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Neuropsychology Review, Vol. 9, No. 2, 1999

A Neo Lurian Approach

to

Assessment

and

Remediation

J. P. Das

1 2

The first part of this

article presents

an operational battery of

tasks

for

measuring

the four cognitive

processes

of

Planning, Arousal-Attention,

and

Simultaneous

and

Successive processing (PASS)

not

only based on the

qualitative

data provided in

Luna's

syndrome analysis, but also taken from tasks

in

experimental cognitive

psychology

and

neuropsychology.

The

second part

of the article presents

a

remedial program

based on

PASS

for

enhancement

of reading.

Because this

part

provides

in some

detail the efficacy of the

remedial

procedure, it simultaneously validates the

PASS

constructs as well.

In

both

parts of the

article,

I have been unmistakably guided by

Luria's views:

Tests are

approaches

to investigating cognitive functions, and the purpose of testing is to guide rehabilitation.

INTRODUCTION

I had the good fortune o f visiting Luria in October

and November of 1975. Beyond any doubt, he is the best

known and the most

frequently

cited Russian psychologist

in

Western psychological literature. As I wrote in a short

biography (Das, 1994), Luria remained productive under

Stalin, did not slow down when removed for a few years

from the Neurosurgical Institute to the Institute of De-

fectology, retained his optimism, and worked extremely

hard until his death

following

a third heart attack. When

I met Luria less than 2 years before his death, I found

that neuropsychology was thriving under his leadership.

He

held clinics three times

a

week

at the

Neurosurgical

Institute and through case presentations discussed many

fine points of assessing intellectual and emotional prob-

lems

as

well

as

methods

for

rehabilitation (Das, 1976).

He

worked hard until the end of his

life,

without any intention

of retirement, because, as he told me, he did not think that

mature

scientists

should retire and be left to grow roses

Luria was born in Kazan, Russia, o n July 16 , 1902,

and he died in Moscow on August 14, 1977. His ideas

have been extremely helpful in understanding cognitive

deficits,

including dyslexia. While extending Luria's neu-

1

University of Alberta,

Edmonton, Canada.

2A11 correspondence

should

be

directed

to the author at Developmental

Disabilities

Centre, 6-123D Education North, University

of Alberta,

Edmonton, AB,

Canada

T5G 2E5. E-mail:

[email protected].

ropsychological

findings to the

area

of

intelligence (Das,

Naglieri, and

Kirby,

1994), I and my coworkers found

that his syndrome analysis is consistent with a psychome-

tric analysis of four major cognitive

processes

composing

Planning, Arousal-Attention, and Simultaneous and Suc-

cessive

processes (PASS) that were directly derived from

his

writings

on the

functional

organization

of the

brain.

Further, Luria's clinical research into neurological

disor-

ders and rehabilitation after brain

injury

(Luria, 1963) has

influenced the construction of a remedial program (PREP)

for

ameliorating cognitive deficits, especially those related

to dyslexia and poor reading. Both of these, that is, con-

ceptualizing

intelligence in terms o f a battery o f

tests

and

constructing a remedial program, are the subject matter of

this article.

THE

PASS THEORY

IN

BRIEF

We must remember that underlying each method of psycholog-

ical investigations (and

this

is also

true

of psychological tests)

are

theoretical assumptions

about the structure of

psychological

processes and their breakdown.

Each

has its own

theory,

its own

ideology.

Therefore, any failure to recognize the theory or their

ideology which lies behind these tests, will quickly lead to disen-

chantment, and sometimes also to great

errors.

(Zeigamik el al.,

1977, p. 91)

The four PASS processes are presented in the con-

text of PASS theory of intelligence. This theory

identifies

three operational units that are important to understanding

107

1040-7308/99/0600-0107$16.00/0

1999 Plenum

Publishing

Corporation

KEY

WORDS: Luria;

neuropsychology;

assessment; neo-Lurian; PASS; remediation.


