Overcoming Learning Disabilities: a Vygotskian-Lurian

overcoming learning disabilities

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 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 foundation 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 psychologists, 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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TatianaV.Akhutina Lomonosov Moscow State University and MoscowStateUniversityofPsychologyandEducation Natalia M. Pylaeva Lomonosov Moscow State University

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C Tatiana V. Akhutina and Natalia M. Pylaeva 2008, 2012

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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

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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

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

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 22. Case 2: Predominant Delay in the Development of Information-Processing Functions (Unit II) 258 23. Case 3: Predominant Delay in the Development of Energy-Support Functions (Unit I) 265

References 275 Recommended Reading: Authors’ Selected Publications 297 Index 299

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Overcoming Learning Disabilities 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 Cambridge University Press 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

Often child development in today’s world is unbalanced: a social situation mightenhancedevelopmentofsomefunctionsattheexpenseofothers,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 development 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 contemporary research in neurobiology, neuropsychology, and economics dedicated to a child’s mental development; and analyze the effectiveness of remedial 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 discussion of these general methodological questions in school neuropsychology and presents the Vygotskian-Lurian approach to the diagnosis and remediation 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 perspective of the prevention of deterioration in the physical health of students during the course of the educational process. We argue that taking into

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:14 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.001 Cambridge Books Online © Cambridge University Press, 2012 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 (whatwecalltheSchool 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 developmental 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:14 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.001 Cambridge Books Online © Cambridge University Press, 2012 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 sincere 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 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 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 neuropedagogy 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.

As far as we know, in Moscow the majority of neuropsychologists working 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 education and advances in research into the neurobiological foundations of learning and developmental disabilities have facilitated the rapid expansion 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 neurovisualization, 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 mechanisms of learning disabilities on different levels. For example, researchers were able to show the connection between severe dyslexia and the disturbance in neuronal migration during fetal development (Galaburda et al., 1985). That disturbance can cause the atypical development of speech centers 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 connection between reading disabilities and genetic chromosomal mutations: phonological processes and analytical reading are connected to chromosome 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

(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 functions) 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 characteristics is not strictly deterministic. This repeatedly observed phenomenon is consistent with the modern understanding of the neurobiological foundations of child mental development that recognizes the complex and closely interconnected interactions of environmental and genetic influences, constructive self-organization of structural-functional systems, and the importance of early stages in child development (Gottlieb, 1992; Johnson, 1997). Vygotsky’sviewsonthatsubjectwereverysimilar(foranoverview,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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 4 Overcoming Learning Disabilities development of structural-functional systems of the brain and their effective 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 organized in a hierarchical manner, with critical periods of development occurring 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 significant 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 experiences 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the Russian-Language Edition 5 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 “mothers” 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 experience (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 general 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 6 Overcoming Learning Disabilities colleagues (2006) assessed the functioning of five main neurocognitive systems: 1. executive/prefrontal system 2. language/left perisylvian system 3. memory/medial temporal system (for example, the system that supports memorization on the first attempt) 4. spatial/parietal system 5. visual/occipitotemporal system The first system, which encapsulates executive functions (known as functions 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 inadequate 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 rightsidethanontheleft. 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 8 Overcoming Learning Disabilities sequence of events. Additionally, they demonstrate the plasticity of the functional 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 neuropsychological 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 taking 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 conducted 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 socioeconomic 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the Russian-Language Edition 9 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 published 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, economics, 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 process, the journal Science printedanarticlebythewell-knownspecialistin 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 program 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:17 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.002 Cambridge Books Online © Cambridge University Press, 2012 10 Overcoming Learning Disabilities in executive functions as compared to those in the control group. The Bodrova-Leong program (development of self-regulation in children during 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 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 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 difficulties derived from it. This review will prepare us to answer the main question posed in this book: How has the Vygotsky-Lurian approach contributed to the elaboration of remedial methods for helping children with learning disabilities? Lev Vygotsky was a founder of cultural-historical psychology. He is commonly associated with general and developmental psychology, educational psychology, special education, and the psychology of art, but his contribution 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 neuropsychology (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 psychological 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 structure 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: casesofagnosia,agraphia,postnatalpsychosiswithaphasia....Weare 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

At last, about the series. If they are going to actually publish it and publish regularly (from issue to issue without fail), it is necessary to take it with all responsibility. I have [the articles] 1). The classiﬁcation of aphasia; 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 number, 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 studies the functional structure and brain organization of higher mental functions (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 distinguishing between higher and lower mental functions as he came to embrace a systemic understanding of higher mental functions: “Higher mental functions 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 presentedinthisbook. Vygotsky’s ideas on the sociogenesis of HMFs and his diagnosis of the zone of proximal development and learning are more familiar to the western scientific community than his understanding of the principles of systemic 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 possible 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 structure 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 diagnostic 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.

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 16 Overcoming Learning Disabilities children). Wehave 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 orientation 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 negative 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 developing 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 introduction), 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 principle (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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the English-Language Edition 17 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 processes 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 analysis and discovery of the means by which a result is achieved to determine lesion localization and to create a profile of impaired and preserved functions (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 disorders in children with right- and left-hemisphere lesions. Infants (10–18 months) with right-hemisphere lesions demonstrate more delayed development 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 18 Overcoming Learning Disabilities 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 consequences 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 problems 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.Vygotskycon- 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the English-Language Edition 19 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 reading, 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 history 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 principal relatedness, the same working style, the “common factor” (Luria, 1970, p. 370, see also pp. 101–3). This is why, when describing the aphasia syndromes, 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 comprehend (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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 20 Overcoming Learning Disabilities 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 learning difficulties in the contemporary body of research on learning disabilities: 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 syndrome usually also involves a decline in short-term auditory-verbal memory, 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 difficulties 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 difficulties 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the English-Language Edition 21 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 analogous 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- tionofthelivingorganismstonatureproceeded....Introducedintothe 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 mental functions is sharply different from the processes of biological evolution 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 studies of education and remediation largely ignore the presence of “characters” in the developmental drama other than the social environment. The neuropsychological approach to development and correction of HMFs considers both the biological and social developmental factors. Following Vygotsky, we consider the developmental syndrome (in normal 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 compensatory 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 22 Overcoming Learning Disabilities 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) neuropsychological 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, individual 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 components 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 opposite 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 factor groups (see Tulsky et al., 2003) shows that in the general population strong and weak mental processes are not distributed in a mosaic pattern,

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the English-Language Edition 23 and it confirms the presence of stable groups of symptoms. Most likely, left posterior zone functions support the functions of language comprehension, 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 neuropsychology 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 processing – 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 predominant weakness in programming and control of actions and serial organization of movements: because of difficulties switching between tasks and the small volume of programming (working memory), these children experience problems with problem solving, and counting, 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 predominant weakness in the analytical (left-hemispheric) strategy of processing 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 vocabulary 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 processing. The third type of learning difficulties, which are caused by weakness in right-hemisphere functions, is very similar to the “syndrome of nonverbal 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 learning 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 understanding 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 neuropsychology, they usually do not carry out the analysis of the components of complex functional systems of academic skills and do not differentiate

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:21 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.003 Cambridge Books Online © Cambridge University Press, 2012 Introduction to the English-Language Edition 25 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 secondary 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 neuropsychological 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 qualitative 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 learning 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 popularity, 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 origin 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

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GENERAL ISSUES IN DEVELOPMENT AND REMEDIATION OF HIGHER MENTAL FUNCTIONS

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 1 - Neuropsychology of Individual Differences in Children as the Found ation for the Application of Neuropsychological Methods in School pp. 29-39 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.005 Cambridge University Press 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 neuropsychologist 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 organization 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 neuropsychology 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 interaction 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 variability 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 structure. r Hypothesis 3: The potential ability to compensate for functional weaknesses can be used as an indicator that separates normal from abnormal: 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 component 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.

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 remediation, 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 treatment of focal brain damage in adults, neuropsychological assessment determines 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 unfolding 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, consequently, functional deprivation can even cause an organic defect. In other words, in children the relationships between organic problems and functional disturbances are less straightforward than in adults. Themattersaremadeevenmorecomplicatedbythefactthatlaterthe 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 cognitive to neural defects (topical diagnosis) in children is on principle hardly possible (see, e.g., Johnson, 1997). Thus, the main task that neuropsychological diagnostics in children competently accomplishes is the assessment

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:29 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.005 Cambridge Books Online © Cambridge University Press, 2012 32 Overcoming Learning Disabilities 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, phonological 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 consists 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 analysis 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 Memor y 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:29 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.005 Cambridge Books Online © Cambridge University Press, 2012 34 Overcoming Learning Disabilities studies of the development of HMFs in 75 first- and second-grade students 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 (positive 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 neuropsychological 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 analysis 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 underdevelopment 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,and4 pupils had both the left-hemisphere weaknesses. Both verbal and nonverbal tests showed these weaknesses to be congruent, which argues against their mosaic character. We did not distinguish subgroups in the second

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:29 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.005 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychology of Individual Differences in Children 35 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.Theverbaltestresultsofthethreegroups–leftfrontal,leftpos- terior, and right hemisphere functions underdeveloped – are presented in Akhutina (1998a R). It is important to note that this division into three groups with relative 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) language 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 stable 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 fulfillment because of fatigue) in the graphic trial (for information on methods and subjects, see Kurgansky & Akhutina, 1996 R). Especially high correlations (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 weaknesses, we suggested that in cases where the deficiencies have been compensated (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 successfully completed, and as a whole the summary results of the neuropsychological 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 presented 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 teachers 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 performance. 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 neuropsychological 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 statistically 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 interesting 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 neuropsychological assessment are more successful than extra lessons with a teacher

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 2 - Methodology of Neuropsychological Intervention in Children with Un even Development of Mental Functions pp. 40-47 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.006 Cambridge University Press 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 better developed visual perception and memory, whereas others have more developed auditory or tactile processes. These differences are not accidental. Development of brain systems and functional groups is a long process contingent on interactions between biological (organic) and social (environmental) 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, environment, 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:32 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.006 Cambridge Books Online © Cambridge University Press, 2012 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 consequences 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 psychophysiological 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). Inthepreviouschapterandintheintroductiontothischapter,we presented arguments that the norm is characterized by an unevenness in development of structural-functional components and that this unevenness 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 pronounced 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:32 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.006 Cambridge Books Online © Cambridge University Press, 2012 42 Overcoming Learning Disabilities symptomatology and children with Williams syndrome with more pronounced right-hemisphere deficiencies (Bellugi et al., 1988; Bihrle et al., 1989). On this continuum the transitional part that goes from normal to abnormal development is wide and includes children with partial underdevelopment of mental functions that was not compensated or compensated insuffi- ciently in the process of education and training. These are the students in particular 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 neuropsychologists 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 consequences, 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 analysis” 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 diagnosis (Akhutina, 1998a R; Johnson, 1997) base their opinion on the principle 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 identification of the affected functional component, but that component’s topical

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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 structures

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 difficult 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 functions, 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 neuropsychological rehabilitation and remediation. Two main approaches have emerged in remedial work with children:

1. development of basic foundations: “prerequisites” of cognitive functions 2. development and remediation of cognitive functions and their components

These approaches are complementary. The ﬁrst one focuses on the sensorimotor level on the assumption that such help activates the development of all the HMFs (Semenovich, 1998 R, 2002 R). The second one focuses on

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:32 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.006 Cambridge Books Online © Cambridge University Press, 2012 44 Overcoming Learning Disabilities the development and remediation of cognitive functions and the components (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 disadvantage of “attack of weakness” approach, which is quite popular in educational 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 disadvantage). 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 systemic dynamic organization of functions (L. S. Vygotsky and A. R. Luria), we have developed a complex approach to remedial-developmental education 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 following 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 component 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 experienced 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:32 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.006 Cambridge Books Online © Cambridge University Press, 2012 46 Overcoming Learning Disabilities 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 thefirstpriority.Whenthechildisnotanobjectbutoneofthesubjectsof 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 StateUniversity:thecentraloneistheSchool of Attention method developedbyN.M.PylaevaandT.V.Akhutina(Pylaeva&Akhutina, 1997/2008 R). The School of Attention method is used to remediate learning disabilities caused by weaknesses in programming and control functions (functional 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) understanding of the mechanism of mistakes in Unit III and II dysfunctions: deficit of Unit III functions is characterized by such mistakes as simplification of the program and lack of inhibition, whereas deficit of Unit II functions features difficulties in the differentiation of similar elements.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 3 - What Psychologists, Teachers, and Parents Need to Know About Child ren with Learning Disabilities pp. 48-64 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.007 Cambridge University Press 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 complex 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 component 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 understanding oral speech and mastering writing and reading; however, they play a minimal role in math problem solving. Visual analysis, recognition, and

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:37 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.007 Cambridge Books Online © Cambridge University Press, 2012 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 completed by the child and thus determining the mechanisms of his or her learning disabilities. 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). DevelopmentofHMFsinchildrenisanextendedprocess:somefunctions 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 compensate for weak components by using strong ones, they are not able to meet social demands, and that failure translates into and gets noticed through learning disabilities. 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 perseverations; 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 problems. 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,andturkey 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 children with partial delays in mental development (the Russian term roughly equivalent to LDs) learn math, gave an accurate description of the difficulties 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 thetypeofthemathoperationrequired;thisproblemcouldnotbesolved 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 caseforthenominativecaseorputtheverbattheendofthesentenceor 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

And here the man is going to the dumpster, and here he dumped it out.Andhere....aswell....andhere...coal(14-secpause).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 orthography 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 executive 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 development 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).

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 maintaining 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:theyarefid- 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 second 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 combinations of weaknesses in the functioning of deep and subcortical structures of the brain (Unit I per Luria); specifically, difficulties in maintaining an optimal 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 (micrographia). 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). Wewould like to make two additional points before moving on to the discussion of learning difficulties caused by delays in Unit II functions. First, weakness in the functioning of Unit I can also be combined with weakness 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:37 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.007 Cambridge Books Online © Cambridge University Press, 2012 58 Overcoming Learning Disabilities 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 struggle with maintaining discipline at school and at home, but do not necessarily havelearningdisabilities;infact,therearemanygiftedchildreninthisgroup.

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 auditory 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 → pin the second word; t → dinthefourthword). 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 accompanied 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 different 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 positions (these problems are described in detail in Chapter 19).

Figure 3.5. Writing mistakes caused by the weak holistic (right-hemisphere) strategy 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 edgeoftheactivevisualﬁeld.

