complete, with an average time of 3 min, 54 sec; the second version took
from 4 min, 25 sec to 8 min, 20 sec, with an average time of 5 min, 54

sec. Only Student D completed the tasks without any mistakes; the rest of
the students each made three to four mistakes and were not able to inde-
pendently correct all of them. Students A and F made the most serious
mistakes:
r Student A did not understand the plan of action in one of the tasks
and put one dot in every cell.
r Student F, having copied the sample, later abandoned it and started
repeating the simple increasing sequence of dots without paying any
attention to the number of dots in the upper row (see Fig. 7.1).
Students performed the task of sorting shapes in Kogan’s test with varying
degrees of success:
r Student C finished the task in 1 min, 30 sec and made two mistakes
that she discovered and corrected on her own.
r Students B and E completed the task in 2 min and 2 min, 40 sec and
made five and six mistakes, respectively. They were not able to correct
all of the mistakes on their own and required the teacher’s help.
r Student D made the same number of mistakes, but it took her even
longer to finish (4 min, 20 sec).
As in the previous task, Students A and F made the most egregious mistakes
due to impulsivity (eight mistakes) and difficulties learning the plan of
action.
Performance of tasks to determine the level of mastery of numerical
sequence (1, 2, 3 . . . ) showed the following:
r The students had sufficient ability to count in direct order; only Student
D omitted one number, but was quickly able to correct herself. Three
students had difficulties counting in reverse order.
r They had sufficient ability to reproduce the numerical row in writing.
r Some children showed hesitations in choosing numbers while laying
out the numerical row (for example, between numbers 6 and 9), with
a performance time between 20–45 sec.
r The children worked slowly and showed doubts, compensatory tech-
niques, and mistakes while searching for numbers from 1–10 in
Schulte’s tables (table 1–16 took 20–50 sec, with an average time of 34
sec; table 1–25 took 30–55 sec, with an average time of 44 sec).
Thus, control tasks revealed that students had mastered the basic concept
of quantity and its numerical representation and were able to count in
direct order and write numbers. However, working with numerical rows in
situations that required less automatic actions posed difficulties that, as data
from all the tests showed, were linked to an incomplete internalization of
these concepts as well as an insufficient development of programming and
control skills; these problems were particularly pronounced in Students A
and F.
school of attention method

When initiating remedial interventions, neuropsychologists use certain tests
to identify the weak and strong components of a child’s higher mental func-
tions. These test results are then used to create a joint activity between an
adult so that strong components “pull in” and involve weak components,
thus developing them and letting them “grow.” In other words, neuropsy-
chologists form an adult–child functional system, in which the adult takes
upon him- or herself the functions of a weak component and performs them
consistently while at the same time switching more and more of these func-
tions to the child. Such techniques are called “scaffolding” using G. Bruner’s
metaphor that designates child–adult co-action in the child’s zone of proxi-
mal development (Wood, Bruner, & Ross, 1976; see also Bodrova & Leong,
2007; Chaiklin, 2003; Daniels, 2007). Based on Vygotsky’s (1997b) theory
of the development of higher mental functions and its further advancement
by Russian psychologists (Galperin, 1969), we suggest that the neuropsy-
chologist arrange the transference of functions to the child by changing the
difficulty level of tasks along three parameters:
1. From joint action under adult guidance to independent action
2. From action based on the external plan of actions (teacher’s instruc-
tions, visual sample) to action based on the internal (internalized)
program
3. From the unfolded element-by-element action and action control
to their more compact, internalized, and efficient forms (Akhutina,
1998a R; Akhutina & Pylaeva, 1995; Pylaeva & Akhutina, 1997/2008
R).
The “scaffolding” and the choice of material are equally important. As
was pointed out earlier, the tasks should be ranked based on the demands
that it places on the weak component: if programming is the weak link, then
the ranking should be based on programming complexity.
Both the content and the degree of independence should be chosen in
such a way as to place higher demands on the student in each consequent
task, while giving the student a “way out” so that he or she can step away
from the maximum requirements of a particular task (if the demands of
the task turn out to be too high) and complete it on an accessible level. To
be able to balance the task requirements and the amount of help offered,
one needs a thorough ranking of tasks based on their complexity so that
a teacher/psychologist can on the spot choose the tasks and the level of
support that are appropriate for each child.
The level of programming and control required to complete each task is
ranked based on the five stages described in Chapter 6. For such a ranking
we have chosen tasks with numerical rows for several reasons. First, they
are a required part of the educational process and form the foundation of
students’ education. Mastery of a numerical row represents one of the main
cultural skills of human beings, is acquired early in life, and is necessary
for everyday functioning. Such mastery presents difficulties for children
with delayed development of mental functions (Kapustina, 1989 R). The
inevitable use of this material at school will help strengthen the skill and
transfer it to other mathematical actions. Second, numerical rows are unique
in that they enable the creation of a plan of action in an external form, can be
used to organize a joint adult–child activity, and enable a gradual decrease in
help offered by an adult and an increase in a student’s independent actions.
Third, numerical rows can be used to create positive feelings for students,
because they can be easily incorporated in a game (for example, pretend-
ing you are at school) that, as psychological data indicate (Lubovskiy &
Kuznetsova, 1984 R), is one of the favorite games for preschoolers.
RDE work using School of Attention methods was conducted during the
entire course of remedial interventions (15 lessons). Overall, the children
completed 38 tasks, with each task consisting of as many as five to six
different actions (laying out cards, tracing the numbers, showing them in a
particular order, etc.). We used tasks from all five cycles:
1. numerical row in familiar situations
2. numerical row in direct order
3. quantitative row in direct order
4. numerical row in reverse order
5. parallel rows
Tasks from the same cycle as well as the two adjacent cycles could be
used during the same lesson (although tasks from other methods were used
as well). Overall, the complexity of programming increased from cycle to
cycle. Within each cycle the initial tasks were, as a rule, easier and more
unfolded than the consequent tasks.
Most of the tasks were assigned to the whole group (although if a student
missed a lesson, he or she would receive individual training). The tasks were
performed by every student at the same time or by taking turns, as in a
competition: one student would start while the rest of the group watched,
and then another student would take over. The complexity (how much
the task was folded that is, externalized/internalized) changed based on the
student’s capabilities.
Using the predominantly group task design in this course for the first
time, we found that working in small groups increased children’s motivation
to complete tasks and saved time. However, this design placed increased
demands on psychologists because it required that they do the following:
r organize work for several students
r find tasks with such variations in complexity that they were appropriate
for different students
r observe the completion of the task on the level that is the most difficult
yet adequate for each student and provide appropriate and timely
support
Let us examine the completion of the tasks in each cycle.
Numerical row in familiar situations. Based on the data obtained in the
control tests we chose as the initial remedial tasks the ones that included
working with numerical rows in familiar situations because they were easy
for the students. In addition, these tasks required only partial actualization
of the numerical row, which allowed for practicing active responses and
fighting stereotypes.
We used the following as familiar situations:
r the plots of two well-known Russian fairy tales (“Turnip“ and “Little
Tower”)
r numbers of floors and sections in apartment buildings
r numbers on the phone pad and the clock face (see Fig. 7.2).
In the tasks that used the fairy tale plots, the numerical row was present
in its complete form; in other words, it was maximally established. In tasks
with floors and stairs students were required to use parts of numerical rows
(from the second to the eighth floor or “skip one step”).
The data showed that in familiar situations students were easily able to
incorporate the plan of action if it included the actualization of the entire
numerical row. However, they started having problems when they needed
to actively select a part of it: they had difficulties initiating the task and were
unable to stop themselves from talking through it out loud. A visual model
Figure 7.2. Pages 2 and 4 of the first cycle of School of Attention.
that clearly marked the beginning and the end of the row or that presented
the plan of action consisting of “skipping one number” allowed them to
overcome these difficulties.
In the tasks using a dial pad of the phone or a clock face where the
students were asked to find a mistake in the numerical row, they had to
analyze the sample, finding and showing every number in it with a finger,
before starting to work on the task itself. Otherwise students were not able
to use the sample effectively and made numerous mistakes.
Overall, the first remedial interventions showed that in familiar situations
students could follow a simple plan of action presented in the form of a
visual sample or an oral instruction. More complicated plans of action
that required partial actualization of the numerical row posed difficulties:
students did not use the visual model and did not sufficiently develop the
skill of using the sample to orient them to the task.
Numerical row in direct order. In the second stage we used the tasks
based on the plan of action that used a sequence of numbers in direct order
from 1–10. These tasks required finding the numbers placed in random
order in the table or in an unstructured field (the first group of tasks is
known as “Schulte tables” and the second as a trail-making test – see Fig.
7.3). In addition, we used tasks involving copying and independent creation
of the tables, as well as connecting the numbered dots (10 tasks in all).
These tasks allowed a gradual transition from maximally externalized
joint actions in creating the plan of action, realizing it, and controlling this
Figure 7.3. Pages 1, 2, and 4–7 of the second cycle of School of Attention.
process to independent efficient completion of the tasks using an inter-

nalized program. In the first task students were given several cards, called
“soldiers.” The psychologist also had her own set of cards (“detachment
of soldiers”). She “paraded” them in order and then asked the children to
“parade” their “soldiers” in order, matching them to the cells of the program
(the places for the elements of the program were marked on top; see Fig.
7.3). The psychologist then pointed out the Shulte’s table and said, “The
soldiers need to go to their posts. Where do you think the first soldier has to
go? – You are correct – to the post N1. You are a sergeant. Post the sentries.”
The child took the token with number 1 and put it in the correct place.
Putting the cards in order (when the sample was available) was the
materialized plan of action of the activity, which was also performed in the
materialized fashion. To teach students how to conduct an organized search
of the numbers, “soldiers” were moved to their posts using a particular
route – from left to right and down line by line.
After the child finished placing the cards, the psychologist said, “The
soldiers are standing, they are watching. The sergeant has to check the
posts. What about the post N1, N2?” (i.e., she explained the first part of
the program in verbal form and observed if this hint was enough for the
child to complete the task – if not, she used her line of tokens as the external
program). Then the “soldiers” returned to the cells of the program in an
orderly fashion.
Let us look at the students’ performance on these tasks. While “parading
soldiers” (laying out the plan of action row), two students hesitated, and
Student D needed to refer to the sample. Students made very few mistakes
in the following actions (placing cards in the table and returning them to
the row) because they were using the complete (unfolded) version of it.
For example, Student F, after placing the card with the number 2 on it,
moved on to the card with the number 4 (skipping number 3). Student
D, having completed laying out the plan of action, began from the last
number instead of the first. It took each of them 15 to 30 sec to complete the
task.
In the subsequent tasks children traced, colored, and copied the num-
bers in order or traced the route from one number to the other. These types
of tasks differed from the earlier ones because they lacked a step-by-step,
element-by-element plan of action: here the students switched to the con-
solidated plan of action with gradual transition into the internal format.
Yet, like the earlier ones, these tasks made the search easier for the students
because the already used route was marked – narrowing down the field of
the future search. This help was not available in the subsequent tasks in
which the search was conducted in the entire numerical field.
While completing initial tasks of this type, students counted out loud;
when they attempted to complete the tasks in silence, mistakes started to
appear in the form of omitting numbers (for example, moving from number
4 to number 6 and omitting number 5). Toward the end of the period of
practicing these tasks, the mastery and internalization of the plan of action
had been accomplished, which allowed the students to conduct the search
successfully without materialized help in a significantly shorter period of
time (6–15 sec). Even more indicative of their success is that students were
able to make a Schulte table, arranging numbers from 1 to 9 in random cells
independently either without any mistakes (four students) or with very few
(two students).
It is important to point out that the psychologists’ suggestion to formu-
late the plan of action (to perform a meta-cognitive task) turned out to be
a significant factor that facilitated the focusing of attention on the plan of
action and on verbalizing it. In such cases the following instructions were
given to the students:
“Pinocchio received an assignment but he is confused and does not know

what to do at all. Let’s help him. What do you think needs to be done
here? Explain it to Pinocchio” (see page 4 in Fig. 7.2).
Moving from the materialized representation of the plan of action to

child’s own verbal plan made the transition from the current task to all the
consequent tasks easier.
Just as with the previous tasks in familiar situations, working with full,
partial, and discrete (even and odd) numerical rows was very beneficial. The
degree of students’ orientation to the plan of action increased if intentional
errors made by adults were included in the plan of action or the table. Doing
so proved to be necessary because in the course of mastering the tasks with
the full numerical row, it became familiar to the students and they stopped
referring to the sample (plan of action). On the one hand, this failure to check
the sample indicated that the plan of action had been internalized, which
can be considered a positive, but on the other hand, checking the sample
would have allowed students to further develop the skill of preliminary
orientation. Every time the stereotype had to be broken to force the student
to start checking the plan of action again. The degree of students’ orientation
in terms of the plan of action increased if tasks with full, partial and discrete
(even and odd) numerical rows were offered or if intentional errors made
by adults were included in the plan of action or the table.
Quantitative sequence in the direct order. The goal of having students
check the sample to orient themselves was also served by the tasks in the next
cycle, in which multiple objects (from 1 to 10) instead of numbers (with
their abstract designation of quantity) were located in the stops along the
way or in the cells of Schulte tables. Their concrete character, which required
the students to independently form an abstract concept of quantity, made
these tasks more complicated than the previous ones.
In several tasks of this cycle (“The Mushrooms,” “The Peas,” “The
Petals”) students had to find the minimal number of objects among the
presented sets of objects, write that number down, and move on to the
next one. The written number could serve as a “crutch” for the subsequent
search; it marked the already used route, thus helping narrow the search
field. In the rest of the tasks of this cycle (variations of the tasks with dots)
students did not have this “crutch” in the form of written numbers (see
Fig. 7.4).
Figure 7.4. Pages of the third cycle of the School of Attention.
The two easier tasks (“The Mushrooms” and “The Peas”) were completed
at the beginning of the cycle, and the third one (“The Petals”) was done
at the end – for control. In the initial tasks four of the six students had
problems mastering and following the plan of action; they each made two
mistakes in quantity and an additional mistake (Student F) in omitting one
set of objects. In control tasks only one student made a mistake in following
the program, but there were no quantitative mistakes. It is important to
Figure 7.5. Pages of the fourth cycle of School of Attention.
note here that in the process of mastering the tasks with dots located in the
cells of the tables we focused on developing not only programming skills
but also the students’ ability to perceive the configurations of dots (which
signified quantity, as in dominos) as one piece, gestalt.
Numerical row in reverse order. In the course of neuropsychological
testing it was already discovered that counting in reverse order was not
a sufficiently automated process in three children, as evidenced by their
slow speed and mistakes (for example, 8-7-4, skipping 6 and 5). Similar
performance was noted in the task where students were asked to lay out
cards from 10 to 1. Students were slow to complete the task (30–50 sec),
had to talk out loud through it, and made a number of mistakes in the
order of the cards. These mistakes were corrected only with the help of the
teacher. In addition, two students started laying out the row from right to
left, so the cards ended up in direct order. Because of the lack of automation
extensive work was needed to create the program and use it. Let us consider
this process using an example of task completion called “Pinocchio” (see
Fig. 7.5).
In this task the students were asked to help Pinocchio find numbers in
reverse order from 9 to 1 in a Schulte table. Pinocchio had already started
to create the plan of action, but had made a mistake, and the students
were encouraged to check whether the plan of action created by Pinocchio
was correct. Having found and corrected the mistake, the students were
supposed to write down their own plan of action. After that they searched for
and showed the numbers in the table, thereby demonstrating to Pinocchio
how to do it. Because there were some problems in the beginning, students
were given an additional task: to trace the numbers in the table in the order
assigned by the plan of action. In this task none of the students made a
mistake except for Student F. During the next lesson students were able to
successfully build the plan of action for a similar task on their own, and
everyone, except one student, was able to follow it correctly when shown the
numbers in the table. However, when asked to copy the numbers in the table
from 9 to 1, two students again had a difficult time using the plan of action,
and one of them made two mistakes: omitting and writing numbers in the
wrong cell. Thus, students were able to master more simple actions with
the reverse-order numerical row, but experienced setbacks in more complex
situations that required additional active attention to find and remember
the location of the numbers in the table.
Reverse-order tasks revealed that students experienced the most diffi-
culties with the first part of the plan of action. To help overcome these
difficulties, the beginning part of the plan of action can be highlighted
using different colors, font sizes, etc. It is also helpful to practice the stage of
materialized action in more detail using “real” objects; for example, mov-
ing a “butterfly” from flower #10 to flower #1 or putting the “cars” with
numbers (cards with an outline of the car) in the garages (the cells of the
table).
As in the previous cycles, reverse-order tasks were practiced using full
and incomplete or discrete rows. Some of these tasks involved graphic
presentation and pointing to even and odd numbers in the reverse order
using the already created plan of action or using a plan of action where the
students had to add the elements themselves.
Performance on tasks involving graphic presentation based on the visual
program improved from task to task: in the first task almost all the students
required help with motivation or organization, whereas all of them com-
pleted the last task on their own. The task of pointing out numbers in the
table was always performed after the graphic presentation. Thus, students
would become familiar with the plan of action in the course of completing
the graphic tasks, and the task of pointing out the numbers helped assess
both their ability to independently use the plan of action for support and
the degree of its internalization.
During completion of the first task of pointing out the numbers, it was
already discovered that students did not need motivating or organizing help:
they were able to use the plan of action for support. However the degree of
internalization of the plan differed:
r Students A, D, and E completed the task without using the sample.
r Students C and F used the sample while working with the first row
of uneven numbers, but did not need it when they moved on to the
second row.
r Student B needed the sample the entire time.
Figure 7.6. Completion of the tasks by Student A: 1 – connecting the dots (cycle 1);
2 – “Pinocchio” (Cycle 4); 3 – “Turtle” (cycle 4).
In addition, the majority of students used their fingers to mark the elements
of the plan and/or talked through all the items of the plan of action out loud
(“2 plus 2”; i.e., the element of the plan and its realization).
Because students did not achieve sufficient internalization of the plan of
action after completion of the first task, in the next task (called “Turtle”),
they were offered the special assignment of building it up. Each student was
given a picture of a turtle with numbered spots on the shell and with two
rows of numbers in green and red (see Fig. 7.6). Here is a dialogue between
student and teacher.
teacher: How do you think this turtle should be painted?”
students: “It should be painted with two colors: red and green as shown
in the task: 15, 13 and 11 in red and 14, 12 and 10 in green.”
teacher: “What other spots should be painted in red?”
Students could not answer this question.
teacher: “How can we continue the row 15, 13, 11?”

Again the students were not able to answer.
teacher: “Here you need to count by every other number. What will be
the next number?”
students: All together (except students B and D): “9, 7, 5 . . . ” In the
process of recounting, Student F experienced a setback, switching to the
complete row in the direct order: “5, 6, 7.”
Teacher: “Finish the row” (i.e., finish the first plan of action).
All students (except student B) were able to complete this task without mak-
ing mistakes – some on their own and others needed adults to help them
organize. They performed the task of completing the even row indepen-
dently, without mistakes caused by insufficient comprehension of discrete
rows or difficulties in switching over. Students successfully completed the
graphic realization of the plan of action (i.e., painting).
It is helpful to start working with incomplete and discrete rows by review-
ing tasks of the first cycle with familiar situations and mastering the oper-
ation in the materialized form first: floors, elevators, odd and even sides of
the streets (e.g. the students show the route of the mail carrier). The task
of laying out the discrete reverse-order row should come before the task
that requires finishing the plan of action or creating a plan of action based
on the analogy. Incomplete even and odd number rows can be used more
extensively. Nevertheless, mastering of even and odd rows should not be a
goal in and of itself: the main issue in that task is the ability of students to
organize their activity according to the plan of action.
Parallel rows. The last cycle was conducted using the most complicated
material – parallel rows. It required greater distribution of attention (i.e.,
greater volume of working memory) and, consequently, stronger reliance
on the plan of action.
The tasks with parallel rows required simultaneous completion of the
two subprograms (see Fig. 7.7). They could be either identical (two rows
of numbers in direct or reverse order), analogous (direct order of numbers
and letters in alphabetical order), or of the opposite direction (one row in
the direct order, the other one in reverse order). In this course students
completed seven tasks of the first two types. As always, the new type of
tasks was introduced in the most unfolded form, using for support the
materialized form of the plan of action and its realization.
In the first task students were given a table with numbers from 1 to 10
in two different colors and two sets of cards with numbers in the same two
colors. First, the students laid out a row of numbers in one color, and then
they laid out the second row of the other color – both in direct order –
Figure 7.7. Pages 1, 2, 7, and 9 of the fifth cycle of School of Attention.
thereby placing the two rows of cards with numbers of different colors on
the table. All students completed this task with no mistakes. After that, the
teacher modeled the order of completing the task (1–1, 2–2) and asked the
students to “read” the plan of action in its entirety (“1 black – 1 white;
2 black – 2 white, . . . ”) while pointing to the numbers in the two rows.
Students were able to do that without any problems. After this successful
trial students were given a task of putting the cards on the table in the same
order. They took the card with black number 1 and put it on the table;
then they did the same with white number 1, and so on. Overall, students
were able to follow the plan of action successfully; however, at times they
“slid” to a wrong color, taking the number from the lower row instead of
the upper. Next, students were supposed to return the numbers to their
original spots following the same plan of action, but this time the plan was
not available in an external form. While putting the numbers back, students
were able to follow the order from 1 to 10, but switching to the wrong color
occurred with higher frequency than in the previous version of the task. By
the time students started the third task, which consisted of parallel tracing
and pointing the numbers in two tables (see Fig. 7.7 – page 1), the program
of operation was internalized enough to enable students to point to the

numbers without mistakes even in the absence of the model.
However, not all the students were successful in working with parallel
rows in reverse order. For example, Student E, while working with reverse
order for the first time, was able to complete it in 68 sec, having made a
mistake of sliding to a wrong color despite the presence of the visual model.
Later doing a similar task without a model, she was able to successfully
complete the search in 55 sec. Student D, having mastered the plan of
action by the time she started the third task, nevertheless made a mistake in
following the plan of action during the completion of the task.
Thus, during the completion of this cycle, as in the previous four, students
displayed positive dynamics in their ability to act according to the plan of
action. They relied less on a trial-and-error method, because counting in
direct and reverse order was becoming automated; they were also more
consistently at the stage of orienting to the task. They started to use the
plan of action in a more organized way and were able to better control
their actions. In addition, they developed the ability to internalize the plans,
even when they were as complicated as the tasks with parallel rows. In
addition, diverse operations with numbers facilitated the strengthening of
the numbers’ visual images and led to the disappearance of mirror-type
errors and to the improvement of writing skills.
Let us analyze the dynamics of improvements in students’ programming
and control abilities using the examples of task completion by Students A
and F, who experienced the most difficulties in this area at the beginning of
the remedial cycle (Figs. 7.6 and 7.8).
These two students were the ones who did not use the plan of actions in
the coding task, “numbers – dots,” in the control stage: Student A ignored
the program and began to put one dot in every cell, whereas Student F
passively reproduced the increase in the number of dots from one to four
(similar to the model), not paying attention to the numbers in the upper
row of the table (see Fig. 7.1).
Students A and F made mistakes at the beginning of the remedial cycle
even in the simplest tasks of connecting the dots (see Figs. 7.6-1 and 7.8-1).
In the middle of the cycle they made mistakes only in the more complex
tasks. For example, in the task “Pinocchio” (see Fig. 7.6-2), Student A, having
found the mistake made by Pinocchio in the plan of action, nevertheless
made two mistakes herself in writing the plan of action for the reverse-order
row: first she started writing numbers in the direct order and then missed
#6. Student F in the reverse-order task missed #8 (see Fig. 7.8-2). By the end
of the cycle these students were able to perform rather complicated tasks;
Figure 7.8 Completion of the tasks by Student F: 1 – connecting the dots (cycle 1);
2, 3 – “following the route” (cycle 4 and cycle 5).
for example, discrete reverse row (Student A, see Fig. 7.6-3) and parallel
rows (Student F, see Fig. 7.8-3).
final performance of control tasks

We begin this section with the tasks that were similar to the ones used during
the intervention cycle; namely, the Schulte tables. In control tasks (at the
beginning and the end of the cycle) we used Schulte tables with fields of 16
or 25 items (in our lessons we only used tables with up to 12 fields).
During the first trial those students who performed the tasks slowly (34
sec and 44 sec), kept their finger on the number, and said the next number
out loud completed the task much faster (21 sec and 32 sec) and without
mistakes and overt verbal mediation at the end of the remedial cycle (Table
7.2).
Coding tasks were not included in the remedial lessons; however, the skills
that were practiced during these lessons (relationship between quantity and
numbers, use of the visual model) were operations included in the coding
tasks. Comparison of students’ performance on these tasks at the beginning
Table 7.2. Completion of control tasks with Schulte tables (sec)
Field 1–16 Field 1–25

Average Average
completion Data completion Data
Trial time scatter time scatter
First 34 20–50 44 30–55

Second 21 12–28 32 27–48
and the end of the cycle showed an increase in speed and confidence. There
were no mistakes made because of insufficient mastery of the plan of action
or slipping from it to the numerical rows in the direct order; however,
because of the increase in the speed of task completion, two children started
making mistakes caused by difficulties in switching, which students were
able to correct themselves. Students began to ask more questions to clarify
the program before starting their work. Some were able to internalize the
plan of action, and others would turn to the external plans if they were
experiencing difficulties (Table 7.3).
Kogan’s method differed from the tasks used during the interventions in
both form and material, which enabled its use to assess the ability to transfer
skills of programming and control to new tasks. If before the remedial cycle
students as a rule worked slowly and made a significant number of mistakes,
after the intervention, their actions were more successful. For example,
Student C, working at his previous fast pace, was able to complete the task
without any mistakes. Student B, although completing the task in the same
amount of time, made slightly less mistakes. Students A, D, and F were
able to reduce both the time of completion and the number of mistakes
significantly: from eight, six, and six mistakes during the first trial to two,
two, and one mistakes in the second trial, respectively. They no longer made
Table 7.3. Completion of coding control tasks
“Figure – number” “Numbers – dots”

Average Data Average Data
Trial completion time scatter completion time scatter
First 3 min, 54 sec 3 min, 10 sec to 5 min, 54 sec 4 min, 25 sec to

4 min, 59 sec 8 min, 20 sec
Second 2 min 43 sec 2 min, 19 sec to 3 min, 43 sec 3 min, 3 sec to
3 min, 2 sec 4 min, 45 sec
Table 7.4. Completion of Kogan’s tasks
Number of mistakes
1st trial 2nd trial
Not Not
Overall corrected Overall corrected
Time of completion
Students of number of by the number of by the
the group 1st trial 2nd trial mistakes student mistakes students
Student A 3 min, 5 sec 2 min 8 7 2 1

Student B 2 min 2 min, 10 sec 5 0 3 0
Student C 1 min, 30 sec 1 min, 32 sec 2 0 0 0
Student D 4 min, 20 sec 2 min, 35 sec 6 5 2 0
Student E 2 min, 45 sec 2 min, 7 sec 6 4 6 1
Student F 2 min, 10 sec 1 min, 10 sec 6 5 0 1
Average in 2 min, 38 sec 1 min, 57 sec 5.5 3.5 2.3 0.5
the group
the most egregious mistakes caused by not knowing the plan of action.
Student E, completing the task faster while not increasing the number of
mistakes, was able to correct practically all of them, thus demonstrating an
improved ability for control (Table 7.4).
Thus, the control task results showed improvement not only in the
performance of tasks similar to those mastered in the process of remedial
interventions but also, more importantly, in the ability of students to transfer
the new skills of programming and control to different types of tasks. They
prove the effectiveness of using numerical sequences to help overcome
the insufficient voluntary regulation of activity in children. However, it is
important to note that, as subsequent studies demonstrated, students from
this group periodically required further supportive remedial interventions.
Yet with this help they were able to successfully handle the school load.
In the following chapters we discuss other methods to develop program-
ming and control functions.
Online ISBN: 9781139012799
Chapter
9 - Numerical Rows in Remedial Work with Fourth Graders pp. 128-135

9
Numerical Rows in Remedial Work

with Fourth Graders
Although methods of remedial-developmental education (RDE) in which

numerical rows were used to overcome delays in the development of pro-
gramming and control functions in kindergarteners and first-grade stu-
dents have been described in detail in the literature (Pylaeva & Akhutina,
1997/2008 R), methods of working with older schoolchildren have received
much less attention. In this chapter we present the results of our experi-
ence of using numerical row tasks in remedial work with two fourth-grade
students, Dima and Maxim.
Dima and Maxim did not complete their homework very often and
had a difficult time becoming engaged in assignments during class. Dima
completed his third grade in a rural area and, not surprisingly, began having
problems when he transferred to an urban school for fourth grade: he no
longer wanted to go to school. When Maxim was in the first grade he lost
his father, and since then his grades had worsened.
Both students had difficulties in counting when solving math problems,
especially more complicated ones. They confused addition, division, and
multiplication. They also had a very difficult time correcting their mis-
takes and would often dwell on them. In addition, they had problems with
reading and retelling stories and made many orthographical and phonetic
mistakes in writing. Teachers complained about their inattentiveness, their
low learning motivation, and inability to master the school curriculum.
The results of neuropsychological testing showed that both students pri-
marily had difficulties in the programming and control of voluntary actions;
in Maxim these difficulties were accompanied by easy fatigability and a low
work capacity.
This work was performed together with school psychologist I. F. Goncharova.
128
Numerical Rows in Remedial Work with Fourth Graders 129
Based on the data obtained in the testing, we turned to the School

of Attention method of development and remediation of these functions
(Akhutina & Pylajeva, 1995; Pylaeva & Akhutina, 1997/2008 R). Given the
students’ age we chose the more complex tasks included in this method that
use parallel rows of numbers in reverse and direct order. We also created
new, similar tasks based on the same principle: creating an external plan of
action and arranging for its internalization. In all exercises we started with
materialized actions (with objects) that, as the plans of action were mas-
tered, turned into actions based on an internalized program. We increased
the complexity of the tasks as the children proceeded.
Each student participated in 30 lessons (45 minutes each), 10 of which
were joint sessions.
first type of exercises

