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Equipping Minds cognitive development training in learners with

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J Altern Med Res 2018;10(2):171-193 ISSN: 1939-5868
© Nova Science Publishers, Inc.

Equipping Minds cognitive development training in learners

with neurodevelopmental disorders: Case studies

Carol T Brown , EdD Abstract

Equipping Minds, Frankfort, Kentucky, USA
The Equipping Minds Cognitive Development Curriculum
(EMCDC), a holistic cognitive intervention program, is
based on the theory of Structural Cognitive Modifiability
(SCM) and Mediated Learning Experience (MLE) of
Reuven Feuerstein. EMCDC has been applied with learners
of all ages with learning and neurodevelopmental
disabilities in the United States and internationally. Five
case studies of learners with a neurodevelopmental disorder
are presented. Brown utilized the following data collection
techniques: clinical observations of the learners, examining
and analyzing the psychological and educational
documents, and interviewing the parents, the learners, and
teachers. Cognitive and academic gains were demonstrated
in all of the case studies. The results are consistent with the
results of Brown’s doctoral research with learners with a
Specific Learning Disorder (SLD) and the four -year case
study with Marie who had Down syndrome. Family
members, therapists, and teachers were included in
the therapy sessions and instructed how to interact and
instruct using mediated learning. This suggests that a
comprehensive intervention program which addresses
numerous cognitive functions and includes parents and
other professionals in the learner’s life allows more
opportunities for modification.

Keywords: Cognitive development, Feuerstein, equipping

minds, autism, post traumatic concussion syndrome,
mediated learning

Introduction
“We know how to test it, you know how to train
it” was the consensus of the psychiatric medical
residents and faculty who experienced the cognitive
development exercises of Equipping Minds Cognitive
Development Curriculum (EMCDC). While psychia-
trists and educators are aware of the discovery of
neuroplasticity, the methods to modify the brain seem
Correspondence: Carol T Brown, EdD, Equipping Minds, illusive. The neuropsychological and educational
751 Stoneleigh Drive, Frankfort, KY40601, USA.
E-mail: [email protected] reports the author has read contain numerous
172 Carol T Brown

recommendations for accommodations, medication, Feuerstein insisted that human cognitive abilities
academic remediation, and strategies. Though can be changed even if the neuro-developmental
some reports may state that IQ is not static, the condition is generally considered irrevocable and
majority of reports give no hope for cognitive irreparable (3). The Feuerstein Institute has conducted
modifiability if a learner has a neurodevelopmental research that confirms cognitive abilities can be
learning disorder (NLD): ADHD (attention deficit modified (1). Instrumental Enrichment (FIE) and
hyperactive disorder), specified learning disorder, MLE have been found to enhance cognitive abilities
motor disorder, communication disorder, autism of learners with neurodevelopmental learning
spectrum disorder, and intellectual disability. The disorders (4). Many of these learners also have
most common therapeutic interventions will be cultural deprivation and differences. These studies
speech therapy, occupational therapy or physical have encompassed many types of student populations
therapy in the schools on a limited basis while parents using FIE (3).
who want intensive services must find a private
provider. Cognitive therapy interventions are rarely
mentioned even though the Feuerstein Institute has Mediated learning
conducted numerous research studies that confirm
cognitive abilities can be modified in learners with a The theory of mediated learning experience
neurodevelopmental disorder (1). (MLE) initially grew as part of Feuerstein’s theory
In fact, as the author has spoken to various of structural cognitive modifiability (SCM) (5).
educational groups, the work of Reuven Feuerstein Mediation is an interaction in which a mediator who
(1921-2014) is virtually unknown in the United possesses knowledge intends to convey a particular
States. Feuerstein, a clinical and cognitive psychol- meaning or skill and encourages the child to
ogist, believed that intelligence was changeable and transcend, that is, to relate the meaning to some other
modifiable regardless of age, neurodevelopmental thought or experience. Mediation is intended to help
conditions, genetics, and developmental disabilities children expand their cognitive capacity, especially
(2). He also disagreed with the accepted concept when ideas are new or challenging. Feuerstein sees
of the critical period or critical age, which states the human mediator as crucial for a learner’s
that if a person has not reached a particular function development (5).
by a certain age, he or she no longer has the ability
to learn that skill (2). Feuerstein’s theory is
known as structural cognitive modifiability (SCM). Cognitive functions
His theory of human development has three basic
ideas: The review of NLDs show a deficit in working
memory abilities for learners diagnosed with ADHD,
Three forces shape human beings: specific learning disorders, motor disorders,
environment, human biology, and mediation. communication disorders, autism spectrum disorders,
Temporary states determine behavior: and intellectual disabilities. While this correlation has
How someone behaves—namely emotional, led many psychologists to focus on working memory
intellectual, and even habitually learned training, Reuven Feuerstein takes a broader view
activities—represents a temporary state, not and examines the cognitive function underlying
a permanent trait. This means that intelligence and what is going on in the learner’s
intelligence is adaptive. In other words, mind. Feuerstein defines cognitive functions as
intelligence can change; it is not fixed once “thinking abilities” that can be taught, learned, and
and for all. developed (61). Feuerstein has categorized the
The brain is plastic: because all behaviors are cognitive functions according to the three major
open and developing, the brain can generate phases of the mental act: input, elaboration, and
new structures through a combination of output. Although artificially separated into three
external and internal factors (3). phases, cognitive functions don’t necessarily occur
 Case studies 173