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108

Das

mental

functioning:

Attention, Simultaneous and Succes-

sive

processing,

and

Planning (Das, Naglieri,

and Kirby,

1994). Based on the work of Luria (1966a, 1966b, 1973),

the PASS theory is grounded in neuropsychology. A neu-

ropsychological view of intelligence is

different from

the

existing psychometric tests

of

intelligence;

it

attempts

to

determine

how the

mind works

by

anchoring

its functions

on the brain and by detecting dysfunctions. It

does

not

seek

to place

people

on a scale of

merit

and

therefore

is not a

tool

for

social selection as IQ tests have been used in the past.

The maintenance of attention and regulation of cor-

tical tone,

the

processing

and

storing

of information, and

the management and direction of mental activity compose

the activities of the

functional units that work together

to

produce cognitive processing (Das, Naglieri,

and

Kirby,

1994; Luria, 1966b).

In the schematic diagram of the PASS model shown

in

Fig.

1, there are

three main divisions: input,

process-

ing,

and output. Input arrives through

sense

organs—eyes,

ears, nose, tongue, and skin—as well as through muscles,

Fig. 1. Schematic diagram of the

PASS

model of cognitive processes.


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Das

Fig. 2. Scheme for assessment of Planning, Attention, and Simultaneous and Successive processing

(PASS).

that

are

associated with dyslexia? Several studies suggest

that this is possible (Das, 1992). The arrangement of tests

for

the PASS

functions

is given in Fig. 2.

As

can be

seen

in

Fig.

2, at the

most general lev-

el, PASS tests measure the four processes: Arousal-Atten-

tion,

Simultaneous-Successive processing, and Planning.

Then,

for

each

process, the

tests

are

named.

For

instance,

Arousal-Attention is divided into two major parts: sus-

tained attention and selective attention. A task for sus-

tained

attention is Auditory Vigilance, in which a man's

voice

and a

woman's voice

are

recorded

on a

tape recorder

cassette and played back to the individual who is being

tested. The man's voice says the names of five animals

and

five

items

of furniture. The

woman's voice does

the

same,

but the

animal

and furniture

words occur

at

random

at the

rate

of one per

second.

The

individual's task

is to tap

the table or desk in front of the tester whenever an animal

word is

spoken

by the man and a

furniture word

is

spo-

ken by the woman. This is an excellent task not only for

sustained attention,

but

also

for

false detections.

We

have

observed that children with attention

deficit

are identified

more easily

by

their

false

detection scores than

by

their

correct detections (Das, Mishra, and Kirby, 1994).

In

selective attention, we have two kinds of tasks; one

involves

selection at the level of reception of the stimu-

lus,

and the other at the stage of expression. The first task


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PASS

111

consists of a Posner-type test (Posner and Boies, 1971),

which

has two p arts. The first consists of letter pairs (BB,

DD,...)

that

ar e

identical (physical match)

and

some dis-

tractor pairs (BN, TP, ...) ,

which

are not. An individu al

is to cross out those that "look the same," that is, those

pairs that

a re

physically identical.

In

Name M atch,

on the

other hand,

the

letters, such

as Bb, Dd, are to be

crossed

out—one of them is written in the upper case, whereas the

other is written in the lower case. This is a receptive atten-

tion

test; selective

attention to the letter

pairs

occurs at the

stage

of

presentation.

In

contrast, selection

at the

expres-

sion,

or response,

stage

is

tested

by the

familiar Stroop

Test (Stroop,

1935). The

last card

in

Stroop

is

used

by

the PASS tests as a measure of interference in selecting to

respond to the color of the ink, a

conflict

card on which

the four

color

words are written in ink color that

does

no t

go with the word.

The

simultaneous scale

may

consist

of

Figure M em-

ory, in which the individual is allowed to look at a geo-

metrical figure such as a diamond for 5 seconds and then

find the figure embedded in another geometrical figure.