The materialized stage uses numbered cards that are put in front of the
student in a row (up to 25). The student is asked to move cards (to a row
above or below the existing row) according to the established plan: down
(while saying the numbers out loud) and up (counting silently). They are
asked to take turns using their right or left hand to move the cards while
continuing to count. The visual aid in the form of cards with numbers
helps the students switch from internal to external speech, while keeping
the program of counting intact. The program proceeds as follows.
Rhythm 1:1. First, the student says the number out loud and moves the
card down using the left hand. The student then says to himself the name
of the number while moving the card up using his right hand. The student
ends up with two horizontal rows of numbers in front of him: he says out
loud the numbers in the first row (odd numbers) and says to himself the
numbers in the second row (even numbers). After laying out the cards, the
student reads the numbers on the cards in one row and then in the other,
and answers question about the difference between them.
Rhythm 2:1. The program gradually becomes more complicated, while
the connection between the movement of the hand and the voice is main-
tained. The student says “one” and “two” out loud, and simultaneously with
one hand moves the cards with numbers 1 and 2 down; she says “three”
silently and with the other hand moves the card with number 3 up, etc. The
student reads the numbers in the upper row and explains in what way these
numbers are different.
Rhythm 3:1. In this optional stage, there is a different rhythm in using
hands and moving cards. The hands are switched in the 1:1 rhythm, while
speech and moving cards follow the 2:1 rhythm. In this case, the student
says two numbers out loud while moving the first card down with the right
hand; he also moves the second card down but with the left hand. He says
the third number to himself while moving the card up with the right hand.
The child says the fourth number out loud and moves the card down with
his left hand, etc.
While completing the first task, Maxim and Dima immediately became
confused about which hand to use and when to say the number out loud or
to themselves. Often they had to stop and think before moving the card, and
they needed help almost every time they were supposed to move it. By the
end of the cycle they had mastered the tasks with simple rhythms, but were
not able to complete them within the designated time and had a difficult
time automating the movements.
second type of exercises

In the second type, the program of counting is similar to the first group
of exercises, except there is no materialized program. Instead, the teacher
provides modeling and oral instructions. The exercises use steps and walking,
as follows:
The student counts the steps according to the given plan either loudly and
in a whisper, or loudly and silently. The teacher walks next to the student.
When a new rhythm is introduced, the teacher starts counting together
with the student, who then joins the teacher. When the student masters
the rhythm, he starts counting on his own and “leads” the teacher. Fifteen
to 30 steps are used in this exercise. The initial rhythms are 1–1 (1 out loud,
2 silently; 3 out loud, 4 silently); 2–1 (1 and 2 out loud, 3 silently, etc.); and
3–2. As the student masters the program he or she is offered a choice of
rhythms. When the exercise is performed in a group, students take turns
leading the group. To make the exercise more complicated, additional
subprograms are introduced. For example, while saying a number out
loud, the student is asked to move one arm and, when saying it silently,
to move the other – or, when counting out loud, to move forward and,
when counting silently, to move backward. Then clapping can be added
to moving backward. In these exercises students are the ones who make
sure that the movements and counting are synchronized. In addition,
these exercises train memory and attention.
First both Maxim and Dima performed poorly on the second type of
exercises. Their body coordination disintegrated, they made unnaturally
large steps, and they could not follow the plan; sometimes they would start
taking steps with the same foot every time while dragging the other behind.
By the end of the cycle, Maxim had mastered this exercise well, but Dima
was still unable to follow the program with the more complex rhythms.
third type of exercises

This cycle helps students develop the concept of numbers using vertical rows
by learning to represent numbers as a sum of other numbers that change in
the order in which they are placed in a row of numbers.
For example: 15 = 14 + 1; 13 + 2, etc. The equations are laid out on the
table or school desk so that number 13 is under 14, 2 under 1, etc. Thus,
two vertical rows are formed. Moving the card with number 15 on it up
and down the rows and inserting the appropriate operational signs, one can
come up with different ways to represent it. These tasks can be performed
by working with objects (cards) as well as in written form.
fourth type of exercises

The fourth type of exercises uses the well-known method of finding all the
numbers in a row of numbers with the same denominator.
The student lays out a numerical row; for example, numbers from 1 to
25. Then he or she moves into a second row those cards with numbers that
can be divided by a particular number; for example, 3 (as in the first type
of exercises). Thus, two horizontal rows are formed. All numbers that have
this denominator are now in the same row. The student then manipulates
the numbers in this row by addition (3 plus 3 is 6, plus another 3 is 9 . . . )
and multiplication (3 times 1 is 3, times 2 is 6 . . . ).
The other row provides an opportunity for the student to master a
particular type of division problems where there is a remainder. If difficulties
occur while checking the division exercises, blank cards can be used. They
are formed into “piles” (17 ÷ 3 = 5 “piles” and 2 more cards) to help
student understand the concept of division with the remainder. Multiple
repetitions of these actions while moving along the row strengthen these
concepts.
Exercises of the third and fourth types created difficulties for both Dima
and Maxim. They could not figure out how to present a number as the sum
of two other numbers. For example, Dima, when asked to present different
variations of number 16, wrote only 16 = 10 + 6, but could not figure
out how to continue. Only creating vertical rows by putting the added-up
numbers, one under the other, enabled the students to visually present the
I II IV
17 = 1 + 16 2 + 15 4 + 13
2 + 15 3 4 + 13 8+9
3 + 14 5 6 + 11 12 + 4 5
4 + 13 8+9 16 + 1
5 + 12 10 + 7
6 + 11 12 + 5 V
6 7 + 10 14 + 3 10 + 7
8+9 15 + 2 15 + 2
9+8 16 + 1
11 + 7 10 + 7
12 + 6 11 + 6 III VI
11 + 5 12 + 5 3 + 14 5 6 + 12 11
12 13 + 4 13 + 4 6 + 11 12 + 6
14 + 3 9+8 11 + 6
15 + 2 12 + 5 12 + 4 5
16 + 1 15 + 2
Figure 9.1. Completion of tasks of the third type by Maxim.
composition of the number. In addition, at first they could only proceed by

adding “1” to the numbers, yet still made mistakes (see Fig. 9.1).
In column I, they made mistakes even when counting by one. In column
II, mistakes were caused by the difficulties of switching to a new plan of
action: having mastered the switch, Maxim became successful from that
point on. He made no mistakes in column III, where the count is by 3. In
column IV, one “falling out of step” when counting by 4 was noted, and
after that, because of exhaustion, the number of mistakes started to increase:
omitting 5 + 12 (column V) and numerous corrections when presenting
number 17 as a sum of two other numbers where the next pair of numbers
was formed by adding or subtracting the number 6. Later the programs of
action became more efficient: students could increase the size of the step
(i.e., add or subtract by 2, 3 etc.).
In tasks of the fourth type, while moving along the row, the students had
to use blank cards at first to help them master the concept of division and
multiplication. We had to help by reviewing the numerical row that had
already been learned.
fifth type of exercises

The exercises of the fifth type are working with tables similar to Schulte
tables in which the cells contain the results of multiplying by a particular
number “X” (Pylaeva & Akhutina, School of Multiplication, 2006 R). Here,
the focus is on practicing the knowledge students obtained while completing
tasks of the fourth type.
72 9 54 126 98 56
27 81 36 84 14 112
45 18 63 42 70 28
Figure 9.2. Examples of the tables.
When filling the cells in succession the student is also asked to complete
an additional task: find the number to fill the next cell by adding number
“X” to the number in the previous cell. In our tables, “X” is equal to 10,
5, 3, 4, 6, 7, 8, 9, 12, 13, 14. These tables can be considered as original
addition tables, and they gradually increase in the difficulty of counting.
The first number in the table is set as equal to “X” or 10. While working
with tables, the student first talks through the addition and then completes
the operations without talking. After that the student can move on to the
next table. This exercise has proved to be very effective in forming the skill
of oral counting, which was presented in a game situation. In addition it can
be used to develop learning motivation because the element of competition
between students during group lessons can be easily added. See Figure 9.2
for examples of these tables.
Both students liked working with the tables, although Maxim had a more
difficult time than Dima getting oriented to them and it took him a long
time to find certain numbers. Nevertheless, he got less tired working with
tables than with abstract oral counting of the same numbers (he needed to
take a break after oral counting). Both students made mistakes in calculating
sums.
In addition to the tasks with rows of numbers, we offered them other
tasks to facilitate the development of visual and verbal logical thinking, as
well as relaxation exercises.
sixth type of exercises

The sixth type of exercises are exercises similar to Raven’s Test or “Analogies”
and “Classification.”
In the first group of exercises students were presented with the square
with four slots and three figures in it, and they had to guess what is the
fourth figure. To find the right answer the children were asked to describe
the changes in the figure drawings located underneath each other (in a
vertical row) and then in the drawing of figures in a horizontal row. They
traced the elements of the figures with different colored pencils, which
made it easier to identify the changes along each direction (some tasks in
the test were modeled with the help of different objects). The students were
supposed to draw the fourth figure and explain why their answer was correct
by describing the identified “rules” according to which the figures in the
drawings were changing.
While performing the exercises similar to Raven’s Test, students experi-
enced the most difficulties providing verbal descriptions of the differences
between figures. They enjoyed completing the “Analogies” and “Classifica-
tion” exercises in joint sessions in the form of a competition.
seventh type of exercises: working with words

A word made out of cards that each have one letter on them is laid out in
front of the student. The student then creates new words by changing the
order of the cards or by using some of them. The exercise helps the student
practice switching, strengthens the visual images of words, and activates
vocabulary. Both students struggled to create new words but became very
excited when they created a new word.
eighth type of exercises: dramatization of verses

The tasks in this group consist of artistic sketches that children create
themselves on the basis of a small poem they read. This method has a wide
range of uses from psychotherapy to remedial and developmental sessions.
Playing an actor (impersonation) gives students a break while providing
them an opportunity to show in a creative way how they understood the
poem. The students created a drawing and a text based on the poem.
Students were offered the following poem from the book, Rhythm and
Sounds (Safonova, 1993 R, p. 67):
Cockroach lived behind the oven

Forty days and forty nights
But one day without warning
He crawled out into the light.
He crawled out into the light
Perched himself on top, up high
And politely asked the question:
“What dinner will we have tonight?”
Initially, only Maxim displayed creativity in acting out the events

described in the poem. For example, he moved away into a corner, squat-
ted to show how he was sitting on the oven sleeping, and then he pre-
tended to wake up. He strolled through the room, came to a table, sat
down, put an imaginary napkin around his neck, and showed how the
cockroach–aristocrat ate. Dima perceived the play emotionally and later
enjoyed attempting to repeat Maxim’s actions. By the end of this remedial
course he also started to show initiative.
what kind of improvements did the students show?

Dima started doing his homework, started to draw and sign his drawings
(which he refused to do earlier), and was able to add multi-digit numbers;
his reading and retelling what he read improved. During joint lessons, he
showed the desire to win. He was advanced to the next grade and so far has
been able to manage on that level.
Maxim’s ability to work improved significantly, and his learning moti-
vation increased. According to his teacher, the volume of his work at school
and at home increased (completing all of his homework); he started to show
interest in oral subjects (looking for additional reading and volunteering
to answer questions); and the number of mistakes in his Russian-language
assignments decreased. However, math tests continued to be stressful for
him, causing him to become disorganized and lose his acquired skills. It was
recommended that Maxim continue with the interventions focused on the
development of cognitive functions and emotional control.
Тhe data described in this chapter allow us to conclude that tasks involv-
ing rows of numbers, as well as additional exercises that are designed on the
basis of the same principle – creating an external program and gradually
internalizing it – are effective methods of overcoming delays in the develop-
ment of planning and control functions. The next chapter presents another
example of our work: it describes our work with a child who at the age of 7
was not ready to start school because of problems in regulating his actions.
Online ISBN: 9781139012799
Chapter
10 - The Role of the Analysis of the Zone of Proximal Development in t
he Course of Remediation of Executive Functions: An Example pp. 136-15

10
The Role of the Analysis of the Zone of Proximal

Development in the Course of Remediation of
Executive Functions: An Example
As we have already noted, to apply neuropsychological methods for the

purposes of remedial-developmental education one must first conduct
an assessment of the child’s psychological development. It is also neces-
sary to monitor the state of higher mental functions in the process of
learning.
The results of the primary testing determine the strategy of the remedial
work, whereas the tactics are based on data obtained by tracking diagnostics.
The analysis of children’s behavior, their participation in different games,
and their successes in completing creative and educational assignments is
the basis for choosing tasks of the appropriate level of complexity. When
the child is completing RDE assignments, the psychologist has to constantly
interpret the kind of difficulties that the child is experiencing and provide
support based on these interpretations. Dynamic tracking (current control),
diagnosing the child’s difficulties, and providing appropriate support form
the basis of neuropsychological remediation. This approach to RDE is based
on L. S. Vygotsky’s concept of the zone of proximal development (ZPD) and
his claim that the defect needs to be “qualified” to diagnose developmental
problems and design the plan of interventions (Vygotsky, 1993, p. 254;
1997b; see also the introduction to the English-language edition of this
book).
In the course of remedial work, the neuropsychologist first identifies the
zone of proximal development and then works within its parameters, pro-
viding support for the child by assuming the functions of the weak compo-
nents and gradually transferring these functions to the child. The qualitative
analysis of the kind and level of scaffolding needed, conducted through the
“lenses” of neuropsychological data, allows progress to be tracked effectively
and the educational process to be modified to fit the changing abilities of a
student. The next section illustrates this process using a case study.
136
The Role of the Analysis of the Zone of Proximal Development 137
assessment results
K. is a 7-year-old boy whose parents brought him to the Center of Curative
Pedagogics because of his misbehavior and difficulties in learning letters
and math. The specialists from the Center recommended a course of RDE
to prepare K. for school. The course included medical treatment, speech
therapy, introductory lessons in grammar and math, physical therapy, music
and art lessons, and neuropsychological remedial intervention.
During the assessment the neurologist noted increased excitability, visual
motor dyscoordination, strabismus, increased dystonia in the arms and the
legs, and endocrinological problems; when the boy felt worse there were
noticeable tremors, pathological toe and hand reflexes, and light weakness
on the right side.
The physical therapist noted some deficiencies in fine motor skills in the
hands, difficulties in simultaneous coordination of the arms and legs, and
an inability to perform a sequence of hand and arm movements without
additional stimulation and visual control.
The speech therapist noted that his speech was fast and rhythmically
disorganized; common, everyday speech was grammatically correct, but K.
experienced difficulties in telling a story. He articulated sounds in words,
but simplified the combinations of consonants. The syllabic structure of the
words was also disturbed. A phonematic analysis was not conducted.
Teachers noted that learning was difficult for K. He experienced severe
problems in getting oriented to new material. The pace of learning new
skills was slow, and he was not able to retain them. He was easily distracted
during classes; it was not unusual for him to get up from his desk and start
a fight with another student in the class. His mood was typically elevated
and cheerful, but highly labile. He was quick to start a conflict, cried easily,
and his emotional reactions were often inappropriate.
K. was also unable to play role games independently. When games were
arranged by teachers he encouraged everyone to play by the rules, but
was unable to do so himself because of difficulties in behavior control. In
his creative artistic activities the content of his fantasies was marked by
stereotypes.
According to the neuropsychological testing, K. was disinhibited and
impulsive, demonstrated motor excitation at times, and had an elevated
mood. He was not fully aware of his mistakes, and his emotional reactions
to those mistakes were diminished. He was easily distracted during class and
could not retain the plan of action when completing assignments; increased
distractibility was present in the form of unproductive operations with
objects, inclusions of irrelevant materials, and lateral associations in speech

assignments. At times he totally abandoned the main task.
When K. was tired, he demonstrated not only disinhibition but also
difficulties engaging in tasks and pronounced perseveration. Nevertheless,
he could get interested in completing some tasks, and it was possible to
organize his activities. When he was interested, his ability to work increased
for a period of time, and the usual difficulties in performing tasks partially
disappeared. However, the period of active work would soon be replaced by
exhaustion, evidenced by increased disinhibition and perseverations.
K.’s knowledge of the outside world was rather limited: he did not know
the current date, day of the week, month, or year or the name of the street
he lived on; he could only name the current season after several hints.
Although the child was right-handed, his left ear and left leg were dom-
inant.
K. was able to understand and do the simple version of “Go-no-go test”
(raise your right arm when you hear one tap; raise your left arm on two).
He only made two mistakes when we tried to alter the pattern (after the
sequence 1-2, 1-2, 1-2 taps, we made 1-1 taps). However, in tasks involving
conflict (for example, raising his finger if he was shown a fist and vice
versa), he found it difficult to form the correct reaction. He copied the
psychologist’s actions and could not follow the verbal instruction, and his
errors increased in number when we attempted to alter the pattern.
In the asymmetrical tapping trial (|∗∗ ), K. was able to learn the task only
when it was mediated through speech. At first we were able to form a motor
pattern only in one hand; later we were able to extend it to both hands.
In the trial on reciprocal coordination (Oseretsky’s test), nonspecific
fine dyscoordination was noted, with no dissimilarities between hands. His
movements were abrupt and sharp, and he tended to lift his fingers; frequent
loss of a step was noticed when he was performing tasks with his eyes
closed.
There was practically no synkinesis noted in the other hand in the Zazzo
test, but slight finger synkinesis on the same hand was present.
K. was able to perform the dynamic praxis test (Palm-First-Edge Test)
only by verbal instruction and had to name his actions during it. When the
naming was interrupted, simplification errors started to occur (instead of
three elements he completed only two elements of the program). Persever-
ation when switching to a different structure was also noted. The teacher’s
verbal instruction helped improve the results. In the course of completing
the task the child started to give instructions to himself.
Copying the rhythms from a model, especially when given by verbal

instruction, was grossly impaired: tapping was chaotic with extra impulses
that K. was not able to inhibit. A materialized plan of action (written
sample of rhythms) and verbal mediation improved the results, but did not
completely eliminate the difficulties.
Searching activity was noted in the pose praxis (Finger Position Test)
along with mirror-type minor errors that could be considered secondary
because they were caused by his impulsivity. K. was able to correct these
mistakes when the teacher pointed them out.
In addition to mirror-type errors caused by impulsivity (that were pos-
sible to correct), some search for the spatial positioning of hands was also
noted in Head’s trials.
Difficulties in spatial positioning of the elements were particularly evi-
dent in constructive praxis (mental rotation of design), drawings, Block
Design Test, and writing letters and numbers. When the plan of action was
presented in its full form, K. was able to complete simple trials with no
mistakes.
In trials on acoustic gnosis (evaluation of rhythms), deficiencies in the
analysis of fast and complex rhythmic structures were noted. These diffi-
culties were eliminated when his attention was organized and the rhythms
were presented at a slower pace.
In verbal memory trials the learning was somewhat slowed. Additional
problems included errors caused by perseveration (lack of cognitive flexibil-
ity), confusing homophonic words, and inclusion of extraneous material.
However, delayed recall (after a small pause and interference by another
activity) was good.
K. showed interest in the visual object gnosis trials. He could easily
differentiate between the figure and the background and find differences
between the pictures. Errors were caused by false interpretations based on
his first impressions.
The volume of K.’s visual memory was good, and he was able to memorize
images of objects well; the only noted difficulties occurred in recalling the
order of the elements. In contrast, memorization of letters and especially
geometric figures was clearly impaired: the memory volume here was low,
and K. was not able to recall the order of the elements. There were also
errors in reproducing spatially oriented figures.
K.’s speech was limited; sentences were short with some stereotypes
and perseverations. However, no noticeable search for words or significant
grammar errors were noted.
The special assessment of speech and language functions revealed the

following:
r K. could easily understand questions and answer more simple ones

in the dialogue trial; however, he experienced difficulties in giving
detailed answers.
r Errors of responding with a phrase instead of a word were present
in the trial on naming the objects and actions, and he could not
separate the word from the context. In addition, when pronouncing
long words that required more complex motor skills, anticipation and
perseveration in pronouncing sounds, especially difficult ones (l-r),
were noted.
r He was able to construct simple sentences. In more complex sentences
K. would often replace an object’s exact name by a more general,
approximate name. In addition, he experienced difficulties in creating
complex structures; the tendency to simplify syntax structures was also
noted.
r The task of creating a story from a picture was performed adequately,
but the content of the story was poor. The lack of cognitive flexibility
was very pronounced here along with limited vocabulary, simplifica-
tion of syntactic structures, and difficulties in programming a coherent
text. The story was short, with omission of important content links;
he showed a tendency to just list the details when looking at the pic-
ture, and perseverations were also noted. When given very simple
pictures (for example, “Family,” “Yard”), difficulties in programming
were minimal but the lack of cognitive flexibility was still present. For
example, “Children went outside and the cat went with them. Some
of the children climbed on the cube and others got on the swing. And
this other boy ran to them on the cube. And this other girl slipped and
fell.”
r In speech comprehension and verbal memory trials, errors were made
primarily in the complex trials (for example, when K. had to memorize
three to four words or when he was presented with complex, reversible
logical grammatical structures). These errors were caused by inatten-
tion. The student was able to correct his mistakes if presented with
the same material for a second time or if an adult drew his attention
to them. Errors in the phonological analysis trials most likely were
caused by perseverations and attention deficits. Perseverations were
also present when repeating words or syllables.
r Overall he performed well on the trial of determining the number of

syllables and sounds in a word; however there was a fluctuation in
answers caused by inattentiveness.
r The reading test showed his ability to read separate letters and simple
words. In comparison to the norm of the same age and social group,
K. had pronounced delays. He also experienced difficulties in reading
separate letters as well as words.
The assessment of cognitive processes showed a noticeable discrepancy
in the results depending on the complexity of the tasks, as follows:
r Understanding the plot of pictures and series of pictures. As noted earlier,
K. did not experience any difficulties in understanding pictures with
simple plots; for example, “Family” (“The mother has given birth to
a baby. Mom and Dad had sisters. . . . They were happy”). At times
there were errors due to impulsivity when putting a simple series of
pictures in order; for example, K. would put a picture at the end
instead of the beginning of the story, but was able to restore the
correct order after the teacher advised him to check if the assignment
was completed correctly. However, more complex picture stories that
required thorough screening of the pictures, comparing details, and
searching for the hidden meaning caused difficulties that he was unable
to overcome: even when he was shown the pictures in the correct order,
he could not grasp the meaning of the story.
r Classification of objects. When presented with three groups of pictures
(“Fish,” “Vegetables,” “Berries”) he was able to identify the group
of pictures with different kinds of fish but combined the other two
groups into one group he named “Vegetables.” When classifying fruits
and vegetables (after the names of the groups were given to him), he
made two mistakes by mixing together perceptually similar objects
instead of identifying their significant characteristics (he put tomato
in the fruit group and lemon in the vegetable group). He was able to
correct these mistakes when they were pointed out to him.
r Classification of objects according to two characteristics. When K. needed
to classify objects according to two characteristics at the same time –
for example, color and shape (modified Kogan’s method of sorting
colored figures; see Chapter 8) – he had even more difficulty: a visual
introduction to the task was required, and in the beginning of the task
the teacher had to search the table together with him to help him find
the appropriate place for the figures. When K. attempted to complete
the task on his own, he started sorting based only on one feature (color
or shape) and ignoring the other. For example, when paying attention
to shape only, he put the square next to another square of the same
shape while not paying attention to its color.
Overall, in all tests of intellect, K. demonstrated a lack of extensive

preliminary orientation, simplification of the plan, errors caused by impul-
sivity and perseverations, and insufficient control. His level of intellectual
functioning was low compared to the norm.
In conclusion, the primary problems in the development of higher
mental functions were problems of programming, regulation, and control
of complex voluntary activity caused by increased disinhibition and lack
of flexibility of mental processes. These types of problems are indicative of
delay in the development of frontal lobes, primarily the left hemisphere of
the brain. In addition, immaturity of the parietal occipital areas of the brain
was evidenced by difficulties in spatial and quasi-spatial synthesis.
Neuropsychological assessment confirmed a favorable prognosis based
on the fact that providing support in organizing his activity noticeably
improved his test results. K. was able to use that support and incorporate it
into his future activities. The assessment data also enabled the formulation
of the main goal of the RDE: to develop programming and control skills
necessary for complex voluntary activity. However, the tactics for the daily
remedial interventions needed to be defined. This was done using methods
for the assessment of the zone of proximal development.
assessment of the zone of proximal development

Assessment of the zone of proximal development (ZPD) is traditionally
included as part of the diagnostic assessment of a student’s abilities. How-
ever, it can be integrated into the educational process, becoming an integral
part of it, by enabling the selection of tasks that are on the brink of attain-
ability for the child and then providing an opportunity for the student to
complete them independently. If the student has difficulty completing the
tasks, minimal support is offered and can be increased if necessary.
Part of the ZPD assessment is the qualitative analysis of needed support;
namely, neuropsychological analysis of the functional components of the
techniques that help the students reach the set goal. These techniques can be
altered to address the functional link that needs to be supported to achieve
maximum results. Doing so requires skillful variations in the quantity and
quality of the tasks offered to the student and in the support provided.
In the course of qualitative analysis of the ZPD, neuropsychologists use

educational assignments that involve a variety of different functional com-
ponents, such as perceptual and memory processes and programming and
control functions. This is the common feature of all the educational assign-
ments; however, the most prominent skills necessary for the completion of
each assignment differ. It is important to emphasize that every task can be
altered to increase its sensitivity to different “factors” (A. R. Luria’s term).
Thus some assignments may put more demands on programming and con-
trol functions, whereas information-processing operations are relatively
simple; in others, the information-processing operations (for example, per-
ceptual skills) are more difficult, and programming and control functions
are relatively simple. In yet another group of assignments, both information-
processing operations and programming and control functions are compa-
rable in difficulty level. Tasks included in the School of Attention method
belong to the first type; tasks on perceptual modeling belong to the second
and third types. This chapter illustrates the process of analysis of the zone
of proximal development (ZPD) when using different methods.
zpd analysis in numerical row assignments

We begin with one of the first tasks in the School of Attention method.
Procedure. The teacher starts laying out cards with numbers from 1 to 10
in direct order on her side of the table and asks the student to do the same,
giving him a similar set of cards (although they could be prettier in color or
material) arranged in random order.
Assessment. The teacher observes if the student is able to pick up the plan
of action and also assesses the technical quality and action control on the
part of the student. These data can be used to verify the neuropsychological
diagnosis and to help choose a direction for future interventions.
If students start confidently laying out the cards, finish the row without
checking the model, and then eyeball the row, checking for mistakes, that
means that the plan of action has been internalized, they are comfortable
with technical details, and they are able to control their actions. This first type
of task performance means that it is possible to switch to more complicated
assignments that can, in turn, prove to have diagnostic value.
If students do not start working right away and need the teacher’s help
in engaging in the task, if they have to constantly check the model and
lay cards out next to the model instead of using the space close to them,
it might mean that the internal concept of a numerical row has not yet
been formed and they are only able to complete the task by using the
materialized plan of actions. This second type of task performance shows that
strengthening the concept of a numerical row and folding joint actions based
on a materialized plan of action are needed. The teacher should focus on
practicing independent, goal-directed actions and increasing the students’
confidence in their abilities.
If students act confidently and complete the task quickly but make mis-
takes due to impulsivity and do not use the model to check their results, this
can signify the lack of an internalized complete concept of a numerical row
and deficiencies in the ability to control their actions. Errors of this third type
mark the need for extensive work on the concept of a numerical row and for
practicing programming and control skills along with voluntary attention
to overcome impulsivity. Tasks with various levels of difficulty with external
plans of action and unfolded action control are used for this practice.
Consistent mistakes in spatial positioning of numbers (making changes
or hesitating between 2 and 5, 4 and 7, 6 and 9) are interpreted as evidence
of the insufficient development of visual images of numbers and underde-
veloped spatial skills. The fourth type of errors is indicative of the need to
improve visual-spatial skills.
The assessment of K’s zone of proximal development using the School of
Attention method showed that he had mastered the concept of a numerical
row and was able to lay out the numbers in direct order without checking
the model (see Chapter 9). However, when this task was replaced by another
task using Schulte tables, specific mistakes started to appear. For example,
when he needed to find numbers in direct order from 1 to 9 in the Schulte
tables, his speed was slow, he experienced difficulties in switching, and he
made mirror-type errors. In addition, he omitted numbers or advanced to
any number that happened to appear in his field of vision. K. was able to
show the numbers in the table in reverse order only with the help of the
full-scale (unfolded) plan of action and with the assistance of a teacher who
could point out the elements of the plan that were being used at that time
and who could exercise control of this activity.
Thus the assessment confirmed the conclusions made on the basis of
the neuropsychological testing; namely, delays in programming and control
functions and, to a lesser degree, in spatial functions. It also determined the
level of difficulties experienced by K.
K. then participated in the remedial cycle based on the School of Attention
method. In the first stage all the assignments were completed using the
materialized plan of actions as follows.
K. was offered a set of cards with numbers from 1 to 9 by the psychologist
(it also could be a teacher or a parent acting under psychologist’s guidance),
who gave him the following instructions: “You are the manager of the garage
and these are your cars. Here are my cars and I arranged them in a particular
order. Could you please arrange your cars in the same order?” After finishing
this part of the task K. was given a Schulte table with numbers from 1 to 9,
and the psychologist explained that it represented the garage: “Please, put
every car in its place. The cars move in a particular order. Car #1 would
be the first to move. Let us move it to its place. What number is its place?
Which one would be the next to move?”
This task was repeated with Schulte tables that varied in size, font, degree
of structuring, and amount of “noise,” thereby enabling this task to be used
as many times as was necessary (see the School of Attention worksheets in
Chapter 7).
zpd analysis in perceptual modeling tasks