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 startedtoconnectthemfromthetopdownanddidnotevennoticethathe 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, competition), 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 development 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 difficulties learning multiplication tables and can make mistakes in assigning place value in multi-digit numbers (1,052 →152) or in solving problems in whichtheyhavetoswitchtoadifferentarray;forexample,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 children’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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 4 - Neuropsychological Support of Remedial-Developmental Education pp. 65-72 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.008 Cambridge University Press 4

Neuropsychological Support of Remedial-Developmental Education

Neuropsychologists working in elementary schools – in remedial- developmental education (RDE) classrooms in particular – have two primary 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 diagnostic 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 identify what kinds of tasks are difficult for different students and, most important, why did these tasks cause problems; that is, we conduct a qualitative 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:41 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.008 Cambridge Books Online © Cambridge University Press, 2012 66 Overcoming Learning Disabilities identifying those characteristics of speech, reading, writing, and math problem 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 organizationalhelp,based on thehypothesis thatthechild’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 situations, 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

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 diagnostics:

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 neuropsychologist in school is to help students learn and teachers teach. We certainly view teachers as the most important contributors to the educational 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 differenttypesofhelpareoffered–isanintegralpartoftheremedialprocess (see Chapter 10). The results of the work are evaluated not only through the final assessment 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. Letuslookatsomeexamples. Among the first-grade students we observed was a student with significant weakness of the energy unit. Periods of successful work, when he displayed high intellectual competence, were quickly replaced by periods 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 engagement 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:41 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.008 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychological Support of Remedial-Developmental Education 69 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.

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:41 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.008 Cambridge Books Online © Cambridge University Press, 2012 72 Overcoming Learning Disabilities 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 5 - Neuropsychological Approach to the Development of Health-Preservin g Educational Techniques pp. 73-86 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge University Press 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 learning 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 neuropsychology 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 74 Overcoming Learning Disabilities 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 components 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 (executive) 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 hierarchical 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.

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 adequately 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,

Theunitsofthoughtandspeechdonotcoincide....Thoughtdoesnot consist of individual words – like speech. ...Thoughtisalwayssome- thing whole, something with signiﬁcantly greater extent and volume than the individual word. ...Whatiscontainedsimultaneouslyinthought 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,AlexanderLobok (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 advocates 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 teaching 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 abbreviated 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. Toparaphrase 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 children 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 children. Her research showed that compared to children in the control group, who attended classes that were based on a traditional kindergarten curriculum, children in two experimental groups, where image or language-speech programs were used, showed significant but different dynamics in developing 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 development 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 several 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 developing 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 disabilities 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychological Approach 79 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 natural 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 – realization 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 following 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 processes, and insufficient speech development (as the function requiring themostenergy) 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,

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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 programming 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychological Approach 81 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 experience 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 82 Overcoming Learning Disabilities 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. Tosafeguard 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 personality and social developmental factors and second on the state of his or her higher mental functions. In the contemporary psychological and educational 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 analysis that identifies strengths and weaknesses in their development. From the point of view of neuropsychology, the main strategy of developmental education (or remedial-developmental education if necessary) is to “stimulate the growth” of the weaker components while relying on the stronger components in completion of specially designed joint activity of the student

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychological Approach 83 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. Toachieve 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 neuropsychological 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 diagnostics (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 insignificant, 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 functions. A teacher might use this assignment sequence at the initial (propedevtic) 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 difficulties 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 assignments 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 Neuropsychological Approach 85 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 similar types presented in different formats. If results are improving for all parameters or if the ﬁrst two measurements improve and then the completion time becomes shorter, one can say that developmental work has been

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:45 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.009 Cambridge Books Online © Cambridge University Press, 2012 86 Overcoming Learning Disabilities 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 (“dosing”) the assignments during a lesson: for example, the increase in the number 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 neuropsychological 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 neuropsychological 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.

METHODS OF DEVELOPMENT AND REMEDIATION OF EXECUTIVE FUNCTIONS

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 6 - Organization of Joint Activity pp. 89-92 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.011 Cambridge University Press 6

Organization of Joint Activity

The development of programming and control functions (executive functions) is a long process that is completed significantly later than the development 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 programming, 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:52 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.011 Cambridge Books Online © Cambridge University Press, 2012 90 Overcoming Learning Disabilities 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 behavioral 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 children start to experience difficulties following teachers’ directions, are not able to listen to complete verbal instructions, and get distracted and confused in the process of completing tasks. These deficits negatively affect learning motivation, and as a result children become consistently unsuccessful. 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 internalized; Galperin, 1969; Vygotsky, 1997b)

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 provided 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.Atthisstage 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). Yetsome 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:52 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.011 Cambridge Books Online © Cambridge University Press, 2012 92 Overcoming Learning Disabilities 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- temsofmethodsthathavebeencreatedtodevelopthefunctionsofplanning, 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 7 - The School of Attention and a Pilot Study of Its Effectiveness pp. 93-114 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge University Press 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 programming 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 beginning 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

AF7.5909089 B F 7.5 79 110 93 C F 6.7 85 108 96 DF6.8959796 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 completing 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 distractibility; her actions were often inconsistent and chaotic. In contrast, theotherfivestudentswereslowandrelativelyinactive,andtheylacked interest in completing tasks. Neuropsychological testing revealed that programming 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 combined 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 processing 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- spondedwithadecreaseinverbalIQ(VIQ):inallchildrenVIQ≤ 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).

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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 96 Overcoming Learning Disabilities 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 numbers (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 comparison 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 understanding 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,withanaveragetimeof3min,54sec;thesecondversiontook

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 The School of Attention and a Pilot Study of Its Effectiveness 97 from4min,25secto8min,20sec,withanaveragetimeof5min,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 independently 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 longertofinish(4min,20sec). 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 techniques, 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

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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 functions. 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, neuropsychologists 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 functions 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 proximal 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 neuropsychologist 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 instructions, 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 The School of Attention and a Pilot Study of Its Effectiveness 99 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 thetaskturnouttobetoohigh)andcompleteitonanaccessiblelevel.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 internalized 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 numberinsteadofthefirst.Ittookeachofthem15to30sectocompletethe task. In the subsequent tasks children traced, colored, and copied the numbers 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 consolidated 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 formulate 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 104 Overcoming Learning Disabilities 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 wayorinthecellsofSchultetables.Theirconcretecharacter,whichrequired 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 The School of Attention and a Pilot Study of Its Effectiveness 107 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 experiencedsetbacksinmorecomplex 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 difficulties 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, moving 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 completed 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 StudentBneededthesampletheentiretime.

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: Alltogether(exceptstudentsB andD):“9,7,5 ...” Inthe 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 making mistakes – some on their own and others needed adults to help them organize. They performed the task of completing the even row independently, 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 reviewing tasks of the first cycle with familiar situations and mastering the operation 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. Inthefirsttaskstudentsweregivenatablewithnumbersfrom1to10 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 –

Figure7.7.Pages1,2,7,and9oftheﬁfthcycleofSchool 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:26:55 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.012 Cambridge Books Online © Cambridge University Press, 2012 The School of Attention and a Pilot Study of Its Effectiveness 111 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). Inthemiddleofthecycletheymademistakesonlyinthemorecomplex 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 Webegin 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 theprogrambeforestartingtheirwork.Somewereabletointernalizethe 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 3min,2sec 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 3min,5sec 2min 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 programming and control functions.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 9 - Numerical Rows in Remedial Work with Fourth Graders pp. 128-135 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.014 Cambridge University Press 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 programming and control functions in kindergarteners and first-grade students 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 experience 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 mistakes 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 primarily 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

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 mastered, 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:00 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.014 Cambridge Books Online © Cambridge University Press, 2012 130 Overcoming Learning Disabilities 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:00 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.014 Cambridge Books Online © Cambridge University Press, 2012 Numerical Rows in Remedial Work with Fourth Graders 131 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 Testor “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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:00 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.014 Cambridge Books Online © Cambridge University Press, 2012 134 Overcoming Learning Disabilities verticalrow)andtheninthedrawingoffiguresinahorizontalrow.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 experienced 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 motivation 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 involving 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 development 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

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 0 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge University Press 10

TheRoleoftheAnalysisoftheZoneofProximal 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 necessary 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 zoneofproximaldevelopment(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, providing support for the child by assuming the functions of the weak components 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

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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 138 Overcoming Learning Disabilities 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 dominant. 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 possible 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 evident 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 difficulties 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 flexibility), 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, simplification 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 picture, 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 alsopresentwhenrepeatingwordsorsyllables.

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 toovercome:evenwhenhewasshownthepicturesinthecorrectorder, 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 impulsivity 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 onthefactthatprovidingsupportinorganizinghisactivitynoticeably 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 components, such as perceptual and memory processes and programming and control functions. This is the common feature of all the educational assignments; 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 control functions, whereas information-processing operations are relatively simple; in others, the information-processing operations (for example, perceptual 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 comparable 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 144 Overcoming Learning Disabilities 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 mistakes 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 underdeveloped 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 rowandwasabletolayoutthenumbersindirectorderwithoutchecking 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 andwhocouldexercisecontrolofthisactivity. 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),

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 particular 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 identical 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 informative; 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 general 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 neuropsychological assessment by helping further clarify the character and the degree

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 The Role of the Analysis of the Zone of Proximal Development 147 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 differences, 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 148 Overcoming Learning Disabilities 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 underdeveloped. 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 operations and the difficulty orienting in the task (including actively examining the picture, identifying significant features, inhibiting bright but insignificant 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. Letuslookattheprocessoffoldingtheplanofperceptualactivity, 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 content of the picture and distinguishing informative from uninformative elements 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 The Role of the Analysis of the Zone of Proximal Development 149 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 considered 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 completed 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:06 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.015 Cambridge Books Online © Cambridge University Press, 2012 150 Overcoming Learning Disabilities 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.

METHODS OF DEVELOPING VISUAL-VERBAL FUNCTIONS

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 11 - Remediation of Visual-Verbal Functions in 5- to 7-Year-Old Childr en pp. 153-163 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.017 Cambridge University Press 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 isexpectedtoreachoverallmaturitybyschoolage,andschoolprograms are created based on that expectation. The elementary school curriculum places high demands on students to develop full and accurate mental representations 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 children’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 conducted 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

Basedonthatdataweidentiﬁedthefollowingobjectivesfordevelopment and remediation of visual perception of objects:

r developing visual gnostic processes, including both holistic and analytical 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 perception are underdeveloped, the whole system is affected. Therefore in the first stage we offered relatively simple, general tasks that children could complete 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 therapeutic 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.

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).

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:16 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.017 Cambridge Books Online © Cambridge University Press, 2012 156 Overcoming Learning Disabilities 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, peripheral, and consequently less familiar ones also increased the tasks’ gnostic and verbal complexity. Each image identification task became a foundation for additional exercises aimed at strengthening visual images. For this purpose, after completing 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- turesthatcouldbeidentifiedinaverbalform.Herestorypictureswereused; 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 quantity, 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 traditional 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 designing 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 manual 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 subjects. All the children were about the same age (average age – 6.5 yrs) and had similar delays in the development of higher mental functions (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 12121212

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∗∗∗ betweengroupsR&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 association. 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 discourse 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 language 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

90 right-handed persons

left-handed 85 persons

control group 80

70 12 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 significantly 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 statistically 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 12 - Perceptual Modeling in the Development of Visual-Verbal Functions pp. 164-176 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.018 Cambridge University Press 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 important 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:16 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.018 Cambridge Books Online © Cambridge University Press, 2012 Figures 12.1a and 12.1b. Images for Task 1.

Figure 12.2. Images for Task 2.

Figure 12.3. Images for Task 3.

Task 4: This task is perceptually more difﬁcult than Tasks2 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 vegetables. 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 operations are completed with an onion and a cucumber. If the student likes this assignment he or she can continue doing it with the remaining pictures (see Fig. 12.5). Any colored pictures of vegetables can be used in this task.

Figure 12.4. Images for Task 4.

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

Figure 12.5. Images for Task 5.

Figure 12.6. Images for Task 6.

Figure 12.7. Images for Task 7. 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).

Figure 12.8. Images for Task 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).

Figure 12.9. Images for Task 9.

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).

Figure 12.10. Images for Task 10.

Figure 12.11. Images for Task 11.

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.

Figure 12.12. Images for Task 12.

Figure 12.13. Images for Task 13.

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).

Figure 12.14. Images for Task 14.

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).

Figure 12.15. Images for Task 15.

Task 15: This task allows for strengthening and specifying visual images of clothing and shoes and practicing the ability to actualize a typical situation 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 following 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.

METHODS OF DEVELOPING VISUAL-SPATIAL FUNCTIONS

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 13 - Development of Visual-Spatial Functions pp. 179-181 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.020 Cambridge University Press 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 external 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 relationships. 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 prepositions, 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

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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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 14 - “Construct the Figure” Methods in Assessment and Remediation of V isual-Spatial Functions pp. 182-192 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.021 Cambridge University Press 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 development of spatial functions is a long and sensitive process (Akhutina & Zolotareva, 1997 R; Manelis, 1997 R; Semenovich, 2002 R), the importance of early diagnostics and timely remediation of spatial functions is self- evident. Traditionally, methods based on copying, 180-degree turn, or memorization (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

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 programming 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 confirmed those uses. In addition, we discovered that children willingly completed 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 difficulties 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 1in20sec,whereasthenextfourtooknolongerthan3seceach(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 earlier, 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 1 5 /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. Yeteven 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 failures, 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 neuropsychologist. 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 preparing a template) and then construct a figure based on this template. Next, after practicing the task completion with and without a template, Nastya

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:30 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.021 Cambridge Books Online © Cambridge University Press, 2012 188 Overcoming Learning Disabilities completed memory tasks and drawing. Even when the tasks were completed successfully, she still practiced creating a template to consolidate construction 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 keypointsofanimageandtolocatethemintheframesofappropriatesize 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 drawingaplot. 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 theprevioustasks).Thetransitiontotheperceptuallymorecomplicated 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 × 1cm)

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 questions 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:30 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.021 Cambridge Books Online © Cambridge University Press, 2012 “Construct the Figure” Methods 191 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 completed 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 process: 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 beginning 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 exhaustion 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 15 - The Use of Construction Methods to Develop Spatial Functions pp. 193-204 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.022 Cambridge University Press 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 1 the whole series can vary from 1 /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

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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? Putitonthetableinsuchawaythattheylookthesame.Nowtrymatching 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.

Figure 15.2. Four-card task assembly, Tasks 3 and 4.

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,alittlebowforagirl’sbraids,andawindow. 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 remembering 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(abowforagirlandabowtieforaman)andawhiteboatwithsails 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.

Figure 15.7. Four-card task assembly, Tasks 15 and 16.

eight- to ten-cards object assembly Foralltasksinthissectionthechildisgivenamodelandcardssimilarto 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 morepattern.Takethefigure(brick)thathasaredlowerleftcorner.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 thelefthalf?” 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.