The other

simultaneous

tests are Tokens,

Design Con-

struction,

an d

Matrices, which

are

w idely used

for

verbal

(Tokens) and nonverbal spatial

tests.

The successive tasks

include Successive Ordering,

in

which

the

subject

is

asked

to watch the examiner as he or she turns over little chips;

then,

the

subject

is

required

to

turn over

the

same chips

in the order that th e exam iner did. In Serial Word Recall,

nine words, all fami liar one-syllable words, are presented

repeatedly in list lengths o f three to nin e words; the sub-

ject's

task is to repeat the words in the order in which they

were presented. Sentence Rep etition

similarly

in volves re-

peating a

sentence

that is read to the individ ual ("The p ur-

ple blued the green yellow"). Speech Rate (Hulme et al.,

1984)

is an

interesting test

in

which three words

are

given

to the individual and the subject is required to repeat the

words aloud as fast as possible ("Say 'egg, bu s, leaf, egg,

bus,

leaf, egg, bus, leaf,' on and on, until I ask you to

stop").

The

examiner stops

the

subject after

10

repetitions

and records the time that the subject

took

for repetition.

Sentence Questioning

is an

extension

of Sentence

Repe-

tition. After

th e

subject listens

to the

sentence, instead

of

repeating

it, the

subject mu st answer

a

question from

the

sentence ("The pink blued the yellow. Wh o was blued ?").

The p lanning tasks are the familiar Visual Search (a

number target embedded among

a field of

random ly scat-

tered num bers, a letter target am ong letters, a picture target

among pictures)

and

Trails

at the low

level

of

planning.

At the

medium level

o f

planning,

the

tasks

are

Matching

Numbers

(finding

tw o

numbers

that are

identical

in a row

of six numbers: 5736, 8295,7168,5736,4273,9571) and

Verbal

Fluency ("Say

as

many words beginning with letter

d as you

can").

At the

high level

of

plann ing, Crack-the-

Code and

Planned Composition have been used. Crack-

the-Code

is

like

th e

Mastermind game.

In

Planned Com-

position, the subject is show n a vague pictu re and is asked

to write a story about it on one page (see Das, Naglieri,

and Kirby, 1994,

for a

description

of

these PASS tasks).

A

diagram, presenting

the

division

of the

PASS tasks

and

their links to perception, memory (mnestic), and concep-

tualization, is provided in Fig. 2.

All these tasks are measures of the

processes

that

were previously identified. However, there are two ways

of evaluating whether or not these tests do measure these

processes—one

is

construct validity,

and the

other

is

through correlations and factor analysis, both of which

are discussed in the next section. We prefer construct va-

lidity to factor analysis.

To

measure attention, simultaneou s and successive

processing,

and

planning,

the

instruments must

be

consis-

tent

with

both the

"process

of

interest"

and the theoreti-

cal foundation from which th e theory wa s derived (Das,

Naglieri,

and Kirby, 1994, p. 102). Tasks used to measure

the

components

of the

PASS model

are

varied

in

terms

of

format

and

content. Figure

2

provides

a

brief overview

of

selected tasks used to measure each

functional

unit of

the PASS model. Extensive research demonstrating the

validity of these tasks has been conducted not only by the

author in his

lab,

bu t

also

by

outsiders (Naglieri, 1989;

Naglieri

et

al., 1989; Naglieri and Reardon, 1993). Many

of the above tests are now normed and included in the

Das-Naglieri

C ognitive Assessment System (1997).

SYNDROM E ANALYSIS AND MULTIVARIATE

ANALYSIS

Of fundamental concern here is the question of the

possible relationships between Luria's theory and data

drawn from

clinical investigations

of

subjects with brain

damage, and the various investigations as conducted by

a

variety of

researchers

using primarily multivariate sta-

tistical methods on data from normal and high-incidence

atypical populations (Das et

al.,

1975, 1979).