These methods were designed with the goal of developing programming and
control functions. As noted earlier, they can be focused on the analysis and
remediation of visual and visual-spatial gnosis as well as the programming
and control of voluntary activity. The tasks were ranked based on their
perceptual complexity and the complexity of the programming involved.
The level of complexity of these parameters in the same task can be either the
same or different. For children with difficulties in programming and control
who do not exhibit specific spatial deficiencies, the level of programming
complexity is particularly relevant.
Let us look at how assessment of the ZPD can determine the level of
programming complexity in a perceptual task that is adequate for a partic-
ular student and after this discussion we return to the case study of K. This
example uses the tasks of putting together a picture puzzle.
Students are given a picture of a dog cut into six pieces vertically and
horizontally. The three pieces from the lower half of the picture are iden-
tical in size and shape to the three pieces from the upper half. The first
piece from the lower half, showing the head of the dog, is the most infor-
mative; the first and the third pieces from the upper part are the least
informative.
The procedure. The teacher gives the students all the pieces, saying,
“Please, put the picture together.” Because they are given only this gen-
eral instruction, they need to find the pieces that are the most informative
in recognizing the animal in the picture. To put the puzzle together they
then need to place the informative pieces correctly and find the pieces to
attach to them.
The assessment. The teacher observes how the student begins the task
and then determines the amount of support needed. If the child is able
to identify the informative pieces, can visually coordinate them and place
them correctly in relation to one another, and then – using the method of
visual sorting or “rational” trials – can add the less informative pieces to
complete the puzzle, that means that both programming functions and the
perceptual actions are developed sufficiently to complete such a simple task.
For a more refined diagnostic assessment the child can be offered similar
but more complicated tasks; for example, the teacher could increase the
number of pieces in the puzzle, change the pattern of the cut-out shapes, or
choose a picture with less contrast between the figure and the background.
If the student is unable to identify the informative pieces in 30 seconds,
puts them together incorrectly, or starts putting them next to each other
randomly by a trial-and-error method, she is given the first hint. The hints
differ depending on the nature of the errors, but all attempt to steer the
student in the right direction. For example, in case of a chaotic search, the
teacher might ask the leading question, “Do you know who this is? Where is
the piece that shows it to you the best?” Thus the teacher is helping the
student identify the most informative pieces. In cases of incorrect spatial
positioning, when it is unclear if the student has made a spatial error or did
not recognize the piece, the form of the question is slightly modified: “Did
you recognize who this is? Do you think you attached this piece correctly?
Did you position it correctly?”
If this verbal support proves insufficient, the student is offered the second
hint: he or she is shown a materialized plan of actions – a card that presents
the frame of the original picture and the lines of cutting. Some students are
able to pick up the hint and then correctly position the pieces in relation to
one another. For others this hint is not enough: some continue to put the
pieces together randomly, not paying any attention to the schematic plan.
Others continue to experience spatial difficulties: they are unable to change
the position of the incorrectly placed piece to align it with the model.
In those cases, children are given the third hint in the form of another,
more detailed materialized plan of action. They are shown a picture where
they can see the outlines of the pieces, and the teacher directs them to put
together the informative parts of the picture first and the less informative
last. In case of spatial problems the teacher directs their attention to the
spatial positioning of the elements on the model and helps them assemble
that part of the puzzle correctly.
Different types of tasks allow expanding the data of the neuropsycho-
logical assessment by helping further clarify the character and the degree
of difficulties experienced by students. Consequent remedial tasks are

chosen depending on the student’s performance in the ZPD assessment.
For example, if the student required the most unfolded support of the
teacher in both programming and control and visual-spatial organization,
tasks addressed to both types of problems are included in the course of
remedial interventions. It is also beneficial to assess visual gnostic and
visual memory abilities through additional trials that are sensitive to these
functions.
Visual perception of objects is a function that develops in a relatively
short period of time. However, it is difficult to overestimate the important
role it plays in the child’s cognitive development because it provides the
basis for the development of speech, visual intellect, and visual memory.
Different types of tasks that address identification of objects, finding dif-
ferences, finding missing parts, and completing the picture can be used for
the purposes of the diagnostic work in the course of remediation. Chil-
dren who require hints of the third (more detailed) type can be offered
simplified versions of these tasks. In cases of less pronounced deficiencies,
more complicated tasks that require fine visual differentiation can be used
to develop visual concepts of objects and visual attention or to optimize
orienting activity.
Assessment conducted using perceptual modeling methods showed that
K. was able to assemble simple objects from their parts. When asked to
put together a six-piece picture puzzle showing children playing outside,
which contained realistic images of the familiar situation with the main
details clearly defined, he was able to confidently put it together and made
a mistake only in connecting the elements of the background.
When presented with a 12-part puzzle with a high level of perceptual
difficulty (a well-structured central part with a less detailed background
that took up a sizable part of the image), K. was able to put together
the central part that was clearly defined by color and shape. However,
after doing that, instead of actively searching for pieces that could be put
together, he kept randomly moving parts of the puzzle around without
taking into consideration their spatial positioning, and he used the trial-and-
error method to solve this problem. He “stretched” pieces of the background
vertically, not noticing that the elements did not connect well. The teacher
then showed K. a card that presented the frame of the original picture and
the lines of cutting. The student noticed his mistake, but continued using
a trial-and-error method. Next he was given the original picture where
the outlines of the pieces were visible. Thus K. was given the plan of how
to put the rest of the pieces together, and the teacher helped him put the
already completed part of the picture in the frame. At this point the support
provided was sufficient for K. to successfully complete the task.
This profile of task completion suggests that gnosis of visual objects was
intact, but programming and control functions were significantly underde-
veloped. In addition, K. exhibited spatial deficiencies. This data coincided
with the results of the neuropsychological assessment and helped clarify
the scope of his abilities in regard to both programming and perceptual
components.
What was the strategy of working with this student to remediate the
programming and control functions where the most unfolded support was
needed? The psychologist made sure that K. was motivated to complete the
assignment. One effective way to activate and increase students’ motivation
for educational games is to use colorful pictures with interesting or puzzling
content. The initial tasks were designed in such a way as to prevent him from
using unproductive methods such as a trial-and-error method. (A task that
allows a student to make numerous unsuccessful attempts is ineffective. Yet
the child’s activity should not be strictly regulated; a task should provide
opportunities for students to take the initiative and make independent
decisions.)
To meet these requirements the tasks on perceptual modeling included
different but complementary types of tasks. Each of these complementary
tasks was ranked based on the internal complexity of the visual gnosis oper-
ations and the difficulty orienting in the task (including actively examining
the picture, identifying significant features, inhibiting bright but insignifi-
cant elements, and developing workable hypotheses).
The level of orientation difficulty of any perceptual task depends on the
number of intermediate steps necessary to complete it. Taking these steps
in the external format and arranging for their internalization form the basis
for developing programming and control skills in gnosis.
Let us look at the process of folding the plan of perceptual activity,
continuing to use the case example of K. The highest degree of unfolded
help in putting the picture together consisted of presenting the picture
showing the outlines of the pieces of the puzzle and organizing K.’s adequate
orientation, planned realization, and control of the process of completing
the task.
Using the outlined model reduced K.’s difficulty in identifying the con-
tent of the picture and distinguishing informative from uninformative ele-
ments because it showed him how the pieces were positioned in relation
to each other. At the stage of maximally unfolded joint activity, aimed
at preparing K. for independent work, the psychologist highlighted this
difficult component and asked him to find the most informative piece to
begin putting the puzzle together. K. then found this piece and placed it
on the model, which helped with the spatial positioning of this piece; if he
had placed the piece next to the model, the psychologist together with him
would monitor this process. After that, K. identified the next informative
piece out of the adjacent pieces, found this piece, and attached it to the first
one. Here again it is very important not to neglect the control process. K.,
with the psychologist’s guidance, compared the combination of the outlines
on the model to the available pieces. Having put the informative pieces
together (these, as a rule, are the central pieces of the puzzle), he and the
psychologist moved on to figure out where to place the less informative
pieces. If, while searching for the informative pieces, K. had mostly con-
sidered the content characteristics, in this stage he could take into account
their formal characteristics, such as the color of the background and the
main picture, the presence of the frame, etc. It is the psychologist who is
responsible for focusing the child’s attention on these details. Even when
K. was able to correctly identify the uninformative pieces, the psychologist
made him aware of those elements of the pieces that allowed making that
determination. The psychologist thus exercised the control function, which
became even more crucial in cases where K. was unable to correctly identify
the uninformative piece.
To monitor the process of mastering the suggested unfolded program of
actions, the psychologist asked K. to put together another puzzle that was
close in content and comparable in structure to the first successfully com-
pleted one. For the second puzzle the psychologist only provided help when
necessary and took a note of those steps that required additional practice.
The tasks of inserting the missing piece of the puzzle were focused either on
searching for the informative piece that changed the general meaning of the
image or on searching for the peripheral pieces, without which the picture
could not be complete (for example, pieces of the ornamental pattern or all
pieces of the frame).
The task of putting the puzzle together based on its partial model was
more complicated and prepared K. for the yet more difficult stage of putting
the puzzle together without a model. Using the partial model, K. could see
the frame, the outlines of the pieces, and only part of the picture. The size
of that part varied (half, one-third, one-sixth). K. was able to complete the
puzzle using the outline as a guide.
In an even more complicated task K. was given the pieces of a picture and
shown a frame with marked outlines of the pieces. Because it is difficult in this
situation to recognize the image, it is important to choose the kind of objects
that are easily recognizable based on their parts. In yet another version of
the task K. was presented with the model or its part where the outlines were
not marked. However, the psychologist had the fully marked model (the
picture with the outlines of the pieces) so that in case of difficulties she was
able to take K. back to the familiar way of completing the task.
Thus increasing the complexity of the task is achieved by increasing the
perceptual complexity of the model or the number of pieces, changing the
pattern of cutting the picture, or cutting it into asymmetrical pieces.
Using the example of K.’s putting a picture puzzle together, we showed
how the neuropsychologist withdraws support and makes the task more
difficult. Similar modifications are possible with other types of perceptual
modeling tasks (see Part III). These principles of support were used not
only by the neuropsychologist but also by the teacher in individual and
group lessons. K.’s strengths and weaknesses were also discussed with other
specialists such as the speech therapist and reading, writing, math, and art
teachers.
Toward the end of the program K. was able to successfully complete
all the tasks offered to him – those for developing executive functions
described in Chapters 8 and 9 and the modifications of tasks described
in Part III. It is important to note that he had also acquired the skill of
following the internalized plan of action and using an external one in case
of difficulties. Overall, the child became more organized; he was now able
to maintain attention for longer periods of time without getting distracted.
His abilities to solve perceptual, memory, and cognitive problems increased
mainly because of his improved capacity for programming and control of
actions. K. transitioned to a regular classroom where he was able to handle
all the requirements. However, he periodically needed neuropsychological
support when new assignments were significantly more complicated than
previous ones.
part iii
METHODS OF DEVELOPING VISUAL-VERBAL

FUNCTIONS
Online ISBN: 9781139012799
Chapter
11 - Remediation of Visual-Verbal Functions in 5- to 7-Year-Old Childr
en pp. 153-163

11
Remediation of Visual-Verbal Functions in

5- to 7-Year-Old Children
Development of sensory functions, including visual perception of objects,

is one of the main objectives of preschool education. Visual perception
is expected to reach overall maturity by school age, and school programs
are created based on that expectation. The elementary school curriculum
places high demands on students to develop full and accurate mental rep-
resentations of objects and, connected with them, verbal concepts, because
those concepts, in turn, form a foundation for developing verbal logical
thinking.
Despite the key role of visual perception, it is often overlooked when chil-
dren’s readiness for school is being assessed. Yet the data obtained through
neuropsychological testing of older preschool children and first graders
reveal that a significant percentage suffers from pronounced difficulties of
visual recognition. This was shown in the series of research studies con-
ducted by the staff members and the students of the Department of Psy-
chology, Moscow University (Kozlova, 1998 R; Ksenzenko, 1998 R; Pylaeva,
1998 R; Yablokova, 1998 R; Yurtova, 1995 R) and summarized in our book
(Akhutina & Pylaeva, 2003a R).
Our research, as well as the studies conducted by L. S. Tsvetkova and
her students (2001 R), O. A. Krasovskaya (1980 R), and E. G. Simernitskaya
(1985 R), show that difficulties in solving visual problems can be caused by
insufficient development of the following functions:
r the holistic (or global) “scanning” perceptual strategy
r the analytical “classification” strategy
r the orienting activity in visual perception acts
Language development in general and its nominative function in particular

also affect the formation and differentiation of visual images.
153
Based on that data we identified the following objectives for development

and remediation of visual perception of objects:
r developing visual gnostic processes, including both holistic and ana-
lytical strategies of visual recognition
r developing “visual image–word” connections and differentiation of
visual images and the meaning of words
r developing visual attention
The main strategy for meeting these goals is to promote the growth of
a weak component or link by using more mature functions in the process
of specially designed interactions. In the process, the adult working with
the student first takes on the functions of the weak component and then
gradually transfers them to the child by presenting tasks in order from
the easiest to the hardest in regard to the demands they put on the weak
component.
To determine the initial level of visual-verbal functioning and find the
adequate level of task complexity (as well as to assess the dynamics of the
learning process), we used an extended set of trials on visual gnosis and
nominative language function, which included the following:
r Recognition of crossed out, overlapping, and unfinished drawings
r Visual memory trial including recognition
r Verbal and nonverbal fluency tests (free drawings, drawings of plants)
r Naming trial
r Identification by name (of words similar in sound or meaning) trial
(Tsvetkova, Akhutina, & Pylaeva, 1981 R)
When any of the components of the functional system of visual percep-

tion are underdeveloped, the whole system is affected. Therefore in the first
stage we offered relatively simple, general tasks that children could com-
plete by engaging their better developed functional components. Further
along, the tasks became more targeted, focusing on the development of a
particular perceptual strategy, image–word connections, or visual attention.
Giving children tasks that were too difficult for them diminished the ther-
apeutic effect. When faced with these tasks they stopped using perceptual
characteristics of objects and instead started choosing the parts through a
trial-and-error method. Therefore it was very important to find the level of
task difficulty that was optimal for each child so that he or she successfully
completed the task by focusing attention on the perceptual characteristics
of objects.
Remediation of Visual-Verbal Functions in 5- to 7-Year-Old Children 155
Figure 11.1. Image identification tasks (an example).
The overall goals for developing visual perception of objects were met
through the first set of methods: identification of visual images. The simplest
task in this set was the identification of different, realistically colored images
of familiar objects in a lotto or bingo-type game. The complexity of these
tasks was increased by altering their gnostic or verbal characteristics. To
increase the perceptual complexity of images, we used black-and-white,
outline, stylized, and schematic copies of the color images (see Figs. 11.1
and 11.2). Comparing real objects and their more complete or generalized
images helped children identify the meaningful characteristics of objects
and focused their attention on scanning of contours. It also helped organize
children’s perceptual attention.
Narrowing the field of choice (initially the images on the cards belonged
to different categories, but later were reduced to the same category) increased
Figure 11.2. Image identification tasks (an example).
both the verbal and perceptual difficulties of the identification process.

Changing from the most frequent prototypical representatives of a category
(for example, fruit – an apple, furniture – a table) to less common, periph-
eral, and consequently less familiar ones also increased the tasks’ gnostic
and verbal complexity.
Each image identification task became a foundation for additional exer-
cises aimed at strengthening visual images. For this purpose, after complet-
ing the tasks, the students were asked to recall the pictures that were shown
(naming or delayed recognition) or the order of their presentation, to read
and choose the written names for the pictures, etc.
The second set of tasks consisted of finding differences between the pic-
tures that could be identified in a verbal form. Here story pictures were used;
initially they contained very few objects, but gradually they became more
saturated. Identifying the easiest types of differences, such as the presence
or absence of an element or an object or a change in color, shape, or quan-
tity, was practiced first. While strengthening visual images of the familiar
objects, these tasks allowed practicing visual attention and the full orienting
process. As usual, we worked on programming and control functions by
introducing the plan of actions – helping students scan the pictures and
determine how many differences could be found, etc. At times we mediated
the search by offering the child the opportunity to trace objects with a finger
(this allowed psychologists to see the type of search that the child conducted
and correct it if the child’s strategy was chaotic).
Some children found it easier to compare the story pictures when they
were positioned vertically one underneath the other as opposed to being
placed horizontally next to one another. Because of that we periodically
changed the way in which the pictures were positioned. A more complex
version of this task was to identify the differences from memory. In that
version we had to make the differences between the pictures more obvious
from the perceptual standpoint, and the initial picture had to be presented
several times.
The third set of tasks were based on perceptual modeling; in other words,
re-creating a whole from its parts. This set included several tasks, starting
with simple ones (putting together parts of an object using the Segen boards)
and progressing to complicated puzzles. As in the first set of tasks, in this
third set the gnostic or verbal complexity of tasks could be varied, a key
feature or several insignificant features could be omitted, and the complexity
of the context in which the choice had to take place could be increased.
The simplest task consisted of finding the second half of symmetrical
objects (apples, houses, clocks, etc). The picture could be cut in two along the
Figure 11.3. Tasks of finishing incomplete images.
middle line or not, the cut could be straight or ragged, etc. Having a ragged
cut increased the possibility of solving the task through manipulations; a
diagonal cut increased the complexity of the tasks because typically it did not
coincide with the natural segmentation (see Fig. 11.3). The task of finding
the other half of an object is an effective way to practice graphic images and
graphic skills. The first half could be used as a stencil for outlining, and the
drawing of a second half could then be added to the stencil. Drawing by
memory, naming, and finding written names for the images could be added
to these tasks.
Adding missing pieces to complete an image (finding a missing piece)
and putting together picture puzzles consisting of 3 or more pieces (up to
12 or 16) proved to be more challenging for the students. Each of these tasks
could be performed with cards depicting parts of objects or on paper (in
that case students connected the pieces by drawing lines between them or
numbered the pieces and the cells in a blank table; see Fig. 11.4).
Putting together a puzzle enabled development not only of visual gnostic
functions (identifying a contour and meaningful characteristics of an object
or an image) but also of visual-spatial and regulatory functions. Mastery of
programming and control functions was achieved with the help of several
methods: creating a plan of action by giving students a frame showing how
the picture was cut or pointing out the difference in color between the
figures and the background frame. Another way was to identify the key
figures and create the verbal plan of action. In that case it was important
to design the sequence of tasks in such a way that the student could later
Figure 11.4. “Finding the missing half” paper test.
use the method independently that was previously shown to him or her
by an adult. We observed students while they were working on their tasks
to identify the pattern of cutting an object into pieces that was easier for
them to work with. As in the tests on finding the missing half, straight
(vertical, horizontal, or diagonal) separation lines helped the students focus
on orienting and searching visual gnostic activity.
Students’ motivation was very important for the successful completion
of these (and all the other!) tasks. Therefore, the content of the picture and
its complexity (for example, the ease of guessing what the complete image
was) had to stimulate students to complete the tasks.
Construction tasks, created by N. G. Kalita (1975 R; advisor, L. S.
Tsvetkova), included in the third set are extremely important. Unlike the
previous tasks, here the picture of an object was cut along functionally
important parts. For example, adding a handle, a lid, or a spout trans-
formed a bowl into a cup, a teapot, a sugar bowl, etc. (see Fig. 11.5). Thus,
in construction tasks, meaningful characteristics of objects were identified
and named, which enabled development of the analytical (“classification”)
perceptual strategy and broadening of students’ vocabulary.
The following construction tasks were used:
r Constructing the model of an object using its parts
r Outlining the model and coloring its parts
r Drawing a missing piece using a model as a stencil
r Drawing independently, without a model
Figure 11.5. Construction task (after Kalita, 1975 R).
r Drawing by memory (“Try to remember the figures we put together”)

r Delayed drawing using the naming word as a help
The following tasks could be used to strengthen learning:

r Picture classification (separating fruits and vegetables; summer and
winter clothes; kitchen utensils and tableware). Here simpler images
could be used along with more complicated, generalized, schematic
ones that require the active use of models.
r Finding missing pieces
r Identifying extra pieces that do not belong with the picture
The fourth set of tasks included those with a primary focus on visual
gnosis. Here we used methods of creating “visual” noise that are tradi-
tional for neuropsychology – superimposing pictures, crossing them out,
inserting visual interferences, or using complex backgrounds (see Fig. 11.6).
(Important: using the material of neuropsychological tests in the remedial
lessons should be avoided at all times!). Students were given an algorithm
of actions – tracing a contour using the visual model or verbal instruction –
and were offered a way to make scanning the contour easier: students traced
the contour with a finger, then named the figure, and then traced it with
the colored pencil, using different colors for different shapes. Thus, if the
sequence of colors was established ahead of time, the order in which the
figures were identified by a particular student could be determined.
This type of tasks helped develop a holistic (global) scanning perceptual
strategy and prepare students for complex trials of image recognition in
Figure 11.6. Example of a task with overlapping drawings.
which visual information is incomplete and for trials of identifying a whole

based on its parts (see Fig. 11.7).
In conclusion, we would like to make a few comments on choosing
materials for the tasks and to discuss the importance of motivation. In
remedial-developmental work we use materials that contribute to the child’s
language and cognitive development based on the “better less but better”
approach. We mean that it is not an effective strategy to present as many
different pictures and words as possible. It is necessary to repeat the new
material regularly in the following lessons to consolidate knowledge. We
already discussed altering the complexity of material based on language and
perceptual development. In addition, we organize the material based on its
content – toys, dishes, means of transportation, etc. – or on its perceptual
component: round, square, red, green, etc.
How can we keep children interested in completing remedial-
developmental tasks?
One way is to place task completion in the context of fairy tales; for
instance, they were given the task of furnishing Pinocchio’s room or design-
ing clothes for him and the Blue Fairy. Children also greatly enjoy completing
tasks that use emotionally significant objects: for example, draw six of your
most favorite fruits. In addition, tasks involving free and directed visual
Figure 11.7. Identifying a whole based on its part.
associations (“Draw the flowers you know”, etc.) can be used to assess the
development of visual-verbal functions.
These methods form the foundation for the manual, Learning to See
and Name (Pylaeva & Akhutina, 2008 R), one part of it is presented in
Chapter 12. The effectiveness of the interventions included in this man-
ual that aim to develop visual-verbal functions was verified in a research
study by N. M. Skityaeva (2010 R; T. A. served as advisor to this research;
see also Skityaeva & Akhutina, 2011 R). The study examined children
preparing to start school, divided into two experimental groups (10 right-
handed subjects and 8 left-handed subjects) and a control group of 8 sub-
jects. All the children were about the same age (average age – 6.5 yrs)
and had similar delays in the development of higher mental func-
tions (HMFs), particularly visual and verbal functions. Subjects in all
three groups received help in developing HMFs to get them ready for
school; children in the control group received interventions to develop
language and visual functions separately, independent of each other. In both
Table 11.1. Language and visual functions characteristics in two experimental and a
control groups (Skityaeva, 2010 R) before the course of remediation (1) and after it (2)
Nominative Lexical Pragmatic

function of aspect of language
Groups language language errors Visual gnosis
1 2 1 2 1 2 1 2
Right-handed (R) 81.6 97.8 9.5 17.5 14 8.4 22.4 31.9

Left-handed (L) 82.5 97.8 13 21.2 15.1 9.5 22.2 29.6
Control group (C) 82.1 87.8 11.3 13.8 13.9 13.3 21.9 26.2
Differences in the dynamics p = 0.018∗ p = 0.022∗ p = 0.014∗ p ≤ 0.001∗∗∗
between groups R & C
Differences in the dynamics p = 0.048∗ p = 0.027∗ p = 0.019∗ p = 0.035∗
between groups L & C
experimental groups, these interventions were conducted in close associa-

tion. Assessment of language and visual perception at the beginning and the
end of the course of intervention revealed significant improvement in both
experimental groups (the assessment was conducted using the methods of
Fotekova & Akhutina, 2007 R, and Akhutina & Pylaeva, 2003b R). The data
are presented in Table 11.1.
The assessment of the nominative language function revealed significant
improvement in children in both experimental groups as compared to
the control group (see Fig. 11.8: the difference between both the control
group and both experimental groups was significant: right-handed group
vs. control group, p = 0.018; left-handed group vs. control group, p = 0.048.
The lexical capabilities of children in the) experimental groups in dis-
course and sentence construction also increased significantly (p ≤ 0.01),
whereas in the control group the increase was insignificant (p = 0.25). The
differences in the dynamics of the subjects in three groups were statistically
significant (see Table 11.1).
In trials on sentence composition based on the picture, pragmatic lan-
guage skills were also assessed. Two types of errors were distinguished:
incompleteness of content and deviation from the picture context. For
example, if describing the picture “The sun comes out from behind the
clouds” the student said: “The sun . . . ” or “The sun is shining,” such errors
were classified as incompleteness of content. If the picture of a man and a
woman who are loading hay on the truck was described like this: “Is it a
sea? . . . They are sweeping. A truck. Don’t know” or “They carry the hay to
the fair,” such errors were classified as deviation from the context. The first
100
95
90 right-handed
persons
left-handed
85 persons
control group
80
75
70
1 2
Figure 11.8. Dynamics of nominative language development in three groups.
type of errors depends on syntactic and lexical development; the errors of

the second type are closely connected with the development of visual-verbal
and visual-spatial functions or more exactly the right hemisphere holistic
strategy of information processing (Akhutina, Zasypkina, & Romanova,
2009 R). The number of both types of content mistakes in language signif-
icantly decreased in both experimental groups (right-handed, p = 0.004;
left-handed, p = 0.013), whereas in the control group it remained practically
unchanged (p = 0.35).
The assessment of visual gnosis showed that, as a result of the remedial-
developmental interventions, visual perception improved significantly in
children in the right-handed experimental group: all the children in this
group reached the average norm. All the left-handed subjects also showed
improvement in visual perception. In six of the eight children in this group
visual gnosis reached normal levels. Average subjects in the control group
showed the least significant improvement: only three of eight children
reached the normal levels of functioning. The difference in the dynamics
between the two experimental groups and the control group was statisti-
cally significant (right-handed vs. control, p ≤ 0.001, left-handed vs. control,
p = 0.035).
Thus, Skityaeva’s study demonstrated the effectiveness of our methods
of remediation of delays in the development of visual-verbal functions.
Online ISBN: 9781139012799
Chapter
12 - Perceptual Modeling in the Development of Visual-Verbal Functions
pp. 164-176

12
Perceptual Modeling in the Development of

Visual-Verbal Functions
This chapter is excerpted from Learning to See and Name, a handbook on

developing visual-verbal functions (Pylaeva & Akhutina, 2008 R). It presents
perceptual modeling tasks focused on the development and remediation of
visual information-processing functions and vocabulary in students (for
other applications of these methods, see Chapters 10 and 11).
The set of tasks presented in this chapter are one of the most impor-
tant in remediation of visual-verbal function because they facilitate further
development of both analytical and holistic (global) perceptual strategies.
With the help of these methods students can learn to analyze an object’s
parts, identify the key characteristics of various shapes, and integrate these
characteristics to form a complete image of an object.
Task 1: One of the simpler tasks, it consists of constructing an image
of a familiar object that has been cut in half. Both halves of the images
are preferably glued to a piece of a cardboard (see Figs. 12.1a and 12.1b).
The child finds the two matching halves, puts them together, and, using
a colored pencil, outlines the entire image on a piece of paper. After he
or she finishes doing that, the paper is turned upside down, and the
student is asked to name the objects and recall their positions on the
paper.
Task 2: The student needs to identify the missing piece, name it, and
draw it to complete the image. After that the paper with the image on it is
turned upside down, and the child names the objects (see Fig. 12.2).
Task 3: The student is shown a picture and told that in it the artist mixed
up parts of different pictures. Then the teacher tells the student, “To help
the duckling you need to connect all the parts correctly. In order to do that
you need to outline each fish with a different color pencil. Let us start with
the first one. First outline it and then find its tail and outline it as well” (see
Fig. 12.3).
164
Figures 12.1a and 12.1b. Images for Task 1.
Figure 12.2. Images for Task 2.
Task 4: This task is perceptually more difficult than Tasks 2 and 3. Students
need to recognize and name different objects and, using colored pencils,
draw the lines from one-half of the object to the other (see Fig. 12.4).
Task 5: Pictures of vegetables that have been cut in half are used. We
recommend that students themselves cut at least some of the pictures in
half. After that students put the two halves together and name the vegeta-
bles. The next step is to remove half of the tomato so that the student can
draw it and complete the image with or without a model. Similar oper-
ations are completed with an onion and a cucumber. If the student likes
this assignment he or she can continue doing it with the remaining pic-
tures (see Fig. 12.5). Any colored pictures of vegetables can be used in this
task.
Perceptual Modeling in the Development of Visual-Verbal Functions 167
Task 6: This task is difficult from both perceptual and graphic points of
view. The child is presented with pictures that show only half of the image of
a symmetrical object and is asked to complete the image. The most difficult
image is a picture of a butterfly. Adult can draw the second half of the image
to model this process for the child (see Fig. 12.6). After the pictures are
completed the teacher asks the child to find all the handles on them (three
objects have handles).
Task 7: This task consists of identifying parts of different pieces of kitchen-
ware, tableware, and cutlery. First the child is asked to name the objects in
the pictures. After that he or she outlines all handles with one color, all lids
with another, and all spouts with the third color (see Fig. 12.7). After the
child completes this part of the task, the page is turned over, and the teacher
asks the following questions:
“Which of the objects have handles? Can you remember the two objects
without handles? (Correct answer: a plate and a glass). Now look around
and find objects with handles in this room. Can you think of some other
objects that have handles?”
Task 8: This task was created by N. G. Kalita (advisor, L. S. Tsvetkova).