separately in life. However, the subdivision is useful 3. Deficient skills in precision and accuracy are
to analyze and describe thinking as well as to present. Correction: The learner collects the
determine what factors might negatively affect correct information.
thinking (3). Teachers and parents can use this model 4. Inability to identify an object when there
to better understand and help the learner who is is a change in size, shape, quantity, or
experiencing difficulties with a particular task. By orientation, though it is the same object.
having a working knowledge of the cognitive Correction: The learner is able to decide what
functions, teachers (6) can differentiate between characteristics stay the same even when
errors due to a lack of knowledge or from a deficient change happens.
cognitive function (3). For example, if the learner 5. Lack of capacity for considering two or more
fails in the task of classification, it is not enough to sources of information at once is present.
comment on the learner’s poor intelligence or This is reflected in dealing with data in a
inability to classify, but rather the underlying causes piecemeal fashion rather than as a unit of
of the difficulty (which can be found in one of the organized facts. Correction: The learner is
three phases of thinking) should be sought. The able to keep two ideas in his mind at the
inability to classify, for instance, may be due to same time and compare them.
underlying underdeveloped functions, such as 6. Impulsive and unplanned exploratory
imprecise data gathering at the input phase or poor behavior is present. Correction: The learner
communication skills at the output phase. A detailed is able to systematically approach new
analysis of a learner’s cognitive functions requires an information and objects (3).
in-depth understanding of the three phases of the
mental act (7).
Deficient cognitive functions and corrections
needed: Elaboration level
Deficient cognitive functions and corrections
needed: Input level 1. Lack of ability to recognize the existence and
definition of an actual problem. Correction:
The following list identifies and describes the The learner can define the problem.
deficient cognitive functions that Feuerstein’s 2. Inability to select relevant vs. non-relevant
Instrumental Enrichment (FIE) seeks to correct in cues or data in defining a problem is present.
learners with neurodevelopmental learning disorders Correction: The learner can recognize what is
and learning disabilities. Understanding the degree to relevant to the problem and what can be
which the learner is affected directs the mediation ignored.
process for cognitive modifiability (3). 3. Difficulty in comparative behavior is present.
This may be due to slow processing and
1. Blurred and sweeping perception of essential inability to make comparisons between two
information occurs. The learner struggles to or more things. Correction: The learner can
gather the correct information. Correction: see the similarities and differences between
The learner learns to focus and perceive the two things.
data through his senses. 4. A narrow mental field is present. There is an
2. Difficulty in temporal and spatial orientation inability to combine, group, and coordinate
occurs. The learner lacks the ability to information. Correction: The learner can
organize information realistically and to recall and use several pieces of information.
describe events in terms of where and 5. The projection of virtual relationships is
when they occur. Correction: The learner impaired. The ability to perceive the
learns the critical concepts of right, left, relationship between events is difficult.
front, and back to know where they are Correction: The learner can understand
positioned in space. relationships, apply conceptual labels, and
174 Carol T Brown