Das and

Jarman (1991) discussed this issue and suggested that the

relationship between these lines of research may be ex-

amined

from

three points

of

view:

1. To what extent should these investigations accept

Luria's model uncritica lly

a nd

merely apply

it in the

interpretation

of the

multivariate data?

2. To what extent does a logical and empirical relation -

ship exist between

the

results

of

Luria's investiga-

tions,

especially syndrom e analysis,

and the

results

from multivariate studies?


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112

Das

3. To

what extent

can or

should Luria's model

be re-

vised

and

affected

by the

outcome

of

various multi-

variate investigations?

With

respect

to the first question, we can find an in-

creasing acceptance

of his

work among neuropsycholo-

gists

and the correspond ing grow ing trend toward a .sys-

tems perspective in neuropsychology (Walsh, 1985,1987).

Briefly,

the second question relates to syndrome anal-

ysis. Its basis may be

found

in Luria's clinical technique

and the interlocking concepts of a

functional

system and

a behavioral syndrom e. Luria's te chni que of clinical re-

search was based on two principles:

1.

That

a

qualitative analysis

of

behavior

w as

neces-

sary,

utilizing

virtually

hundreds

of

tasks

in

some

cases, to lead to the

identification

of a defect.

2. That a single lesion or defect may demonstrate itself

in

diverse behaviors (Cicerone

and

Tupper, 1986).

The concept of a syndrome, as an extension of these

principles, was central to Luria's work, whereby a syn-

drome

was

identified

as a

constellation

of

signs

and

symp-

toms,

which, in turn, supplied what we would now term

an operational

definition for a

functional

system. Thus,

Luria's c linical method entailed the accumulation of con-

verging evidence

from

many tasks to

define

a syndrome.

The syndrome, then,

emerged

as a common cognitive pro-

cess that was disrupted in seemingly disparate tasks. This

clinical method,

in

turn, allowed Luria

to define

various

areas of

regional specialization

in the

brain

and to map

sets of functional systems that operate at various levels of

generality within and between these areas.

The research

process

that Luria utilized, therefore,

involved

the

definition

of a

variety

of

syndromes

by

iden-

tifying one or more cognitive processes that are common

to

tasks performed

b y

subjects

with

brain damage.

A

par-

allel approach is to operationally define co nstructs. This is

achieved

by identifying one or

more cognitive processes

that form

the

principal basis

for

individual differences

within

a set of tasks.

Such differences among normal

and

various atypical subjects

are

then supported

by

using mul-

tivariate methods, particularly factor analysis, whenever

possible.

The

approach adopted

in the

m ultivariate studies

by

Das

and

collaborators (Das

et

al., 1979; Das, Naglieri,

and Kirby, 1994) has been to focus mainly on the use of

tasks that were employed extensively by Luria or tasks

that

are very similar to them (although, as noted previ-

ously, the

tasks used

by

Luria

are

many

and frequently too

easy

for a nonclinical population), combined with other

tasks derived

from

the constructs of planning,

arousal-

attention,

and so forth.

Thus,

in

factor analytic terms,

this research is confirmatory in two ways: the selection

of

tasks and the hypothesized outcomes of the analyses.

By

using both a variety of

tasks

common to

Luria's

inves-

tigations and a wide selection

from

cognitive psychology,

and

then

by

varying subject populations with known dis-

orders, research support for the neo-Lurian model, PASS,

has gradually

emerged.

There

is increasing evidence that

multivariate investigations

of

normal subjects that parallel

syndrome analysis

can

inform theory

in

neuropsychology

(Clark, 1981; Dean,

1985).

Among

the multivariate techniques, a new advance-

ment, structural factor analysis, or LISREL, has added

significant

power

to

traditional factor analysis (McArdle,

1996).