This is a prototypical task that captures the main idea behind perceptual
modeling, which in essence is the process of constructing images of objects.
Here “the student is shown a certain fragment of an object that is typical for
all the objects in a particular group, for example a bowl. Certain elements
are then added to this main fragment” (Kalita, 1975 R, p. 186). After each
addition the child is asked, “What do you see? What parts did we add?”
Then the child outlines the objects and colors those parts that constitute
the key characteristics of all the objects in this group.
Thus, in this task the child identifies key features of different objects
(practicing the analytical strategy), constructing and recognizing a complete
image (thus practicing the holistic perceptual strategy). Naming the objects
and their parts enriches child’s vocabulary and makes naming more precise
(see Figs. 11.5 and 12.8).
Task 9: The purpose of this task is to strengthen skills learned in all the
previous tasks. The child is asked what elements need to be added to the
images in the upper row to make a teapot, a sugar bowl, and a cup. Then he
or she is asked to outline the elements that are necessary to make a teapot
and after that to add these elements to images in the upper row by drawing
them in the appropriate place. While outlining the image the child names
its details, and after the drawing is complete he or she names the picture
that was created as a result. Then the child moves on to the next image (see
Fig. 12.9).
Task 10: This task is focused on differentiating visually similar images
and training visual attention. Additional difficulty is created by turning the
shadows of the objects upside down, therefore requiring that students be
able to visualize turning them back to their correct position. The child is
asked to outline the first image with a colored pencil, name it (a teapot
without lid), find its shadow, and draw a line to it. Then he or she is asked
to outline a second object using a pencil of a different color, etc. (see Fig.
12.10).
Task 11: The child gives names to geometric figures and adds elements to
them to create an image of an object; for example, a spoon, teapot, fork, pot,
frying pan, and cup. This task requires the ability to work independently in
both perceptual and graphic formats (see Fig. 12.11).
Task 12: First the child names different items of clothing. After that the
teacher suggests that the student finds and outlines or colors various parts
of the clothing items: collars, sleeves, pockets, buttons, zipper, and hood
(see Fig. 12.12).
The next step is to strengthen the knowledge of the names of different

items of clothing or their parts using the following model:
r A t-shirt has two short sleeves and does not have a collar.
r A dress has two sleeves, a collar, two buttons, etc.
Task 13: Students need to figure out how to assemble different parts of
clothing to make a dress, a blouse, a t-shirt, and a shirt. They outline the
parts necessary for a dress and connect all of them with a line. Then they
follow the same procedure with the parts necessary for a blouse using a
different colored pencil, etc. While they are outlining the parts they are
asked to name them, and at the end they name the item of clothing that was
created by connecting these elements. If students are interested, they can
then draw these and other articles of clothing (see Fig. 12.13).
Task 14: This task focuses on putting parts together to create an object.
A teacher gives a student the following instructions:
These clothes belong to a doll. Here are its blouses, cardigans, and sweat-
shirts. A little girl was playing with them and cut off all the sleeves. Can
you find the ones that belong to each item of clothing? Outline every
piece with its own color and draw lines to the sleeves that belong to it.
Make sure you know how to tell the left sleeve from the right sleeve.
Which of these clothes do we wear in summer and which in winter?
What kinds of sleeves can a blouse have? (Correct answer: Long and
short). What kinds of sleeves does a sweater normally have? What are
they made of? (Correct answer: They are made of wool). What kinds of
sweaters are there? (for example, warm, soft, fluffy). What kind of sweater
do you have? (Blue, pretty, my favorite) (see Fig. 12.14).
Task 15: This task allows for strengthening and specifying visual images
of clothing and shoes and practicing the ability to actualize a typical situ-
ation based on its details. Children with a weak holistic strategy of visual
perception particularly benefit from this task.
A teacher gives the following instructions:
All these clothes and shoes belong to a family. This family consists of a
father, a mother, a daughter, and a son. Find the clothes that belong to
the son. Find his shoes. Draw lines of the same color to the items that he
can wear together (jeans – sneakers, shorts – sandals, etc.). Draw lines of
different colors to the items that belong to each member of the family
(see Fig. 12.15).
After the child finishes drawing these lines, the teacher starts the dialogue
with the student that includes the following questions:
Can you guess, based on their clothing, what each member of the family
was doing? Let us start with the father. What kind of shoes and clothes
did he wear? – Yes, you are right, he wore a suit and dress shoes to work.
What did the mother do? What did she wear first? What did she wear
after that? – Yes, you are right. She wore the skirt and the blouse from the
previous picture and shoes with heels; then she came home and put on
the slippers and the dressing gown. What did the son and the daughter
do?
To differentiate between the pictures of different clothing items the fol-
lowing questions can be discussed with the student:
r “Suit”: what parts does a suit consist of, what kind of fabric is typically
used for suits, when do people normally wear suits
r “Robe”: where do people typically wear robes, what material are they
made from (cotton, terry), how are they different from dresses
Then the teacher has a discussion about different types of shoes with
the child; for example, what types of shoes do people wear in the winter,
in the summer, when the weather is good, when it is raining, and in the
home versus outside. The teacher asks the student these types of questions:
“What kind of shoes are you wearing now? What will you wear when you go
outside? What is the difference between boots, dress shoes, and high boots?
What kinds of shoes do you know about?”
The pairing of shoes and clothes also needs to be discussed. For example,
jeans are an everyday casual type of clothing, so normally people wear them
with sneakers or some other type of comfortable shoe. The teacher might
ask, “How do you think it would look if someone would wear a fancy suit
with sneakers or go to the theater in flip flops?”
Finally, the last part of this cycle is to draw on the child’s personal
experience and to predict a person’s behavior in different situations: “What
kind of clothes would you wear in summer if you are going to play soccer?
What kind of shoes will you put on?” Or, “What would you wear if you were
going to take a nature walk? Or if you were going to a theater?”
In this chapter we have shown the progression from very simple tasks
for developing visual and verbal functions and their connections to more
complicated tasks that involve the pragmatic dimension of language and
general knowledge of the world. Part IV is devoted to methods of developing
visual-spatial functions.
part iv
METHODS OF DEVELOPING VISUAL-SPATIAL

FUNCTIONS
Online ISBN: 9781139012799
Chapter
13 - Development of Visual-Spatial Functions pp. 179-181

13
Development of Visual-Spatial Functions
Development of spatial functions occurs over a long period of time, starting

in the first several days after birth. At first a child sees an object and flings
his or her hand in that direction. Later visual control of this action fixes not
only the point of destination but also starts to determine the stretching itself;
in other words, children develop more complex forms of integrating exter-
nal visual-spatial and internal kinesthetic information. The child’s overall
development affects the development of spatial functions. Once children
are able to sit up they can better orient themselves in the immediate space
and reach for different objects. Thus emerges the union between vestibular
apparatus, kinesthetic sensitivity, and visual functions. Each component in
this union is very important because together they form an interdependent
system. If the development of motor functions is delayed and the child is
not able to sit up until later than the norm, then the development of spatial
functions is delayed as well. The development of spatial functions is also
delayed in children who are visually impaired.
Speech plays a significant role in the development of spatial functions.
When the child first starts to differentiate and name spatial relationships, at
first differentiation is passive and is based on the verbal information received
from an adult; later the child can actively name different spatial relation-
ships. In the perceptual format the child first masters the relationships
“behind” and “under” and uncovers hidden forms; in the verbal format he
or she first learns the meaning of the prepositions “in” and “on” and only
later acquires other prepositional constructions.
When we are speaking about understanding sentences with preposi-
tions, it is important to distinguish these sentences where the meaning
of a sentence is clear based on the situation – the so-called irreversible
sentences – from reversible sentences, in which the meaning depends on
179
correctly identifying which of the two objects is the reference point that
defines the relationship (Slobin, 1966). For example, let us compare two
sentences with the same grammatical construction: A book is on a table and
A book is on a magazine. The understanding of grammatical construction
of the first sentence is very clear (a table cannot be on top of a book) but
that of the second sentence is more complex: one needs to understand that
the magazine is the reference point that helps determine the relationship
between the two objects. Consider another two sentences with the same
grammatical constructions: A boy eats a candy and A boy insulted a girl. In
the first sentence the words cannot be switched if the sentence is to make
sense (a candy cannot eat a boy); this is an example of irreversible construc-
tion. In the second sentence the words can be switched (a boy can insult
a girl, and a girl can insult a boy). These examples show that the develop-
ment of spatial functions is not limited to understanding the relationships
between actual objects; quasi-spatial functions that develop on the basis of
spatial functions should also be considered (cf. Luria, 1970, 1980, 1986). To
understand reversible logical grammar constructions, quasi-spatial analy-
sis and synthesis are necessary, even though the constructions themselves
do not define the actual relationships in space (The cowboy is wounded by
the Indian). The connection between spatial functions and understanding
of reversible sentences is very clear in children with Williams syndrome,
who have pronounced deficit of spatial functions and high language ability.
Despite their language proficiency they have difficulty processing reversible
sentences with such words like “inside,” “above,” and “darker” (Baddeley,
2001).
When designing methods of remediation of visual-spatial functions we
took into account their consecutive development in the process of ontoge-
nesis, as well as the syndromes of their dysfunctions in adults and children
described in the literature (Chentsov, Simernitskaya, & Obukhova, 1980
R; Gadzhiev, 1966 R; Luria 1980; Melikyan & Akhutina, 2002 R; Simernit-
skaya, 1985 R; Tsvetkova, 1966 R). In addition, we also considered methods
for rehabilitating, developing, and remediating visual-spatial functions that
were highlighted in multiple publications (Luria & Tsvetkova, 1990; Manelis,
1997 R; Semago, 2000 R; Semago & Semago, 2001 R; Semenovich 2002 R;
Tsvetkova, 1972a R, 1972b R, 1995 R, 2001 R; Tsyganok et al., 2006 R;
Venger & Venger, 1994 R).
The most commonly used approach to developing visual-spatial func-
tions is to arrange assignments based on the sequence of these functions’
development in the process of ontogenesis. This approach suggests the par-
allel introduction of such assignments as the following:
Development of Visual-Spatial Functions 181
r orienting in one’s own body space and verbalization

r orienting in the surrounding space and one’s own movements in space
r movements of other objects in space
r mastering the space of a notebook paper and geometric figures, letters,
and numbers
r developing quasi-spatial functions in speech, counting, and problem
solving
In this part of the book, we describe specific methods that address some of
those skills. They include sets of construction tasks, computer games, and
paper-and-pencil methods all aimed at mastering the space of notebook
paper and teaching children how to follow the lines in the notebook and use
graph paper. They also facilitate mastery of geometric figures and numbers.
These methods were designed as games to keep children interested, and
their difficulty level can be modified.
Online ISBN: 9781139012799
Chapter
14 - “Construct the Figure” Methods in Assessment and Remediation of V
isual-Spatial Functions pp. 182-192

14
“Construct the Figure” Methods in Assessment

and Remediation of Visual-Spatial Functions
The appropriate and timely development of visual-spatial functions is an

important prerequisite of successful learning at school. When children start
school they face a wide range of spatial tasks, including navigating a school
building and a classroom, knowing their own body, navigating pages of a
notebook, using ruled and graph paper, and understanding the structure
of a letter and a number. A certain level of spatial function development
is also needed to perform quasi-spatial operations that lay the foundation
for understanding reversible logic grammar constructions and learning
how to count and solve math problems (Luria, 1980). Because the devel-
opment of spatial functions is a long and sensitive process (Akhutina &
Zolotareva, 1997 R; Manelis, 1997 R; Semenovich, 2002 R), the impor-
tance of early diagnostics and timely remediation of spatial functions is self-
evident.
Traditionally, methods based on copying, 180-degree turn, or memo-
rization (with recognition or recall) of spatially oriented figures are used
to assess visual-spatial functions; for example, tasks of constructive praxis
(copying figures with 180-degree turn), the Ray-Taylor test, and the Beery
Developmental Test of Visual Motor Integration (VMI). Along with these
methods, other widely used tasks are constructing figures out of sticks,
using Kohs blocks (as in the Block Design Test of the Wechsler Intelligence
Scale), or using cards (two-dimensional version of Kohs blocks). Tasks of
constructing figures from their parts, the so-called tasks using perceptual
modeling, are also well known.
The key element of all these tasks is visual-spatial orientation, and several
versions are used for the purposes of development and remediation. One
of the sets of tasks that are well known to Russian teachers and parents is
found in the book, Developing Games, by B. P. Nikitin and L. A. Nikitina
(1990 R); they are based on the Kohs method.
182
“Construct the Figure” Methods 183
In this chapter we present our experience using the “Construct the Fig-
ure” and “Black and White Squares” methods. The work was conducted
with first-grade students in the school of the Moscow Child and Adolescent
Center for Psychological, Medical and Social Support. The students in this
remedial-developmental education (RDE) class received interventions to
overcome the delay in the development of their higher mental functions
(HMFs). All the children had difficulties in solving spatial problems, but in
some children the difficulties were caused by underdevelopment of spatial
functions, whereas in others they were caused by weaknesses in program-
ming and control and/or neurodynamic characteristics of activity (increased
exhaustion and attention fluctuations).
The “Black and White Squares” method created by Finnish psychologist
M. Saarela (1995) consists of constructing figures using black panels. A
child is supposed to re-create a pattern by inserting panels into the frame
with nine white squares (3 × 3). The large size of the panels (11 × 11 cm)
and the use of a handle make it easier for children with motor difficulties to
complete these tasks (see Fig. 14.1). The sample figures are arranged in order
from simplest to most complicated and come in two sizes: their natural size
(which allows them to be used as a foundation for inserting the panels)
and a smaller size. Variations in the content and the size of the samples
allow the complexity of the tasks to be varied. Therefore this method can
be used for diagnostic tracking of the state of visual-spatial functions and
their remediation.
Our experience with using the “Black and White Squares” method con-
firmed those uses. In addition, we discovered that children willingly com-
pleted the tasks because of their engaging design. The positive effect of
increased motivation on students’ ability to work and concentrate allowed
us to clarify their primary problems and distinguish between spatial diffi-
culties per se and persistent problems in regulation of activity.
Let us consider the diagnostic capacities of this method by using specific
examples to show the qualitative characteristics of children’s performance
in the trials depending on their primary difficulties. We use two first-grade
students as case examples.
Ann G. was experiencing problems due to the delay in the development
of programming and control and secondary spatial difficulties. The analysis
of her task completion showed the following:
r Difficulties becoming engaged in the assignments: she completed trial

1 in 20 sec, whereas the next four took no longer than 3 sec each (see
these and next trials in Fig. 14.1).
Figure 14.1. Samples and equipment for “Black and White Squares” method by M.
Saarela.
r Trial-and-error type manipulations: most clearly seen in Trials 8 and

15, which were completed in 20 sec and 95 sec, respectively.
r Difficulties in identifying new ways of solving problems; for example,
in Trial 16 she needed a hint to realize that the central figure was
composed of four panels; in Trial 19 the time of completion increased
significantly to 124 sec.
Insufficient orienting activity and difficulties in formulating a plan and

finding the solution were the reasons behind these problems.
Nastya I. experienced very different problems with these tasks. She was
diagnosed with delays in the development of spatial functions as part of the
syndrome of underdevelopment of right-hemisphere functions.
Nastya I., who was 8 years old, had repeated first grade. A year ear-
lier, when she was admitted to school she was diagnosed with pervasive
developmental delays, selective mutism, and possible mental retardation.
She was born prematurely (7 months) by Cesarean section, and her
birthweight was 2,600 grams. At 4 months she had closed brain injury. She
had limited contact with her mother for most of her childhood.
Nastya’s speech development was delayed: she learned to say words
when she was 4 years old and started putting together sentences at
51/2 years of age. At the time of admission to the program, she very rarely
engaged in verbal contact, and if she did, it was only with her grandpar-
ents; verbal contacts with peers were even less frequent (because of selective
mutism).
Neuropsychological assessment conducted on admission was hindered
by her unwillingness to make verbal contact and her negative reactions to
a number of assignments. At the start of her second year in first grade she
gradually began to answer the teacher’s questions during play time and
afterschool programs and later started communicating during class as well.
Neuropsychological assessment conducted in the course of remedial lessons
showed pronounced dissociative development of visual and visual-spatial
functions (visual functions were developing according to the norm, whereas
development of visual-spatial functions was grossly impaired). In addition,
the development of other HMFs was delayed, with the pattern of delay being
typical for right-hemisphere deficiencies.
The diagnostic assessment using the “Black and White Squares” method
revealed the following. She completed the Zero trial (black cube in the lower
left corner – see Figs. 14.1 and 14.2) incorrectly: she created the “mirror”
image by putting the black panel in the top corner. Of the seven initial trials
she was able to complete the three easier trials – numbers 3, 4, and 6. Yet even
in these trials a particular strategy of completing assignments was noted: in
Trial 4 she started constructing the figure from its right side and from the
bottom to the top. In Trial 1, pronounced fragmentation of perception was
noted: she divided the figure into two parts (see Fig. 14.2). In Trials 2 and 5,
where the pattern resembled the Russian letters “H” and “П,” she could not
recognize the letters despite the leading questions or the fact that the letter
“H” was the first letter of her name in Russian. In Trial 2 Nastya could not
identify the spatial structure, and twice she constructed figures that were
quite different from the model; she created “mirror” figures, confusing top
and bottom and then turning the figure by 90 degrees. Similar mistakes
(loss of figure, creating mirror image, and difficulty switching from the old
Figure 14.2. Completing the tasks by Nastya I: a – models; b – laying them out on
the frame; + – correct answers
structure to the new one) were noted in constructing figures in Trials 5 and
7 (see Fig. 14.2).
Nastya’s motivation to complete the tasks decreased because of her fail-
ures, and therefore, no further trials were conducted. However, the results of
these eight trials showed the entire range of her spatial difficulties: perceptual
fragmentation, difficulties in comprehending the visual gestalt, mistakes in
orienting figures in space (turning them by 90 degrees, confusing top and
bottom and left and right), and a tendency to ignore the left side (she would
start completing the task on the right and would go from the bottom to the
top).
In addition to her school classes Nastya also attended group (consisting
of two to six other children) and individual sessions with the neuropsy-
chologist. The program of working with the teacher (E. V. Zolotareva) and
the neuropsychologist (N. M. Pylaeva) included a set of methods focused
on remediation and developing visual-spatial functions. These methods
included tasks on mastering the body scheme; orienting in the classroom,
Figure 14.3. Examples of the “Construct the Figure” task.
in the playroom, on a piece of notebook paper, or on the surface of the table;

and perceptual modeling – “Construct the Figure.”
The “Construct the Figure” task set involved constructing an image
from its parts. The images included objects, picture stories, and geometric
figures that were ranked based on perceptual complexity. It is important to
note that similar tasks are used to develop visual-verbal functions (Pylaeva &
Akhutina, 2008 R; see Chapters 11 and 12). The two methods differ primarily
in the choice of material: images used to develop visual-spatial functions are
of objects, for which key perceptual characteristics are spatial (e.g., table,
chair); examples of images for developing visual-verbal functions were given
in Chapters 11 and 12 (e.g., apple, lemon).
The first and simplest version of the task included construction using
fragments and later cards (similar to the two-dimensional version of the
Kohs method) of images of real objects: a house, a pine tree, a butterfly, and
a flower (see Fig. 14.3; for more details see Chapter 15). First, constructing
the figures using models was practiced; when Nastya was able to do that
successfully, the psychologist moved on to constructing from memory and
finally to figure drawing. When using the model did not result in successful
completion of the task, she asked Nastya to outline the model (thus prepar-
ing a template) and then construct a figure based on this template. Next,
after practicing the task completion with and without a template, Nastya
completed memory tasks and drawing. Even when the tasks were completed
successfully, she still practiced creating a template to consolidate construc-
tion skills in the graphic tasks. Nastya was offered the use of templates as
a support for figure drawing. Graphic tasks required the ability to identify
key points of an image and to locate them in the frames of appropriate size
and on a piece of graph paper, which was similar to a page from a school
notebook.
The second set of tasks included transitional tasks from constructing
single actual objects to drawing a plot. They involved the use of plastic
blocks secured on the plastic panel with pins, and different types of blocks
were available: some were fully painted, and others were only partially
painted and had either straight or rounded lines dividing the painted from
the unpainted parts, similar to the cards in the two-dimensional version of
the Kohs method. Nastya was asked to construct the picture with a house,
pine tree, fence, gate, and the sun. Constructing the figures and geometric
figures from blocks (see Fig. 14.3) presents a more complex perceptual
activity than creating a figure out of its actual pieces (part of the roof, part
of the pine tree, etc.). It requires a more detailed analysis of the model and
preliminary orientation of the elements.
In the third set of tasks we used a modified version of the “Black and
White Squares” method. On the one hand, it was more complicated than
the previous sets because the frame contained nine cells as compared to
four cells. On the other hand, it was simpler because the elements of the
figure were one-colored squares (as opposed to the two-colored blocks in
the previous tasks). The transition to the perceptually more complicated
figures was effectively combined with a less demanding activity of inserting
larger parts into the frame (the parts were supplied with an easy-to-use
handle). Thus a mix of various didactic materials was used in this set of
tasks to facilitate the transition from the plastic elements, cards, and blocks
on the panel to the new objects.
As with the previous tasks, we included the “Black and White Squares”
method in a wide range of remediation activities:
r analysis of the frame and the model

r constructing the figure by using the model and from memory
r searching for the model that corresponded to the constructed figure
r constructing the figure using the smaller size model
r drawing the frame and the smaller size model on the piece of graph
paper (if the child had difficulty conducting an analysis of frame
drawing and identifying and transferring the key supporting points)
r outlining the contour of the figure independently or along the dotted

line that was drawn by the teacher and then coloring the figure
r constructing the figure from smaller elements (1 × 1 cm)
In addition to changing the size of the model, its position could also be
changed from vertical to horizontal and vice versa.
We started by acquainting Nastya with the frame. She took off all the
panels; counted the total number of cells (squares); identified the number
of squares on each side of the panel; and found the central one, a row at the
top, a row at the bottom, and then a row on the left and a row on the right.
As in her class assignments she searched for the upper left square, upper
right square, etc.
When the “Zero” model was introduced to her, she had to answer ques-
tions like “Where is the black square – at the top or at the bottom? On the
left or on the right?” After verbal analysis of the model she was asked to find
the appropriate place within the frame and insert the panel. After that the
psychologist presented a smaller frame on a piece of paper and asked her
to find the same position on it. The corresponding square was outlined and
colored. Similar copying was done with the figures 1, 2, and 3 (see Fig. 14.4 –
Line 1).
After that the girl was asked to build these figures independently using a
large frame. She was able to successfully build all of them and also figure 4.
In the next copying task, although overall she re-created the model
correctly, she shaded it inaccurately, ignoring the structure of the frame (see
Fig. 14.4, Line 1, the last figure).
She made more serious errors when completing Task 14 (cross).
Although she correctly constructed the figure, in the graphic part of the
task she first drew the cross in fragments; later, when attempting to shade it,
she lost the structure (see Fig. 14.4, Line 2a, 2b). To help her complete the
task correctly the teacher had to go back to the joint extended analysis of the
model; after that discussion she marked with the dotted line the contours
of the figure that Nastya then shaded (see Fig. 14.4, Line 2c).
In the next stage she continued the initial figure construction, but the
structure of the graphic part changed to include more independent actions
on her part. Meaningful figures were used in these tasks; for example, the
letters O and H, a staircase, and a “plus” sign. Working with letters O and H
required Nastya to select empty squares; for the other two figures she had
to select shaded squares.
Nastya was easily able to assemble the figures from the panels and find the
corresponding small models. The psychologist provided a small frame for
Figure 14.4. Copying of different figures by Nastya.
copying the figures, and after a discussion, Nastya identified the contours of
the figures on her own and then shaded the figures. There were no significant
mistakes in losing the figure while shading it; she was able to stay within the
borders that were brightly marked, although she crossed them at times due
to motor difficulties. Later the trial performance was consolidated, and the
structure of graphic actions was shortened: after another discussion with
the psychologist, Nastya independently shaded the figures without outlining

them first (see Fig. 14.4, Line 4).
The important stage in the remedial interventions was teaching the
student to independently draw the frame. At the beginning of the “Construct
the Figure” method the analysis of the frame was conducted using the already
prepared frame to insert panels; the prepared frame was later used for the
graphic part of the task. In this new stage the student transitioned from the
passive use of the frame to actively drawing it. When Nastya was given the
task to draw the frame, she started drawing it element by element, outlining
each square (see Fig. 14.4, Line 5). To move her away from that method
and to teach her to draw the whole structure of the frame, the psychologist
“materialized” it by putting a number in each square jointly with the student.
After discussing it with Nastya, the psychologist would write number 1 in
the upper square; the student then would find the next square, using the
“from top to bottom” strategy. At first, the psychologist used this strategy
as well, but then suggested a different one (see Fig. 14.4, Line 5).
After this practice, Nastya attempted to draw the whole structure of
the frame: she correctly outlined the square with the sides consisting of
three smaller squares, and then she correctly divided the bigger square by
drawing lines from the top to the bottom; however, she made a mistake when
dividing horizontally. The next attempt was successful, and she correctly
drew a complicated figure in the prepared frame (see Fig. 14.4, Line 6).
Thus she was able to master in graphic form the completion of tasks where
the elements did not need to be shifted in relation to the cells of the frame.
The control tasks on constructing figures 1–14 (see Fig. 14.1) were com-
pleted with a significantly higher success rate. She correctly completed Tasks
2–6, 8, 11, and 14, spending on each task (except for Task 8) from 3–16 sec
(respectively 10, 3, 5, 7, 15, 11, 16 sec). Only figure 8 (the white cross)
required extended orientation, and it took Nastya 59 sec to complete it, in
contrast with only 16 sec to complete Task 14 with the black cross. Nastya
was able to complete the remaining six tasks, but made mistakes in the pro-
cess: two mirror-type mistakes, one switching the figure and background,
and three due to insufficient model analysis. She was able to correct the
mirror-type mistakes herself, but we had to draw her attention to the model
to help her correct the other mistakes.
Overall, the set of methods aimed at developing visual-spatial functions
allowed Nastya to advance significantly in learning writing, reading, and
counting skills. This was evident from comparing her writing at the begin-
ning and the end of the school year. Until mid-November she was regularly
making mistakes in writing her name; she also omitted and switched vowels.
That made the results of her final written task even more impressive: of the
first 20 words, she correctly wrote 17 and made mistakes due to exhaus-
tion only in the last 3 words. The mistakes mainly consisted of omitting
vowels (more detailed information about typical mistakes can be found
in Akhutina & Zolotareva, 1997 R, and also in Chapter 18). The type of
mistakes and her inability to coordinate the size and the slant of the letters
show that her primary deficiency (delay in the development of visual-spatial
functions) was still present, although it was reduced to a significant degree,
allowing her to master basic school skills.
Thus, the pilot study of the “Construct the Figure” methods showed that
its use to remediate visual-spatial functions was effective. These methods
allow switching between different formats (constructive or graphic) and
modification of the degree of task complexity; consequently, they can be
used to develop visual-spatial gnosis and praxis by transitioning from the
joint extended actions to internalized, independent actions of the student.
The full description of these methods with details of individual tasks is
presented in Chapter 15.
Online ISBN: 9781139012799
Chapter
15 - The Use of Construction Methods to Develop Spatial Functions pp.
193-204

15
The Use of Construction Methods to Develop

Spatial Functions
The goal of “Construct the Figure” methods is to develop visual-spatial

functions in 5- to 8-year-old children using tasks designed as games. These
tasks help children learn the skills of orienting in space and expressing
spatial relationships in the form of visual diagrams as well as concepts. The
cycle consists of 18–20 half-hour lessons, which children should attend at
least two to three times a week to achieve the maximum effect. The length of
the whole series can vary from 11/2 to 3 months depending on the frequency
of attendance. The lessons can be conducted in individual or group sessions
(with groups consisting of two to four children).
The impact of the lessons on students’ development is tracked in the
course of the assignments’ completion. It is evidenced by a decrease in the
amount of help needed from an adult, the time needed to complete the
tasks, and the number and seriousness of mistakes. Kohs cubes method
(like the Block Design Test of WISC), presented at the beginning and at the
end of the remediation cycle, may be used to determine the effectiveness of
the interventions.
four-card object assembly

These tasks require cards similar to the ones used in the “two-dimensional”
version of the Kohs method; namely, cards with two types of squares pictured
on them, which are either painted with only one color or divided diagonally
into two parts of two different colors. The cards used in the tasks in this
chapter are black and white, but they can be red and white, and blue and
yellow (similar to Kohs blocks). If the leader constructed a house using black
and white cards first, the next time he or she might change the colors of the
cards to make it look like a new task. In all tasks of this type a leader uses
193
Figure 15.1. Four-card task assembly, Tasks 1 and 2.
the cards to put together a model and children then copy it, but first they
jointly analyze the cards and the model.
In Task 1, “Find Using the Model,” the child adds the cards according to
the model (see Fig. 15.1).
In Task 2, “Take a Look and Tell,” the child answers questions about the
model; for example, “What part is colored on figure number three?” (upper
left); “And what about figure number four?” etc. (see Fig. 15.1).
In Task 3, “A House,” a set of cards (cards number one through six) and
a picture of the house are laid out in front of the child (see Fig. 15.2). The
child is given the following instruction: “Look at the house and show me
the cards you need to build the house just like it. Now build the house.” The
instruction helps direct the child’s attention to the analysis of the model
and prevents a trial-and-error approach to the task.
In Task 4, “A House and a Pine Tree,” the child is instructed to choose
the cards for the house and build it and then to choose the cards for the
pine tree and make it (see Fig. 15.2). So as not to repeat Task 3, the leader
changes the color of the house.
In Task 5, “Rotating the Cards,” four cards divided diagonally are laid
out in front of the child (see Fig. 15.3). The child is then given another
diagonally divided card and asked, “Can this one be similar to the first card?
Put it on the table in such a way that they look the same. Now try matching
it up with the second card. What did you do with the card?” (I rotated it).
The child then works in a similar way with the third and the fourth
cards. This strategy helps lead the child to the conclusion that any of the
four versions of these cards can be obtained by rotating one card.
The Use of Construction Methods to Develop Spatial Functions 195
Figure 15.3. Four-card task assembly, Tasks 5–7.
After that the child is given the following instructions: “Let us draw the
four cards. Here is a square. We connect the opposite corners of it and color
one of the halves” (The psychologist marks the two corners and the child
connects them with the line).
In Task 6, “Guess the Card,” the same four cards are laid out in front of
the child (see Fig. 15.3). The psychologist instructs the student, “I thought
of a card and I want you to find it. Its upper left corner is red. Now find me
another card. This card’s lower left corner is red. Now find a card that has a
red lower right corner.”
In Task 7, “Think of a Card,” the child and the psychologist sit next to
each other, and the same four cards are put in front of them. The child is
given these instructions: “Think of a card, describe it for me, and I will try
to find it. (The verbal description of cards is practiced similarly to how it
was done in the previous task.)
Here are the instructions for Task 8, “Make a Flower”: “Make a flower
like this one. Tell me where the red corners will be” (for the first card they
should be in the lower left corner, for the second card. . . . , etc.; see Fig.
15.4).
In Tasks 9–12, “Construct a Figure,” children construct a butterfly, a sand
watch, a little bow for a girl’s braids, and a window. If a student starts having
difficulties, he or she is asked to point out where the colored corner is on the
model (see Fig. 15.5). The psychologist monitors the number of tasks and
the repetitions, which depend on the child’s tiredness and how well he or
she has mastered the material. Tasks that involve competition or in which
Figure 15.4. Four-card task assembly, Task 8.
Figure 15.5. Four-card task assembly, Tasks 9–13.
children are asked to think of their own figure are very effective in helping
them master the material.
In Task 13, “Draw a Figure,” the child is asked, “Can you remember
the figures that you constructed today?” (The child then goes over them).
“Can you draw the figures that you liked?” (The child is given a piece of
paper with four squared frames that each are divided into four parts by
horizontal and vertical lines). If the student experiences difficulties remem-
bering or drawing the pictures, the model is used to help the child (see
Fig. 15.5).
In Task 14, “Make a Diamond,” the cards are laid out in front of the child
and positioned in such a way that they look like a diamond (with the corner
down as opposed to one of the sides down, as in prior tasks). The model
of the figure is also presented to the child (see Fig. 15.6). The following
instruction is given: “You already know how to construct figures really well.
Try to make a figure like this (pointing to the model). Did you notice how
the cards are positioned?”
In Tasks 15–16, “Make a Bow and a Boat,” the child is asked to make a
bow and a boat. If necessary the psychologist can help the child recognize a
bow (a bow for a girl and a bow tie for a man) and a white boat with sails
and highlight the outlines of one or each of the four cards for them (see
Fig. 15.7).
Figure 15.6. Four-card task assembly, Task 14.
eight- to ten-cards object assembly