categorize objects. He understands the main 7. Lack of self-control, impulsive, or acting-out

idea. behavior is demonstrated. Correction: The
6. The absence of or need for logical evidence, student exhibits self-control in speech and
inferential hypothetical thinking, and hypoth- behavior.
esis development occurs. Correction: The 8. Unable to visually transport information from
learner is able to use hypothetical thinking to one place to another, or unable to see the
test a hypothesis. He can see cause-and-effect missing part. Correction: The learner is able
relationships and use logical evidence. to see the relationship between things that are
7. Inability to visualize and create mental not present (3).
images is present. Correction: The learner is
able to move away from concrete thinking to Feuerstein has sought to identify and correct
visualization. these deficits to enable students to reach their
8. Difficulty defining goals, planning behavior, full cognitive potential, as well as to increase their
and taking steps in problem solving occurs. internal motivation and personal confidence. By using
Correction: The learner is able to form mediation, these deficient functions can be corrected,
problem-solving strategies, make a plan, state formed and modified in significant ways (2).
the steps, and provide the reasons (3).

Equipping Minds Cognitive

Deficient cognitive functions and corrections Development Curriculum
needed: Output level
The Equipping Minds Cognitive Development
1. Egocentric communicational modalities Curriculum (EMCDC) seeks to correct these
are present. It is difficult for the learner to deficient cognitive functions through cognitive
relate to others and to see things from developmental exercises based on the theory of
another’s perspective. Correction: The Structural Cognitive Modifiability (SCM), Mediated
learner is able to consider another person’s Learning Experience (MLE), and a biblical worldview
point of view. of human development (see table 1). In Brown’s
2. Lack of ability to repeat an attempt after a doctoral research with EMCDC, the participants were
failure or blocking is present. Correction: The learners with specific learning disorders (SLD).
learner is able to persevere and overcome Learners were randomly assigned into one of two
blocking. groups. The active control group received small group
3. Difficulty in projecting virtual relationships. intervention in academic subjects an hour a day five
Correction: The student is able to see virtual times a week for seven weeks. The training group
relationships (such as two women can be received small group intervention in the EMCDC an
cousins or four dots can be a square). hour a day five times a week for seven weeks. All
4. Use of trial-and-error responses, which leads participating learners continued to receive standard
to failure to learn from previous attempts, is special educational support services as a result of their
present. Correction: The learner is able to learning difficulties. Both groups were tested on
stop and think through a plan of action. measures of working memory, verbal and nonverbal
5. Lack of, or impaired tools for communicating ability, and academic attainment before the training
adequately elaborated responses. Correction: and re-tested on the same measures after training.
The students is able to give a thoughtful Analysis of the pre-to post-test scores demonstrated a
response. significant (p < 0.05) advantage for the training group
6. Lack of, or impaired, need for precision and over the active control group on the KBIT-2 in verbal,
accuracy in communicating one’s responses. nonverbal, and IQ composite, as well as far transfer
Correction: The student is able to be precise effects in science. Therefore, the implication from the
and accurate when communicating. present research is that working memory training does
 Case studies 175