Figure 15.13. Lego Dakta, Task 4.

Figure 15.14. Lego Dakta, Task 6. 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.”

Figure 15.15. Lego Dakta, Task 7.

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.

Figure 15.21. “White and Black Squares” construction method, Task 9.

Figure 15.22. “White and Black Squares” construction method, Task 10.

Figure 15.23. “White and Black Squares” construction method, Task 11.

“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 psychologist 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 16 - Table and Computer Games to Improve Spatial Functions in Children with Cerebral Palsy pp. 205-214 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.023 Cambridge University Press 16

Table and Computer Games to Improve Spatial FunctionsinChildrenwithCerebralPalsy

The delay in development of spatial functions can be caused by immaturity 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 functions 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 targets 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

ThisworkwasconductedtogetherwithN.Foreman,A.N.Krichevets,L.Matikka,V.Narhi, and E. Vahakuopus. 205

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:39 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.023 Cambridge Books Online © Cambridge University Press, 2012 206 Overcoming Learning Disabilities 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 assessment 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:39 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.023 Cambridge Books Online © Cambridge University Press, 2012 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 experimental group (but none in the control group) had the hyperkinetic form of CP. Additionally, there were two wheelchair- bound children in the experimental 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 average number was eight. All tests and remedial interventions were conducted individually in a separate room. Supportivetasks. 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 material 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”

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:39 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.023 Cambridge Books Online © Cambridge University Press, 2012 208 Overcoming Learning Disabilities method;seeChapter15);“TheFlightoftheBalloon”(seeTask1inChapter 17); “Postman” (both games use a metal board); graphic dictations; and “Teacher and Robot.” Each game-task allowed for a wide range of movements. 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, backward, 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 navigation. (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 computer 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 constructive 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:39 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.023 Cambridge Books Online © Cambridge University Press, 2012 212 Overcoming Learning Disabilities 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 thetarget(thereweretwooneachform). “Paths.” The test, which was created at the Institute of Pre-school Educa- tion AO USSR and also included in NEPSY,measures visual-spatial relationship 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 particularly effective for the development of spatial functions (Foreman, Stanton,

–1

–2 2 4 6 8 101214161820

Figure 16.3. Dispersion diagram for the test results: horizontal axis – pre-training score, vertical axis – difference between pre- and post-training scores. O – experimental 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 navigation games), in the main experiment progress was noted in all children; it was especially pronounced in children with a low baseline level (indicated by a high negative correlation between the baseline and the improvement). With the aid of additional supportive tasks all children managed to internalize spatial concepts and to operate successfully in the new environment. 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 17 - Directions of Intervention for Developing Visual-Spatial Function s to Prepare Children for School pp. 215-228 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.024 Cambridge University Press 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 development 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 assignment: “The balloon flies upward. Draw a line to where it flew and draw a balloon above,intheupper 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:43 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.024 Cambridge Books Online © Cambridge University Press, 2012 216 Overcoming Learning Disabilities

Figure 17.1. Task 1.

Figure 17.2. Task 2.

To more fully establish this skill – naming directions for the actions – other labyrinths or routes with right-angle turns are used. Special attention 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) Figure 17.3. Task 3.

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 dividing squares in half by drawing vertical, horizontal, or diagonal lines, and they practice making squares out of two or four parts.

Figure 17.4. Task 4.

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).

Figure 17.5. Task 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.

Figure 17.6. Task 6.

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 amugtoaspoon.

Figure 17.7. Task 7.

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.

Figure 17.8. Task 8.

Figure 17.9. Task 9.

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).

Figure 17.10. Task 10.

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).

Figure 17.11. Task 11.

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 piecetothecorner;thechildthenfindsthepiecethatbelongsinthelower 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

Figure 17.12. Task 12. 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 movedtheapple.Canyouguesswhereto?” As psychologists working in classrooms we interact with teachers very closely. In the next two chapters we describe this collaboration.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 18 - Neuropsychologist–Teacher Collaboration in Designing a “Numbers C omposition” Manual pp. 229-235 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.025 Cambridge University Press 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 + 4or2+ 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 material. Weidentified the following difficulties that children typically experience when learning how to compose numbers.

The work was conducted together with T. Ju. Khotyleva.

229

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Visual and visual-spatial problems: r Difficulties orienting on a piece of notebook paper r Difficulties in recognizing, memorizing, and actualizing spatial structures 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: creating tasks in a variety of formats including a game format, repetition without boredom r Ranking difficulties and arranging step-by-step mastery using an external 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 saturation 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

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.

Figure 18.2. Worksheets 3 and 4.

Figure 18.3. Worksheets 5 and 6.

Figure 18.4. Worksheets 7 and 8.

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 picture 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).

Figure 18.5. Worksheets 9 and 10.

Figure 18.6. Worksheets 11 and 12.

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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 19 - On Visual-Spatial Dysgraphia: Neuropsychological Analysis and Met hods of Remediation pp. 236-242 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.026 Cambridge University Press 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 information. Typically when describing learning problems caused by right- hemispheric functional deficiencies, authors emphasize nonverbal difficulties and difficulties in learning how to count (dyscalculia; Rourke et al., 1983). However, in this chapter we focus on writing difficulties, their diagnosis, 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

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 horizontal 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, fragmentation 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 Egordidnotwanttolearnorevenbeatschool,andhedidnotwantto interact with peers. However, when he became engaged in group work in class, he showed a sufficient level of general development, extensive vocabulary, 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 reactions subsided. He became more active in class, showed interest in creative 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 abilitytoworkﬂuctuatedinthecourseofevenoneclass,letaloneaweekora 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 wouldhavehelpedhimrecognizeamistake In addition, when the student became fatigued we would start seeing perseverations of letters and syllables and contamination of words; that is,themergingoftwowordsinone(24February–24февраля –“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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:52 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.026 Cambridge Books Online © Cambridge University Press, 2012 240 Overcoming Learning Disabilities control in particular) were affected secondarily to these two main dysfunctions. To increase his ability to work it was necessary both to increase his motivation and interest in completing tasks and to divide and thus decrease the size of each task and, whenever possible, simplify the process of completing 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)andfivebelow(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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:27:52 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.026 Cambridge Books Online © Cambridge University Press, 2012 On Visual-Spatial Dysgraphia 241 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.

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NEUROPSYCHOLOGICAL INTERVENTIONS IN CHILDREN WITH SEVERE DEVELOPMENTAL DELAY

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Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 20 - “Tracking Diagnostics” Methods pp. 245-250 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.028 Cambridge University Press 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 neurodynamic characteristics: reduced performance speed or increased impulsivity, 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 development 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 – auditory, visual, kinesthetic, and visual-spatial, as evidenced by the decrease in the volume of perception and memory, weakness of memory traces, difficulties 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 disproportion 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 information 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 dissociation 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 neuropsychological 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.

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 pronunciation 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 participated 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 situations 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 psychomotor development. It was necessary to simplify either the task itself or the procedure or both. For example, when assessing praxis some of the trials 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 pictures 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 difficult to perform. To facilitate their completion we slowed the speed of

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:02 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.028 Cambridge Books Online © Cambridge University Press, 2012 “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 presenting 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 interactions 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 support 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 neuropsychological 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 consisting 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 earlier, 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 neuropsychological assessment, including tracking diagnostics. Determining

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:02 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.028 Cambridge Books Online © Cambridge University Press, 2012 250 Overcoming Learning Disabilities factors that cause the failure of a particular higher mental function and, at the same time, identifying conditions that could help at least partially compensate 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 21 - Case 1: Predominant Delay in the Development of Programming and C ontrol Functions (Unit III) pp. 251-257 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.029 Cambridge University Press 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 psychomotor and speech development at the Center of Curative Pedagogy. The special education teacher had diagnosed her with pronounced developmental disability and the consequences of cerebral palsy.WhenNinafirststarted 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:08 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.029 Cambridge Books Online © Cambridge University Press, 2012 252 Overcoming Learning Disabilities 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 coordination 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 preliminary 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).

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, regulation, 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 programming 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 programming 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 perception 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 materialized 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 wascompletedtogetherwithotherchildrenandwasalwaysprecededby 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 developing 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), perception, 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.

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:08 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.029 Cambridge Books Online © Cambridge University Press, 2012 Case 1: Predominant Delay in the Development of Programming 257 although certain symptoms decreased, the character of the neuropsychological 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 education class of a regular school after receiving 3 years of development and remediation interventions.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 22 - Case 2: Predominant Delay in the Development of Information-Proce ssing Functions (Unit II) pp. 258-264 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.030 Cambridge University Press 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 fatigability. 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 reciprocal 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:08 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.030 Cambridge Books Online © Cambridge University Press, 2012 Case 2: Predominant Delay 259 though sizing up a model. Pronounced synkinesis (accompanying movements 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 analysis 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 particularly 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 grammatical 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 mental 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 particularly 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.Inthesetrialswevaried 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 belonging 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:08 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.030 Cambridge Books Online © Cambridge University Press, 2012 Case 2: Predominant Delay 261 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 reciprocal 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 ability 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 processes and difficulties in visual-spatial function development remained, Katya needed continued remedial support during the next stage of the educational process.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter 23 - Case 3: Predominant Delay in the Development of Energy-Support Fu nctions (Unit I) pp. 265-274 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.031 Cambridge University Press 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 interventions at the Center for Curative Pedagogy that included play, music, movement, and educational formats. In the initial observation stages his poor motor development was particularly 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 improvements 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 constructive 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 functional 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:12 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.031 Cambridge Books Online © Cambridge University Press, 2012 268 Overcoming Learning Disabilities 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 difficulties in distribution of attention. Thus, the primary difficulties in his neuropsychological profile were problems in maintaining and regulating cortical tone; exhaustion of mental 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 development 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 facilitated 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 operational 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:12 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.031 Cambridge Books Online © Cambridge University Press, 2012 270 Overcoming Learning Disabilities 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 tendency 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

Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:12 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.031 Cambridge Books Online © Cambridge University Press, 2012 Case 3: Predominant Delay 271 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 ofthefiguresoneachdoorwayandthecolorsofthefiguresoneachfloor. 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 differently or using a larger table r Creating a similar house independently by choosing from the colored imagesofobjectsorﬁguresgiventohim

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 characteristics 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 concepts 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 content; 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.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter References pp. 275-296 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.032 Cambridge University Press references

publications in english and german Akhutina, T. V. (1997). The remediation of executive functions in children with cognitive disorders: The Vygotsky-Luria neuropsychological approach. Journal of Intellectual Disability Research, 41(2), 144–151. Akhutina, T. V.(2003). Foundations of neuropsychology. Journal of Russian and East European Psychology, 41(3–4), 159–190. Russian ed.: Akhutina, T. V. (1996) – see in the list of publications in Russian. Achutina, T. V. (2004). Kulturhistorische und naturwissenschaftliche Grundlagen der Neuropsychologie [Cultural-historical and natural-scientific foundations of neuropsychology]. Behindertenpadagogik¨ , 43(4), 339–351. Russian ed.: Akhutina (2004) – see in the list of publications in Russian. Akhutina, T.V.(2004). Writing: Assessment and remediation. In T.V.Akhutina, J. M. Glozman, L. I. Moskovich, & D. Robbins (Eds.), A. R. Luria and Contemporary Psychology: Festschrift celebrating the centennial of his birth (pp. 125–144). New York: Nova Science. Akhutina, T. V., & Cole, M. (2008, September). A cultural-historical approach to rehabilitation science. In ISCAR 2008: Ecologies of diversities: The developmental and historical interarticulation of human mediational forms: Book of abstracts. Accessed from http://iscar2008.org/ISCAR web/Program files/ISCAR BOA.pdf. 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, 25(24), 1361–1371. Akhutina, T. V., & Kamardina, I. O. (2008, September). The Vygotsky-Luria neuropsychological approach to remediation of psychological functions deficit in children with learning disabilities. In ISCAR 2008. Ecologies of diversities: The developmental and historical interarticulation of human mediational forms: Book of abstracts. Accessed from http://iscar2008.org/ISCAR web/Program files/ ISCAR BOA.pdf. Achutina, T. V., Obuchova, L. F., & Obuchova, O. B. (2001). Schwieringkeiten bei der Aneignung von Grundkenntnissen der Mathematik durch Kinder im Grundshulalter und die Gruende dafuer [The difficulties of acquisition of the basis

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Downloaded from Cambridge Books Online by IP 14.139.43.12 on Tue Oct 09 10:28:15 BST 2012. http://dx.doi.org/10.1017/CBO9781139012799.032 Cambridge Books Online © Cambridge University Press, 2012 276 References

of mathematical knowledge and their causes]. In W.Jantzen (Hrsg.), Jeder Mensch kann lernen – Perspektiven einer kulturhistorischen (Behinderten-) Paedagogik [Every person can learn – Perspectives of cultural-historical (special) pedagogy] (pp. 178–203). Berlin: Luchterhand. 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. Alfano, D. P., & Finlayson, M. A. J. (1987). Clinical neuropsychology in rehabilitation. Clinical Neuropsychologist, 1, 105–123. Anderson, V., Northam, E., Hendy, J., & Wrennall, J. (2001). Developmental neuropsychology: A clinical approach. Hove, UK: Psychology Press. Baddeley, A. D. (2001). Is working memory still working? American Psychologist, 56(11), 851–864. Barkley, R. A. (1998). Attention-deﬁcit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York, NY: Guilford Press. Baron, I. S. (2004). Neuropsychological evaluation of the child.NewYork,NY:Oxford University Press. Bates, E., Thal, D., Trauner, D., Fenson, J., Aram, D., Eisele, J., & Nass, R. (1997). From ﬁrst words to grammar in children with focal brain injury. Developmental Neuropsychology, 13, 447–476. Bellugi, U., Marks, S., Bihrle, A., & Sabo, H. (1988). Dissociation between language and cognitive functions in Williams syndrome. In D. Bishop & K. Mogford (Eds.), Language development in exceptional circumstances (pp. 177–184). Edinburgh, UK: Churchill Livingstone. Benson, D. F., & Ardila, A. (1996). Aphasia: A clinical perspective.NewYork,NY: Oxford University Press. Benton, A. L., Hamsher, K., Varney, N. R., & Spreen, O. (1983). Contributions to neuropsychological assessment. New York, NY: Oxford University Press. Berninger, V.W.(2004). Understanding the “Graphia” in developmental dysgraphia: A developmental neuropsychological perspective for disorders in producing written language. In D. Dewey & D. E. Tupper (Eds.), Developmental motor disorders: Aneuropsychologicalperspective(pp. 328–350). New York, NY: Guilford Press. Berninger, V. W., & Winn, W. D. (2006). Implications of advancements in brain research and technology for writing development, writing instruction, and educational evolution. In C. MacArthur, S. Graham, & J. Fitzgerald (Eds.), The writing handbook (pp. 96–114). New York, NY: Guilford Press. Bernstein, N. A. (1967). The co-ordination and regulation of movements. Oxford, UK: Pergamon Press. Bernstein, N. A. (1996). On dexterity and its development.InM.L.Latash&M.T. Turvey (Eds.), Dexterity and its development (pp. 1–244). Mahwah, NJ: Erlbaum. Bihrle, A. M., Bellugi, U., Delis, D., & Marks, S. (1989). Seeing either the forest or the trees: Dissociation in visuospatial processing. Brain and Cognition, 11, 37–49. Bodrova, E., & Leong, D. J. (2007). Tools of the mind: The Vygotskian approach to early childhood education (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall. 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.