For all tasks in this section the child is given a model and cards similar to
the “two-dimensional” Kohs cards.
In Task 1, “Candy,” the psychologist tells the child, “Did you recognize
what this figure looks like? How many cards do you think you will need
to make a figure like this? How many cards of the same color? How many
two-colored cards? Choose the color and put the ‘candy’ together please”
(see Fig. 15.8)
In Task 2, “Chocolate Candy,” the instruction for the child is, “This
candy is a chocolate candy. Let us put it together. How many and what type
of cards do you need? Choose them and make the candy” (see Fig. 15.9).
In Tasks 3–4, “A Boat and a Fish,” those figures are constructed in a
similar way (see Fig. 15.10).
In Task 5, “Drawing a Figure from the Model,” the child is instructed as
follows: “Which figure did you like the most? Let us copy it.” After that the
child is given an empty frame consisting of 8 or 10 pieces.
Figure 15.8. Eight- to ten-cards object

assembly, Task 1.
Figure 15.9. Eight- to ten-cards object

assembly, Task 2.
Figure 15.10. Eight- to ten-cards object assembly, Tasks 3–5.
use of lego dakta

To complete these tasks you will need either a Lego Dakta set or something
similar (one that uses plastic bricks for mosaics; see Fig. 15.11).
In Task 1, the child sorts the figures from the Dakta set by shape according
to the sample shown in Figure 15.11.
In Task 2, the game “Remember,” this instruction is given: “Which one
of the figures do you like most of all?” (The child points to the figure and
names it). “Pick all the similar figures” (see Fig. 15.11).
The teacher or another child then picks all the figures of any other shape.
The figures are turned upside down, and everyone plays the memory game
in which each player turns two figures face up. If they are the same the player
keeps them and continues to turn the figures face up. If the two figures are
different, the player turns them back over and ends his or her turn. The
player who collects the most pairs of figures wins. Another version of the
same game is for every player to choose a “favorite” figure, and at the end
the player who collects the highest number of favorite figures wins.
In Task 3, “Find the Missing Piece,” the child is shown a card from the
Lego set and is asked to finish assembling “a pine tree,” a pattern, or “a
boat”; in other words, the child needs to find one piece missing from each
figure (see Fig. 15.12).
The child is then given this instruction: “Now let us put together one
more pattern. Take the figure (brick) that has a red lower left corner. Now,
underneath it put the figure that has a red upper left corner. Did you guess
what pattern we are making? Please, finish it. Are you finishing the right or
the left half?”
In Task 4, “Let Us Build a House,” The child is shown a card (see Fig.
15.13) and told, “This is a house. It has three floors and three rooms on each
floor. The house would look nicer if the figures of the same color occupy
the same floor; for example, all the greens are on the first floor. Build the
first floor. What color will be on the second floor? What about the third?
You built a very nice house. What is the color of the figures that live above
Figure 15.11. Lego Dakta, Tasks 1 and 2.
Figure 15.12. Lego Dakta, Task 3.
the green ones? What is the form of the figures to the right of the middle
room? What is the form of the figures to the left?”
The instruction for Task 5, “Snake,” is “Let us make a snake. What
kind of head does it have? Put this piece in the upper left corner of the
panel. Now let us make its body and its tail. Put the next piece in. It
has to be different from the previous one either by color or by shape.
For example, any red figure can be used after the red triangle except
for a triangle. But if you choose the same shape, it has to be a different
color from the previous one. There are two players in this game and they
take turns. The player who makes a mistake loses the turn.” This task is
good for developing not only visual-spatial functions but also executive
functions.
In Task 6, “Steam Engine,” the child is shown a model and pieces from
Lego Dakta set (see Fig. 15.14) and is told, “Make a steam engine. Start with
the chimney. Keep adding pieces and tell me where you are putting them
(under, over, to the right, etc).” After that the child is given a piece of graph
paper (with large rules) and asked to draw a steam engine.
In Task 7, “Using a Smaller Size Model,” the child is given a picture
to serve as a model and all the pieces necessary to construct an object (see
Fig. 15.15). The instruction to the child is, “Let us figure out what is pictured
here (a pine tree, the sun, a fence, and a gate). Let us build the gate. What
kind of blocks will you need for the lower part? What about the upper part?
Put them on the panel.”
The other elements of the picture are put together in a similar way. Thus
the child is learning the strategy of reading the elements of a model in an
orderly fashion.
“white and black squares” method

In this method, the child is given a frame with nine white squares and nine
black panels with handles. The child completes patterns by either putting
in or removing these panels from the frame. The size of the panels (11 × 11
cm) and the presence of the handles make it easier for children with motor
difficulties to complete the task (this method was originally created by the
Finnish psychologist, M. Saarela; for more details see Pylaeva & Akutina,
2000 R, or Chapter 14).
In Task 1, “Getting to Know the Material,” the child is given the following
instruction: “Take all the panels off and count all the squares. Find the central
square, then an upper row, a lower row, and a row to the right and a row to
the left. How many squares are there in each of these rows? Find the upper
left square, the upper right square etc. Put the black square in the middle.
Now put it in the upper left corner” (see Fig. 15.16).
In Task 2, “Build a Figure,” the child is shown a model on cards that are
smaller than the frame and asked to make figures one after the other (see
Fig. 15.17).
In Task 3, “Building by Memory,” the instruction is, “Remember the
figures you built and build them again by memory” (see Fig. 15. 17).
Figure 15.16. “White and Black Squares”

construction method, Task 1.
In Task 4, “Make Letters,” the child is given a model and asked whether
he or she recognizes the letter. After that the child is asked to make the letter
using the blocks. Then the child is shown several models in sequence and
puts these letters together (see Fig. 15.18). The child can be asked, “What
word can you make out of these letters?”
In Task 5, “Making Letters by Memory,” the child is given this instruction:
“Remember the letters you made and make them again in the same order.
What was the first letter you made? What was the second?” etc.
In Task 6, “Drawing by Memory,” the child is given a piece of graph
paper with the following instruction: “Let us draw these letters. First draw
the frame.” (If the child starts to experience problems, the psychologist
marks the key points of the frame, and the child draws it and divides it into
parts with the psychologist’s help.) “Now draw this letter. Choose the pencil
of your favorite color. Which squares are you going to color? Now use a
different color to draw another letter, but first prepare the frame.”
In Task 7, “Building Familiar Figures,” the child is given a sequence
of samples and asked what these samples look like (stairs, white and
black crosses; see Fig. 15.19). The instruction for this assignment is,
Figure 15.17. “White and Black Squares” construction method, Tasks 2 and 3.
Figure 15.18. “White and Black Squares” construction method, Task 4–6.
Figure 15.19. “White and Black Squares” construction method, Task 7.
Figure 15.20. “White and Black Squares” construction

method, Task 8.
“Make a staircase. Tell me, where did you put the black squares?” (in the
lower left corner, etc.). The other two objects are constructed in a similar
way with verbal explanations. After finishing the third figure the leader can
ask: “What has to be done to make a part of chess board out of this figure?”
In Task 8, “Figure Quiz” (dictation of figures), the child is given a card,
and he or she gives the psychologist instructions on what needs to be done
to build the figure on the card; for example, put the black square in the lower
left corner, etc. (see Fig. 15.20). Other samples can be used for this task as
well. The psychologist can “make mistakes” while completing the task.
In Task 9, “Figures Identification and Memorization,” three cards with
sample figures are laid out in front of the child (see Fig. 15.21). The psy-
chologist copies the middle figure on the panel and says to the child, “Show
me the figure I made. Look at it closely. Now make it yourself.” After that
the psychologist shows and asks the child to recall from memory first Figure
1 and then Figure 3. One figure can be made and the other one drawn.
In Task 10, “Practicing Visual Measurements,” the child is given two
sample cards (see Fig. 15.22) and asked, “Name the letters that are pictured
on the cards” (“T” capital and “t” regular). “Make the big letter. You’ve
done it and it was easy for you. Now try making the small one.” In case of
difficulties the child is given the following hint: “See where the border for
the panels is.”
In Task 11, “Making Shifted Figures,” the child is given a sequence of
samples and asked what these samples look like (a pyramid, a well, a target,
and a mill; see Fig. 15.23). The child builds the figures using the sample and
then repeats it from memory. It is possible to practice these tasks further in
a graphic format.
We used the complex of construction tasks presented here for developing
visual-spatial functions not only in preschool and first-grade students (see
Chapter 14) but also in 8- to 14-year-old children with pronounced delays
in the development of spatial functions. In the next chapter we describe the
use of these methods to prepare children with cerebral palsy to use computer
games aimed at developing spatial functions.
Online ISBN: 9781139012799
Chapter
16 - Table and Computer Games to Improve Spatial Functions in Children
with Cerebral Palsy pp. 205-214

16
Table and Computer Games to Improve Spatial

Functions in Children with Cerebral Palsy
The delay in development of spatial functions can be caused by immatu-

rity or damage to certain brain structures. It can also develop secondary
to disturbances that cause limitations in the autonomous survey of space
(Foreman, Orencas, Nicholas, Morton, & Gell, 1989; Stanton, Wilson, &
Foreman, 1996). Poorly developed movement and navigation skills and
visual-motor coordination can affect orientation in the nearby space (Fore-
man et al., 1989; Stanton, Foreman, & Wilson, 2002). The opposite is also
true: developmental education aimed at remediation of certain spatial func-
tions can lead to improvement in other functions as well (Kass & Ahlers,
1998; Snodgrass, 2000).
Children with cerebral palsy (CP) have particularly pronounced deficits
in spatial functions; however, typically, remedial work that specifically tar-
gets these functions is not conducted, but rather is included as part of the
general complex of medical and psychoeducational interventions (Finnie,
2009; Levchenko & Prichodko, 2001 R).
Contemporary computer technologies have opened new possibilities
for creating special remediation tools to use with children diagnosed with
pronounced problems in motor development. The environment of virtual
reality (EVR) that is created by a computer allows those who are unable
to travel conduct imaginary “travels in space.” Research shows that spatial
skills practiced using EVR are transferred to real-life situations by children
in both normal and developmental deviation groups (McComas, Pivik, &
Laflamme, 1998; Rose & Foreman, 1999; Stanton et al., 1996, 2002). Children
who are not able to operate the computer mouse or joystick by themselves
can obtain spatial information from the computer screen by controlling
This work was conducted together with N. Foreman, A. N. Krichevets, L. Matikka, V. Narhi,
and E. Vahakuopus.
205
the virtual movements by giving appropriate verbal commands to experi-

menters (Wilson, 1997). This research opens a wide range of possibilities
for using EVR in remedial-developmental interventions with children with
psychomotor difficulties.
The goal of our research was to investigate how the set of computer and
table games that we and our colleagues created promote orientation in space
(egocentric and allocentric) and whether they positively affect other types of
spatial functions in children with CP. This set of rehabilitation techniques, as
well as the tests to measure results, were designed for children with moderate
and severe forms of cerebral palsy who had pronounced difficulties with
movements and lacked skills for orienting in “large” space and coordinating
in “small” space. Among them were children who were unable to speak, yet
who met the minimum requirements to be able to complete the tasks;
namely, the ability to communicate five commands using words, glances, or
head movements. All operations to realize the commands were performed
by a trainer-operator.
We first did a pilot study of the computer methods. From this study, we
reached the following two conclusions:
1. The remedial techniques used in the study facilitated development
of spatial functions in children, although they were only effective for
children with a certain baseline level of mastering space.
2. It is necessary to complete preliminary assignments before giving the
computer tasks so that children with more pronounced deficiencies
are prepared to solve visual-spatial tasks (Akhutina & Krichevets,
2002 R).
Discussion of the second, main stage of the research follows.
method
All study participants were undergoing treatment at the Gorki Leninskie
Remediation Institute and were diagnosed with cerebral palsy. Fifty-one
children aged 8–14 participated in the experiment. After the clinical assess-
ment and preliminary discussion, the children were divided in pairs based
on similar assessment results. One child from each pair was assigned to
the experimental group and the other one to the control group. Six of the
51 children left the study prematurely, so that complete data were collected
on 23 children in the experimental group and 22 children in the control
group. Both groups included children with diplegia, left-side and right-side
hemiparesis, and mixed (spastic/ataxic) form of CP (in the experimental
Table and Computer Games to Improve Spatial Functions in Children 207
group the number of children with these abnormalities were 13–2–1–1; in

the control group, 14–6–1–1, respectively). Three children in the experi-
mental group (but none in the control group) had the hyperkinetic form of
CP. Additionally, there were two wheelchair- bound children in the experi-
mental group and none in the control group.
Children from both groups underwent the standard rehabilitation course
(medication management, physical therapy, etc.) at the facility. In addition,
children in the experimental group participated in the interventions using
experimental methods, which took place in twice-weekly to three times a
week sessions over a 5-week period; each session lasted from a half-hour to
an hour. The children from the control group were invited to play computer
games during the same period of time. Children’s spatial functions were
tested before the beginning of the experiment and after its completion using
computerized methods and tests that we developed and included as part of
the neuropsychological assessment. Full neuropsychological assessment and
testing using Raven’s matrices were conducted only once at the beginning
of the experimental course.
We created the course of remedial-developmental education based on
Vygotsky-Lurian methodology. It started with preparatory games and
assignments. After Lesson Five, computer games were added to the set.
The number of supportive lessons depended on how successful children
were in completing the program. In total children had between 15 to
30 half-hour supportive sessions. The number of computer assignments
also depended on how fast children were able to learn the games; the aver-
age number was eight. All tests and remedial interventions were conducted
individually in a separate room.
Supportive tasks. The goal of these assignments was to strengthen spatial
concepts and to develop verbal regulation of spatial actions; in other words,
to develop spatial and executive functions necessary for solving spatial
problems. During the completion of these tasks the concepts of “top,”
“bottom,” “forward,” “backward,” “to the right,” and “to the left” from the
child’s point of view were either introduced or practiced. Combinations of
several of these concepts were also introduced or practiced; for example,
upper right corner, etc. The movement commands (“forward,” “stop,” “turn
right”) were learned separately.
All games were arranged in order of gradually increasing demands on
spatial functions and regulatory speech function. The educational mate-
rial was freely modified to maintain children’s interest in the tasks. The set
included the following games: “Construct the Figure” (with figures made
from cards, Lego pieces, and wooden panels used in the “Black Squares”
method; see Chapter 15); “The Flight of the Balloon” (see Task 1 in Chapter
17); “Postman” (both games use a metal board); graphic dictations; and
“Teacher and Robot.” Each game-task allowed for a wide range of move-
ments.
For example, in the “Construct the Figure” task the children did the
following actions:
r Frame and sample analysis, constructing figures using samples and
from memory
r Searching for the sample of smaller size
r Constructing a figure using the smaller size sample
r Outlining the contour of the figure and coloring the figure
r Constructing the figure from the smaller size pieces
r Drawing the frame and the smaller size sample on the graph paper
In addition, the children completed a set of pencil-and-paper tasks of
varying levels of complexity on recognition, copying, and recall (using a
sample or by memory) of different spatial structures (the separate tasks and
sets of tasks presented earlier).
Computer development games. An IBM-PC computer was used in this
part of the study. The assignments were designed using the software package,
Superscape. Children sat in front of the 40 × 30 cm monitor at a comfortable
distance (about 40 cm) away. Movements in virtual space (forward, back-
ward, turning right and left) were conducted by the trainer as directed by the
subject. All movements were conducted at the same slow speed and would
end once the command to stop was received from the child. Actual copies of
the mazes (see the later discussion) were made using plastic magnetic chips
(to build walls) that were placed on a 40 × 40 cm metal surface.
The idea behind the computer methods was to model the same spatial
tasks (mazes) using different means so that generalization of spatial skills
would occur. Children were presented with the following three tasks:
r navigate in a computer-generated two-dimensional labyrinth
r create a toy copy of the labyrinth and navigate it
r use the virtual three-dimensional labyrinth and the toy copy for nav-
igation. (A labyrinth with the same structure was used in all three
tasks.)
The goal was to reach a tree inside a maze (the tree was either in a virtual
format [two- or three dimensional] or made of wood). The lesson started
with the two-dimensional computer game: the child moved a “ladybug”
toward a tree that was visible, giving the trainer commands (“forward,”
Figure 16.1. Examples of two-dimensional mazes: simple maze (left) and medium
difficulty maze (right).
“stop,” “turn right”) based on their (the child and the trainer) common
point of view. In the second task the child built a model of the maze using
plastic strips with magnets inside them and moved the toy toward the exit.
In moving the “ladybug,” the “turn right” command was interpreted as
a turn in the direction of its right front leg. This was done so that the
commands in all three types of tasks were the same, eliminating multiple
interpretations.
In the third task the children practiced movements and reaching a goal
in virtual space, using the real model for support. In this task the “point of
view” of the player was moved in the virtual environment horizontally below
the edge of the labyrinth’s walls. The walls of the labyrinth blocked the small
tree, and it was visible only from the close proximal point. The structures
of the labyrinth, which were similar for all three tasks, gradually increased
in complexity as the remedial interventions progressed (the examples of the
two-dimensional labyrinths are presented in Fig. 16.1).
An additional fourth task was offered to those students who completed
the entire course of the “labyrinth” assignments. It consisted of the six
different versions of a virtual park with an object (a small weathervane)
hidden in a ditch that could only be seen from a close distance. The “map”
of the park was available for all six versions, and the place where the object
was hidden was marked. Also marked were locations of two landmarks that
were large enough to be visible from any spot in the park. Starting from
some arbitrary point the student was supposed to find the hidden object
(for a more detailed description of this method, see Akhutina, Foreman,
et al., 2003; Akhutina & Krichevets, 2002 R).
assessment of spatial functions’ dynamics

To assess the effectiveness of the remedial interventions we used two com-
puter tests that we designed for this purpose and neuropsychological trials
that did not require graphic activity. Before the remedial interventions we
used Raven’s matrices to compare children in the experimental and control
groups.
The following computer methods were used for the assessment:
Computer version of Kohs Blocks: In the right half of the screen the subject
was shown a configuration consisting of three kinds of squares: all white,
all red, and squares divided diagonally into red and the white parts. The
same squares were presented in the left part of the screen, but in a different
configuration. The goal of the assignment was to re-create the configuration
shown on the right in the left part of the screen. The subjects could give
the following commands: “up,” “to the right,” “to the left,” “down,” “turn,”
and “change the figure.” A 22.5-degree turn to either side was conducted
after each command. The tasks were divided into four categories based on
complexity, which depended on whether the following were present:
r The borders of the squares coincided/did not coincide with the borders
of the colored fields.
r The sides of the squares were parallel to the sides of the screen or were
positioned at a 45-degree angle to the screen (“diamond” position).
The results were assessed using five scales that measured the quality of
the subject’s reproduction of the general Gestalt, ability to orient the main
parts in relation to the screen, the presence of space between the squares,
etc. The child could receive scores from zero (correct) to two (completely
incorrect) on each scale.
Computer tasks on constructive praxis. Children were shown images of
two clowns that were symmetrical along the vertical axis of the screen. The
subject was asked to memorize the image and its “reflection.” After one
minute the left image was removed, and in the lower left part of the screen
the pieces of the image were displayed (the arms, the body, the legs, and the
head). The arms and the legs were displayed in two positions (created by
the positioning of hands and soles). The same commands as in the previous
task were used to move the figures (see Fig. 16.2 for the test results for one
of the subjects). The results were also assessed using five scales to evaluate
how well the subject reproduced the general Gestalt, ability to orient the
main parts of the body, the angles of different parts of the clown, ability to
orient the arms and the legs, and the distance between the elements that
Figure 16.2. The sample (right) and results (left) of the computer task on con-
structive praxis: “the clown” before (upper picture) and after (lower picture) the
remedial course.
were supposed to be connected. The scores on each scale were from zero
to two. The assessment of the results was conducted by a group of experts
who did not know to which group (control or experimental) the subject
belonged.
Neuropsychological trials included the following methods:
Benton’s test on line orientation (Benton, Hamsher, Varney, & Spreen,
1983). This test was used to assess visual-spatial perception. The children
were presented with five angled lines and asked to find the line with the same
angle as the line on the control card. The number of incorrect segments
determined the penalty score. Single scores were then added up to receive
an overall score.
Subtest “Arrows.” This subtest from the neuropsychological battery for
children, NEPSY (Korkman, Kirk, & Kemp, 1998), was also used to assess
the orientation of the lines. Each task consisted of a picture of eight arrows
and a target. The subject was asked to identify the arrow that was aimed at
the target (there were two on each form).
“Paths.” The test, which was created at the Institute of Pre-school Educa-
tion AO USSR and also included in NEPSY, measures visual-spatial relation-
ship perception and ability to use the diagrams of the routes. The number
of correct answers is recorded (maximum 10).
results
Both groups had similar gender (52% males in experimental group and
55% in control group) and age composition (identical means of 9.7 and
standard deviation of 1.6). No significant differences in scores between the
groups were noted in the Raven’s matrices.
The data on spatial trials before and after the remediation course were
normalized based on pre-intervention data so that it could be used in the
statistical analysis. No differences between the groups in regard to spatial
functions were identified before the remedial training.
Correlation analysis showed significant negative correlation between the
state of spatial functions before the remedial course and improvements in
this measurement in both groups through the course of the experiment
(r = −0.51; p < 0.001). To control for this, we included the variable, pre-
training score, in the later analysis as a covariate. The dispersion diagram is
presented in Fig. 16.3.
To analyze the efficacy of the treatment, we used the dispersion analysis
(ANOVA), with the dependent variable, “improvement in testing summary
indicator”; the independent variable, “experimental/control group”; and
the covariant described earlier. Both groups demonstrated improvement:
t-criteria for the control group showed t = 5.71, df = 21, p < 0.001; for
the experimental group, t = 8.65, df = 22, p < 0.001. However, for the
experimental group the progress was more significant (ANOVA, F = 5.35,
p = 0.0026).
discussion
This experiment showed that spatial functions in children with difficulties
in motor area could be improved by using the battery of tasks described in
this chapter. The results coincide with earlier observations that the naviga-
tional experience in virtual reality in both children and adults is particu-
larly effective for the development of spatial functions (Foreman, Stanton,
–1
–2
2 4 6 8 10 12 14 16 18 20
Figure 16.3. Dispersion diagram for the test results: horizontal axis – pre-training
score, vertical axis – difference between pre- and post-training scores. O – experi-
mental group, – control group.
Wilson, & Duffy, 2003; Foreman, Stirk, Pohl, Mandelkow, Lehnung, Herzog,
& Leplow, 2000; McComas et al., 1998; Stanton et al., 1996).
Unlike the pilot study (where the children with underdeveloped spatial
and regulatory functions were not successful in mastering computer navi-
gation games), in the main experiment progress was noted in all children;
it was especially pronounced in children with a low baseline level (indi-
cated by a high negative correlation between the baseline and the improve-
ment). With the aid of additional supportive tasks all children managed
to internalize spatial concepts and to operate successfully in the new envi-
ronment. Their success attests to the advantages of interactive education
and the effectiveness of methods created on the basis of Vygotsky-Lurian
methodology.
In both the pilot and the main experiment all students underwent the
standard rehabilitation process, and therefore improvement of the indicator
tested was noted in both groups; however, it was significantly higher in the
experimental group. This fact clearly attests to the usefulness of this remedial
course.
We only have limited data on the improvement in the students’ general

level of functioning after the completion of the remedial course. How-
ever, anecdotal evidence we obtained from teachers, nurses, and parents
attests to the positive influence of the training on the children’s successes
at school. The extent of the positive influence of spatial functions training
on general life skills and mastering of the school program deserves separate
consideration.
Online ISBN: 9781139012799
Chapter
17 - Directions of Intervention for Developing Visual-Spatial Function
s to Prepare Children for School pp. 215-228

17
Directions of Intervention for Developing

Visual-Spatial Functions to Prepare
Children for School
In this chapter we present the sequence of methods aimed at the develop-

ment and remediation of visual-spatial functions that we use to prepare
preschool children for school. The psychologist can use these 12 tasks and
tasks similar to them after or in parallel with the methods described in the
previous chapters.
task 1: orienting on a piece of notebook paper

A child is asked to find the middle point (center) on a piece of notebook
paper and to draw a balloon. The child is then given the following assign-
ment: “The balloon flies upward. Draw a line to where it flew and draw a
balloon above, in the upper part of the paper.” The psychologist emphasizes
the keywords (in italics) by his or her voice. The child then practices drawing
lines and balloons in other directions: the balloon “flies” to the upper left
corner, upper right corner, etc. (see Fig. 17.1). At the next session the child
is asked to draw a butterfly or a leaf and perform similar actions.
The next step is to transition to a more complex picture. “Draw some
grass at the bottom, a mushroom in the lower left corner, a cloud in the
upper part of the paper, and the sun in the upper right corner.”
task 2: a maze
First, the child helps hedgehogs find the way to the apples by showing the
path with his or her finger. After that the child draws the path with a pencil
and corrects mistakes if necessary (using an eraser). Then he or she outlines
the path with a colored pencil, giving instructions to the hedgehogs: Go
up, down, turn right, turn left (see Fig. 17.2). These commands to the
hedgehog are also the commands to the child, which he or she can use later
in externally directed as well as internal speech.
215
Figure 17.1. Task 1.
Directions of Intervention for Developing Visual-Spatial Functions 217
To more fully establish this skill – naming directions for the actions –
other labyrinths or routes with right-angle turns are used. Special atten-
tion is given to the step in which a child combines his or her actions and
verbal commands directed at a different character, “robot,” or self as a
driver.
task 3: getting used to graph paper

The child is asked to find the center point and outline one square on a piece
of graph paper. After that, he or she outlines a square in the bottom, left
and right parts, and the upper left corner, etc.
Then the child practices movements in different directions (see Fig.
17.3a). First he or she “plants carrots” by drawing lines from the marked
points down one, two, etc., squares; then “grows flowers” by drawing lines
up from the marked points and “hammers nails” by drawing lines to the
left and to the right. The child then learns how to indicate the length and
the direction of a movement with a number and an arrow pointing in the
direction of the movement. He or she is asked “to read” the following: 2→
(i.e., two squares to the right). These tasks prepare children for a graphic
dictation.
The graphic dictations are presented to the child during the next several
lessons (see Fig. 17.3b). They gradually become more complicated, although
all the programs are talked through:
r Draw a pattern following the verbal commands of psychologist; for

example, “One square up, two squares to the right . . . (the child repeats
the commands in a whisper).
r Continue a pattern based on a sample (the child dictates to him- or
herself).
r Complete a pattern according to the given written plan (the child reads
and executes the plan).
r Analyze a sample and create a program (the level of difficulty for this
task can vary).
task 4: graphic dictations (“gnomes invite quests”)

These tasks are taken from the handbook on preparing children for school,
School Is Soon: Traveling with Bim and Bom to “Math” Country (Akhutina,
Manelis, Pylaeva, & Khotyleva, 1999/2006 R).
(a)
(b)
The first graphic dictation is performed using a plan that is verbalized by

an adult (the child not only sees the plan but also hears it step by step). Every
completed step is marked by a colored marker. The children perform the
next several tasks on their own, dictating to themselves out loud or silently.
Completed steps are marked in the plan (see Fig. 17.4).
task 5: copying the drawings along the squares

Before starting work on these tasks children complete assignments on divid-
ing squares in half by drawing vertical, horizontal, or diagonal lines, and
they practice making squares out of two or four parts.
In the first task adult helps the child analyze the drawing of the sunshade.
Together they discuss the direction of the movement and the number of
squares. After that the child completes the task. The children do the second
task on their own (see Fig. 17.5).
task 6: different versions of drawing using squares

It is recommended that children learn different ways of completing this task
(see Fig. 17.6):
r The adult dictates and the child completes the drawing using verbal
instructions.
r The child completes the drawing based on the visual sample.
r The child analyzes the drawing, creates a plan, and dictates it to another
child or an adult.
task 7: the dotted structures

These tasks are used for practicing spatial functions as well as developing
programming and control functions (see School of Attention; Pylaeva &
Akhutina, 1997/2008 R).
When practicing spatial functions the adult asks the child to do the
following:
r Outline the circles on the mugs, count their number, and discuss their
location;
r Identify mugs and spoons with similar patterns, and draw a path from
a mug to a spoon.
r Compare mugs and plates with one and two circles to determine
whether they are decorated in the same way.
r Decorate the plates repeating the design on the cups (see Fig. 17.7).
task 8: bim and bom conduct “scientific research”

on numbers
In this task we discuss the composition of numbers; children outline the
numbers and construct them independently from clay or real dough.
To overcome mirroring it is helpful to put the numbers in a row and to
mark the beginning of every number so that children can “discover,” for
example, that only number “6” is turned to the right and away from number
“5” (see Fig. 17.8).
The task of completing the picture is difficult. At first children should
write the numbers using a pencil so that mistakes can be corrected.
task 9: recognize and complete a letter