not have a causative effect in relationship to verbal, syndrome) (13-14). The author worked with the
nonverbal, and academics abilities when using learner an hour of every school day. At the end of
EMCDC for 30 hours (4). nine weeks, academic testing demonstrated significant
While computerized cognitive training programs gains in reading, math, science, and language arts.
are prolific, EMCDC supports the use of a human Until this time, the learner had made minimal
mediator, which is rooted in Scripture and progress and her academic test scores had remained
Feuerstein’s theory of Mediated Learning Experience static. The change in these scores had been achieved
(MLE) and affirms that cognitive skills can be through one-on-one cognitive developmental exer-
developed in the classroom or clinical setting cises for enhancing processing, working memory,
through a human mediator (5-7). The cognitive comprehension, and reasoning; this was divorced
developmental exercises set aside academic content from academic content. Previously, the learner
to target cognitive functions. Learners participate had received the standard interventions, which
in interactive games and paper-and-marker activities included remediation of content, learning strategies,
which are organized in a progressive and challenging and accommodations. These may have short-
manner to strengthen working memory, processing term benefits but were not targeting the underlying
speed, perceptual reasoning, and comprehension. A cognitive deficits in processing and working
trained mediator encourages the learner to “think memory, which would increase her cognitive
aloud” and verbalize what they are processing abilities. Over the next four years the academic test
and thinking. The structure for mediating within results demonstrated significant gains in academic
the curriculum is specified in the teacher workbook abilities (13-14).
and summarized in table 2. While the model of Single N-back task (1958) and Dual N-back task
mediation is the same for all learners, individ- (2003) have been used in research as a method to train
ualization will occur based upon the learner’s working memory for many years. Some studies have
progression. By using mediation, these cognitive reported near transfer effects but failed to demonstrate
functions can be corrected, formed and modified in far transfer effects confirming that generalization
significant ways enabling students to reach their full remains elusive (15, 16).
cognitive potential (8). Brown developed an adaptive n-back with six
Furthermore, EMCDC employs a holistic tasks or the “Brown Six N Back” in which learners
approach to cognitive development training through were asked to associated animals with symbols, letters
primitive reflex exercises, sensory-motor develop- with sound, symbols and colors, numbers with
ment exercises, and cognitive developmental symbols and colors, recall images and sequence of US
exercises. The “Maintaining brains everyday” presidents, identify colors, and identify directions of
DVD for the primitive reflex exercises (9) and left, right, up, and down. To Brown’s knowledge,
the fear paralysis exercises (10) are done by the there has not been a Six N-back task which utilizes a
participants at home or at school for 15 minutes a human mediator requiring the leaner to hear auditory
day. The sensory-motor development exercises instructions, use their hands to write or place a cube
include the use of sound therapy (11) which the while holding a pattern for six categories, and saying
participants wear during the EMCDC intervention what they are doing. There are over 40 possible items
sessions while doing the cognitive developmental the learner is retrieving from their long-term memory
exercises. The mediators follow the EMCDC full while using their working memory and regions of the
program as the intervention is typically 60 hours brain which contain letters, numbers, pictures, sounds,
over 12 20 weeks (12). directions, and colors. If the learners succeeded at a
An individual four-year case study was done particular level of n, the task was made incrementally
with the Equipping Minds Cognitive Development more difficult by increasing the size of n to six. Table
Curriculum (EMCDC) (12) from 2011-2015 on a 1 describes the exercises in the Brown 6 n-back while
learner with a neurodevelopmental disorder (Down Figures 1-5 show examples of the exercises (12).
176 Carol T Brown