InR.M.Lerner,J.V.Lerner,E.P.Bowers,S.Lewin-Bizan,S.Gestsdottir,&J.B. Urban (Eds.), Thriving in childhood and adolescence: The role of self-regulation processes. New Directions for Child and Adolescent Development, 133, 11–28. Braga, L. W., Campos da Paz, A., & Ylvisaker, M. (2005). Direct clinician-delivered versus indirect family-supported rehabilitation of children with traumatic brain injury: A randomized controlled trial. Brain Injury, 19(10), 819–831. Brown, T. E. (2005). Attention deficit disorder. New Haven, CT: Yale University Press. Casey,B.J.,Castellanos,F.X.,Giedd,J.N.,Marsh,W.L.,Hamburger,S.D.,Schubert, A. B., . . . Rapoport, J. L. (1997). Implication of right frontostriatal circuitry in response inhibition and attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 374–383. Casey, B. J., & Durston, S. (2006). From behavior to cognition to the brain and back: What have we learned from functional imaging studies of attention deficit hyperactivity disorder? American Journal of Psychiatry, 163(6), 957–960. Casey, B. J., Tottenham, N., & Fosella, J. (2002). Clinical, imaging, lesion, and genetic approaches toward a model of cognitive control. Developmental Psychobiology, 40, 237–254. Castles, A., & Coltheart, M. (1993). Varieties of developmental dyslexia. Cognition, 47, 149–180. Castles, A., & Coltheart, M. (1996). Cognitive correlates of developmental surface dyslexia: A single case study. Cognitive Neuropsychology, 13, 25–50. Chaiklin, S. (2003). The Zone of Proximal Development in Vygotsky’s analysis of learning and instruction. In A. Kozulin, B. Gindis, V. S. Ageyev, & S. M. Miller (Eds.), Vygotsky’s educational theory in cultural context (pp. 39–64). Cambridge, UK: Cambridge University Press. Chittooran, M. M., & Tait, R. C. (2005). Understanding and implementing neu- ropsychologically based written language interventions. In R. C. D’Amato, E. Fletcher-Janzen, & C. R. Reynolds (Eds.), Handbook of school neuropsychology (pp. 777–803). Hoboken, NJ: John Wiley. Cole, M. (1985). The zone of proximal development: Where culture and cognition create each other. In J. Wertsch (Ed.), Culture, communication, and cognition: Vygotskian perspectives (pp. 146–161). Cambridge, UK: Cambridge University Press. Cole, M. (1996). Cultural psychology: A once and future discipline.Cambridge,MA: Belknap Press. Cunha, F., Heckman, J. J., Lochner, L. J., & Masterov, D.V. (2006). Interpreting the evidence on life cycle skill formation. In E. A. Hanushek & F. Welch (Eds.), Hand- book of the economics of education (pp. 697–812). Amsterdam: North-Holland. D’Amato, R. C., Fletcher-Janzen, E., & Reynolds, C. R. (Eds.). (2005). Handbook of school neuropsychology. Hoboken, NJ: John Wiley. Daniels, H. (2007). Pedagogy. In H. Daniels, M. Cole, & J. Wertsch (Eds.), The Cambridge companion to Vygotsky (pp. 307–331). New York, NY: Cambridge University Press. Daniels, H., Cole, M., & Wertsch, J. (Eds.). (2007). The Cambridge companion to Vygotsky. New York, NY: Cambridge University Press. Daw, N. W.(1997). Critical periods and strabismus: What questions remain? Optom- etryandVisualScience, 74(9), 690–694.

DeFries, J. C., & Alarcon, M. (1996). Genetics of specific reading disability. Mental Retardation and Developmental Disabilities Research Reviews, 2, 39–47. Dewey, D., & Tupper, D. E. (Eds.). (2004). Developmental motor disorders: A neuropsychological perspective. New York, NY: Guilford Press. Diamond, A. (2005). Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder with hyperactivity. Develop- mental Psychopathology, 17(3), 807–825. Diamond, A., Barnett, W. S., Thomas, J., & Munro, S. (2007). Preschool program improves cognitive control. Science, 318(30), 1387–1388. Dick, F., Dronkers, N. F., Pizzamiglio, L., Saygin, A. P., Small, S. L., & Wilson, S. (2005). Language and the brain. In M. Tomasello & D. I. Slobin (Eds.), Beyond nature – nurture: Essays in honor of Elizabeth Bates (pp. 237–260). London, UK: Erlbaum. Dobbing, J. (1968). Vulnerable periods in the developing brain. In A. N. Davison & J. Dobbing (Eds.), Applied neurochemistry (pp. 287–316). Oxford, UK: Blackwell. Dobbing, J. (1975). Prenatal nutrition and neurological development. In N. A. Buchwald & M. A. Brazier (Eds.), Brain mechanisms in mental retardation (pp. 401–420). New York, NY: Academic Press. Elman, J., Bates, E., Johnson, M. H., Karmiloff-Smith, A., Parisi, D., & Plunkett, K. (1996). Rethinking innateness: A connectionist perspective on development.Cam- bridge, MA: MIT Press. Farah, M., Shera, D. M., Savage, J. H., Betancourt, L., Giannetta, J. M., Brodsky, N. L., Malmud, E. K., & Hurt, H. (2006). Childhood poverty: Specific associations with neurocognitive development. Brain Research, 1110(1), 166–174. Finnie, N. R. (2009). Handling the young child with cerebral palsy at home (4th ed.). Oxford, UK: Butterworth Heinemann Elsevier. Fisher, K. W., Bernstein, J. H., & Immordino-Yang, M. H. (Eds.) (2007). Mind, brain, and education in reading disorders. New York, NY: Cambridge University Press. Fletcher, J. M., Lyon, G. R., Fuchs, L. S., & Barnes, M. A. (2007). Learning disabilities: From identification to intervention. New York, NY: Guilford Press. Flynn, J. (1987). Neurophysiologic characteristics of dyslexic subtypes and response to the remediation. Grant awarded by the Initial Teaching Alphabet Founda- tion. Roslyn, New York. Cited by Lyon, G. R., Moats, L, & Flynn, J. M. (1988). From assessment to treatment. Linkage to interventions with children. In M. G. Tramontana & S. R. Hooper (Eds.), Assessment issues in child neuropsychology (pp. 113–144). New York, NY: Plenum Press. Foreman, N. P., Orencas, C., Nicholas, E., Morton, P., & Gell, M. (1989). Spatial awareness in seven to eleven year-old physically handicapped children in mainstream schools. European Journal of Special Needs Education, 4, 171–179. Foreman, N., Stanton, D., Wilson, P., & Duffy, H. (2003). Spatial knowledge of a real school environment acquired from virtual or physical models by able- bodied children and children with physical disabilities. Journal of Experimental Psychology: Applied, 9, 67–74. Foreman, N., Stirk, J., Pohl, J., Mandelkow, L., Lehnung, M., Herzog, A., & Leplow, B. (2000). Spatial information transfer from virtual to real versions of the Kiel Locomotor Maze. Behavioural Brain Research, 112, 53–61.

Frampton, I. (2004). Research in paediatric neuropsychology – past, present and future. Pediatric Rehabilitation, 7(1), 31–36. Galaburda, A. M., Sherman, G. F., Rosen, G. D., Aboitz, F., & Geschwind, N. (1985). Developmental dyslexia: Four consecutive patients with cortical anoma- lies. Annals of Neurology, 18, 222–233. Galperin, P. Y. (1969). Stages in the development of mental acts. In M. Cole & I. Malzman (Eds.), A handbook of contemporary Soviet psychology (pp. 249–273). New York, NY: Basic Books. Gayan, J., & Olson, R. K. (2001). Genetic and environmental influences on orthographic and phonological skills in children with reading disabilities. Developmen- tal Neuropsychology, 20(2), 487–511. Gayan, J., & Olson, R. K. (2003). Genetic and environmental influences on individual differences in printed word recognition. Journal of Experimental Child Psychology, 84(2), 97–123. Gioia, G. A., & Isquith, P. K. (2004). Ecological assessment of executive function in traumatic brain injury. Developmental Neuropsychology, 25, 35–158. Gottlieb, G. (1992). Individual development and evolution.NewYork,NY:Oxford University Press. Gottlieb, G. (2001). The relevance of developmental-psychobiological metathe- ory to developmental neuropsychology. Developmental Neuropsychology, 19(1), 1–9. Grigorenko, E. L., & Naples, A. J. (Eds.). (2008). Single-word reading: Behavioral andbiologicalperspectives. Mahwah, NJ: Erlbaum. Grigorenko,E.L.,Wood,F.B.,Meyer,M.S.,Hart,L.A.,Speed,W.C.,Shuster,A.,& Pauls, D. L. (1997). Susceptibility loci for distinct components of developmental dyslexia on chromosomes 6 and 15. American Journal of Human Genetics, 60(1), 27–39. Hale, J. B., & Fiorello, C. A. (2004). Handbook of school neuropsychology: A practi- tioner’s guide. New York, NY: Guilford Press. Hale, T. S., Hariri, A. R., & McCracken, J. T. (2000). Attention-deficit/hyperactivity disorder: Perspectives from neuroimaging. Mental Retardation and Developmen- tal Disabilities, 6, 214–219. Heaton, R. K. (1981). Wisconsin Card Sorting Test manual.Odessa,FL:Psychological Assessment Resources, Inc. Heckman, J. J. (2006). Skill formation and the economics of investing in disadvan- taged children. Science, 312, 1900–1902. Hensch, T. K. (2005). Critical period plasticity in local cortical circuits. Nature Reviews Neuroscience, 6(11), 877–88. Hooper, S., Swartz, C., Wakely, M., DeKruif, R., & Montgomery, J. (2002). Executive functions in primary school children with and without problems in written expression. Journal of Learning Disabilities, 35, 57–68. Hubel, D. H., Wiesel, T. N., & LeVay, S. (1977). Plasticity of ocular dominance columns in monkey striate cortex. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 278(961), 377–409. Hynd, G. W., & Reynolds, C. R. (2006). School neuropsychology: The evolution of a specialty in school psychology. In R. C. D’Amato, E. Fletcher-Janzen, & C. R. Reynolds (Eds.), Handbook of school neuropsychology (pp. 3–14). New York, NY: Guilford Press.

Hynd,G.W.,Semrud-Clikeman,M.,Lorys,A.R.,Novey,E.S.,&Eliopulos,D. (1990). Brain morphology in developmental dyslexia and attention deficit disorder and hyperactivity. Annals of Neurology, 47, 919–926. Johnson, M. H. (1997). Developmental cognitive neuroscience. Oxford, UK: Black- well. Johnson, M. H., & Karmiloff-Smith, A. (2004). Neuroscience perspectives on infant development. In G. Bremner & A. Slater (Eds.), Theories of infant development (pp. 121–141). Malden, MA: Blackwell. Kaplan, E. (1988). A process approach to neuropsychological assessment. In T. Boll &B.K.Bryant(Eds.),Clinical neuropsychology and brain function: Research, measurement and practice. The master lecture series, Vol. 7 (pp. 125–167). Washington, DC: American Psychological Association. Karmiloff-Smith, A. (1997). Crucial differences between developmental cognitive neuroscience and adult neuropsychology. Developmental Neuropsychology, 13(4), 513–524. Karmiloff-Smith, A. (2002). Development itself is the key to understanding developmental disorders. In M. H. Jonson, Y. Munakata, & R. O. Gilmore (Eds.), Brain development and cognition: A reader (2nd ed., pp. 375–391). Oxford, UK: Blackwell. Karmiloff-Smith, A. (2005). Bates’s Emergentist Theory and its relevance to understanding genotype/phenotype relations. In M. Tomasello & D. I. Slobin (Eds.), Beyond nature-nurture: Essays in honor of Elizabeth Bates (pp. 219–236). Mahwah, NJ: Erlbaum. Kass, S., & Ahlers, R. (1998). Eliminating gender differences through practice on spatial skills in girls and boys. Journal of Applied Developmental Psychology, 15, 13–32. Kaufman, A. S., Long, S. W., & O’Neal, M. R. (1986). Topical review of the WISC-R for pediatric neuroclinicians. Journal of Child Neurology, 1, 89–98. Kibby, M. Y., Kroese, J. M., Morgan, A. E., Hiemenz, J. R., Cohen, M. J., & Hynd, G. W.(2004). The relationship between perisylvian morphology and verbal short- term memory functioning in children with neurodevelopmental disorders. Brain and Language, 89, 122–135. Kirk, S. (1972). Education of exceptional children. Boston, MA: Houghton-Mifflin. Knudsen, E. I., Heckman, J. J., Cameron, J. L., & Shonkoff, J. P. (2006). Economic, neurobiological, and behavioral perspectives on building America’s future work- force. Proceedings of the National Academy of Sciences, 103(27), 10155–10162. Kolb, B., & Fantie, B. (1997). Development of the child’s brain and behavior. In C. R. Reynolds & E. Fletcher-Janzen (Eds.), Handbook of clinical child neuropsychology (2nd ed., pp. 102–119). New York: Plenum Press. Konopka, G., Bomar, J. M., Winden, K., Coppola, G., Jonsson, Z. O., Gao, F., . . . Geschwind, D. H. (2009). Human-specific transcriptional regulation of CNS development genes by FOXP2. Nature, 462, 213–217. Korkman, M., Kirk, U., & Kemp, S. (1998). NEPSY. A developmental neuropsychological assessment. San Antonio, TX: Psychological Corporation. Kozulin, A., & Gindis, B. (2007). Sociocultural theory and education of children with special needs: From Defectology to Remedial Pedagogy. In H. Daniels, M. Cole, & J. Wertsch (Eds.), The Cambridge companion to Vygotsky (pp. 332–362). New York, NY: Cambridge University Press.