Working with letters facilitates development of visual-spatial functions.
One of the methods used for this purpose is to make a letter by putting
its parts together. Children are asked to figure out what letters can be
constructed from sticks and what letters need round parts. The simpler
letters are constructed from sticks of different sizes.
From the very beginning it is extremely important to establish spatial
positions of letters and their parts to prevent mirror-type mistakes. Usually
we start with capital letters. Symmetrical letters, such as A, Н, I, M, O, Q,
Т, U, V, W, Х, Y, typically do not cause problems. Mirror-type mistakes
(left–right) are most often noted in 12 letters that are turned to the right
(В, C, D, Е, F, G, К, L, N, P, R, S) and in 2 letters that are turned to the left
(J, Z).
In this task the vowels and the consonants that can be used to guess
the coded words are presented at the top. A child together with an adult
decides what part is missing in a particular set of letters; in this example, the
letters miss the left part. The child then chooses his or her favorite colored
marker and, guessing each letter, completes it and reads the whole word.
After completing several of these tasks by adding right, bottom, and top
parts of the letters, the child starts coding the words him- or herself for the
teacher or other children to guess (see Fig 17.9).
task 10: roman numerals

Working with Roman numerals provides practice in number composition
and understanding the meaning of the position of sign I to the left or to
the right of V or X (before or after V or X). The adult tells the child about
Roman numerals using the text and the picture. Roman numerals are shown
using fingers and sticks. Particular attention is paid to numbers 5 and 10
and the numbers next to them on both sides. After that the numbers are
outlined and related to Arabic numerals (see Fig. 17.10).
task 11: tasks on visual-spatial cognition

A child together with an adult examines the carpet, naming the parts that
are missing (“upper right corner and upper left corner”). Then the child
highlights the word “left,” colors it, and uses a blue marker to color all
the patterns that are turned to the left. After that the child finds the same
design on the pieces and colors it as well. Next, he or she determines which
one of the pieces matches the upper left corner and draws a line from that
piece to the corner; the child then finds the piece that belongs in the lower
left corner. The child colors the word “right” and corresponding patterns
in red, and then they are connected with lines as well. In the central part
the child first colors the pattern turned to the left and to the right in the
corresponding colors (blue and red); then he or she colors the patterns that
are turned upward (toward the sun) in yellow and those turned downward
(toward the grass) in green. In the second part of the task the child solves
logic problems based on the concepts of “left–right” and “up–down” (see
Fig. 17.11).
task 12: understanding reversible grammar

constructions with prepositions
This task is an example of working with quasi-spatial functions (for details,
see Chapter 13). The adult tells the child that an animal is hiding in the barn
(see Fig. 17.12):
First it was hiding where the barrel is ON top of the box (put a dot and
a number 1 in that spot). After that it ran where the box is IN the barrel
(put a dot and a number 2 there). Then it moved to the place where the
box is BEHIND the barrel (put the dot and number 3 there). After that
it moved to where the barrel in UNDERNEATH the box (put a dot and
a number 4). Then it ran where the box is IN FRONT of the barrel (put
a dot and number 5 there). Now connect all the dots based on the order
of the numbers. What do you see? (A star). What is it missing? Draw the
missing line.
This material can also be used to practice prepositional constructions.
The adult says: “I put an apple on the barrel on the box. Find it. Then I
moved the apple. Can you guess where to?”
As psychologists working in classrooms we interact with teachers very
closely. In the next two chapters we describe this collaboration.
Online ISBN: 9781139012799
Chapter
18 - Neuropsychologist–Teacher Collaboration in Designing a “Numbers C
omposition” Manual pp. 229-235

18
Neuropsychologist–Teacher Collaboration in
Designing a “Numbers Composition” Manual
When teachers and neuropsychologists work together, that collaboration

creates opportunities to use the neuropsychological approach in remedial-
developmental education. To take advantage of these opportunities, new
educational methods need to be created to facilitate learning in school.
Teachers’ participation is particularly important in designing such didactic
materials because they are familiar with different school programs and
they possess a rich arsenal of methods for developing cognitive activity in
children (see e.g., Khotyleva (Trosman), 1998; Borisova & Galaktionova,
2000 R; Khotyleva, 2006 R; Khotyleva et al., 2006 R). Experience shows that
joint efforts of teachers and neuropsychologists create conditions that help
prevent school failures.
We chose to collaborate with teachers to develop a manual on the topic,
the composition of numbers, because it is one of the most important and
most complicated topics that children study in grade school. Despite a large
amount of didactic materials, most children find it difficult to learn how to
compose numbers, in other words, to know that 5 could be represented not
only as 1 + 1 + 1 + 1 + 1, but also as 1 + 4 or 2 + 3. When they do not
master this material, students are not able to comprehend subsequent topics
(automation of counting skills to 10, addition and subtraction of numbers,
etc.).
The existing didactic literature does not sufficiently take into account a
variety of difficulties experienced by students, and therefore, teachers are
unable to apply a comprehensive systematic approach to teaching this mate-
rial. We identified the following difficulties that children typically experience
when learning how to compose numbers.
The work was conducted together with T. Ju. Khotyleva.
229
Visual and visual-spatial problems:

r Difficulties orienting on a piece of notebook paper
r Difficulties in recognizing, memorizing, and actualizing spatial struc-
tures
r Mirror-type mistakes
r Difficulties working in a visually saturated field
r Difficulties relating numbers to quantity
Programming and control problems:

r Inability to orient in the task and create a plan of work
r Inability to follow an extended plan, requiring step-by-step planning
from an external source
r Impulsivity or inactivity
r Difficulties checking results without relying on external programs
r Difficulties in serial organization, namely establishing the correct
sequence of movements
r Difficulties in transferring acquired mathematical skills
Analysis of the difficulties experienced by children enables formulation of

the requirements that any system of methods for developing the concept of
number composition in children should meet, which include the following:
r Creating conditions that would increase learning motivation: creat-
ing tasks in a variety of formats including a game format, repetition
without boredom
r Ranking difficulties and arranging step-by-step mastery using an exter-
nal plan of action; gradual transition from actions with objects to
performing actions in one’s head
r Taking spatial factors into account; presenting the concept of quantity
using certain structures
r Taking the visual factor into account by ranking the degree of satura-
tion of a visual field
Our manual consists of a packet of different paper-and-pencil methods
created based on those requirements. Here we present examples of tasks on
mastering the number three.
Three is one of the most perceptually simple quantity structures that
could be grasped as one Gestalt, it can easily be identified visually even
by small children. To teach children how to “read” different structures, we
decided to present the composition of number three using four spatially
Neuropsychologist–Teacher Collaboration 231
Figure 18.1. Worksheets 1 and 2.
different variants. This makes the tasks more interesting and gives a child
an opportunity to learn how to analyze visual material, orient on notebook
paper, and develop visual perception and visual-spatial concepts.
Worksheets 1 and 2 (see Fig. 18.1) include the following types of tasks:
outlining the structures; making them out of play dough, mosaic tiles, and
buttons; and copying the structures from the model. These tasks are at the
first difficulty level in which the child uses the most detailed unfolded plan
of actions. At this stage the child is not required to memorize the structure
(the plan of actions) and has the opportunity to complete a task step by
step.
Worksheets 3, 4, and 5 are used for structure recognition and recall:
Worksheet 3 for recognizing the structures with the help of a model; Work-
sheet 4 for recalling the dotted structures from memory (control task;
see Fig. 18.2); and Worksheet 5 for recognizing the structures in which
images of real objects are used in place of dots (see Fig. 18.3). Tasks of this
type require that the child is able to internally maintain the image of the
structure.
On the next difficulty level are tasks in which a child is asked to finish a
structure by adding the missing elements. Worksheet 6 (see Fig. 18.3) uses
the external program to construct groups out of three objects. The child is
asked to add the missing elements while repeating the spatial structure of
the model shown by dots.
Worksheets 7 and 8 (see Fig. 18.4) offer tasks that should be completed
using the internalized program. These tasks are more difficult than the
previous ones because to complete them children have to analyze the pic-
ture that is given to them, consider all possible structures, and choose the
appropriate one.
In Worksheet 8 the child is supposed to draw additional objects so that
there are three objects altogether in each cell and then to write in the
empty cell the total number of objects he or she added. Here numbers
are introduced for the first time to identify the quantity of objects, but
no math symbols are used. This prepares children for the next level of
difficulty.
Worksheet 9 (see Fig. 18.5) contains a control task, in which the child
has to add to the structure to create a complete image. Ideally the child uses
all four spatial structures that represent the number three.
Worksheets 10, 11, and 12 contain several final tasks that encourage
children to actively apply to math equations the knowledge they obtained
about the composition of number three. Using the material of all the tasks
completed earlier, children learn to add and subtract using numbers that
are equal to or smaller than three (see Fig. 18.6).
These tasks were piloted with schoolchildren with underdevelopment of

programming and control functions and difficulties orienting in space. The
pilot study showed that the choice of material and the way of presenting
it were adequate for children’s abilities and facilitated development of the
weak components of higher mental functions in these children.
Online ISBN: 9781139012799
Chapter
19 - On Visual-Spatial Dysgraphia: Neuropsychological Analysis and Met
hods of Remediation pp. 236-242

19
On Visual-Spatial Dysgraphia: Neuropsychological

Analysis and Methods of Remediation
In this chapter we discuss the learning difficulties that occur as a result of

functional weaknesses in the right hemisphere, in particular problems with
developing a holistic (global) strategy of processing visual-spatial infor-
mation. Typically when describing learning problems caused by right-
hemispheric functional deficiencies, authors emphasize nonverbal diffi-
culties and difficulties in learning how to count (dyscalculia; Rourke et al.,
1983). However, in this chapter we focus on writing difficulties, their diagno-
sis, and remediation, although reading and counting problems also receive
attention.
Writing difficulties are frequently noted among students in elementary
school. They are initially detected in first grade and often persist, resurfacing
when writing requirements increase. So that remedial work can be designed
based on the particular difficulties experienced by each child, we need to
understand the mechanisms underlying writing difficulties.
The neuropsychological analysis of writing conducted by A. R. Luria
(1950 R, 1980), as well as by contemporary Russian (Akhutina, 2004; Kornev,
1997 R; Velichenkova et al., 2001 R) and Western researchers (Berninger,
2004; Castles & Coltheart, 1996; Chittooran & Tait, 2005; Fletcher et al.,
2007; Hooper et al., 2002; Temple, 1997; cf. Fisher et al., 2007 about reading),
has shown that the functional writing system consists of the following
components:
r Processing of auditory information (phonological analysis, auditory
memory)
r Sound differentiation and control of handwriting based on kinesthetic
information
This work was performed together with the teacher E.V. Zolotaryova, who was studying
neuropsychology at Moscow University at that time.
236
On Visual-Spatial Dysgraphia 237
r Actualization of visual images of letters and words

r Spatial orientation of letters’ elements, letters, and lines
r Motor (serial) programming of graphic movements
r Planning, realization, and control of the writing process
r Maintaining the working state and active cortical tonus
If any one of these components is compromised, writing difficulties develop

either on their own or in conjunction with difficulties in other components.
Although the presence of spatial problems in writing has been noted
by teachers for a long time, contemporary neuropsychological research
allows us to clarify the mechanisms underlying these problems. Orient-
ing and organizing actions in space is a complicated activity that requires
participation of both hemispheres. The simplest functions that develop
early on are mostly based in the right hemisphere, which regulates visual-
motor coordination, the ability to relate movements to vertical and hor-
izontal coordinates, and the ability to unite and remember the general
interlocation of different pieces so that the whole image (Gestalt) can be
grasped.
The left hemisphere is responsible for more complicated tasks, especially
those that require fine analysis and verbal mediation. The left hemisphere
works by analyzing details and parts, and it is not as successful as the right
hemisphere in integrating these parts into a single whole.
In this chapter we discuss writing problems and their remediation in
a third-grade (remedial) student, Egor P. (his name has been changed to
protect his identity).
assessment and observations of egor

Egor’s neuropsychological assessment revealed deficiencies in right-
hemisphere functions as evidenced by spatial and visual difficulties, frag-
mentation errors, and difficulties in automation of motor, especially visual-
motor, skills. He also experienced a decrease in functioning of the “ener-
getic” unit of the higher mental functions, which enables a necessary level
of activity and helps maintain a working state (Luria, 1973).
The teacher’s observations of his behavior in class showed that initially
Egor did not want to learn or even be at school, and he did not want to
interact with peers. However, when he became engaged in group work in
class, he showed a sufficient level of general development, extensive vocabu-
lary, and well-developed speech. At the same time he was disorganized and
unable to focus on the task at hand, which, combined with his lack of study
Figure 19.1. A sample of writing by Egor, a third grader.
skills, caused frequent refusals to complete tasks, irritability, and extremely

fast exhaustion.
After several lessons in his RDE class, Egor’s negative behavioral reac-
tions subsided. He became more active in class, showed interest in cre-
ative oral assignments, and connected with several teachers and students at
school.
Completion of written tasks, however, remained unattainable for this
student. Because of the difficulties he experienced in becoming engaged in
assignments and his slow speed of task completion, Egor often got nervous,
would rush through the assignment, and would cross out what he had
written. Often he would end up in tears, and it would take him a long time
to calm down. He would make comments about being different from other
kids, not knowing how to do anything, and never being able to learn. His
ability to work fluctuated in the course of even one class, let alone a week or a
month. However, gradually his ability to work increased, which was closely
connected with his increased motivation to communicate meaningfully
and to engage in cognitive activity as well as a greater awareness of his own
successes.
Let us look at his work during Russian-language classes. In the initial
sessions the difference between his oral and written work was obvious. He
had good knowledge of the spelling rules and could skillfully explain the
orthograms; however, he could not manage writing. Figure 19.1 shows a
sample of his writing.
The sentence he attempted to copy was: Na korable s nami bylo dva

malьchika.
The sentence he wrote: nakoroble s naimI bAla DVam malьchьchka.
Word-for-word translation: On ship with us were two boys.
The analysis of his writing problems revealed that they all were easily
explained by right-hemispheric deficiencies in processing visual and visual-
spatial information:
r Difficulties in orienting on a piece of notebook paper and finding the
beginning of a line
r Difficulties following the line
r Variations in letters’ size and slant and the space between letters
r Lack of connection between the elements of letters and disproportion
of their size
r Difficulties remembering graphic and motor images of letters and
confusing letters that looked similar (for example, K – H – N)
r Persistent “mirror” type errors when writing letters
r Practicing writing very frequent words did not lead to formation of
stable ideograms (he made mistakes in words like “homework” or
names of the months that he wrote at least three times a day during
the entire month – see Fig. 3.5 for one more example of his writing)
r Changing or missing vowels, even when they were accented (bylo –
bala; park – prk)
r Inability to follow the correct order of letters
r Tendency for phonetic (transcription) writing (regularization errors,
as in English “come” – cum; “comb” – koum; cf. Temple, 1997)
r Writing two to three words (e.g., a verb and a noun with a preposition)
together, because he did not have a holistic image of words, which
would have helped him recognize a mistake
In addition, when the student became fatigued we would start seeing
perseverations of letters and syllables and contamination of words; that
is, the merging of two words in one (24 February – 24 февраля – “24
ферваа”; На ели лежит – “На елижит”). It is worth noting that he
performed much better on more complicated creative tasks that were more
emotionally significant for him than on simple tasks.
methods of remedial work used with egor

According to the Vygotsky–Lurian neuropsychological approach, the main
strategy of remedial interventions is to “grow” a weak component using the
support of strong components in the process of specially organized joint
activity.
Egor had two weak links: maintaining the ability to work and visual-spatial
organization of the writing process. The other functions (programming and
control in particular) were affected secondarily to these two main dysfunc-

tions.
To increase his ability to work it was necessary both to increase his moti-
vation and interest in completing tasks and to divide and thus decrease the
size of each task and, whenever possible, simplify the process of complet-
ing each task. Egor’s spatial difficulties were addressed during the individual
remedial sessions with a psychologist, in which his teacher also participated.
Considering his difficulty in orienting on a piece of notebook paper, the
teacher marked the margins and initially even the working line (line below
the letters). In the fourth grade the teacher returned to use of a notebook
with a particular rule pattern and lines that usually stopped being used
at the end of first grade. The teacher gave clear instructions on where to
start writing and checked to see whether Egor was able to follow them.
The program of practicing writing included the sequential repetition of the
primary orthographic rules and the practice of graphic skills.
In the first 2 months the teacher followed the “one difficulty at a time”
rule. For example, if the goal of the task was to learn a grammar rule,
then the graphic work that Egor had to do was minimal. It included, for
example, inserting letters and words, sentence completion, or doing only
certain parts of regular exercises. If the focus was on practicing graphic
skills, then the assignments consisted of writing letters accompanied by a
mnemonic symbol to help remember them. For example, while completing
the task, Egor wrote a letter “b” and an arrow pointed upward next to it
(b↑) to help him remember the correct orientation of the letter (for “p” it
was p↓). The teacher also provided verbal mnemonic means to remember
a letter; for example, “b is a back with a big belly”; “p is a part of pants.”
Parallel to the teacher’s activity, the psychologist conducted a “scientific
analysis” of the letters during her lessons (for details, see Task 9 in Chap-
ter 17). Egor was able to notice that only seven letters went outside the
line: two above (б, в) and five below (like р, y); in addition, two letters, ц
and щ, had small “tails” (the boy compared the elements of the two letters
y and ц that were outside the line). To overcome mirror-type errors, the
psychologist identified the letters that look forward (я, y) or back (c, p).
Extensive work on spatial issues was also conducted during math lessons
where just writing numbers in columns and keeping them all the same size
initially presented an irresolvable difficulty for this student. To eliminate
these problems a large piece of fabric with pockets was hung next to the
blackboard. While students were solving math problems in their notebooks,
Egor was solving them using this “device” by inserting numbers in the
pockets, which represented squares in the notebook paper. That allowed
him to solve complicated addition and subtraction problems; it also helped

eliminate his fear of math problems, thus preparing a foundation for writing
them down and solving them in his notebook where the space for solving
the problems was marked using a red pen. Later such markings were no
longer necessary.
The spatial organization of actions was practiced during reading lessons
as well. To overcome his chronic mistakes of reading from right to left, he
was allowed to follow the line with the finger or use a special ruler that had
the following form: |_____.
In addition, Egor was required to regularly read the tables of syllables
and one-syllable words with his classmates. The same table was used at
the beginning of every reading lesson for the duration of one month. The
children worked in pairs reading columns or rows and recorded the time
and the mistakes made. In the pairs, the students switched roles, with each
one wanting to give his or her partner a more complicated task and to
read without any mistakes him- or herself. Because the goal of this exercise
was to recognize the visual images of syllables and words, it was focused
on optimization of both analytical (reading of syllables/words) and holistic
(global) reading. Two rows (of eight that were used) from one of the tables
are shown here (they were changed to be close to English orthography):
at on cake bone snake stone train snow
bad pot lake tone stage close brain slow
These methods enabled Egor to catch up and complete the third-grade
school program. However, certain spatial difficulties remained. For example,
he completed the final math test for the third quarter without any mistakes,
but lacking confidence, he asked the teacher about the subtraction problem:
“Should I subtract this number from that number?”
Today Egor is a student at a theater college.
part v
NEUROPSYCHOLOGICAL INTERVENTIONS
IN CHILDREN WITH SEVERE
DEVELOPMENTAL DELAY
Online ISBN: 9781139012799
Chapter
20 - “Tracking Diagnostics” Methods pp. 245-250

20
“Tracking Diagnostics” Methods
In this part of the book we discuss the experience of working with children
with pronounced delays in psychomotor and speech development. The work
started at the Center of Curative Pedagogy when the children were 5 years
old and continued for four years. Initially the neuropsychologist conducted
tracking diagnostics (Pylaeva, 2004, 1995 R,) while children participated in
the sessions with the special education teacher – play therapist A. L. Reva
and the classroom teacher T. Ju. Trosman (Khotyleva). Later an extended
neuropsychological assessment was conducted (one of the versions of Luria’s
test battery created for and piloted on the 5- to 9-year old age group by the
staff of the laboratory of neuropsychology, Moscow University; head, T. V.
Akhutina). The methods of the tracking diagnostics were inclusive, which
allowed the neuropsychologist to smoothly transition from diagnostics to
remedial education.
The children in this group showed functional immaturity of deep as well
as cortical structures of the brain as evidenced by disruption in neurody-
namic characteristics: reduced performance speed or increased impulsiv-
ity, rapid fatigability, distractibility, difficulties of concentration, attention
fluctuations, and increased difficulties when performing a lengthy task in
the same modality (visual or auditory). A significant delay in the devel-
opment of programming and control functions as well as motivation was
also noted. Externalization of simple programs and step-by-step control
by an adult did not always lead to completion of even the simple tasks.
The processing of information also suffered in several modalities – audi-
tory, visual, kinesthetic, and visual-spatial, as evidenced by the decrease in
the volume of perception and memory, weakness of memory traces, dif-
ficulties in the acoustic analysis, and underdevelopment of visual-spatial
concepts.
245
However, the delay in the development of higher mental functions was

not even. The assessment enabled clarification of the type of the dispro-
portion and changes in it over time; namely, the degree of the delay in
the development of various processes. In addition, it allowed identification
of the weak and strong links between different functions and within the
same function. For example, one student had weaker programming and
control functions, whereas his abilities to process different kinds of infor-
mation were more intact. In another student the problems were reversed.
The development of visual memory might be close to the norm, while
auditory memory could be significantly delayed; in other words the dis-
sociation of mnestic processes of different modalities was also present. In
addition, even if the volume of short-term memory was intact, the child
might not be able to retain the order of the elements or retain information
for extended periods of time. We now discuss the methods of tracking
diagnostics used to make these determinations, demonstrating this very
important and ecologically valid way to assess the state of HMFs in children
who are not ready yet to participate in a traditional neuropsychological test
examination.
Observations of students during the group lessons enabled us to assess
the neurodynamic characteristics of their mental processes: how quickly the
children engaged in the task, how quickly they became tired, how well they
were able to maintain attention, fluctuations in their attention in the process
of completing a task and during the day, when during the day (morning or
evening) they became more productive, how strong were their reactions to
external (side) stimuli, and whether they had a hypersensitivity to different
auditory or light stimulation.
Children’s motor abilities were observed most clearly during musical
rhythmic lessons, physical therapy, or participation in active games when
coordination, precision of movements, the ability to perform a sequence
of movements, and the ability to orient in space and in one’s own body
could be traced. The morning greeting procedure called “The Fingers
Are Saying Hello” (finger sequencing) allowed observation of fine motor
skills.
Determining the dominant hemisphere is a very important part of a neu-
ropsychological analysis. To determine the dominant hand we observed
which hand the child was using to eat; hold a pencil, brush, or scissors;
shake hands; take a toy; put blocks together; and hold a phone receiver
during a game; to determine the dominant leg, we noted which leg he or
she jumped on better and more frequently.
“Tracking Diagnostics” Methods 247
The analysis of auditory perception and memory was conducted using tasks
on retaining verbal instructions (“Go to the playroom and bring a bear and
a doll”), learning rhythmic melodic structures during music lessons, and
memorizing short poems and songs.
A very important component of the tracking diagnostics was speech
assessment; in particular, assessing difficulties understanding speech and
the development of passive vocabulary. Analysis of expressive speech relied
on the assessment of speech motor development: pronunciation of sounds,
syllabic structure of words, prosody, the presence of slurred pronuncia-
tion or monotonous speech, broadcast speech, and the tendency to stutter.
Observing children’s communications with each other and with adults,
particularly their verbal activity during games, enabled assessment of the
volume of their active vocabulary and the structure of their sentences.
Development of visual-spatial functions was assessed when children par-
ticipated in different play activities, such as construction games using blocks
and drawing. For example, during games children’s abilities to orient in the
kindergarten building and in the play and study rooms could be assessed.
During drawing or paper craft activities we paid attention to their ability to
orient on a piece of paper or on the surface of a table. Particularly valuable
observations were made when children played with construction blocks or
put together a mosaic pattern. (For example, one of the first observations
that allowed us to suggest the presence of visual-spatial difficulties in one of
the children was his drawing of a house in which the house was positioned
horizontally instead of vertically.)
To make the transition from tracking diagnostics to test assignments, we
assessed the children in a microgroup: we started with those children who
showed a readiness for interactions with adults, whereas children who were
more reluctant to engage joined in gradually. The children who voluntarily
joined the microgroup typically worked more successfully. In these situa-
tions we could assess praxis, visual-motor coordination, and participation
in drawing, graphics, and construction tasks. If a child refused to pick up a
pencil and draw at an adult’s request, the presence of another child who was
already doing it often attracted his attention and motivated him to complete
the same task.
Another way to engage a child in a task was to have a neuropsychologist
complete it using similar materials and commenting on his or her actions
while the child was getting situated; later this child would engage in the task
him- or herself. This method alleviated children’s fears and helped them
overcome anxiety over failing.
One other necessary condition for conducting the neuropsychological

assessment was creation of a game situation, which provided meaningful
contexts for the tasks:
r “The Fingers Are Saying Hello”: when assessing finger sequencing
(each finger touches the thumb) in right and left hands
r “Drawing a Fence”: Graphomotor Sequences Test
r “Playing Traffic Controller”: Head’s trials
r “Turn Over”: constructive praxis
r “Transmitting Cipher Signals”: auditory-motor coordination
r “Remove the Spell That an Evil Sorcerer Cast on Objects” or “Solving
the Artist’s Puzzles”: when identifying complex visual images in visual
gnosis trials
Putting tasks in a familiar game context made them more interesting and
accessible for children.
Along with deciding how to conduct the neuropsychological assessment
we also faced the problem of adapting a number of tasks from Luria’s test
battery to be appropriate for 5- to 6-year-old children with delays in psy-
chomotor development. It was necessary to simplify either the task itself or
the procedure or both. For example, when assessing praxis some of the tri-
als were used without much modification (finger pose praxis and one-hand
Head’s trials that did not require recoding). However, during the assessment
of serial movement organization in the dynamic praxis trial, children were
offered a two-part instead of a three-part movement series. In the presence
of pronounced graphic motor difficulties we used sticks instead of drawing
in the constructive praxis trial. The task included direct copying, but not the
complicated top–bottom and left–right recoding.
During the auditory memory assessment we first used just one instead of
two groups of words with up to five elements in each group and then two
groups with two elements; only at the end did we use two groups of words
consisting of three elements each. The presence of significant pronunciation
problems required the use of words that had simple articulation.
Visual and visual-spatial memory were assessed first using realistic pic-
tures that the children were asked to remember and later find among other
pictures. They were also asked to recall the order of the elements in the
pictures. The next step was to copy geometric figures and recall them
from memory. We used figures that were less complicated than in the
original test.
The children found the auditory-motor coordination trials very dif-
ficult to perform. To facilitate their completion we slowed the speed of
“Tracking Diagnostics” Methods 249
presentation and decreased the complexity of rhythmic structures. We also

introduced mediation and checked the ability to complete these tasks using
different means of support, such as laying out sticks on the table or present-
ing the rhythmic structure in a graphic format.
The Kohs Block Design Test, which was used to assess the development
of spatial orientation and visual thinking, was practically impossible for
children in this group to complete. Therefore their abilities were assessed
using the perceptual modeling method that consisted of constructing the
whole out of its parts (images of objects, picture stories, geometric figures).
The complexity of tasks depended on the number of parts, perceptual
complexity of images, the cutting pattern in picture puzzles, and whether
there was an opportunity to use a model or a spatial frame. Gradually we
introduced the two-dimensional version of the Kohs method, as well as
assignments of copying a pattern using blocks with one side that was ruled.
The results of the neuropsychological assessment of children using the
tracking diagnostics methods were supplemented by data obtained by a
neurologist (B. A. Arkhipov). The reason for using these additional data is
that formation of the higher mental functions depends on formation of the
lower, more basic ones. Determining their pathology required close interac-
tions between the neuropsychologist and the neurologist who possessed the
arsenal of methods that enabled analysis of the lower levels of psychomotor
processes organization.
Based on the assessment data we created an individualized remedial-
developmental program for each child based on his or her deficiencies. It
included a set of methods focused on overcoming difficulties in the most
dysfunctional components of mental activity and involved a wide use of sup-
port from the more developed types and components of mental activity. The
groups of techniques aimed at developing visual perception, visual-spatial
concepts, planning, and control were incorporated in the neuropsycho-
logical remedial methods. Individual remedial education was introduced
gradually, depending on the child’s readiness for such tasks. The lessons
were conducted either with each child individually or in microgroups con-
sisting of two to three students. At the advanced stage when the children
were adapting to school, group lessons became not only possible but also
effective. At this stage children’s successes became more noticeable, but ear-
lier, very important, although less noticeable, dynamics had paved the way
for them.
Analysis of our results showed that the most adequate way to increase the
effectiveness of remedial-developmental work is to conduct an early neu-
ropsychological assessment, including tracking diagnostics. Determining
factors that cause the failure of a particular higher mental function and, at
the same time, identifying conditions that could help at least partially com-
pensate for the deficiency facilitate the design of a more efficient program
of remedial education. This assessment helped predict future difficulties in
the development of different cognitive processes and built the foundation
to minimize them.
The next three chapters examine the neuropsychological assessment and
direction of the remedial-developmental educational program for three
students in this group.
Online ISBN: 9781139012799
Chapter
21 - Case 1: Predominant Delay in the Development of Programming and C
ontrol Functions (Unit III) pp. 251-257