Table 1. Brown Six N Back Equipping Minds Cognitive Development Curriculum

Description
Mediator states 1-2 directions ex: “I see you putting a circle
Cognitive Functions Targeted Exercise around the one…” What do you see yourself doing? Learner
replies, “I see myself putting a circle around the one” and
performs the action. Use a page protector and dry erase marker.
Visual processing, auditory
processing, working memory, visual
Circle around the bear, box around the snake, X on the fish,
motor coordination, receptive and
Animals triangle around the cat, line under the elephant, line above the
expressive language, visual spatial
turtle and continue for 20 directions
reasoning, abstract thinking,
refraining impulsivity
Describe the pictures of the presidents by stating the size,
Presidents
Projection of relationships, shapes, colors, objects, quantities, location, positions, and
“Yo Millard
comparisons, visualization, relationships. 1 Washington, 2 Adams, 3 Jefferson, 4 Madison, 5
Filmore”
expressive language Monroe, 6 JQ Adams, 7 Jackson, 8 Van Buren and continue to
Book
45 Trump
Use a page protector and dry erase marker. First, place symbols
Working memory, visual and and then cubes with corresponding number. Circle and green
auditory processing, long term cube on 1, x and blue cube on 2, box and red cube on 3, yellow
memory, attention, expressive and Numbers cube and underline 4, black cube and line above 5. Remove page
receptive language, abstract thinking, 1-5 protector and read symbols back by alternating saying the
visual motor coordination, refraining number. Then say number, color. Next, number, color, animal.
impulsivity, logic thinking Then, number, color, animal, letter. Finally, number, color,
animal, letter, president: a 5 n back.
First, place symbols and then cubes with corresponding letter.
Working memory, visual and Circle and green cube on a, x and blue cube one, box and red
auditory processing, long term cube on i, yellow cube and underline o, black cube and line
memory, attention, expressive and above u. Remove page protector and read symbols back by
receptive language, abstract thinking, Letters a-e alternating saying the letter. Then say letter, and sound. Add
phonemic processing, refraining letter, sound, color. Next, letter, sound, color, number. Then,
impulsivity, logical thinking, letter, sound, color, number, animal Finally, letter, sound, color,
spontaneous comparison number, animal, president: a 6 n back. Also do the 6 n back with
the cubes covering the letters.
Say the direction of the arrow, then the color, then alternate
color, direction. Add the corresponding number and say number,
color, direction. Add the corresponding animal and say number,
color, animal, direction. Add the corresponding letter and say
Spatial concepts of left, right, up, the number, color, animal, letter, and direction. Add the
down, Inductive thinking, inductions president sequentially and say the number, color, animal, letter,
of rules, seriation, working memory, president, and direction.
long term memory, auditory and
Colored Use a page protector and dry erase marker and put the symbol
visual processing, abstract thinking,
Arrows on each arrow while saying the number, color, animal, letter,
Systematic approach to new
president, and direction. Remove the page protector and read the
information and object, refraining
symbols only saying the number, color, animal, letter, president,
impulsivity, logical thinking,
and direction.
spontaneous comparison
* Add an additional mark at the tip of the arrow when marking
the direction.
Now use the colored cubes and place them down while saying
number, color, animal, letter, president, direction.
 Case studies 177

Table 2. Equipping Minds mediation questions based on

Feuerstein’s cognitive functions and Aristotle’s ten categories of being

Collecting Processing Expressing

What or who do you see, hear, feel, taste, What am I to do? What does the other
touch, and smell? Problem, what problem? person believe and why?
What can you visualize or imagine in your What do you need to figure out? How does the other
mind? What is relevant to the problem? person feel?
What do you see yourself doing? What is needed, and what can be Can you imagine how you
What is the name of what you see or are ignored/omitted? would feel in their
thinking? What is similar? position?
Where are you starting? What characteristics are different? How would the other
Do you have the correct materials? Consider: number, color, shape, person want to be viewed
What parts do you need, and what order will size, direction, position, and feeling and treated?
you need to follow to make the finished What different categories do you Have you thought through
product? see? what you want to say or
What do you know to be true, or what is How are these related to each other? write?
constant and does not change? Ask: What is your plan? What are Are your words relevant
What is to your right? What is to my right? the steps you will follow and the to the situation?
If you are facing in this direction, what is to reasons? Is your language clear to
your right? Left? Front? Back? East? West? Avoid trial and error! Have a plan. the audience?
North? South? Northwest? Southeast? Does this make sense? Do you need to take a
When do you see this happening – past, If this is true, then what else must break and attempt later or
present, future? be true? tomorrow?
How long did the event occur? In what order Are there different possibilities?
did it happen? How can you see if this is true?