Kozulin, A., Gindis, B., Ageyev, V. S., & Miller, S. M. (Eds.) (2003). Vygotsky’s educational theory in cultural context. Cambridge, UK: Cambridge University Press. Lorch, M. P. (1995). Disorders of writing and spelling. In H. S. Kirshner (Ed.), Handbook of neurological speech and language disorders (pp. 295–324). New York, NY: Marcel Dekker. Luria, A. R. (1965). L. S. Vygotsky and the problem of localization of functions. Neurosychology, 3, 387–392. Luria, A. R. (1970) Traumatic aphasia.TheHague:Mouton. Luria, A. R. (1973). The working brain: An introduction to neuropsychology. Translated by B. Haigh. New York, NY: Basic Books. Luria, A. R. (1976). Basic problems of neurolinguistics.TheHague:Mouton. Luria, A. R. (1980). Higher cortical functions in man. New York, NY: Basic Book. Luria, A. R. (1987). The man with a shattered world. Cambridge, MA: Harvard University Press. Luria, A. R., & Tsvetkova, L. S. (1990). The neuropsychological analysis of problem solving.TranslatedbyA.Mikheyev&S.Mikheyev.Orlando,FL:PaulM.Deutsch Press. Marr, D. (1976) Early processing of visual information. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 275(942), 483–524. McBurnett, K., Pfiffner, L. J., & Frick, P.J. (2001). Symptom properties as a function of ADHD type: An argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29(3), 207–213. McComas, J., Pivik, J., & Laflamme, M. (1998). Children’s transfer of spatial learning from virtual reality to real environments. Cyberpsychology and Behavior, 1, 121– 128. Meaney, M. J. (2001). The development of individual differences in behavioral and endocrine responses to stress. Annual Review of Neuroscience, 24, 1161–1192. Milberg, W. P., Hebben, N., & Kaplan, E. (1986). The Boston process approach to neuropsychological assessment. In I. Grant & K. M. Adams (Eds.), Neuropsycho- logical assessment of neuropsychiatric disorders (pp. 65–86). New York, NY: Oxford University Press. Morris, R. D., Stuebing, K. K., Fletcher, J. M., Shaywitz, S. E., Lyon, G., Shankweiler, D. P., et al. (1998). Subtypes of reading disability: Variability around a phonological core. Journal of Educational Psychology, 90(3), 347–373. Nass, R. (2002). Plasticity: Mechanisms, extent, and limits. In Handbook of neuropsychology. Vol. 8, part 1: Child neuropsychology (2nd ed., pp. 29–68). Amsterdam: Elsevier Science. Pennington, B. F. (1993). Diagnosing learning disorders. A neuropsychological framework. New York, NY: Guilford Press. Pennington, B. F. (1999). Toward an integrated understanding of dyslexia: Genetic, neurological, and cognitive mechanisms. Development and Psychopathology [Spe- cial Issue], 11, 629–654. Pennington, B. F. (2002). Genes and brain: Individual differences and human uni- versals. In M. H. Jonson, Y. Munakata, & R. O. Gilmore (Eds.), Brain development and cognition: A reader (2nd ed., pp. 494–508). Oxford, UK: Blackwell. Pennington, B. F. (2006). From single to multiple-deficit models of developmental disorders. Cognition, 101(2), 385–413.

Plomin, R., Owen, M. J., & McGuffin, P.(1994). The genetic basis of complex human behaviors. Science, 264, 1733–1739. Polyakov, V. M. (2004). Neuropsychological screening of child populations. In T. V. Akhutina,J.M.Glozman,L.I.Moskovich,&D.Robbins(Eds.),A. R. Luria and contemporary psychology: Festschrift celebrating the centennial of his birth (pp. 93– 104). New York: Nova Science. Russian ed.: Polyakov V. M. (2002) – see in the list of publications in Russian. Poreh, A. (2000). The quantified process approach: An emerging methodology to neuropsychological assessment. Clinical Neuropsychologist, 14(2), 212–222. 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. Moskovich, & D. Robbins (Eds.), A. R. Luria and contemporary psychology: Festschrift celebrating the centennial of his birth (pp. 157–166). New York: Nova Science. Russian ed.: Pylaeva N. M. (1995) – see in the list of publications in Russian. Ramey, C. T., Campbell, F. A., Burchinal, M., Skinner, M. L., Gardner, D. M., & Ramey, S. L. (2000). The persistent effect of early intervention on high-risk children and their mothers. Applied Developmental Science, 4(1), 2–14. Ramey, S. L., & Ramey, C. T.(2000). Early childhood experiences and developmental competence. In J. Waldfogel & S. Danziger (Eds.), Securing the future: Investing in children from birth to college (pp. 122–150). New York, NY: Russell Sage. Reitan, R. M. (1980). REHABIT – Reitan evaluation of hemispheric abilities and brain improvement training. Tucson, AZ: Reitan Neuropsychological Laboratory. Rose, D., & Foreman, N. (1999). Virtual reality. The Psychologist, 12, 550–554. Rourke, B. P. (Ed.). (1995). Syndrome of nonverbal learning disabilities: Neurodevel- opmental manifestations. New York, NY: Guilford Press. Rourke, B. P., Bakker, D., Fiske, J. L., & Strang, J. D. (1983). Child neuropsychology: An introduction to theory, research, and clinical practice.NewYork,NY:Guilford Press. Rourke, B. P.,&, Finlayson, M. A. J. (1975). Neuropsychological significance of variations in patterns of academic performance: Verbal and visual abilities. Journal of Abnormal Child Psychology, 6, 121–133. Rourke, B. P., Van der Vlugt, H., & Rourke, S. B. (2002). Practice of child-clinical neuropsychology: An introduction. Lisse: Swets & Zeitlinger. Ryabova (Akhutina), T. V. (2003). Mechanism of speech production based on the study of aphasia. Journal of Russian and East European Psychology, 41(3–4), 12–32. Russian ed.: Ryabova (Akhutina), T. V. (1967) – see in the list of publications in Russian. Saarela, M. (1995). “Miten taä¨ pelaa”? – 5–6-vuotiaan kehitysvammaisen lapsen pelaamiseen orientoituminen [“How does it go” – Orientation towards games in mentally retarded children aged 5–6 years]. In Nappuloiden tutkimisesta yhteiseen peli-iloon (pp. 176–200). Riihimaki:¨ Kehitysvammaliitto ry. Valtakunnallinen tutkimus- ja kokeiluyksikko.¨ Schretlen, D. J., Munro, C. A., Anthony, J. C., & Pearlson, G. D. (2003). Examining the range of normal intraindividual variability in neuropsychological test performance. Journal of International Neuropsychological Society, 6, 864–870.

Schweinhart,L.J.,Montie,J.,Xiang,Z.,Barnett,W.S.,Belﬁeld,C.R.,&Nores, M. (2005). Lifetime effects: The HighScope Perry Preschool study through age 40. (Monographs of the HighScope Educational Research Foundation, 14). Ypsilanti, MI: HighScope Press. Segalowitz, S. J., & Hiscock, M. (2002). The neuropsychology of normal development: Developmental neuroscience and a new constructivism. In Handbook of neuropsychology. Vol. 8, part 1: Child neuropsychology (2nd ed., pp. 7–28). Amsterdam: Elsevier Science. Semrud-Clikeman, M., Goldenring Fine, J., & Harder, L. (2005). Providing neuropsychological services to students with learning disabilities. In R. C. D’Amato, E. Fletcher-Janzen, & C. R. Reynolds (Eds.), Handbook of school neuropsychology (pp. 403–424). Hoboken, NJ: John Wiley. Shaywitz, B. A., Shaywitz, S. E., Blachman, B., Pugh, K. R., Fulbright, R., & Skud- larski, P.(2004). Development of left occipito-temporal systems for skilled reading following a phonologically-based intervention in children. Biological Psychiatry, 55(9), 926–933. Shaywitz, S. E., & Shaywitz, B. A. (2005). Dyslexia (speciﬁc reading disability). Biological Psychiatry, 57(11), 1301–1309. Shear, P. (2007, February 9). Quantitative examination of process-based assessment procedures. Paper presented at the Annual Meeting of the International Neu- ropsychological Society, Portland, OR. Shonkoff, J. P. (2006). A promising opportunity for developmental and behavioral pediatrics at the interface of neuroscience, psychology and social policy. Pediatrics, 118(5), 2187–2191. Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press. Simos, P. G., Fletcher, J. M., Denton, C., Sarkari, S., Billingsley-Marshall, R., & Papanicolaou, A. C. (2006). Magnetic source imaging studies of dyslexia interventions. Developmental Neuropsychology, 30(1), 591–611. Slobin D. (1966). Grammatical transformation and sentence comprehension. J. verb. learn. verb. behav., 5, 219–222. Snodgrass, L. (2000). Imagery training improves both spatial skills and graph reading. Abstracts of the 27th International Congress of Psychology, Stockholm. Snowling, M. J. (2000). Dyslexia (2nd ed.). Malden, MA: Blackwell. Spreen, O., Risser, A. H., & Edgell, D. (1995). Developmental neuropsychology.New York, NY: Oxford University Press. Stanton, D., Foreman, N., & Wilson, P. (2002). Effects of early mobility on shortcut performance in a simulated maze. Behavioural Brain Research, 136, 61–66. Stanton, D., Wilson, P., & Foreman, N. (1996). Using virtual reality environments to aid spatial awareness in disabled children. In P. M. Sharkey (Ed.), Proceedings of the 1st European conference on disability, virtual reality and associated technologies (pp. 93–101). Maidenhead, Berkshire, UK: University of Reading. Stiles, J., Bates, E. A., Thal, D., Trauner, G., & Reilly, J. (1998). Linguistic, cognitive, and affective development in children with pre- and perinatal focal brain injury: A ten-year overview from the San Diego Longitudinal Project. In C. Rovee-Collier, L. P. Lipsitt, & H. Hayne (Eds.), Advances in infancy research (pp. 131–163). Stamford, CT: Ablex.

Swanson, H. L., & Berninger, V. W. (1996). Individual differences in children’s working memory and writing skills. Journal of Experimental Child Psychology, 90, 492–505. Tagawa, Y.,Kanold, P.O., Majdan, M., & Shatz, C. J. (2005). Multiple periods of functional ocular dominance plasticity in mouse visual cortex. Natural Neuroscience, 8, 380–388. Tallal, P. (1980). Auditory temporal perception, phonics, and reading disabilities in children. Brain and Language, 9(2), 182–198. Taylor, H. G., Minich, N. M., Bangert, B., Filipek, P. A., & Hack, M. (2004). Long- term neuropsychological outcomes of very low birth weight: Associations with early risks for periventricular brain insults. Journal of the International Neuropsy- chological Society, 10, 987–1004. Temple, C. M. (1997). Developmental cognitive neuropsychology. Hove, UK: Psychol- ogy Press. Temple, C. M., & Marshall, J. C. (1983). A case study of developmental phonological dyslexia. British Journal of Psychology, 74, 517–533. Thal, D., Marchman, V.,Stiles, J., Aram, D., Trauner, D., Nass, R., & Bates, E. (1991). Early lexical development in children with focal brain injury. Brain and Language, 40(4), 491–527. Thelen, E. (1995). Motor development: A new synthesis. American Psychology, 50, 79–95. Thelen, E. (2000). Motor development as foundation and future of developmental psychology. International Journal of Behavioral Development, 24(4), 385– 397. Thelen, E. (2002). Self-organization in developmental processes: Can systems approaches work? In M. H. Jonson, Y. Munakata, & R. O. Gilmore (Eds.), Brain development and cognition: A reader (2nd ed., pp. 336–374). Oxford, UK: Black- well. Tulsky,D.S.,Saklofske,D.H.,Chelune,G.J.,Heaton,R.K.,Ivnik,R.J.,Bornstein, R., Priﬁtera, A., & Ledbetter, M. F. (2003). Clinical interpretation of WAIS-III and WMS-III. San-Diego, CA: Academic Press. Tupper, D. E., & Cicerone, K. D. (Eds.) (1991). The neuropsychology of everyday life: Issues in development and rehabilitation. Boston, MA: Kluwer Academic. U.S. Department of Education, Ofﬁce of Educational Research and Improvement (1993). Digest of educational statistics: 1993. Washington DC: Author. Vygotsky, L. S. (1988). The collected works of L.S. Vygotsky. Vol. 1: Problems of general psychology, including the volume Thinking and Speech.EditedbyR.W.Rieber& A. S. Carton. New York, NY: Plenum Press. Vygotsky, L. S. (1993). ThecollectedworksofL.S.Vygotsky.Vol.2:Thefundamentals of defectology (abnormal psychology and learning disabilities).EditedbyR.W. Rieber & A. S. Carton. New York, NY: Plenum Press. Vygotsky, L. S. (1997a). The collected works of L. S. Vygotsky. Vol. 3: Problems of the theory and history of psychology.EditedbyR.W.Rieber&J.Wollock.London, UK: Plenum Press. Vygotsky, L. S. (1997b). ThecollectedworksofL.S.Vygotsky.Vol.4:Thehistoryof the development of the higher mental functions.EditedbyR.W.Rieber.NewYork, NY: Plenum Press.