21
Case 1: Predominant Delay in the Development of

Programming and Control Functions (Unit III)
assessment
The assessment was initiated when Nina (her name has been changed), a
5-year-old girl, started to attend a group for children with delays in psy-
chomotor and speech development at the Center of Curative Pedagogy. The
special education teacher had diagnosed her with pronounced developmen-
tal disability and the consequences of cerebral palsy. When Nina first started
attending the group, she reminded us of a little fearful and stubborn animal
that did not want to look anybody in the eye. She was very inert and had
a tendency to get stuck in a situation. She had no play or communication
skills and was not at all ready for group lessons.
In the first stages of the assessment Nina was difficult to work with: she
refused most contacts, would not talk, and sat with her head down and hands
behind her back. She could only be engaged in tasks when they involved a
group of other children in the play situation, and even that was difficult.
At first her actions were preceded by a long latent period. When difficulties
arose, she would switch from productive activity to aimless manipulations
with objects. She showed rigid stereotypes when playing and tended to
repeat the same actions with the same toys. All attempts of the teacher
to switch her to another kind of activity met with refusal and a negative
reaction, which could be overcome only if the child was included in the
group with other children. Yet even then she was only passively present and
would not engage in any activity. To complete her tasks required constant
prompting, extended help, or co-actions with an adult. In addition to her
difficulty engaging in tasks, she also showed perseverations and difficulties
switching from one task to the next.
Nina’s motor functions were slow and hypodynamic. Her face was hypo-
mimic; her fine motor skills were poorly developed, with awkwardness
251
in both hands. She used her left hand to hold a pencil. Both copying and
independent drawing were restricted. She was more successful in simple
construction tasks, yet even in these tasks, in addition to displaying a slow
speed of activity, perseverations, and unproductive attempts to complete the
tasks through trial and error, she also showed difficulties in spatial positioning
of elements.
Nina’s speech was unproductive and her vocabulary poor.
Observations of the child at this stage suggested a predominant delay
in the development of programming, regulation, and control functions.
This was confirmed by the results of the full neuropsychological assessment
conducted a year later.
That neuropsychological assessment showed that Nina had become more
social and easier to assess. However, she still worked at a slow speed and
had difficulty becoming engaged in tasks and switching between different
tasks. She was left-handed and used her left hand to write, draw, eat, and
point to objects. Her left ear and left eye were dominant as well; she had
tetraparesis in anamnesis, but the right arm was more paretic. Some of her
family members were left-handed.
She was now able to complete the Go-no-go test, but the latent time
was significantly increased and problems of inhibition were noted when the
model of movements was changed. She did the trial of reciprocal coordina-
tion at a very slow speed. The coordination itself had some correct elements,
with more problems noted in the right hand. It seemed easier for Nina to
complete the tasks in this trial in the air. Serial movement organization
was compromised in the dynamic praxis trials as well, which she was only
able to complete together with the teacher when the activity was verbally
controlled. Nina started to develop the ability to have verbal mediation,
and she would give instructions to herself while completing tasks. She was
now able to perform a graphic trial very close to the sample (“a fence”),
although very soon after she began it, the simplification of structure and
pronounced inertia were noted. In addition, she was not able to follow a line
(see Fig. 21.1).
In the finger praxis trial the child demonstrated pronounced slowness,
inertia, impulsive pose trying, and mirror-type mistakes. Lack of prelimi-
nary analysis caused mirror-type mistakes in the Head’s trial; her somato-
spatial difficulties also contributed to poor results. In constructive praxis
the figures were put together in a mirror image, and she made no recoding
attempts. Oral praxis was characterized by inertia, apathy, and awkwardness.
She was able to repeat simple rhythms following a sample or an instruction
if she used re-counting (verbal mediation).
Case 1: Predominant Delay in the Development of Programming 253
Figure 21.1. Examples of the graphic trial completion: at the age of 5 (two upper
ones), 6 (third example), and 7 years (bottom example).
Visual gnosis remained one of the weakest functions, with a low activity
level, lack of orienting research activity, and inertia contributing to the
problems. This led to incorrect recognition of visual images and story
pictures, difficulties in constructing the whole from its parts, etc. The volume
of visual memory was decreased, she confused semantically close images,
would lose parts of the elements, and would mix up groups. Verbal speech
memory was even less productive, and in addition to inertia and increased
inhibition of traces, semantic and sound interchanges and side interjections
were noted here. Speech continued to lack productivity, and vocabulary
remained poor; her sentences were short and lacked details. A decrease in
the volume of verbal information perception and difficulties understanding
logic grammatical structures were also noted.
Thus, the neuropsychological assessment revealed weakness of the energy

unit functions, and that had an influence on all higher cortical functions.
Among them a primary delay in the development of programming, reg-
ulation, and control functions was found (as evidenced by slow mental
processes, difficulties engaging and switching tasks, pronounced inability
to inhibit actions, and a lack of orienting research activity and control).
In turn, this primary delay caused delays in the development of all mental
functions and slow acquisition of new experiences and new learning.
battery of remedial techniques

We used the School of Attention method, which focuses on developing pro-
gramming and control skills and can be successfully used in remedial work
with a group of children whose problems in concentration, programming,
and control of their actions have different clinical presentations depending
on their severity.
Along with Nina’s pronounced delay in the development of program-
ming and control, she also experienced significant difficulties in acquiring
new knowledge and skills. For that reason we often had to practice the
same tasks in different contexts; for example, after asking her to position
soldiers at their posts we would modify the same task to ask her to distribute
cars between the garages or put dolls in boxes. The task of composing and
realizing the plan of actions was the same in all of these assignments.
In the course of practicing the tasks “Dots” (the third cycle of “School
of Attention”; see Chapter 7) we paid a lot of attention not only to forming
programming and control skills but also to developing the holistic per-
ception of different structures that signify quantity. Together with Nina we
analyzed the principles of composing these structures and practiced graphic
tasks (traced, colored, copied, and completed unfinished images). During
the next few lessons we copied or independently constructed new tables
based on a program; for example, “Snowflakes” (see Fig. 21.2).
In the initial stages the main focus was on working in the material-
ized format; for example, put soldiers or cars with numbers in order, or
arrange the numbers that signify floors or rooms of the house. The task
was completed together with other children and was always preceded by
a stage of creating the plan of actions; for example, arranging numbered
cards in order from smallest to largest. Thus, Nina could always check her
activities against the plan of future actions. It is important to note that Nina
found mastering the concept of the numerical row to be a difficult and
slow process. The main difficulties were noted in learning the order of the
elements (she missed numbers or would switch their places); she also had
Figure 21.2. Completion of the task “Snowflakes.”
difficulty mastering graphic images of numbers. Using visual programs with

real numbered objects, especially in familiar, socially significant situations,
facilitated and consolidated learning of the order of elements. Completing
tasks in a graphic format (tracing numbers in order, coloring) facilitated
not only the formation of actions according to a given plan but also helped
Nina learn to write numbers and improve her visual-motor coordination.
Gradually Nina learned the rules of actions based on the given visual plan,
which she started to use on her own whenever she experienced difficulties.
As a result, difficulties engaging in tasks and switching from one task to
the next decreased. Nevertheless, automation of actions based on the given
voluntary program (even counting in direct order) did not occur by the age
of 7 and remained one of the goals of future remedial work.
Other methods of remediating delays in the development of visual
perception, memory, and intellectual functioning were used during the
Figure 21.3. Completion of graphic tasks: copying at the age of 5.
interventions. Based on the structure of the defect, the focus was on devel-
oping Nina’s orientation research activity and control and increasing her
level of activity.
impact of the intervention

The neuropsychological assessment, which was conducted when Nina was
7 years old, showed significant positive dynamics in the areas of motor
development, visual-motor coordination, graphic skills (see Fig. 21.3), per-
ception, memory, and speech. Improvement in completing graphic tasks
could be clearly seen when we compared her copying skills at the age of
5 (see Fig. 21.3) to her writing at the age of 7 (see Fig. 21.4). However,
Figure 21.4. Completion of graphic tasks: sample writing at the age of 7.
although certain symptoms decreased, the character of the neuropsycho-

logical symptom complex remained the same: a predominant delay in the
development of programming and control functions.
Yet the diagnosis of intellectual disability (mental retardation) was
removed, and Nina was able to enter the remedial-developmental edu-
cation class of a regular school after receiving 3 years of development and
remediation interventions.
Online ISBN: 9781139012799
Chapter
22 - Case 2: Predominant Delay in the Development of Information-Proce
ssing Functions (Unit II) pp. 258-264

22
Case 2: Predominant Delay in the Development

of Information-Processing Functions (Unit II)
assessment
The neuropsychologist started working with Katya when, at 5 years old, she
began attending a group for children with delays in psychomotor and speech
development at the Center for Curative Pedagogy. During the first stage of
the interventions we conducted the tracking diagnostics and assessment in
play situations.
Katya was sociable and friendly, and she willingly attended the group
lessons. However, we noted some detachment, increased sensitivity (loud
noises and bright light caused her unpleasant sensations), and rapid fatiga-
bility. Her movements were awkward and uncoordinated.
We noted right-sided hemiparesis (but no left-handedness found in the
family); she used her left hand more actively, holding a pencil, spoon, and
brush with it, but she was also able to hold all these objects with her right
hand. She actively used both hands when constructing with play dough,
with either hand assuming the leading role at different times.
During neuropsychological assessment of lateralization and hemispheric
differentiation, we identified the left hand, arm, ear, and eye as leading in
respective trials. However, the right hand was stronger than the left. The
results of the graphic trials were inconclusive: copying the picture of a house
and geometric figure and connecting the dots were done better with either
her left or right hand depending on the task.
We noted a general awkwardness of praxis. Completion of reciprocal
coordination trials was done in turns, with elements of correct recipro-
cal implementation present. Often, missteps were noted in both hands,
with problems occurring more frequently in the right hand. She was able
to perform finger pose praxis trials, but before finding a correct pose
she had to conduct an extensive search and sort through her fingers as
258
Case 2: Predominant Delay 259
though sizing up a model. Pronounced synkinesis (accompanying move-

ments of other fingers) was also noted. The dynamic praxis trial (Three
Positions Test) presented significant difficulties. Katya was only able to
complete it together with an adult; when trying to do it on her own,
she immediately simplified the structure of the trial, movements became
deautomated and sweeping, and the position of her arm in space was
inaccurate.
Auditory-motor coordination trials (rhythms), including auditory anal-
ysis and motor recall, were impossible for her to perform.
Pronounced difficulties were noted in the area of visual perception:
she was able to recognize realistic images of isolated objects, but even the
slightest stylization of the picture, perceptual noise, or saturation caused
perceptual fragmentation and visible difficulties of recognition (a pine tree
was perceived as fingers, a bird’s feather as a tree, etc.).
The capacity and precision of her visual and auditory memory were
decreased, and she struggled to recall the order of the elements.
The most pronounced difficulties were identified when assessing visual-
spatial concepts: she was poorly oriented in space and her own body;
made frequent mistakes identifying top, bottom, or right or left sides;
and was unable to complete simple construction tasks with blocks or
to put together a simple picture puzzle. These difficulties were partic-
ularly clear in the drawing and copying tasks (elements of the picture
were out of proportion; elements were positioned horizontally instead of
vertically).
Katya’s speech was not articulate, with nasal inflections, difficulties in
pronunciations, disturbances in intonation, and melodic components. Her
vocabulary was poor, and she frequently searched for words; her sentences
were not expanded. Although there were no pronounced aggramatisms
(grammatical mistakes in speech), she had difficulty understanding gram-
matical structures. In addition, she experienced difficulty differentiating
between words that were close in meaning or in sound.
The neuropsychological assessment showed pronounced disturbances
of energy unit functions (including neurodynamic characteristics of men-
tal processes, increased tiredness, exhaustion, difficulty concentrating, and
increased sensitivity to intense stimulation). These disturbances led to the
underdevelopment of the unit of processing of kinesthetic, auditory, and par-
ticularly visual and visual-spatial information. These deficiencies in mental
function development in children can be caused by functional inadequacy
of cortical–subcortical connections, dominant hemisphere formation, and
interhemispheric interactions.
When designing the program of remedial interventions we focused on

methods of developing visual perception and visual-spatial functions. Dur-
ing lessons it was also important to track which hand she used more actively
and to facilitate the emergence of a dominant hand. We also needed to
take into account her tendency to become easily fatigued. The system of
methods included trials for development visual gnosis, visual memory, and
visual-spatial functions.
identifying images
Bingo (lotto) with perceptually dissimilar images. In these trials we varied
colored/uncolored (black-and-white) images, full realistic/contour pictures,
and ordinary/saturated pictures; if the big picture had colored realistic
images, the small cards had black-and-white images; in the next trial it was
vice versa. The combination of more simple and more complicated images
in one task helped Katya extend her perceptive abilities. Examples of such
tasks are bingo (lotto) assignments or “Decorating the Christmas Tree” task,
in which the student has to put colorful images of Christmas decorations
in the right place marked by black-and-white or contour drawings of the
same decoration.
Bingo (lotto) with perceptually close images. This more complicated series
of tasks involved variations primarily in the color of the images and the
degree of detailing. These tasks strengthened visual images of objects belong-
ing to different semantic groups (an apple – a tomato – a balloon) and within
one semantic group (a goat – a cow; a pen – a pencil). In some of the task
variations it was necessary for Katya to master the generalized meaning and
polysemy of words to identify the image correctly:
r Images of objects (a dining table and a writing table, ping-pong table)
r Images of actions (washing hands and washing dishes or floor)
We increased the difficulty of the tasks by increasing the number of

elements from three to nine. At this stage, every version of the bingo game
enabled further mastery by switching to a graphic format and adding the
element of memorization: drawing from memory, copying, finishing the
drawing, restoring the order or position of images, recognizing pictures,
and classifying pictures.
finding differences
A great variety of tasks are available in this category and range from finding
differences between almost identical images (for example, differences in the
presence of decorative elements) to widely used methods of visual attention

development in children (“Find differences”). We arranged these tasks in
order of increasing difficulty, gradually introducing the parameters that were
significant for their completion. Initially, we introduced easy-to-recognize
elements, such as the presence or absence of an object or differences in
color, size, shape, and position. In addition, initially we showed images that
significantly differed from each other, but in later tasks their perceptual
similarity increased.
It is important to emphasize that in these tasks we helped Katya master
productive forms of orienting activity and of planned, organized search
(identifying the central figure; eye movements from left to right and up and
down).
finding the missing details and completing the

unfinished image
This task was completed in three different versions: Katya first found a
missing piece, then drew it, and then named it. Often one version was used
to consolidate the skills learned in the previous one.
The difficulty of the tasks increased in the following manner:
r A detail is missing in a symmetrical object where the visual plan is
available (the second half of an apple, a house).
r A detail is missing in an asymmetrical object, but the part that is
present implies one single correct way to complete the image (a car).
r A detail is missing in an object, and a number of different objects
(a cup, a teapot, a sugar bowl) can be created by adding different
elements.
The difficulty of the tasks was increased by introducing perceptually
complex images (from realistic to black and white, schematic, contour). The
field of choices for pictures in the tasks on recognition gradually increased
in volume.
doing construction tasks

This type of task is widely used in diagnostic and remedial work. Two of
the tasks in this category are putting a puzzle together and putting together
a figure using Kohs blocks (see Parts III and IV). We arranged the tasks as
follows:
1. Constructing a whole out of its parts
r All parts belong to the same object, but the number of the parts
varies.
r The parts belong to two or more objects that can be perceptually

close or distant.
2. Constructing a story picture:
r Inserting the missing parts of the picture
r Creating a picture based on a partial model (the outlines of the
pieces are visible on the model and on a part of the picture. The size
of that part can vary; for example, one-half or one-third of the
picture.)
r Putting a puzzle together using an outlined model or a frame with
marked lines
The tasks’ difficulty was increased by increasing the number of parts or

by changing the perceptual saturation of the picture, the pattern of cutting
pieces, or the picture’s form and symmetry:
1. Constructing geometric figures from their parts

r Using complex (component) versions of Segen’s tables
r Constructing simple geometric figures that increase in number of
parts and changes in their form
r Using “two-dimensional” version of Kohs blocks (see Chapter 15)
The work using construction tasks was an integral part of the sessions
conducted with Katya. The tasks were presented as games and included
as part of the individual and group lessons; some versions were given as
homework to be completed together with the parents.
impact of the intervention

A neuropsychological assessment conducted 2 years later, when Katya was
involved in a series of interventions to help her make a transition to the
school setting, showed the following.
A significant positive dynamic was noted in the development of her
higher mental functions. She was now able to complete bimanual recipro-
cal movements, although they were conducted in a deautomated manner
and required constant control. The tasks on dynamic and pose praxis also
required constant control and verbal mediation. She was able to complete
Go-no-go tasks, but the learning was slow. She could also perform Head’s
trials, even with two hands. Significant positive dynamics were noted in
constructive praxis, Kohs trials, drawing (see Fig. 22.1 – upper part), and
visual memory, although she still had difficulty positioning elements in
Figure 22.1. This figure shows the dynamics of copying the drawings and her name:
1, at the age of 5; 2, at the age of 6; 3, at the age of 7.
space. It is particularly important to note that these difficulties could be

partially eliminated with speech mediation and external organization.
Her vocabulary broadened and her ability to construct sentences
improved, pronunciation difficulties were partially eliminated, and the abil-
ity to make verbal generalizations as well as her understanding of logical
grammatical structures increased. Her verbal memory improved to the
point of reaching the age norm, but difficulty remembering the order of
elements remained.
Katya was rather successful in learning the curriculum of the school
preparation program. She started to read and write printed letters (see Fig.
22.1 – lower part) and was able to master simple math operations.
The character of her neuropsychological syndrome remained the same,

although some symptoms were much less pronounced. Disturbances in
the neurodynamic aspect of mental activity were still present, which led
to variations in her completion of the tasks: from close to the norm to
pronounced difficulties when she became tired or when her functional state
was low. These fluctuations could occur in the course of one day or even
one lesson. In the presence of these fluctuations, difficulties in visual and
visual-spatial concepts could be clearly seen: mistakes of visual recognition,
mirror-type mistakes, difficulties orienting in the space of a notebook paper,
and mistakes in the order of the elements would start to occur. Problems in
the formation of the dominant hand remained: she mostly used her right
hand when writing, but could use the left hand as well when she became
fatigued and her control decreased.
Because weaknesses of the neurodynamic component of mental pro-
cesses and difficulties in visual-spatial function development remained,
Katya needed continued remedial support during the next stage of the
educational process.
Online ISBN: 9781139012799
Chapter
23 - Case 3: Predominant Delay in the Development of Energy-Support Fu
nctions (Unit I) pp. 265-274

23
Case 3: Predominant Delay in the Development

of Energy-Support Functions (Unit I)
assessment
Denis, a 5-year-old boy, participated in the psychological educational inter-
ventions at the Center for Curative Pedagogy that included play, music,
movement, and educational formats.
In the initial observation stages his poor motor development was partic-
ularly evident. He had a difficult time walking, his motor coordination was
poor, and his movements were awkward. He had poor control of his arms
and had problems holding a pencil: it would often fall out of his hand. When
trying to draw, his muscle tonus would increase, and he would tear the paper
with the pencil, which created a negative attitude and frequent refusals to
continue the task. Even the tasks of picture completion and writing numbers
by connecting the dots were beyond his abilities (see Fig. 23.1).
His speech was poor, limited, and practically barely intelligible. Increased
salivation, oral apraxia, and dysarthria were also noted. He tired quickly
and could not focus for prolonged periods of time. He was very reluctant
to participate in individual sessions and would often refuse to do so. If even
the slightest difficulties arose, he would start playing the fool and would
display inappropriate behavior, including increased distractibility.
At age 7, when he was transitioning to the group that would prepare him
for school, a neuropsychological assessment noted the following improve-
ments in his status. He became more social, and his ability to communicate
verbally significantly improved because of improvements in his speech. His
motor sphere improved, and the right hand became dominant. In the area
of praxis the reciprocal movements remained difficult, and he was not able
to perform them on his own, although in the situation of joint performance
with an adult several correct movements became possible. Use of his left
hand, however, was somewhat delayed.
265
Figure 23.1. Completing the picture by connecting the dots at the initial stage of
remediation.
In all motor trials pronounced synkinesia was noted. He was able to

perform a series of movements in the situation of joint activity with adults,
but was unable to master them on his own. It was difficult for him to
reproduce the very simple structure in the graphic trial, “Fence” (∧∧∧ – see
Fig. 23.2).
When repeating rhythmic structures, chaotic tapping and extra impulses
that he was unable to inhibit were noted. Oral and finger apraxia were also
noted, as well as pronounced difficulties in the search for arm positioning
relative to the body in Head’s trials. He was able to perform simple construc-
tive praxis trials (constructing from sticks) and Kohs trials, but required help
in analyzing every element of the structure. He was still refusing to draw
on his own and was only willing to outline, connect the dots, or complete a
picture with simple elements (see Fig. 23.2).
In tasks of visual recognition of images, his visual perception improved,
and he was able to use verbal mediation for assistance, but his eye movements
were still slow and orienting research activity was poor. He was able to
recognize realistic images and a simple story picture. Yet when presented
Figure 23.2. Copying of pictures of a house and a man; completion of the graphic
trial, “Fence.”
with “noisy,” stylized, or contour images he would begin to make inadequate

guesses based just on the fragments of images. Memory processes were
weak in all modalities (visual, auditory, motor). His memory capacity was
decreased, the order of elements disrupted, and inclusions of extraneous
materials were present.
Denis’s speech remained slurred with a nasal tone, difficulties in sound
articulation, literal paraphasias (substitutions of sounds) that were both
close and distant in form, and anticipations and transpositions of sounds.
His vocabulary was poor with frequent repetitions, perseverations, and
difficulty searching for words. However, in the presence of stimulation and
within a context, he could produce significant verbal output when asked a
specific question (for example, name 10 plants).
He was also able to make simple verbal generalizations based on func-
tional characteristics. His sentences expanded noticeably, but grammatical
mistakes in speech were frequently present. He was able to compose a short
story based on a series of pictures, but needed to conduct a preliminary
analysis together with a psychologist to identify the context. Disturbances of

the neurodynamic aspects of mental activity remained pronounced, namely
a decreased ability to work, increased exhaustion, perseverations, and diffi-
culties in distribution of attention.
Thus, the primary difficulties in his neuropsychological profile were
problems in maintaining and regulating cortical tone; exhaustion of men-
tal processes; speech problems of the dysarthria type; poor development
of general and fine motor skills; the prevalence of slow, uncertain, large-
scale, poorly differentiated movements; synkineses; tremor; disturbances in
visual-motor coordination; and modal nonspecific memory problems. All
these deficits stemmed from damage in the deep structures of the brain.
Pronounced underdevelopment of cortical functions also was seen that
manifested in delays in the development of the programming, regulation,
and control functions, as well as the functions of receiving, processing, and
storing different kinds of information: these delays resulted in decreased
motivation, insufficient orienting research activity and control, poor devel-
opment of memory and perceptual functions, and delay in the development
of cognitive processes.
program of remedial interventions

During remedial sessions with Denis, it was necessary to create conditions
under which the neurodynamic disturbances of mental processes were less
pronounced. To achieve this, we needed to follow a light workload schedule
in terms of the length of sessions and the number and complexity of tasks
offered. It was also important to secure at least small successes in every
task to promote his self-confidence. Thus, we needed to give Denis time to
familiarize himself with the tasks so that he felt that he would be able to
at least partially complete them. For that purpose (as in the assessment),
the psychologist would first complete the tasks in front of Denis so that he
could see that he would be able to complete them as well. After that, every
task was completed by the psychologist and the child together and then
gradually offered for independent completion by the student. Figure 23.3
shows examples of these tasks.
To make such a transition successful and to increase Denis’s interest in
the tasks it was necessary to include an element of play and to provide a
meaningful context for the tasks. It was also necessary to move from the
emotionally “colored” and spontaneous activity to a more voluntary action,
to actively engage the boy in the preliminary planning and in finding ways
to complete each task, and to teach him how to control the process of
Figure 23.3. Joint completion of graphic tasks in the process of remediation.
completion. Development of the planning and control processes was facili-

tated by using tasks in which the plan of actions could be presented visually
and repeated and then created together with the child in the visual opera-
tional format (in a materialized format). Tasks using cards, pictures, sticks,
and figurines were also included to address the gross underdevelopment of
fine motor skills and inability to complete tasks in the graphic format. Ini-
tially, the psychologist completed the tasks in the graphic format, and later
the child joined in: first, by outlining and coloring, and then using a dotted
line for drawing, connecting the dots, completing the drawing, or writing
the simple elements. To encourage Denis to work in the graphic format, we
deliberately allowed for a certain degree of sloppiness in the course of the
joint activity to decrease the contrast between the psychologist’s and the
child’s results.
When working in the graphic format became easier for Denis, the ten-
dency for macrography – enlarging the size of the elements – became very
prominent (see Fig. 23.2). Therefore, when using the graphic format, size
was taken into consideration: initially the drawings were large, and later we
moved to smaller size drawings and started to enforce the limit of the size
that the child could use.
So far we have discussed specific methods we used to develop Denis’s
higher mental functions. During intervention sessions we also used a set
of traditional remedial methods aimed at strengthening different mental
functions: programming and control functions and functions of processing
visual and visual-spatial information. Every method was modified to match
Denis’s abilities.
As an example of such modifications, let us consider in more detail
the use of V. M. Kogan’s “Sorting the Colored Figures” method (for more
information, see Chapter 8). This method involves counting 49 geometric
figures that differ in color and shape (seven different shapes and seven
different colors) and sorting them first by color, then by shape, and finally
combining these two characteristics by placing the cards displaying the
figures in the appropriate cells of the table. Twenty-five figures are typically
used with 5- to 7-year-old children. When creating this method V. M. Kogan
specifically emphasized that most types of intellectual activity require “the
process of combination”; namely, taking into account several conditions.
That situation is modeled in his method.
In our version a table divided into 9, 12, 16, 20, and 25 squares was
presented in the form of a funny house inhabited by different-colored
objects (for example, balls, pencils, books, cars, etc.) or geometric figures.
Each house had entrances and floors (three, four or five). Only objects
or figures of the same type could “enter” the same entrance: triangles enter
the first doorway, circles the second, squares the third. The picture on the
front door indicated which objects or figures “entered” each doorway of the
house.
Each floor was inhabited by objects or figures of the same color: red on
the first, blue on the second, and yellow on the third floor. Colored spots
attached to the balconies matched the colors of the objects or figures on the
cards. The positioning of the shapes and colors along vertical or horizontal
lines could be changed, and in that case the picture with the shape was
attached to balconies and the colored spots to the front doors. To create
additional supports the color could be depicted on both the left and the
right sides of the table at the same time, and the shapes of the figures could
be presented not only at the bottom but also at the top – on the roof of the
building in the attic windows.
The degree of difficulty depended on the number of figures (from 9–25)
and the perceptual closeness of the colors (blue – dark blue; yellow – orange)
and shapes (circle-oval; square-rectangular) within the same task.
The child was asked to help the objects or figures move in the house. In
order not to mix up the “apartments,” he needed first “to sort everything
out.” When the size of the table was small (nine elements), we started by
counting the cards with the figures on them and the squares to make sure
that there was enough space in the house “for everyone.” If the child got
confused or mixed up, we turned the cards with the figures upside down
and asked him to distribute the “empty” cards between the cells of the table.
After that we sorted the cards by color and then by shape using the visual
plan of actions. To do that, we would cover part of the table so that only one
of the characteristics displayed on the balconies or doors remained visible.
We laid out the cards in a horizontal or vertical direction depending on the
way it was presented in the plan, but we always followed the order of the
elements.
After that we proceeded to the stage of populating the house. By that time
we already knew that we had enough apartments; we also knew the shapes
of the figures on each doorway and the colors of the figures on each floor.
The psychologist together with Denis would find an appropriate square for
one to three figures, and as Denis was mastering the algorithm of actions
(choosing the doorway and then choosing the floor) the psychologist would
give him all the cards so he could complete the task on his own.
If Denis made a mistake, the psychologist would draw his attention to it
and would show him the part of the plan where the mix-up occurred. To
help develop control it was also useful to present the table with an error in
it and ask Denis to find the mistake made by the psychologist or (in a group
session) by another child. (The question asked of the child was, “Which of
the figures moved into the wrong apartment?”; see Fig. 23.4).
After the house was filled, Denis was asked to complete the task of copying
the table. Because of his poor visual-motor coordination and weak graphic
skills, the following exercises were given before this task:
r Touching and feeling the figures made of plastic with his eyes open
r Recognizing the figures with his eyes closed
r Finger drawing in the air or on the table
r Outlining the contours with the finger
Figure 23.4. Example of using “Sorting the Colored Figures” method.
r Using the figures as stencils for drawing

r Drawing using the dotted lines or connecting the dots (see Fig. 23.4)
The following tasks were used to make sure that Denis had learned to
use the plan of action:
r Completing the tasks using the same-sized table but arranged differ-
ently or using a larger table
r Creating a similar house independently by choosing from the colored
images of objects or figures given to him
Figure 23.5. Example of the task of finding the missing figures.
After strengthening the skills we then worked on increasing the speed of

completing the tasks by creating a situation of competition between children
(who can fill the house faster?).
Thus, this remedial method allowed practicing actions based on a visual
plan that required identifying and considering two independent character-
istics of objects; it created the necessary conditions for developing Denis’s
cognitive activity. In addition, the tasks included in this method facilitated
the development of visual-spatial concepts, motor coordination, forming
the visual images of objects and their verbal expression, learning the con-
cepts of geometric figures, and development of visual memory.
We were not able to complete all the stages described in this section,
at the age of 7, Denis still needed to practice tasks that included more
than 16 elements, the independent creation of tables, and recalling them
from memory in the graphic format. However, we could assess his mastery
of the material by looking at the results of other tasks similar in con-
tent; for example, logic tasks on finding the missing figures (see Fig. 23.5)
Figure 23.6. Adding the second row in a Schulte table.
or adding a second parallel row of numbers in a Schulte table (see