Circle the Bear

Box the Snake
X the Fish
Underline the Elephant
Line above the Turtle

Figure 1. Animal.
178 Carol T Brown

Basic US Presidents
1. Washington green
2. Adams blue
3. Jefferson red
4. Madison yellow
5. Monroe black
Advanced US Presidents are said sequentially for n –back
6. Washington
7. Adams
8. Jefferson
9. Madison
10. Monroe
11. John Quincy Adams
12. Jackson
13. Van Buren
14. Harrison
15. Tyler
16. Polk
17. Taylor
18. Fillmore
19. Pierce

Figure 2. US presidents “Yo Millard Fillmore.”

2 1 5 4 3 circle the 1 and place a green cube

5 3 5 4 1 X the 2 and place a blue cube
3 1 4 2 5 box the 3 and place a red cube
5 4 3 1 2 line under the 4 and place a yellow cube
4 2 5 3 1 line above the 5 and place a black cube

Figure 3. 1-5 Numbers.

e a u o i circle the a and place a green cube

u i e o a X the e and place a blue cube
i a o e u box the i and place a red cube
u o i a e line under the o and place a yellow cube
o e u i a line above the u and place a black

Figure 4. Letters a, e, i, o, u.
 Case studies 179

4 blue Turtle I Washington left

3 black Snake E Adams Right

5 yellow Bear I Jefferson Down

Say the number, color, animal, letter, president (sequentially), direction.

Use a page protector and dry erase marker say and mark the six items. Place a point at the tip of the arrow for the direction.
Remover the page protector and read the symbols: number, color, animal, letter, president (sequentially), direction.
Next, place the colored cubes down turned to match the direction of the arrow while saying the number, color, animal,
letter, president (sequentially), direction.

Figure 5. Brown Six N Back.

Case studies his biological mother due to neglect and alcohol

abuse. Joseph has fetal alcohol syndrome, a language
This article will present five case studies of learners processing disability with impairments in both
with a neurodevelopmental disorder. Brown utilized expressive and receptive channels, and developmental
the following data collection techniques: clinical coordination disorder.
observations of the leaners, examining and analyzing
the psychological and educational documents, and
interviewing the parents, the learners, and teachers. Assessment

At the age of 8 years, Joseph received an extensive

Case 1. Joseph: Fetal alcohol syndrome, mixed evaluation of his cognitive abilities in 2015 and
expressive/receptive language disorder, further evaluations in 2016 at 10 years of age. The
evaluation procedures used included:
developmental coordination disorder
Clinical observation sessions
Joseph was adopted from Poland at five years of age
and lives in the United States. He was removed from Interview with parents
180 Carol T Brown