Vygotsky, L. S. (1998). ThecollectedworksofL.S.Vygotsky.Vol.5:Childpsychology. Edited by C. Ratner. New York, NY: Plenum Press. Vygotsky, L. S. (1999) The collected works of L. S. Vygotsky. Vol. 6: Scientific legacy. Edited by R. W. Rieber. New York, NY: Plenum Press. Waber, D. P. (2010). Rethinking learning disabilities: Understanding children who struggle in school. New York, NY: Guilford Press. Waber, D. P., Wolff, P. H., Forbes, P. W., & Weiler, M. D. (2000). Rapid automatized naming in children referred for evaluation of heterogeneous learning problems: How specific are naming speed deficits to reading disability? Child Neuropsychol- ogy, 6(4), 251–261. Weiler, M. D., Bernstein, J., Bellinger, D. C., & Waber, D. P.(2000). Processing speed in children with attention deficit/hyperactivity disorder, inattentive type. Child Neuropsychology, 6(3), 218–34. Weiler, M. D., Bernstein, J., Bellinger, D. C., & Waber, D. P. (2002). Information processing deficits in children with attention deficit/hyperactivity disorder, inattentive type, and children with reading disability. Journal of Learning Disabilities, 35(5), 448–461. Wertsch, J. V. (1985). Vygotsky and the social formation of mind.Cambridge,MA: Harvard University Press. White, R. F., & Rose, F. E. (1997). The Boston process approach. A brief history and current practice. In G. Goldstein & T. M. Incagnoli (Eds.), Contemporary approaches to neuropsychological assessment (pp. 171–211). New York, NY: Plenum Press. Wilson, P. N., Foreman, N., Gillet, R. et. al. (1997). Active versus passive processing of spatial information simulated enviroment. Ecological Psychology, 9, 207–222. Wood, D., Bruner, J. C., & Ross, G. (1976). The role of tutoring in problem solving. Journal of Child Psychology and Psychiatry, 17, 89–100. Wulfeck, B., Trauner, D., & Tallal, P. (1991). Neurologic, cognitive and linguistic features of infants after focal brain injury. Pediatric Neurology, 7, 266–269. Ylvisaker, M. (2003). Context-sensitive cognitive rehabilitation after brain injury: Theory and practice. Brain Impairment, 4(1), 1–16. Ylvisaker, M., & Feeney, T. (2008). Helping children without making them helpless: Facilitating development of executive self-regulation in children and adolescents. In V.Anderson, R. Jacobs, & P.Anderson (Eds.), Executive functions and the frontal lobes: A lifespan perspective (pp. 409–438). New York, NY: Psychology Press. Zavershneva, E. I. (2010). The Vygotsky family archive: New findings. Notebooks, notes, and scientific journals of L. S. Vygotsky (1912–1934). Journal of Russian and East European Psychology, 48(1), 34–60.

publications in russian Akhutina, T. V. (1975/2002). Neirolingvisticheskii analiz dinamicheskoi afazii [The neurolinguistic analysis of dynamic aphasia]. Moscow: Moscow University Press. 2nd edition: Moscow: Terevinf. Akhutina, T. V.(1989/2008). Porozhdenie rechi. Neirolingvisticheskii analiz sintaksisa [Language production: Neurolinguistic analysis of syntax]. Moscow: Moscow University Press. 3rd edition: Moscow: URSS.

Akhutina, T. V. (1996). L. S. Vygotsky i A. R. Luria: Stanovlenie neiropsikhologii [L. S.VygotskyandA.R.Luria:Foundationsofneuropsychology].Voprosy psikhologii [Problems of Psychology], 5, 83–98. Akhutina, T. V. (1998a). Neiropsikhologiya individual’nykh razlichiy detey kak osnova ispol’zovaniya neiropsikhologicheskikh metodov v shkole [Neuropsy- chology of individual differences in children as a basis for the use of neuropsychological methods in school]. In T. V. Akhutina & E. D. Khomskaya (Eds.), I Mezhdunarodnaya konferentsiya pamyati A. R. Luriya. Sbornik dokladov [First International Luria Memorial Conference: Collection of selected contributions] (pp. 201–208). Moscow: Russian Psychological Society. Akhutina, T. V. (1998b). Neirolingvistika normy [Neurolinguistics of normal subjects]. In T. V. Akhutina & E. D. Khomskaya (Eds.), I Mezhdunarodnaya konferentsiya pamyati A. R. Luriya. Sbornik dokladov [First International Luria Memo- rial Conference: Collection of selected contributions] (pp. 289–298). Moscow: Russian Psychological Society. Akhutina, T. V. (2001). Trudnosti pis’ma i ikh neiropsikhologicheskaya diagnostika. [Difficulties of writing and their neuropsychological diagnostics]. In O. B. Inshakova (Ed.), Pis’mo i chtenie: Trudnosti obucheniya i korrektsiya [Writing and reading: Learning difficulties and remediation] (pp. 7–20). Moscow: MPSI. Akhutina, T. V. (2004). Kul’turno-istoricheskie i estestvenno-nauchnye osnovy neiropsikhologii [Cultural-historical and nature-scientific fundamentals of neuropsychology]. Psikhologicheskii zhurnal [Psychological Journal], 4, 20–27. Akhutina, T. V. (2007). Rol’ L. S. Vygotskogo v razvitii neiropsikhologii [The role of Vygotsky L.S. in the development of neuropsychology]. Metodologiya i istoriya psikhologii [Methodology and History of Psychology], 2(4), 58–67. Akhutina, T. V., Ignat’eva, S. Y., Maksimenko, M. Y., Polonskaya, N. N., Pylaeva, N. M., & Yablokova, L. V.(1996). Metody neiropsikhologicheskogo obsledovaniya detey 6–8 let [Methods of neuropsychological assessment of children 6–8 years old]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow Univer- sity Bulletin. Series 14, Psychology], 2, 51–58. Akhutina, T. V., & Kamardina, I. O. (2008). Korrektsionno-razvivayushchaya pomoshch detyam s trudnostyami obucheniya, osnovannaya na ideyakh L. S.Vygotskogo i A. R. Lurii: Analiz effektivnosti [Remedial-developmental help to children with learning difficulties, based on the ideas of Vygotsky and Luria: Analysis of effectiveness]. Kul’turno-istoricheskaya psikhologiya [Cultural- Historical Psychology], 1, 58–69. Akhutina, T. V., & Krichevets, A. N. (2002). Ispol’zovanie virtual’nykh sred dlya razvitiya prostranstvennykh funktsiy u detey s tserebral’nym paralichom [Using virtual environments for the development of spatial functions in children with cerebral palsy]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 4, 77–85. Akhutina, T. V., Manelis, N. G., Pylaeva, N. M., & Khotyleva, T. Y. (1999/2006). Skoro shkola. Puteshestvie s Bimom i Bomom v stranu matematiku [School is soon: Traveling with Bim and Bom in the country of mathematics]. Moscow: Terevinf. Akhutina, T. V., Polonskaya, N. N., Pylaeva, N. M., Maksimenko, M. Y., et al. (2008). Metodiki neiropsikhologicheskoi diagnostiki detei [Methods of

neuropsychological assessment of children]. In T. V. Akhutina & O. B. Inshakova (Eds.), Neiropsikhologicheskaya diagnostika, obsledovanie pis’ma i chteniya mladshikh shkolnikov [Neuropsychological diagnostics, writing and reading assessment in junior schoolchildren] (pp. 4–64). Moscow: Sfera; V. Sekachev. Akhutina, T. V., & Pylaeva, N. M. (1995). Neiropsickhologicheskiy podhod k korrektsii trudnostey obucheniya [Neuropsychological approach to the remediation of learning disabilities]. In E. D. Khomskaya (Ed.), Neiropsikhologiya segodnya [Neuropsychology today] (pp. 160–169). Moscow: Moscow University Press. Akhutina, T.V.,& Pylaeva, N. M. (2003a). Diagnostika razvitiya zritel’no-verbal’nykh funktsiy [Diagnostics of development of visual-verbal functions]. Moscow: Akademiya. Akhutina, T. V., & Pylaeva, N. M. (2003b). Metodologiya neiropsikhologicheskogo soprovozhdeniya detei s neravnomernost’yu razvitiya psikhicheskikh funktsii [Methodology of neuropsychological support of children with uneven development of higher mental functions]. In T. V. Akhutina & Z. M. Glozman (Eds.), A. R. Luriya i psikhologiya XXI veka: Doklady Vtoroi Mezhdunarodnoi konferentsii, posvyashchennoi 100-letiyu so dnya rozhdeniya A. R. Luriya [Alexander Luria and psychology of the XXIst century: Proceedings of the Second International Luria Memorial Conference] (pp. 181–189). Moscow: Smysl. Akhutina, T. V., Pylaeva, N. M., & Kamardina, I. O. (in press). Neiropsikholog v shkole [The neuropsychologist at school]. Moscow: Terevinf. Akhutina, T. V., Pylaeva, N. M., & Yablokova, L. V. (1995). Neiropsikhologicheskiy podkhod k profilaktike trudnostey obucheniya. Metody razvitiya navykov programmirovaniya i kontrolya [Neuropsychological approach to the prevention of learning difficulties. Methods of programming and control functions development]. Shkola zdorov’ya [School of Health], 2(4), 66–84. Akhutina, T. V., Velichenkova, O. A., & Inshakova, O. B. (2004). Disgrafiya: Neirop- sikhologicheskiy i psikhologo-pedagogicheskiy analiz [Dysgraphia: Neuropsy- chological and psychological-pedagogical analysis]. In L.A. Piotrovskaya & T.V. Chernigovskaya (Eds.), Chelovek pishushchiy i chitayushchiy: problemy i nablyu- deniya [Writing and reading man: problems and observations] (pp. 82–97). St. Petersburg: St. Petersburg University Press. Akhutina, T. V., Yablokova, L. V., & Polonskaya, N. N. (2000). Neiropsikhologich- eskiy analiz individual’nykh razlichiy u detey: Parametry otsenki [Neuropsycho- logical analysis of individual differences in children: Parameters of assessment]. In E. D. Homskaya & V. A. Moskvin (Eds.), Neiropsikhologiya i fiziologiya individual’nykh razlichiy Neuropsychology and physiology of individual differences (pp. 132–152). Moscow-Orenburg: OOIPKRO Publishing House. Akhutina T. V., Zasypkina K. V., & Romanova A. A. (2009). Analiz smyslovoy storony rechi u detey 5-7 let s tochki zreniya kontseptsii rechemyshleniya L. S. Vygotskogo.[Theanalysisofsensesideofspeechin5-to7-year-oldchildren from the point of view of Vygotsky’s conception of thought and language]. In E. F. Kirov & G. M. Bogomazov (Eds.) Sistema yazyka i yazykovoe myshlenie [The system of language and verbal thinking] (pp. 162-173), M.: Librokom. Akhutina, T. V., & Zolotareva, E. V. (1997). O zritel’no-prostranstvennoy disgrafii: neiropsikhologicheskiy analiz i metody korrektsii [On visual-spatial dysgraphia:

Neuropsychological analysis and methods of remediation]. Shkola zdorov’ya [School of Health], 3, 38–42. Asmolov, A. G. (1996). Ot prakticheskoy psikhologii – k razvivayushchemu obra- zovaniyu [From practical psychology toward developmental education]. Detskiy prakticheskiy psikholog [Child Practical Psychologist], 1–2, 9–13. Bakhtina, E. V. (2001). Tablitsa umnozheniya [Multiplication table]. Moscow: Eksmo-Press. Borisova, O. V.,& Galaktionova, O. G. (2000). Ispol’zovanie konstruktora “Lego” na urokakh obucheniya gramote v 1 klassakh KRO [Using the constructor “Lego” in grammar lessons in Grade 1 of remedial education program]. In Ukreple- nie zdorov’ya v shkole. Materialy vserossijskoi nauchno-prakticheskoi konferentsii [Health promotion in schools. Abstracts of All-Russian scientiﬁc-practical conference]. Kazan’: Ministerstvo obrazovaniya RF. Chentsov, N. Y., Simernitskaya, E. G., & Obukhova, L. F. (1980). Neiropsikho- logicheskiy analiz narusheniy prostranstvennykh predstavleniy u detey i vzroslykh [Neuropsychological analysis of disorders of spatial representations in children and adults]. Vestnik Moskovskogo universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 3, 63–71. Davydov, V. V. (Ed.) (1990). Psikhicheskoe razvitie mladshikh shkol’nikov [Psycho- logical development of junior schoolchildren]. Moscow: Pedagogika. Doronova, T. N., Yakobson, S. G., Solov’eva, E. V, Grizik, T. I., & Gerbova, V. V. (1992). Raduga: Posobie dlya vospitateley detskogo sada [Rainbow: Handbook for teachers of kindergarten]. Moscow: Prosveshchenie. Dubrovina, I. V. (Ed.). (1991). Rabochaya kniga shkol’nogo psikhologa [Workbook of a school psychologist]. Moscow: Prosveshchenie. Dubrovinskaya, N. V. (1996). Neiroﬁziolog v shkole [Neurophysiologist at school]. Shkola zdorov’ya [School of Health], 1, 24–35. Egorova, M. S., & Maryutina, T. M. (1992). Razvitie kak predmet psikhogenetiki [The development as a subject of psychogenetics]. Voprosy psikhologii [Problems of Psychology], 5–6, 3–14. Farber, D. A. (Ed.). (1990). Strukturno-funktsional’naya organizatsiya razvi- vayushchegosya mozga [Structural and functional organization of the developing brain]. Moscow: Nauka. Fotekova, T.A. (2004). Razvitie vysshikh psikhicheskikh funktsiy v shkol’nom vozraste [The development of higher mental functions at school age]. Abakan: Khakassian University Press. Fotekova, T. A., & Akhutina, T. V. (2007). Diagnostika rechevych narusheniy shkol’nikov s ispol’zovaniyem neiropsickhologicheskikh metodov (metodicheskoe posobiye). [Diagnostics of speech disorders of schoolchildren with the use of neuropsychological methods] (2nd ed.). Moscow: Airis-Press. Gadzhiev, S. G. (1966). Narushenie naglyadnoy intellektual’noy deyatel’nosti pri porazheniyakh lobnykh doley mozga [Disorder of visual intellectual activity in frontal lobe lesions]. In A. R. Luria & E. D. Khomskaya (Eds.), Lobnye doli i regulyatsiya psikhicheskikh protsessov [The frontal lobes and the regulation of mental processes] (pp. 618–640). Moscow: Moscow University Press. Gesell, A. (1930). Umstvennoerazvitierebenka[Child’s mental development]. Moscow: Rabotnik prosveshcheniya.