Fig. 23.6).
As can be seen from Figure 23.6, the child correctly wrote numbers from
1 to 5, but after that, because of exhaustion, he started writing the number
2 instead of number 6 because he saw this number in the adjacent square.
Nevertheless, he was able to correct himself and completed the row without
mistakes. His correct insertion of the numbers in the squares of the table
showed that he understood the meaning of this type of tasks, which he
completed based on the School of Attention method.
Denis made great progress in psychomotor and cognitive development,
but because of residual weakness of the neurodynamic component of mental
processes and delay in the development of higher cortical functions, he
continued to need remedial support during the next stage of the educational
process.
Online ISBN: 9781139012799
Chapter
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Chapter
Recommended Reading: Authors’ Selected Publications pp. 297-298

recommended reading:
authors’ selected publications
publications in english
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Glozman, L. I. Moskovich, & D. Robbins (Eds.), A. R. Luria and Contemporary
York: Nova Science Publishers.
Akhutina, T. V., Foreman, N., Matikka, L., Narhi, V., Pylaeva, N. M., & Krichevets,
A. N. (2003). Improving spatial functioning in children with cerebral palsy using
computerized and traditional game-task. Disability and Rehabilitation, 2(24),
1361–1371.
Akhutina T. V., Shereshevsky G. (2012). Addressing children’s learning problems
through helping them control their attention difficulties. In T. Cole, H. Daniels,
& J. Visser (Eds.), The Routledge International Companion to Emotional and
Behavioural Difficulties. Routledge (in press).
Akhutina, T. V., & Tsvetkova, L. S. (1983). Brain and Cognition, 2, 129–134. See also
(2004). Comments on a standardized version of Luria’s tests. In T. V. Akhutina,
J. M. Glozman, L. I. Moskovich, & D. Robbins (Eds.), A.R. Luria and Contemporary
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Bodrova, E., Leong, D. J., & Akhutina, T. V. (2011). When everything new is well-
forgotten old: Vygotsky/Luria insights in the development of executive functions.
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processes. New Directions for Child and Adolescent Development, 133, 11–28.
Pylaeva, N. M. (2004). Neuropsychological assessment of 5–6-year-old children
with delayed mental development. In T. V. Akhutina, J. M. Glozman, L. I.
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298 Recommended Reading: Authors’ Selected Publications
publications in german
Achutina, T. V. (2004). Kulturhistorische und naturwissenschaftliche Grundlagen
der Neuropsychologie. Behindertenpädagogik, 43(4), 339–351.
Achutina, T. V., Obuchova, L. F., & Obuchova, O. B. (2001). Schwierigkeiten bei
der Aneignung von Grundkenntnissen der Mathematik durch Kinder im Grund-
shulalter und die Gründe dafür. In W. Jantzen (Hrsg.), Jeder Mensch kann ler-
nen – Perspektiven einer kulturhistorischen (Behinderten-) Paedagogik (S. 178–
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dertenpädagogik und Integration”, G. Feuser (Hrsg.)) (S. 165–176). Frankfurt a.
M.: Peter Lang Verlag.
publications in spanish
Akhutina, T. V. (2002). L. S. Vigotsky y A. R Luria: La formación de la neuropsi-
cologı́a. Revista Española de neuropsicologı́a, 4(2–3), 108–129.
Akhutina, T. V. (2002). El diagnóstico y corrección de la escritura. Revista Española
de neuropsicologı́a, 4(2–3), 236–261.
Akhutina, T. V. (2008). Neuropsicologia de la edad escolar: Una aproximacion
historico-cultural. Acta Neurologica Colombiana, 24(2), 17–30.
Akhutina, T. V., & Pilayeva, N. M. (2004). Metodica para el Desarollo y la Correccion
de la Atencion en Ninos Escolares. México: Universidad Autonoma de Puebla.
Akhutina, T. V., & Pilayeva, N. M. (2006). Correccion de las funciones visuo-verbales
en ninos de 5 a 7 anos de edad. En L. Quintanar & Yu. Solovieva (Eds.), Métodos
de intervención en la neuropsicológica infantil (pp. 31–42). México: Universidad
Autónoma de Puebla.
Akhutina, T. V., & Zolotariova, E. V. (2001). Acerca de la disgrafia visuo-espacial:
Análisis neuropsicológico y métodos de corrección. En L. Quintanar & Y.
Solovieva (Eds.), Métodos de intervención en la neuropsicológica infantil (pp. 39–
46). México: Universidad Autónoma de Puebla.
Pilayeva, N. M. (2008). Apoyo neuropsicologico para los grupos de ninos sometidos
a ensenanza de correccion y desarollo. Acta Neurologica Colombiana, 24(2), 45–
54.
publication in finnish
Akhutina, T. V., & Pylayeva, N. M. (1995). Tarkkaavaiseksi Oppiminen. Suunnittelun
ja Kontrollin taitojen neuropsykologisten kuntoutuksen ohjeita ja tehtavia [If your
child is inattentive. The neuropsychological method of planning and control
functions remediation]. Helsinki: Kehitysvammaliitto.
publication in slovak
Achutina, T. V., & Pylajeva, N. M. (2009). Škola pozornosti [School of Attention].
Bratislava: Dialog.
index
Aphasia syndromes, 19 “constructivist” view of development,

Assessment, neuropsychological, 17, 31. See 19
also Developmental assessment, “drama” metaphor, 18
neuropsychological Developmental assessment,
in cases of local brain damage in adults, 31 neuropsychological, 31. See also
Process Approach to neuropsychological Neuropsychological syndrome
Tests,
assessment, 17 neuropsychological
Attention deficit and hyperactivity disorder assessment of individual strengths and
(ADHD), 2, 55–56, 69 weaknesses in remedial-developmental
problems in maintaining the optimal level of education, 82–83
cortical tone, 24 assessment of ZPD, 142–147. See also Zone
problems in the frontal striatal and/or of proximal development (ZPD)
frontal parietal connections, 89 in cases of local brain damage in adults, 31
under-development of executive functions, ecological approach to assessment, 67. See
89–90 also Tracking (ongoing) diagnostics
Auditory memory, 2, 24, 248, 259. See also methodological foundations, 31–32, 34,
Tests, neuropsychological – verbal 42–43
memory factor analysis, 32
Autistic spectrum disorders, 69 functional diagnosis, 31–32, 42–43
Automatization of mental processes, 17, 24, 45, qualitative analysis, 52–55, 56–186
58, 74, 76 primary assessment, 66, 136, 245
problem of adapting of methods for 5-6-y.o.
Behavioral observations. See Tracking children, 248–249
(ongoing) diagnostics repeated assessments, 66–67
tests battery for the assessment of children
Cerebral palsy, 204–215, 251 6-9 y.o., 33–36. See also Tests,
deficit of visual-spatial functions, 205 neuropsychological
ways of engagement of children in process of
Development as a probabilistic self-organizing assessment, 247–248
process, 18 assessing the children in a microgroup,
dynamic interplay of various factors in 247
development, 19, 30 creating a game situation, 248
probabilistic epigenesis, 19, 42 preliminary completion of a task by a
relational causality, 19 neuropsychologist, 247
social and biological factors of development, Developmental assessment of the information
20–21 processing (Unit II) functions, 58
299
300 Index
Developmental assessment (cont.) Dyslexia, 2, 58. See also Speech disorders
difficulties in processing of auditory and Reading disabilities

Writing
kinesthetic information, 58–59 brain activation and dyslexia, 6–8
difficulties in visual and visual-verbal neurobiological factors of dyslexia, 2
information processing, 63
“Diagnostics of development of Effectiveness of remedial methods, 45, 160–214
visual-verbal functions” method, Error analysis. See Qualitative analysis of
78 errors
special set of trials on visual gnosis and Executive functions (programming and
nomination, 154 control functions), 3, 6, 49–55. See also
difficulties in visual-spatial information Developmental assessment of the
processing, 59–186, 209–212, programming and control (Unit III)
259 functions
Remediation of the
diagnostics of visual-spatial dysgraphia, programming and control (Unit III)
237–238 functions
Kohs cubes method, 193, 210 development of programming and control
“tracking” diagnostics, 247 functions, 89–90
“Black and White Squares” method, executive disfunction as a mechanism of
183–186 learning disabilities, 23
tests for assessment of the information
processing (Unit II) functions, 33. See Frontal lobe system, 7. See also Executive
also Tests, neuropsychological functions (programming and control
Developmental assessment of the maintaining functions)
the brain’s working state (Unit I) Frontal striatal and frontal parietal circular
functions, 55 connections, 89
assessment of the memory, 57 its development, 89–90
copying a geometrical design Functional system, 15, 32, 45, 48–49
(micrographia), 56
tests for assessment of the maintaining the Games and their role in development, x
brain’s working state (Unit I) functions, table and computer games in development
36. See also Tests, neuropsychological of visual-spatial functions, 204–214
“tracking diagnostics,” 55 Genetic factors of development, 2–3
Developmental assessment of the gene expression, 4–5
programming and control (Unit III) Genes, organism and environment – the
functions, 49–55 “coactive” developmental factors, 19,
“Coding” method, 96 30, 49
counting (direct, reverse, selective), 51–52, “domain-relevant” functions, 19–20
96
problem solving, 50–51 Health preserving learning techniques,
problems in language and writing, 52–55 73
Schulte tables, 96, 112, 114 Higher mental functions (HMF), ix, 13–14. See
tests for assessment of the programming and also Vygotsky – Luria
control (Unit III) functions, 33. See also methodology
Internalization
Tests, neuropsychological definitions, 13–14
“tracking diagnostics,” 49–50, 90 dynamic organization and localization of
V.M. Kogan’s “Sorting of colored fugures” HMF, 16, 74, 76
technique, 96, 115–117, 141–142 hierarchical organization, 4, 74
Drawing and writing skills, 118, 269–270. See probabilistic self-organizing process of
also Writing development. See Development as a
Dynamic (neurodynamic) characteristics of probabilistic self-organizing process
activity, 117, 183, 245, 246, 263, 268 role of social interaction in development of
Dyscalculia, 51–52, 62–63, 236 HMF, ix, 14–15
Index 301
sensitive periods of development, 4, 76 Low birth weight, ix, 3

social genesis of HMF, 14–15, 74, 75, 76
speech and verbal thinking, x Mentally retarded children, 42, 69, 251, 256
structure and systemic organization of Motor skills, x, 117, 118, 246, 251, 265
HMF, 7–8, 14–16, 49, 74. See also Multi-deficit (polyfactor) model of
Three functional units of the brain developmental disorders, 3
its application in learning techniques, 74
neuropsychological structure of writing Neurobiological development, ix. See also
system, 236–237 Development as a probabilistic
systemic organization of writing, 74 self-organizing process
unevenness of HMF. See Uneven development of brain circuits, 4, 43
development of HMF heterochronic maturation of brain
structures, 30
Internalization, 14, 21, 45, 76–77 sensitive period in the development of brain
stages of internalization, 14 circuits, 4
extra-psychological stage, 14 Neurobiological problems, ix
inter-psychological stage, 14 consequences of lesions in children and
intra-psychological stage, 14 adults, 18
the concept of a “developmental cascade,”
Language disorders, 17–18 18, 31
Specific language impairment (SLI), 20 effects of plasticity, 18, 43
Lateral characteristics, 138, 252, 258, 264 disturbance in neuronal migration during
determining the dominant hemisphere, 246 fetal development, 2
Learning disabilities (LD), ix–x, 48 effects of brain lesions in children with
gifted students and their school adaptation, language disorders, 17–18
86 minimal brain dysfunction (MBD), 2
increase of social demands and LD, ix their compensation, plasticity of brain
interaction of neurobiological and social systems, ix, 7–8, 18
factors, ix, x, 3 Neuropedagogy, 1
LD as a partial disturbance or delay of HMF, Neuropsychological syndrome, 15–16. See also
ix, 22, 41–42, 48, 49, 86. See also Developmental assessment,
Uneven development of HMF neuropsychological
LD as an insufficient adaptation, ix factor analysis (syndrome analysis), 19,
learning difficulties (Russian term), ix, 22 42
main types of LD, 23–24, 67–79 convergence profile analysis (I. Baron), 42
problems in maintaining the optimal level examples of qualitative syndrome analysis
of activity, 24, 55–58, 67, 68, 79 in children, 183–186
problems in visual information its structure, 15–16
processing, 59, 68–79 compensatory reorganization, 16
weakness in holistic strategy, 24, 59–79 primary defect, 16
weakness in processing of auditory and secondary defects, 16
kinesthetic information, 23, 24, 58–59, neuropsychological factor, 19
68, 79 Neuropsychology of the norm (of individual
weakness in programming and control, differences), 30, 73–74
23, 24, 49–55, 68, 79 uneven development of separate
mechanisms of LD, ix. See also components of HMF in norm, 30,
Neurobiological problems
Genetic 40–41, 49, 79. See also Uneven
factors of development development of HMF
role of early intervention, 8–9 genetic program and environment – 2
unevenness in the development of HMF and basic factors of unevenness, 79
LD, x. See also Uneven development of the potential for compensation in normal
HMF unevenness, 30, 31, 34, 36–37, 41, 79
302 Index
Neuropsychology of the norm (cont.) Remediation of the information processing

reflection of the component structure of (Unit II) functions, 47
HMF in normal unevenness, 30 auditory and kinesthetic information
Neurovisualization methods, 6–7 processing, 59
EEG and evoked potential methods, example of remedial-developmental work,
7 256–264
Functional magnetic resonance imaging main principle – simplicity of selection,
(fMRI), 6 47
Magnetic electroencephalography (MEG), visual-spatial information processing, 63.
6–8 See also Remediation of visual-spatial
functions
Pragmatic language skills, 162 visual-verbal functions and visual
two types of errors, 162 information processing, 70. See also
remediation of pragmatic skills, 175–176 Remediation of visual and visual-verbal
Principles of neuropsychology. See Vygotsky – functions
Luria methodology objectives for development and
remediation, 154
Qualitative analysis of errors, 52–55, 56–186 Remediation of the maintaining the brain’s
working state (Unit I) functions,
Reading disabilities, 2–3. See also 56–58, 79–82
Dyslexia
Speech disorders
Writing example of remedial-developmental work,
brain functions and reading difficulties, 263–274
6–8 main principles – increasing motivation and
genetic factors of reading disabilities, 2–3 “dosing” the tasks, 81
remediation of reading disabilities, 7–8 support of appropriate energy restoration,
Remedial-developmental education, 8, 33, 38. 81–82
See also School neuropsychology Remediation of the programming and control
all-encompassing method “School is Near,” (Unit III) functions, 47, 55, 89
92 example of remedial-developmental work,
different strategies of remediation, 250–257
44–48 example of the work in zone of proximal
analytical approaches, 44 development, 150
holistic approach, 44 “Houses” – modified V.M. Kogan’s “Sorting
integrative strategy, 44 of coloured figures” method, 117–119,
studies of their economic effectiveness, 270–273
8–9 main principle – externalization of the
different types of remedial-developmental program, 47
work, 68 organization of joint activity and its main
group work, 68–70 stages, 90–92
individual lessons, 72 the perceptual modeling tasks, 93, 145–150
work in microgroups, 70–72 remedial-developmental program “Tools of
its theoretical foundations, 43–48 the Mind,” 9–11, 16
Vygotsky-Luria methodology in “School of Attention” method, 69, 83–84,
remediation, 9–11, 29, 43–44, 47. See 92, 254–255, 274
also Vygotsky – Luria methodology 5 cycles of the tasks in the method,
dynamics of the process of 99–111
internalization, 45, 76 approbation and pilot study of
emotional involvement of a child, 46, effectiveness, 94
160–161, 268 example of the remedial work with the
regard to the weak link of child’s 4th-graders, 126–135
functional system, 45, 82–83, 98. See numerical rows as a material of the
also Scaffolding method, 99
Index 303
“School of Multiplication” method, 92, remediation of visual-spatial dysgraphia,

123–127 236–241
“Graphical dictation” method, 121–123 remediation of visual-spatial functions in
“Link’s cube” method, 119–121 children with cerebral palsy, 204–214
“Schulte Tables” method, 123 approbation of method and its results,
Remediation of visual and visual-verbal 206–214
functions, 151 computer development games, 208–209
“Learning to See and Name” method, supporting tasks, 207–208
161 use of Lego Dakta, 200–201
1st set of tasks – identification of visual
objects, 155–156, 260 Scaffolding, xi. See also Zone of proximal
2nd set of tasks – finding differences, 156, development (ZPD)
260–261 School neuropsychology, 1–2. See also
3rd set of tasks – perceptual modelling, Remedial-developmental education
156–159, 261 individual approach to the student, 82–86,
4th set of tasks – developing of visual 249–251
gnosis with creating “visual” noise, 159 1) identifying individual strengths and
examples of the tasks, 163–176 weaknesses, 82–83
study of effectiveness, 161–162 2) finding the direction of
main objectives for development and remedial-developmental interventions,
remediation, 154 83
developing of the “visual image,” 154 3) determining the level of complexibility
developing of visual attention, 154 of the tasks, 83–84, 98–99
developing of visual gnostic processes – 4) using of hints, 84–85, 136
analytical and holistic strategies, 154 5) using of feedback, 85
Remediation of visual-spatial functions, 6) using of alternative (multi-channel)
180–182 modalities, 85
“Construct the Figure” methodical set, 7) control over the dynamics of
186–188, 261–262, 264 assignment completion, 85–86
1st set of tasks – construction the images 8) the change in motivation, 86,
of objects using fragments and cards, 268
187–188 training in school neuropsychology, 1–2
2nd set of tasks – drawing a plot, 188 in Russia, 2
3rd set of tasks – modification of “Black in the USA, 1
and White Squares” method, 188–192, Self-regulatory skills, x. See also Executive
201–204 functions (programming and control
approbation of method, 183–192 functions)
examples of tasks, 193–201, 261–263 Sluggish cognitive tempo, 24, 56
directions of intervention for pre-school Social situation of development, ix, x, 21
children, 228 brain architecture and the experience:
main types of assignments, 180–182 two-directional process of interaction,
developing quazi-spatial functions, 181 4–5, 6
mastering the space, 181 role of parent and adult attention, ix, x
movements of other objects in space, 181 social neglect, 5, 6
orienting in one’s own body space, 181 urban and country environment, x, 77
orienting in the surrounding space, 181 Speech disorders, 2. See also Dyslexia
Reading
modification of Kohs method, 193–200 disabilities
Writing
Numbers’ Composition manual, 229–235 deficits in processing of auditory
examples of tasks, 230–235 information as a mechanism of
main difficulties, 229–230 learning disabilities, 23
requirements for developing the concept speech disorders assessment in “tracking”
of numbers’ composition, 230 diagnostics, 247
304 Index
Tests, neuropsychological, 39–40 “Black and White Squares” method,

acoustic gnosis (evaluation of rhythms), 183–186
139 Three functional units of the brain, 49
Benton’s test on line orientation, 211 action programming and control – Unit III
classification of objects, 141 functions, 49, 89, 245, 253
constructive praxis test, 139, 182, 248, 252, information processing – Unit II functions,
262, 266 49, 245, 259–260
computer version, 210–211 maintaining the brain’s working state –
copying a geometrical design (“a fence”), 56, Unit I functions, 49, 89, 245, 268
252, 266 Tracking (ongoing) diagnostics, 25, 31, 67, 83,
copying the rhythms from a model and by 136, 243–251
the verbal instruction (auditory-motor assessment of the results of the work, 67
coordination), 138, 248, 259 assessment of writing difficulties, 53–55, 57,
dynamic praxis test (Palm-First-Edge), 138, 58, 59, 237
248, 252, 258, 262 methods of tracking diagnostics, 67,
extended set of trials on visual gnosis and 246–248. See also Developmental
nominative language function, 154 Assessment of the information
identification by name (similar in processing (Unit II)
sounding or meaning words) trial, 154 functions
Developmental assessment
naming trial, 154 of the maintaining the brain’s working
recognition of crossed out, overlapping state (Unit I) functions
Developmental
and unfinished drawings, 154 assessment of the programming and
verbal and non-verbal fluency tests, 154 control (Unit III) functions
visual memory trial including the ongoing control, 67, 136
recognition, 154
Finger Position Test, 139, 252, 258, 262 Uneven development of HMF, x, 3, 22–23, 30,
Head’s trials, 139, 252, 262, 266 40, 41, 49, 245–246. See also
Kohs method, 182, 193, 249, 262, 266 Neuropsychology of the norm (of
computer version, 210 individual differences)
Nepsy test battery, 211 in factor analysis of Wechsler tests, 22–23
“Arrows” subtest, 211 groups of risk in students with uneven
“Paths” subtest, 212 development of HMF, 40
oral praxis test, 252 left frontal functions, 23, 34, 36–38
plans of actions (simple and conflict), or left posterior zone functions, 22, 34
choise reaction, 138, 252 partial underdevelopment of HMF, 41–42.
Raven’s matrices, 210 See also Learning disabilities (LD)
Ray-Taylor test, 182 right hemisphere functions, 22, 35, 185, 236,
reciprocal coordination, 138, 252, 258, 262 237
speech functions assessment, 139–141, 253, speed of information processing (Ist unit
259, 263, 267 functions), 23
structural rhythmic tapping, 35, 266 unevenness and problems of adaptation, 41,
asymmetrical tapping, 138 49, 79, 245–246
understanding the plot of pictures and series
of pictures, 141, 263 Visual and visual-verbal information
verbal memory trials, 139, 248, 253 processing, 63, 78
visual memory trials, 139, 248, 253, 259, 262 development of visual perception, 153
Visual Motor Integration test, 182 difficulties in visual information processing,
visual object gnosis trials, 139, 252, 259, 266 63
Wechsler intelligence tests, 22–23, 94 mechanisms of visual difficulties, 153
Block Design Test, 3, 139, 182, 193 the analytical “classification” strategy
the Zazzo test, 138 weakness, 153
Index 305
the basic orienting component of visual combining natural-scientific and

acts weakness, 153 social-scientific paradigms, 12
the holistic (or global) strategy weakness, main principles of neuropsychological
153 methodology, 13–17, 74
visual brain system, 4, 6, 7 The principle of dynamic organization
visual-verbal functions’ role in thinking and and localization of HMFs, 16–18,
speech development, 78 42
Visual-spatial functions, 3, 6, 117, The principle of social genesis of HMF,
182 14–15
analytical strategy of visual-spatial The principle of systemic structure of
orientation, 62, 153 HMF, 14–16
deficit of spatial functions as a mechanism new diagnostic approach, 15–16. See also
of learning disabilities, 24, 59–64 Neuropsychological
development of spatial functions, 179 syndrome
Developmental assessment,
role of speech, 179 neuropsychological
holistic (global) strategy of visual-spatial
processing, 61, 153, 236 Working memory, 6, 35, 89
main types of assignments in Writing, 32
remedial-developmental work, functional analysis of writing, 15, 32, 74,
180–182 236–237
quasi-spatial functions in speech, counting writing difficulties, 20, 24, 236
and problem solving, 179–180, 182 phonological dysgraphia, 20, 58
role of right and left hemisphere, 237 regulatory dysgraphia caused by Unit III
visual-spatial dysgraphia, 238–239 functions’ delay, 53–55
diagnostics, 59, 238 visual-spatial dysgraphia, 59–238
remediation, 239–241 Written speech, 54–55, 75
Vygotsky – Luria methodology, ix, 3, 4, 9, 11,
15, 29 Zone of proximal development (ZPD), 14, 31,
causal dynamic point of view on 83, 98, 136
development, 19, 25 assessment of ZPD, 142–147
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Subjects: Developmental psychology , Cognition
 Book Description
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Based on the ideas of Russian psychologists Lev Vygotsky and Alexander Luria, this book
explores methods of preventing or overcoming learning disabilities. Tatiana V. Akhutina and
Natalia M. Pylaeva build on Vygotsky and Luria’s sociocultural theory and their principle of a
systemic structure and dynamic organization of higher mental functions. They focus on the
interactive scaffolding of the weak components of the child's functional systems, the transition
from joint child-adult co-actions, and the emotional involvement of the child. The authors
discuss effective ways to remediate issues with attention, executive functions (working memory
and cognitive control), and spatial and visual-verbal functions. Overcoming Learning Disabilities
translates complex problems into easily understandable concepts useful to school psychologists,
special and general education teachers, and parents of children with learning disabilities.
Frontmatter:
pp. i-iv
 Read PDF
pp. v-
Contents:
viii
 Read PDF
Preface:
pp. ix-
 Read PDF xii
Introduction to the Russian-Language Edition: Contemporary Research in Child

Psychological Development and Remediation: An Overview:
pp. 1-10
 Read PDF
Introduction to the English-Language Edition: Vygotskian-Lurian Approach to

Neuropsychology:
pp. 11-
26
 Read PDF
Part I - General Issues in Development and Remediation of Higher Mental Functions:

pp. 27-
 Read PDF 28
1 - Neuropsychology of Individual Differences in Children as the Foundation for

the Application of Neuropsychological Methods in School:
pp. 29-
39
 Read PDF
2 - Methodology of Neuropsychological Intervention in Children with Uneven

Development of Mental Functions:
pp. 40-
47
 Read PDF
3 - What Psychologists, Teachers, and Parents Need to Know About Children with
Learning Disabilities:
pp. 48-
64
 Read PDF
4 - Neuropsychological Support of Remedial-Developmental Education:

pp. 65-
 Read PDF 72
5 - Neuropsychological Approach to the Development of Health-Preserving pp. 73-

Educational Techniques: 86
 Read PDF
Part II - Methods of Development and Remediation of Executive Functions:

pp. 87-
 Read PDF 88
6 - Organization of Joint Activity:

pp. 89-
 Read PDF 92
7 - The School of Attention and a Pilot Study of Its Effectiveness:

pp. 93-
 Read PDF 114
8 - Modified Psychological Methods to Facilitate Development of the Executive

Functions:
pp. 115-
127
 Read PDF
9 - Numerical Rows in Remedial Work with Fourth Graders:

pp. 128-
 Read PDF 135
10 - The Role of the Analysis of the Zone of Proximal Development in the Course
of Remediation of Executive Functions: An Example:
pp. 136-
150
 Read PDF
Part III - Methods of Developing Visual-Verbal Functions:

pp. 151-
 Read PDF 152
11 - Remediation of Visual-Verbal Functions in 5- to 7-Year-Old Children:

pp. 153-
 Read PDF 163
pp. 164-
12 - Perceptual Modeling in the Development of Visual-Verbal Functions:
176
 Read PDF
Part IV - Methods of Developing Visual-Spatial Functions:

pp. 177-
 Read PDF 178
13 - Development of Visual-Spatial Functions:

pp. 179-
 Read PDF 181
14 - “Construct the Figure” Methods in Assessment and Remediation of Visual-

Spatial Functions:
pp. 182-
192
 Read PDF
15 - The Use of Construction Methods to Develop Spatial Functions:

pp. 193-
 Read PDF 204
16 - Table and Computer Games to Improve Spatial Functions in Children with

Cerebral Palsy:
pp. 205-
214
 Read PDF
17 - Directions of Intervention for Developing Visual-Spatial Functions to Prepare

Children for School:
pp. 215-
228
 Read PDF
18 - Neuropsychologist–Teacher Collaboration in Designing a “Numbers

Composition” Manual:
pp. 229-
235
 Read PDF
19 - On Visual-Spatial Dysgraphia: Neuropsychological Analysis and Methods of pp. 236-

Remediation: 242
 Read PDF
Part V - Neuropsychological Interventions in Children with Severe Developmental

Delay:
pp. 243-
244
 Read PDF
20 - “Tracking Diagnostics” Methods:

pp. 245-
 Read PDF 250
21 - Case 1: Predominant Delay in the Development of Programming and Control

Functions (Unit III):
pp. 251-
257
 Read PDF
22 - Case 2: Predominant Delay in the Development of Information-Processing

Functions (Unit II):
pp. 258-
264
 Read PDF
23 - Case 3: Predominant Delay in the Development of Energy-Support Functions

(Unit I):
pp. 265-
274
 Read PDF
References:
pp. 275-
 Read PDF 296
Recommended Reading: Authors’ Selected Publications:

pp. 297-
 Read PDF 298
Index:
pp. 299-
 Read PDF 305
No references available.
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overcoming learning disabilities

Tatiana V. Akhutina is the head of the Laboratory of Neuropsychology at

Natalia M. Pylaeva is a neuropsychologist at Lomonosov Moscow State Univer-

This publication is in copyright. Subject to statutory exception

First English edition published 2012

Library of Congress Cataloging in Publication data

ISBN 978-1-107-01388-9 Hardback

Introduction to the Russian-Language Edition: Contemporary

part i. general issues in development and

part ii. methods of development and remediation of

part iii. methods of developing visual-verbal

part iv. methods of developing visual-spatial

part v. neuropsychological interventions in

Overcoming Learning Disabilities

Tatiana V. Akhutina, Natalia M. Pylaeva

Book DOI: http://dx.doi.org/10.1017/CBO9781139012799

Online ISBN: 9781139012799

Hardback ISBN: 9781107013889

Preface pp. ix-xii

Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.001

Cambridge University Press

Often child development in today’s world is unbalanced: a social situation

consideration the general neuropsychological characteristics of early school-

significant delays in programming and control functions (Unit III according

Overcoming Learning Disabilities

Tatiana V. Akhutina, Natalia M. Pylaeva

Book DOI: http://dx.doi.org/10.1017/CBO9781139012799

Online ISBN: 9781139012799

Hardback ISBN: 9781107013889

Introduction to the Russian-Language Edition: Contemporary Research in

Child Psychological Development and Remediation: An Overview pp. 1-10

Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.002

Cambridge University Press

Our book is dedicated to the neuropsychological remediation of learning

As far as we know, in Moscow the majority of neuropsychologists work-

(h2g) of the state of phonological operations and analytical reading capacity

development of structural-functional systems of the brain and their effec-

colleagues (2006) assessed the functioning of five main neurocognitive sys-

Children undergoing MEG wear a helmet that registers magnetic signals

sequence of events. Additionally, they demonstrate the plasticity of the func-

percentage of those who received a college education, had a higher salary,

in executive functions as compared to those in the control group. The

Overcoming Learning Disabilities

Tatiana V. Akhutina, Natalia M. Pylaeva

Book DOI: http://dx.doi.org/10.1017/CBO9781139012799

Online ISBN: 9781139012799

Hardback ISBN: 9781107013889

Introduction to the English-Language Edition: Vygotskian-Lurian Approa

ch to Neuropsychology pp. 11-26

Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.003

Cambridge University Press

The goal of our introduction to the Russian-language edition was to acquaint

I am completing my studies of aphasia patients and trying to convince

The progress they were making in intensive research in the field of

a series of articles on the “investigation of higher psychological functions in

Vygotsky never wrote the articles he mentioned, although items 2

Thus, the three main principles of Vygotsky-Lurian neuropsychology are

1. social genesis of higher mental functions (HMFs)

social genesis of higher mental functions

(prophylactic) of learning difficulties (Bodrova & Leong, 2007; Braga et al.,

systemic structure of higher mental functions

dynamic organization and localization of higher

the finding in the toddlers is more complicated. Could we conclude that in