Woodcock Johnson-III Academic Skills as 
well as for simple language (i.e.,

Index vocabulary, syntax, and grammar) as well as
Wechsler Intelligence Scale for Children- complex language abilities (i.e., the ability to
Fourth Edition (WISC-IV) make inferences or to understand intention).
Wechsler Intelligence Scale for Children- The examiner believes that Joseph’s
Fifth Edition ( WISC-V) difficulties are consistent with a diagnosis of
Kaufman Brief Intelligence Second Edition a Mixed Expressive/Receptive Language
(KBIT-2) Disorder (ICD 10: F80.1). This profoundly
Kaufman Test of Educational Achievement- impacts his ability to learn in a classroom
3rd Edition-Form A environment (i.e., receptive language) as well
Test of Variables of Attention (TOVA) as severely limits his capacity to participate
in class or group based activities (i.e.,
The examiners found him to be a sweet and softly expressive language).
spoken child, who seemed to have a gentle soul. He 2. Very weak visual-spatial processing skills
was polite and friendly, and displayed interest and as well as poor fine-motor control, which
curiosity about many of the tasks that were is likely to profoundly impact his ability
administered. The assessment found many other to learn, unless accommodations are made
strengths, including: to support this challenge. His difficulties
are consistent with a diagnosis of a
Exceptional academic abilities for a child Developmental Coordination Disorder (i.e.,
of his age, with a performance at the 92nd dysgraphia, ICD 10 Code: F82).
percentile on the Woodcock Johnson-III 3. Some weakness for sustaining attention and
Academic Skills Index, which includes executive functioning, that while likely to
measures of reading, writing, and math. significantly impact his daily life at school, is
Exceptional ability for doing simple reading, likely to be related to the specific learning
writing and math tasks with accuracy, speed challenges described above. At this time,
and efficiency, with a performance at the although these challenges would typically be
98th percentile on the Woodcock Johnson-III indicative of an attention disorder, it is the
Academic Fluency Index. examiners impression that his learning
challenges are a better explanation for why
It is very impressive that Joseph had such strong he has weakness in tasks of Working
academic skills, which is a testament to his desire to Memory and Processing Speed.
work hard, as well as the support of his parents and
teachers. It is the examiners impression that it is likely Working Memory is the ability to hold
that school-based tasks are easier for him because information in your head to be used in that moment
they are familiar, and he is familiar with what he (e.g., remembering a telephone number). Joseph’s
needs to do. More abstract and less context- rich performance was weak with a working memory index
tasks are much more likely to be challenging. The score of 80, which is the 13th percentile for the
assessment found significant challenges in his WISC-IV. Processing speed is the ability to quickly
cognitive development, which are likely to negatively complete simple clerical-like tasks and is a measure
impact his future learning as the curriculum becomes of how efficiently a person is able to do the task.
more demanding, and when there are higher Joseph’s performance was also in the 13th percentile
expectations of independent working. These for the WISC-IV for a processing index score of 83.
challenges need to be addressed, and include the However, it should be noted that on the more worldly
following: and typical tasks of speed and efficiency, such as the
reading, writing, and math fluency tasks of the
1. Very weak language processing skills, for Woodcock Johnson-III, Joseph’s performance was
both expressive and receptive language tasks, incredibly strong at the 98th percentile.
 Case studies 181

Intervention performed equally well with written expression and

spelling.
In March 2015, Joseph’s parents contacted Brown to The current scores are in some way similar to
discuss using EMCDC to strengthen his cognitive previous results and in some ways dissimilar. The
abilities; visual and auditory processing speed, WISC-V has a differing format than the WISC-IV,
comprehension, working memory, long term memory, which was used last year. With one exception, each of
and reasoning skills. According to Joseph’s parents, the index scores has at least one and sometimes two
despite all the support from Joseph’s teachers, an subtests within the average range, suggesting that
occupational therapist, and a speech therapist, he was Joseph’s potential is at least in the average range in
not able to work independently in class. Brown all of the tested areas, except for one. Joseph’s
reviewed the academic and psychological testing Vocabulary score was in the middle of the average
showing cognitive deficits in processing, working range. Vocabulary is the single best estimate of
memory, comprehension, and perceptual reasoning; intelligence and based on that score, it would suggest
she then agreed to begin working with Joseph using that he has average intellect. However, as he did on
EMCDC. Joseph received cognitive developmental the 2015 WISC-IV, he had extreme difficulty in
therapy with Equipping Minds Cognitive understanding superordinate concepts. In other words,
Development Curriculum from April 2015-January understanding the relationship to how things are
2017 for 30-minute sessions, 5 days a week for 150 similar. Another way of saying it would be that he had
hours. During this time, he also did primitive reflex difficulty detecting the conceptual relationship among
exercises and listened to sound therapy for a few objects. In the 2015 report, Joseph had very poor
months. visual spatial ability. However, on this measure, there
is an addition of another subtest not given on the
WISC-IV. On the Block Design subtest, which is a
Results after intervention visual spatial task or a task of perceptual analytic
reasoning, he scored in the average range (in 2015 he
In December 2016, another psychological evaluation was in the low average range.). The same is true on a
was given. Previously Joseph’s working memory was task in which he had to analyze and synthesize visual
an index score of 80, which is the 13th percentile. In objects. The index score of 92 falls in the average
contrast to the 2015 evaluation, the working memory range. Thus, visual spatial reasoning or perceptual
index score increased to 103 and the 58th percentile analytic abilities are in the average range, albeit at the
in the average range. The Processing Speed is lower end of average.
considerably higher on the 2016 evaluation increasing Where Joseph had the most difficulty was in
from an index score of 83 to 98 and from the 13th to Fluid Reasoning. These tasks require him to detect
48th percentile in the average range. underlying conceptual relationships among visual
In March 2017, the Kaufman Test of Educational objects and then use reasoning to identify and
Achievement-3rd Edition-Form A (KTEA-3) was apply the rules. Joseph had extreme difficulty.
administered. The KTEA-3 is comprised of subtests Similarly, as already mentioned, Joseph had difficulty
that measure a student’s academic achievement in the understanding conceptual relationships on a verbal
areas of reading, written language, and math. Joseph task (Similarities subtest). It should be noted that the
is performing in the average range in all academic examiner who administered the WISC V was not
areas. When compared to grade norms, Joseph’s familiar to Joseph and noted significant impulsivity
scores are higher. While he demonstrated average and anxiety during the testing.
comprehension abilities when reading expository However, at 10 years of age, Joseph was
passages and literal questions, he demonstrated administered the Kaufmann Brief Intelligence- 2
weaknesses when reading fictional passages and (KBIT-2) in September 2016 by Brown who had been
answering inferential questions. Math concepts and working with him on a daily basis for 1.5 years. The
applications are a relative strength for Joseph while test was given over two days. Joseph exhibited no
math computations are a relative weakness. Joseph impulsivity or anxiety and was extremely thoughtful
182 Carol T Brown