Glozman, Z. M. (2002). Kulturno-istoricheskiy podkhod kak osnova neiropsikhologii XXI veka [Cultural historical approach as the basis of neuropsychology in the 21st century]. Voprosy psikhologii [Problems of Psychology], 4, 62– 68. Ivanova, A. Y. (1976). Obuchaemost’ kak printsip otsenki umstvennogo razvitiya detei [Learning aptitude as a principle of assessment of children’s cognitive development]. Moscow: Pedagogika. Kalita, N. G. (1975). Metody vosstanovleniya nominativnoy funktsii rechi pri akustiko-mnesticheskoy afazii [Methods of restoring the nominative function of language in acoustic mnestic aphasia]. In L. S. Tsvetkova (Ed.), Problemy afazii i vosstanovitel’nogo obucheniya [The problems of aphasia and rehabilitative training] (pp. 183–195). Moscow: Moscow University Press. Kapustina, G. M. (1989). Kharakteristika elementarnykh matematicheskikh znaniy i umeniy detey s ZPR shestiletnego vozrasta [Characteristics of elementary mathematical knowledge and skills of 6 years old children with delay of mental development]. In V. I. Lubovskiy & N. A. Tsypina (Eds.), Gotovnost’ k shkol’nomu obucheniyu detey s zaderzhkoy psikhicheskogo razvitiya 6-letnego vozrasta [Readi- ness for school in children with delay of mental development at age of six] (pp. 90–115). Moscow: APN SSSR Press. Khomskaya, E. D. (1996). Rol’ L. S. Vygotskogo v tvorchestve A. R. Luria [The role of Vygotsky in the works of Luria]. Voprosy psikhologii [Problems of Psychology], 5, 72–83. Khomskaya, E. D. (1998). Lateral’naya organizatsiya mozga kak neiropsikhologicheskaya osnova tipologii normy [Lateral organization of the brain as the neuropsychological basis of typology of normal subjects]. In T. V. Akhutina &E.D.Khomskaya(Eds.),I Mezhdunarodnaya konferentsiya pamyati A. R. Luriya. Sbornik dokladov [First International Luria Memorial Conference: Col- lection of selected contributions] (pp. 138–144). Moscow: Russian Psychological Society. Khomskaya, E. D., Efimova, I. V.,Budyka, E. V.,& Enikolopova, E. V.(1997). Neirop- sikhologiya individual’nykh razlichiy [Neuropsychology of individual differences]. Moscow: Rospedagentstvo. Khotyleva (Trosman), T. Y. (1998). Neiropsikhologicheskiy podkhod k organizatsii obucheniya v klassakh KRO [Neuropsychological approach to learning in remedial classes]. Razvitie i korrektsiya [Development and Remediation], 3. Khotyleva, T. Y. (2006). Pedagogicheskie usloviya preodoleniya trudnostey v obrazo- vatel’noy rabote s doshkol’nikami 5–7 let. Dissertatsiya . . . kand. pedagogicheskikh nauk [Pedagogical conditions to overcome difficulties in the educational work with 5–7 years old preschool children]. PhD dissertation. Khotyleva, T. Y., Galaktionova, O. G., & Borisova, O. V. (2006). Preodolenie trudnostey pri obuchenii matematike na rannem etape [Overcoming the difficulties of learning mathematics at the early stage]. Shkola zdorov’ya [School of Health], 3, 5–22. Kogan, V. M., & Korobkova, E. A. (1967). Printsipy i metody psikhologicheskogo obsledovaniya v praktike vrachebno-trudovoy ekspertizy. Metodologisheskoe pis’mo TsIETIN [Principles and methods of psychological assessment in the medical- labor examination practice. Methodical letter of TsIETIN]. Moscow: TsIETIN.

Korneev, A. A., Krichevets, A. N., Babaeva, Y. D., & Akhutina, T. V. (2002). Psikho- logicheskiy analiz effektivnosti obucheniya pis’mu [Psychological analysis of the effectiveness of learning to write]. Shkola zdorov’ya [School of Health], 4, 44–50. Kornev, A. N. (1997). Narusheniya chteniya i pis’ma u detey [Disorders of reading and writing in children]. St. Petersburg: ID MiM. Korsakova, N. K., Mikadze, Y. V., & Balashova, E. Y. (1997). Neuspevayushchie deti: Neiropsikhologicheskaya diagnostika trudnostey obucheniya [Underachiev- ing children: Neuropsychological diagnostics of learning difficulties]. Moscow: Pedagogicheskoe obshchestvo Rossii. Kozlova, Z. M. (1998). Issledovanie zritel’no-verbal’nykh funktsiy u detey mladshego vozrasta: Diplomnaya rabota [The study of visual-verbal functions in young children]. Master’s thesis, Moscow State University. Krasovskaya, O. A. (1980). O narusheniyakh zritel’no-pertseptivnykh funktsiy pri ochagovykh porazheniyakh mozga v detskom vozraste [On disorders of the visual-perceptual functions in focal brain lesions in childhood]. In A. N. Leont’ev, E. D. Khomskaya, & E. Y. Artem’eva (Eds.), Problemy meditsinskoy psikhologii [Problems of medical psychology] (pp. 79–88). Moscow: Moscow University Press. Ksenzenko, A. A. (1998). Zritel’nyy gnozis detey 6–7 let: Diplomnaya rabota [Visual gnosis of 6–7 year-old children]. Master’s thesis, Moscow State University. Kukolevskaya, G. I., & Lomova, N. V. (2007). Matematika. Rabochaya tetrad’. Uchimtablitsuumnozheniya[Math workbook: Learning the multiplication table]. Moscow: Perspektiva. Kurganskiy, A. V., & Akhutina, T.V.(1996). Trudnosti v obuchenii i seriynaya organizatsiya dvizheniy u detey 6–7 let [Learning difficulties and the serial organization of movements in 6–7 years old children]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 2, 58–64. Lalaeva, P. M. (1989). Narusheniya pis’mennoy rechi [Disorders of written language].InL.S.Volkova(Ed.),Logopediya [Logopaedics] (pp. 345–382). Moscow: Prosveshchenie. Lebedinskiy, V. V., Markovskaya, I. F., Lebedinskaya, K. S., Fishman, M. N., & Trush, V. G. (1982). Kliniko-neiropsikhologicheskiy i neirofiziologicheskiy analiz anomaliy psikhicheskogo razvitiya detey s yavleniyami “minimal’noy moz- govoy disfunktsii” [Clinical-neuropsychological and neurophysiological analysis of abnormalities of mental development of children with symptoms of “minimal braindysfunction.”].InE.D.Khomskaya,L.S.Tsvetkova,&B.V.Zeigarnik (Eds.), A. R. Luria i sovremennaya psikhologiya [A.R. Luria and contemporary psychology] (pp. 62–68). Moscow: Moscow University Press. Levchenko, I. Y., & Prikhodko, O. G. (2001). Tekhnologii obucheniya i vospitaniya detey s narusheniyami oporno-dvigatel’nogo apparata [Technologies of training and education of children with disorders of the musculoskeletal system]. Moscow: Akademiya. Lobok, A. M. (1998). Drugaya matematika [Another math]. Moscow: Narodnoe obrazovanie. Lubovskiy, V. I., & Kuznetsova, L. V. (1984). Psikhologicheskie problemy zaderzhki psikhicheskogo razvitiya [Psychological problems in delay of mental development]. In T. A. Vlasova, V. I. Lubovskiy, & N. A. Tsypina (Eds.), Deti s zaderzhkoy

psikhicheskogo razvitiya [Children with delay of mental development] (pp. 6–19). Moscow: Pedagogika. Luria, A. R. (1950). Ocherki psikhoﬁziologii pis’ma [Essays on the psychophysiology of writing]. Moscow: APN RSFSR Press. Luria, A. R., Simernitskaya, E. G., & Tybulevich, B. (1973). Ob izmenenii mozgovoi organizatsii psikhicheskikh protsessov po mere ikh funktsional’nogo razvitiya [On changes in the brain organization of psychological processes during their functional development]. In A. N. Leontiev, A. R. Luria, & E. D. Khomskaya (Eds.), Psikhologicheskie issledovaniya [Psychological studies]. (Vol. 4, pp. 111– 119). Moscow: Moscow University Press. Luria, A. R., & Tsvetkova, L. S. (1996). Neiropsikhologiya i problemy obucheniya v obshcheobrazovatel’noy shkole [Neuropsychology and the learning problems in mainstream school]. Moscow: Institut prakticheskoy psikhologii; Voronezh: NPO “MODEK.” Luria, E. A. (2004). Moy otets A. R. Luriya [A.R.Luriaismyfather].Moscow: Gnozis. Manelis, N. G. (1997). Razvitie optiko-prostranstvennykh funktsiy v ontogeneze [The development of optical-spatial functions in ontogeny]. Shkola zdorov’ya [School of Health], 3, 25–37. Melikyan, Z. A., & Akhutina, T. V. (2002). Sostoyanie zritel’no-prostranstvennykh funktsiy u detey v norme i s zaderzhkoy psikhicheskogo razvitiya [State of visual- spatial functions in normal children and children with delay of mental development]. Shkola zdorov’ya [School of Health], 1, 28–36. Meshcheryakov, B. G. (1998). Logiko-semanticheskiy analiz kontseptsii L. S. Vygot- skogo [Logico-semantic analysis of Vygotsky’s conception]. Samara: Samara Ped- agogical Academia Press. Mikadze, Y. V. (2002). Differentsial’naya neiropsikhologiya detskogo vozrasta [Dif- ferential neuropsychology of childhood]. Voprosy psikhologii [Problems of Psy- chology], 4, 111–119. Mikadze, Y.V.(2008). Neiropsikhologiya detskogo vozrasta [Child neuropsychology]. St. Petersburg: Piter. Mikhaylova, Z. A. (1985). Igrovye zanimatel’nye zadachi dlya doshkol’nikov [Game entertaining tasks for preschoolers]. Moscow: Prosveshchenie. Nikitin, B. P., & Nikitina, L. A. (1990). Razvivayushchie igry dlya detey [Developing games for children]. Moscow: Fizkul’tura i sport. Nosova, E. A., & Nepomnyashchaya, R. L. (2007). Logika i matematika dlya doshkol’nikov [Logic and math for preschoolers]. St. Petersburg: Detstvo-Press. Osipova, E. A., & Pankratova, N. V. (1997). Dinamika neiropsikhologicheskogo statusa u detey s razlichnymi variantami techeniya sindroma deﬁtsita vnimaniya i giperaktivnosti [Dynamics of neuropsychological status of children with different variants of ADHD]. Shkola zdorov’ya [School of Health], 4, 34–43. Perezhigina, N. V. (1999). Rol’ organizatsii kognitivnogo opyta rebenka starshego doshkol’nogo vozrasta v razvitii produktivnogo voobrazheniya. Avtoreferat diss. na soiskanie uchenoy stepeni kand. psikhol. nauk [Role of the organization of cognitive experience of the child of preschool age in the development of productive imagination]. PhD dissertation, Moscow: Insitut of Psychology RAO.

Plomin, R., & Price, T. S. (2001). Genetika i kognitivnie sposobnosti [Genetics and cognitive abilities]. Inostrannaya psihologia [Foreign Psychology], 14, 6–16. Polonskaya, N. N. (1999). Primenenie neiropsikhologicheskogo metoda issledovaniya v diagnostike detey s narusheniyami rechi [Use of neuropsychological method in the diagnostics of children with speech disorders]. Shkola zdorov’ya [School of Health], 2, 72–79. Polonskaya, N. N. (2002). Neiropsikhologicheskiy podkhod k korrektsii trudnostey resheniya zadach mladshimi shkol’nikami [Neuropsychological approach to the remediation of difﬁculties of solving problems by junior pupils]. Shkola zdorov’ya [School of Health], 2, 53–56. Polonskaya, N. N. (2003). Neiropsikhologicheskie osobennosti detey s raznoy uspeshnost’yu obucheniya [Neuropsychological features of children with different learning success]. In T. V. Akhutina & Z. M. Glozman (Eds.), A. R. Luriya i psikhologiya XXI veka: Doklady Vtoroi Mezhdunarodnoi konferentsii, posvyashchennoi 100-letiyu so dnya rozhdeniya A. R. Luriya [Alexander Luria and psychology of the 21st century: Proceeedings of the Second International Luria Memorial Conference] (pp. 206–214). Moscow: Smysl. Polonskaya, N. N. (2007). Neiropsikhologicheskaya diagnostika detey mladshego shkol’nogo vozrasta [Neuropsychological diagnostics of children of primary school age]. Moscow: Akademiya. Polonskaya, N. N., Yablokova, L. V., & Akhutina, T. V. (1997). Dinamika funktsiy programmirovaniya i kontrolya i ee svyaz’ s trudnostyami obucheniya mladshikh shkol’nikov [Dynamics of programming and control functions and its relation to learning difﬁculties of primary schoolchildren]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 2, 42–51. Puente, A. (1998). Primenenie Lurievskogo podkhoda v SShA [The application of Luria’s approach in North America]. In T. V.Akhutina & E. D. Khomskaya (Eds.), I Mezhdunarodnaya konferentsiya pamyati A. R. Luriya. Sbornik dokladov [First International Luria Memorial Conference: Collection of selected contributions] (pp. 73–75). Moscow: Russian Psychological Society. Pylaeva, N. M. (1995). Opyt neiropsikhologicheskogo issledovaniya detei 5–6 let s zaderzhkoi psikhicheskogo razvitiya [Experience of neuropsychological assessment of 5–6-year-old children with delayed mental development]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 3, 37–45. Pylaeva, N. M. (1996). Neiropsikhologicheskaya podderzhka i korrektsiya detey s osobennostyami razvitiya [Neuropsychological support and remediation of children with disabilities]. In V. I. Slobodchikov (Ed.), Podkhody k reabilitatsii detey s osobennostyami razvitiya sredstvami obrazovaniya [Approaches to rehabilitation of children with disabilities through education] (pp. 267–272). Moscow: IPI RAO Press. Pylaeva, N. M. (1998). Neiropsikhologicheskaya podderzhka klassov korrektsionno- razvivayushchego obucheniya [Neuropsychological support of classes of remedial-developing education]. In T. V. Akhutina & E. D. Khom- skaya (Eds.), I Mezhdunarodnaya konferentsiya pamyati A. R. Luriya.