This procedure allows hypothesis testing and,

through path diagrams,

can

even suggest causal pathw ays

between

cognitive

processes

and performance. "Is the ob-

served syndrome consistent with the model of cognitive

dysfunction?"

is the sort of question Luria would have

asked and answered had he been given the technique fo r

structural

factor analysis. However,

he

would

no t

have

looked for a model after doing the factor analysis, but

before; nor would he have determined tha t a certain

test

is

good

for

diagnosis

of the

syndrome merely because

it

has a high loading on a factor—for these are

some

of the

pitfalls in

using

the

advanced structural factor analysis,

as they were in traditional factor analysis. If multivariate

analysis must inform neuropsychological theory, w e can-

not,

for

example, assume

that a test of

planning

or

attention

is a

test

of that process simply because it loads on the same

factor as two other

tests

o f planning or attention. Clinical

data obtained

from

known

cases

of attentional or plan ning

deficit

must support the use of the test. Alternatively, the

test must have been used

in

cognitive psychology experi-

ments

as a

test

of

attention

or

planning.

The

last question

is

answered

in the

context

of the

section on Future Directions.

USING PASS THEORY FOR READING

REMEDIATION

When

primary school children

of

otherwise normal

intelligence fail to acquire reading, they are labeled as

learning

disabled, poor readers, or dyslexic. In an attempt

to remediate their problem in word reading, which

also

created

difficulties

in reading comprehension, we used a

cognitive

remedial program, PREP (The PASS Remedial

Program) (Das,

1999).

Remediation Program: PREP

The

PREP

w as

designed

to

improve

selected

aspects

of

children's inform ation-processing skills and to increase

their

word-reading

and

decoding abilities.

Procedures

such


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PASS

113

as rehearsal, categorization, monitoring of performance,

prediction, revision of prediction, word sounding, and

sound blending are an integral part of each of the PREP

tasks. Rather tha n being exp licitly taught by the tutor, chil-

dren receiving training in PREP are encouraged to become

aware of the use of u nderlying cognitive

processes.

This

is achieved throug h discussion

of

what they

did

during

the

tasks.

In this w ay, inductive inference and internalization

occur spontaneously rather than through deductive rule

learning

(Campione and Brown, 1987; Vygotsky, 1962).

The first part of the remediation program consists of

training tasks tha t challenge the children to use successive

or simultaneous processing when required. The objective

is

to

improve children's

"global"

processes.

These

pre-

cede

the

"bridging" tasks that have reading-related

ma-

terial. Children are taken through the training tasks in a

way that provides structured experience in using the tar-

geted cognitive process and facilitates the discovery and

internalization

of the strategies.

Transfer occurs as a result of the

fact

tha t the surface

structures of the tasks are diverse and not too much time

is spent in practicing a single task. "High road" transfer

(Salomon

and

Perkins, 1989),

a

transfer

of

principle,

oc-

curs in the "bridging" part of this program, as evidenced in

the study by Das

et al.

(1995) an d the new studies reported

in the next section. The "global" part is essential for the

program to be effective in imp roving word-decoding per-

formance, as shown in empirical studies (Das et al., 1995;

Das, Naglieri, and Kirby, 1994, chapters 9 and 10).

The PREP remediation program comprises 8 tasks,

each with a global-processing training

form

and a curric-

ulum-related bridging form. The global

form

has no read-

ing

content,

but it

provides

a

structured

series of exercises

that require the application of successive and simultane-

ous

strategies

as well as planning and attentional resource

allocation.

The

bridging form

has the

same cognitive

de-

mands as its matched global form, but it employs letters

and their combinations.

Each task has three levels of difficulty; the

easiest

level allows

the

child

to

have initial success with

the ma-

terials and to become familiar

with

the task and the expec-

tations

of the

training program.

The

more difficult levels

build on the

easiest

level through added complexity. De-

pending on the progress the child makes, the remediation

program typically requires 15 to 18 hours during approx-

imately

12

weeks.

In

each session,

one

teacher gives

the

PREP to four students.