Sbornik dokladov [First International Luria Memorial Conference: Collec- tion of selected contributions] (pp. 238–244). Moscow: Russian Psychological Society. Pylaeva, N. M., & Akhutina, T. V. (1997/2008). Shkola vnimaniya. Metodika razvitiya i korrektsii vnimaniya u detei 5–7 let (Metodicheskoe posobie i Didakticheskii material) [School of attention. The method of development and remediation of attention in 5- to 7-year-old children (Toolkit and didactic material)]. Moscow: “Intor.” 4th ed. St. Petersburg: Piter. Pylaeva, N. M., & Akhutina, T. V. (2000). Metodika “Slozhi figuru” v diagnostike i korrektsii zritel’no-prostranstvennykh trudnostey [“Make a figure” method in diagnostics and remediation of visual-spatial difficulties]. Shkola zdorov’ya [School of Health], 3, 26–30. Pylaeva, N. M., & Akhutina, T. V. (2006). Shkola umnozheniya. Metodika razvitiya vnimaniya u detey 7–9 let. (Metodicheskie ukazaniya i Rabochaya tetrad’) [School of multiplication. Method of development of attention in children of 7–9 years old: Guidelines and workbook]. Moscow: Terevinf. Pylaeva, N. M., & Akhutina, T.V.(2008). Uchims’a videt’ i nazyvat’.Razvitie zritel’no- verbal’nykh funktsii u detei 5–7 let [Learning to see and name. Development of visual-verbal functions in 5- to 7-year-old children]. St. Petersburg: Piter. Rubinshtein, S. Y. (1979). Psikhologiya umstvenno otstalogo shkol’nika [Psychology of a mentally retarded student]. Moscow: Prosveshchenie Press. Ryabova (Akhutina), T. V. (1967). Model’ porozhdeniya rechi po dannym afazi- ologii. [The model of speech production based on the study of aphasia]. In A. A. Leontiev&T.V.Ryabova(Eds.),Voprosy porozhdeniya rechi i obucheniya yazyku [Problems of speech generation and language learning] (pp. 76–94). Moscow: Moscow University Press. Sadovnikova, I. N. (1995). Narusheniya pis’mennoy rechi i ikh preodolenie u mladshikh shkol’nikov [Disorders of written speech and their overcoming in pupils of primary school]. Moscow: Vlados. Safonova, E. G. (1993). Ritm i zvuki: Posobie po fonetike dlya izuchayushchikh russkiy yazyk kak inostrannyy [Rhythm and sounds: Guide to phonetics for studying Russian as a foreign language]. Moscow: GITIS. Samukhin, N. V., Birenbaum, G. V., & Vygotsky, L. S. (1934). K voprosu o struk- ture dementsii pri bolezni Pika [The problem of the structure of dementia in Pick’s disease]. Sovetskaya nevropatologiya, psikhiatriya i psikhogigiena [Soviet Neuropathology, Psychiatry and Psychohygiene], 3(6), 97–136. Semago, N. Y. (2000). Sovremennye podkhody k formirovaniyu prostranstvennykh predstavleniy u detey kak osnovy kompensatsii trudnostey osvoeniya programmy nachal’noy shkoly [Current approaches to the formation of spatial representations in children as a basis for compensation for the difficulties of mastering primary school programs]. Defektologiya [Defectology], 1, 12–18. Semago, N. Y., & Semago, M. M. (2001). Problemnye deti. Osnovy diagnosticheskoy i korrektsionnoy raboty psikhologa [Problem children: Fundamentals of diagnostic and remedial work of a psychologist]. Moscow: ARKTI. Semenovich, A. V. (Ed.). (1998). Kompleksnaya metodika psikhomotornoy korrektsii [Complex method of psychomotor remediation]. Moscow: MGPU.

Semenovich, A. V. (2002). Neiropsikhologicheskaya diagnostika i korrektsiya v detskom vozraste [Child neuropsychological diagnostics and remediation]. Moscow: Akademiya. Semenovich, A. V.(2005). Vvedenie v neiropsikhologiyu detskogo vozrasta [Introduc- tion to child neuropsychology]. Moscow: Genezis. Shcheblanova, E. I. (1999). Neuspeshnye odarennye shkol’niki: Ikh problemy i osobennosti [Unsuccessful gifted students: Their problems and peculiarities]. Shkola zdorov’ya [School of Health], 3, 41–51. Simernitskaya, E. G. (1985). Mozg cheloveka i psikhicheskie protsessy v ontogeneze [The human brain and psychological processes in ontogenesis]. Moscow: Moscow University Press. Simernitskaya, E. G., & Matyugin, I. Y. (1991). Neiropsikhologicheskaya diagnostika i korrektsiya shkol’noy neuspevaemosti [Neuropsychological diagnostics and remediation of school underachievement]. Moscow: VASKhNIL. Skityaeva, N. M. (2010). Razvitie zritel’no-predmetnogo vospriyatiya i rechi v grup- pakh podgotovki detey k shkole. Avtoreferat diss. na soiskanie uchenoy stepeni kand. psikhol. nauk [The development of visual-object perception and language in groups to prepare children for school]. PhD dissertation, Moscow University of Psychology and Education. Skityaeva, N. M. & Akhutina T.V.(2011). Razvitie zritel’no-predmetnogo vospriyatiya irechiudetey. [The development of visual-object perception and language in children]. Saarbruecken: LAP LAMBERT Academic Publishing Gmbh & Co. Tikhomirova, L. F., & Basov, A. V. (1995). Razvitie logicheskogo myshleniya detey [Development of children’s logical thinking]. Yaroslavl’: Akademiya Razvitia. Triger, R. D. (2000). Podgotovka k obucheniyu gramote [Preparation for literacy training]. Smolensk: OOO Izdatel’stvo “Assotsiatsiya XXI vek.” Tsvetkova, L. S. (1966). Narushenie konstruktivnoi deyatel’nosti pri porazheniyakh lobnykh i temenno-zatylochnykh otdelov mozga [Disturbance of constructive activity in frontal and parietal-occipital brain lesions]. In A. R. Luria & E. D. Khomskaya (Eds.), Lobnye doli i regulyatsiya psikhicheskikh protsessov [The frontal lobes and the regulation of psychological processes] (pp. 641–663). Moscow: Moscow University Press. Tsvetkova, L. S. (1972a). Narushenie i vosstanovlenie scheta pri lokal’nykh porazheniyakh mozga [Disorder and restoration of calculation in focal brain lesions]. Moscow: Moscow University Press. Tsvetkova, L. S. (1972b). Vosstanovitel’noe obuchenie pri lokal’nykh porazheniyakh mozga [Rehabilitative training in focal brain lesions]. Moscow: Pedagogika. Tsvetkova, L. S. (1995). Mozg i intellect [Brain and intelligence]. Moscow: Prosveshchenie. Tsvetkova, L. S. (Ed.). (2001). Aktual’nye problemy neiropsikhologii detskogo vozrasta [Actual problems of child neuropsychology]. Moscow: MODEK MPSI. Tsvetkova, L. S., Akhutina, T. V., & Pylaeva, N. M. (1981). Metodika otsenki rechi pri afazii [Method of language evaluation in aphasia]. Moscow: Moscow University Press. Tsyganok, A. A., Vinogradova, A. L., & Konstantinova, I. S. (2006). Razvitie bazovykh poznavatel’nykh funktsiy s pomoshch’yu adaptivno-igrovykh zanyatiy

[Development of basic cognitive functions using the adaptive-game activities]. Moscow: Terevinf. Valentovich, T. S. (2002). Vliyanie raznykh tipov obucheniya na dinamiku razvitiya VPF u detey. Diplomnaya rabota [Influence of different learning types on children HMF development]. Master’s thesis, Moscow State University. Velichenkova, O. A., Akhutina, T. V., & Inshakova, O. B. (2001). Kompleksniy podhod k analizu specificheskih narushenij pis’ma u mladshih shkol’nikov [Complex approach in the analysis of specific writing disorders in schoolchildren in an primary school]. Shkola zdorov’ja [School of Health], 3, 38–42. Velichkovskiy, B. M. (1999). Moduli, gradienty i geterarkhii: Gde my nakhodim- sya v izuchenii kognitivnoy arkhitektury? [Modules, gradients and geterarchies: Where we are in the study of cognitive architecture?]. In A. E. Voyskunskiy, A. N. Zhdan, & O. K. Tikhomirov (Eds.), Traditsii i perspektivy deyatel’nostnogo podkhoda v psikhologii: Shkola A. N. Leont’eva [Traditions and perspectives of the activity approach in psychology: School of Leontiev] (pp. 161–190). Moscow: Smysl. Venger, A. L. (1994). Struktura psikhologicheskogo sindroma [The structure of psychological syndrome]. Voprosy psikhologii [Problems of Psychology], 4, 82– 92. Venger, L. A., Dyachenko, O. M., et. al. (1994). Programma “Razvitie”[Program “Development”]. Moscow: Novaya Shkola. Venger, L. A., & Venger, A. L. (1994). Gotov li vash rebenok k shkole? [Is your child ready for school?]. Moscow: Znanie. Vygotsky, L. S. (1995). Problema razvitiya i raspada vysshikh psikhicheskikh funktsii [The problem of development and disintegration of higher mental functions]. In L. S. Vygotsky, Problemy defektologii [Problems of defectology] (pp. 404–418). Moscow: Prosveshchenie. Vygotsky, L. S. (1996). Lektsii po pedologii 1933–1934 [Pedology lectures 1933–1934]. Izhevsk: Udmurtian University Press. Vygotsky, L. S. (2004). Pis’ma k uchenikam i soratnikam [Letters to students and colleagues]. Vestnik Moskovskogo Universiteta. Seriya 14, Psikhologiya [Moscow University Bulletin. Series 14, Psychology], 3, 3–40. Yablokova, L. V. (1998). Neiropsikhologicheskaya diagnostika razvitiya vysshikh psikhicheskikh funktsiy u mladshikh shkol’nikov: Razrabotka kriteriev otsenki. Dissertatsiya . . . kand. psychologicheskikh nauk [Neuropsychological diagnostics of the development of higher mental functions in primary school children: Development of evaluation criteria]. PhD dissertation, Moscow State University. Yurtova, E. A. (1995). Razrabotka metodiki preodoleniya verbal’no-pertseptivnykh trudnostey u detey mladshego shkol’nogo vozrasta. Diplomnaya rabota [Develop- ment of a technique to overcome verbal and perceptual problems in children of primary school age]. Master’s thesis, Moscow State University. Zavadenko, N. N. (2005). Giperaktivnost’ i defitsit vnimaniya v detskom vozraste [Attention-Deficit/Hyperactivity Disorder in childhood]. Moscow: Akademiya. Zeigarnik, B. V. (1986). Patopsikhologiya [Pathopsychology]. Moscow: Moscow University Press.

Zeigarnik, B. V., & Birenbaum, G. V. (1935). K probleme smyslovogo vospriyatiya. [The problem of semantic perception]. Sovetskaya nevropatologiya, psikhiatriya i psikhogigiena [Soviet Neuropathology, Psychiatry and Psychohygiene], 4(6). Zolotareva, E. V. (1997). Neiropsikhologicheskiy podkhod k korrektsionno- razvivayushchemu obucheniyu v 1 klasse (propedevticheskiy podkhod). Diplom- naya rabota [Neuropsychological approach to remedial-developing education in Grade 1 (propaedeutic approach)]. Master’s thesis, Moscow State University.

Overcoming Learning Disabilities Tatiana V. Akhutina, Natalia M. Pylaeva Book DOI: http://dx.doi.org/10.1017/CBO9781139012799 Online ISBN: 9781139012799 Hardback ISBN: 9781107013889

Chapter Recommended Reading: Authors’ Selected Publications pp. 297-298 Chapter DOI: http://dx.doi.org/10.1017/CBO9781139012799.033 Cambridge University Press recommended reading: authors’ selected publications

publications in english Akhutina, T. V. (1997). The remediation of executive functions in children with cognitive disorders: The Vygotsky-Luria neuropsychological approach. Journal of Intellectual Disability Research, 41(2), 144–151. Akhutina, T. V. (2003). L. S. Vygotsky and A. R. Luria: Foundations of neuropsychology. Journal of Russian and East European Psychology, 41(3–4), 159–190. Akhutina, T.V.(2004). Writing: Assessment and remediation. In T.V.Akhutina, J. M. Glozman, L. I. Moskovich, & D. Robbins (Eds.), A. R. Luria and Contemporary Psychology: Festschrift celebrating the centennial of his birth (pp. 125–144). New 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 Psychology: Festschrift celebrating the centennial of his birth (pp. 169–174). New York: Nova Science Publishers. 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. InR.M.Lerner,J.V.Lerner,E.P.Bowers,S.Lewin-Bizan,S.Gestsdottir,&J.B. Urban (Eds.), Thriving in childhood and adolescence: The role of self-regulation 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. Moskovich, & D. Robbins (Eds.), A. R. Luria and Contemporary Psychology: Festschrift celebrating the centennial of his birth (pp. 157–166). New York: Nova Science Publishers.

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publications in german Achutina, T. V. (2004). Kulturhistorische und naturwissenschaftliche Grundlagen der Neuropsychologie. Behindertenpadagogik¨ , 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 Grunde¨ dafur.InW.Jantzen(Hrsg.),¨ Jeder Mensch kann lernen – Perspektiven einer kulturhistorischen (Behinderten-) Paedagogik (S. 178– 203). Neuwied; Berlin: Luchterhand. Achutina, T. V., & Pylaeva, N. M. (2010). Das neuropsychologische Herange- henandieKorrekturvonLernschwierigkeiten.InB.Siebert(Hrsg.),Inte- grative Padagogik¨ und kulturhistorische Theorie (Band 5. Shriftreihe “Behin- dertenpadagogik¨ 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 formacion´ de la neuropsicolog´ıa. Revista Espanola˜ de neuropsicolog´ıa, 4(2–3), 108–129. Akhutina, T. V. (2002). El diagnostico´ y correccion´ de la escritura. Revista Espanola˜ de neuropsicolog´ıa, 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.Mexico:´ 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 intervencion´ en la neuropsicologica´ infantil (pp. 31–42). Mexico:´ Universidad Autonoma´ de Puebla. Akhutina, T. V., & Zolotariova, E. V. (2001). Acerca de la disgrafia visuo-espacial: Analisis´ neuropsicologico´ y metodos´ de correccion.´ En L. Quintanar & Y. Solovieva (Eds.), Métodos de intervencion´ en la neuropsicologica´ infantil (pp. 39– 46). Mexico:´ Universidad Autonoma´ 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). Skolaˇ pozornosti [School of Attention]. Bratislava: Dialog.

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.Seealso 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.Seealso 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.Seealso 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.Seealso 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

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Developmental assessment (cont.) Dyslexia, 2, 58.Seealso 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.Seealso 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.Seealso 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.Seealso 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.Seealso 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

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.Seealso 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.Seealso 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.Seealso ix, 22, 41–42, 48, 49, 86.Seealso 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.Seealso components of HMF in norm, 30, Neurobiological problems Genetic 40–41, 49, 79.Seealso 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.Seealso Uneven development of thepotentialforcompensationinnormal HMF unevenness, 30, 31, 34, 36–37, 41, 79

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.Seealso 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.Seealso 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 numericalrowsasamaterialofthe also Scaffolding method, 99

“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.Seealso Zone of proximal 2nd set of tasks – finding differences, 156, development (ZPD) 260–261 School neuropsychology, 1–2.Seealso 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.Seealso 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.Seealso 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

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.Seealso 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.Seealso 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

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.Seealso 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–Luriamethodology,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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Overcoming Learning Disabilities

By Tatiana V. Akhutina Lomonosov Moscow State University Open URL Link By Natalia M. Pylaeva Resolver Lomonosov Moscow State University Buy the Book

The linked image cannot be displayed. The file may have been Find This Book in a moved, renamed, or deleted. Verify that the link points to the correct file and location. Library Publisher: Cambridge University Press Email Link to This Print Publication Year: 2012 Book  Enlarge Online Publication Date: May 2012 Image Citation Tools Link to This Book Online ISBN: 9781139012799 Hardback ISBN: 9781107013889  Print This Page Book DOI: http://dx.doi.org/10.1017/CBO9781139012799

Subjects: Developmental psychology , Cognition

 Book Description  Table of Contents  References

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

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