Through its cognitive-processing tasks, the PREP

program provides children with an opportunity to develop

strategies for the key cogn itive processes required for word

decoding. In contrast to direct practicing of phonemic

skills,

the

cognitive strategies that children with reading

disabilities discover and learn by themselves in one part

of the program are then transferred to word decoding and

spelling

in the second part. The PR EP's application for im-

proving reading skills

in

und erachieving children

is

briefly

discussed

in the

next section.

The R emediation

Studies

The most recent study of the PREP program, using a

multistudent format, four students to one tutor, was done

by Carlson and Das

(1997),

to improve reading in under-

achieving ch ildren (the so-called Chapter 1 children) in

Hemet, C alifornia. In this study, one teacher instructed

children in two 50-minute sessions per week during a

3-month period. Both the PREP N = 22) and control

N = 15) group samples continued to participate in the

regular Chapter 1 programs offered in their schools. To ex-

amine

th e

efficacy

of the

PREP

in

terms

of

improvement

in

reading achievement, we administered Word Attack

and Letter-Word Identification subtests

of the

Woodcock

Reading Mastery Test—Revised (WRMT-R; Woodcock,

1987) at the beginning and the end of the study in a

pre/post design. The results showed that the children who

received PREP remediation gained substantially (almost

1 year in word reading an d decoding). Th e children in

the

control group

did not

show

any

improvement. How-

ever, when comparing the treated and untreated students

to determine the efficacy of PREP training , one must re-

member that the gains achieved for the group exposed to

PREP were compared with the gains of untreated students

in

the control group who were nonetheless receiving the

usual remedial education in their

classroom.

Although the data from the initial Hemet study pro-

vided support for the

utility

of the PREP program in im-

proving word reading, the number of children in the sam-

ple was small N = 22 in the remedial group, N = 15 in

the comparison group).

In

the second study in Hemet, we asked (a) if the

improvement due to the PREP could be replicated with a

larger group of Chapter 1 children, and (b) if the PREP

could also bring about any improvement in some of the

PASS cognitive

functions

underlying word reading and

decoding.

As mentioned earlier,

in

recent research

on

reading

disability, deficits

in

phon ological coding

and

articulation

have been identified as core difficulties

associated

with

reading disabilities, d espite norm al intelligence (Torgesen

et al.,

1987). We

have conducted studies that show that

successive processing is required for phonological coding

and

articula tion of sequences of letters and soun ds (Das,

Mishra, and Kirby, 1994; Kirby and Das,

1990),

and that


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PASS 115

the functional organization of higher cortical processes;

the

PASS model and the PREP provide a neo-Lurian ex-

pansion.

In conclusion, we hope that the PREP program is

just the beginning of a scientific approach to learning dys-

functions; it should be

developed

to

remediate math prob-

lem solving, and even beyond learning disabilities to other

learning problems such as attention deficit disorder.

The gap between a theory of cognitive functions and

amelioration of cognitive deficits needs to be bridged; our

approach is one attempt to

fulfill

this need. We have tried to

provide a

scientific basis

for

remediation

and

intervention

and, at the same time, question the rationale of adminis-

tering standardized intelligence tests.

Great changes have occurred in the field of intel-

ligence and the neuropsychology of cognitive processes

since Luria's time.

It

would

be a

mistake

to

ignore these,

and Luria would have been the first to advise us against

adhering to his original notions. The

greatest

changes

have occurred in our understanding of the functions of

the frontal lobes, and Luria longingly suggested that only

the young scientists who would follow him would be able

to discover such functions, which are planning and con-

sciousness.

The

challenge

for a

neo-Lurian theory

is to in-

vestigate the highest cognitive functions of humans, which

was

begun

by

Luria

and has

been followed

by

Sperry, Shal-

lice, and others (see Das et al., 1996), and the challenge

can be met not so

much

by

theorizing,

but by

observation

and more observation, to quote Pavlov's dictum.

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