in his responses. KBIT-2, a brief intelligence test average and visual attention span is also in the
which measures verbal and nonverbal intelligence for average range. The Processing Speed Index also
individuals from 4 to 90 years of age. The test is considerably higher on the 2016 evaluation. His
yields three scores: Verbal, Nonverbal, and an IQ motor response to a visual perceptual task was
Composite. The Verbal scale is composed of relatively quick. However, when cognitive tasks are
two subtests that assess receptive vocabulary and added to the task such as discrimination and scanning,
general information (Verbal Knowledge) as well as he falters significantly. These gains demonstrate the
comprehension, reasoning, and vocabulary knowledge impact of EMCDC on working memory and
(Riddles). Joseph had a standard score of 102 in the processing speed.
55th percentile and average range. The Nonverbal Furthermore, the psychological examiner notes
scale uses a Matrices subtest to measure the ability the Full-Scale IQ cannot be used as a fixed figure.
to solve new problems by accessing an individual There are a number of indicators on the measure that
ability to complete visual analogies and understand would suggest average intellect. This would be in
relationships (17). Joseph had a standard score of 112 agreement with Brown’s assessment on the KBIT-2
in the 79th percentile in the average range. The IQ placing Joseph in the average range.
composite had a standard score of 109 in the 73rd The Test of Variables of Attention (TOVA) was
percentile also in the average range. This is the only administered on December 2, 2016. The results are
examine administered by Brown. It is Brown’s similar to those diagnosed with ADHD. The examiner
opinion that the difference in fluid reasoning scores recommended medication on a trial basis.
on the WISC V and KBIT 2 are a result of the In conclusion, Joseph has shown strong cognitive
cognitive training and having a relationship with the modifiability throughout the program with ECMDC.
examiner allowing Joseph to complete the test in He has an incredible work ethic and maintains a
optimum conditions. positive growth mindset. Joseph’s visual and verbal
In contrast to the 2015 evaluation, the Working memory, visual- spatial memory, and reasoning skills
Memory Index is in the 58th percentile and solidly in have developed significantly. He is giving more
the average range. Both of the measures here are attention to detail, following 3-4 step directions, and
solidly average. Auditory short-term memory is verbalizing his thought process.

Table 3. Results of WISC IV and WISC V of Joseph

Scale Scale
Composite Composite Composite
WISC – IV Percentile WISC –V Percentile
Score Score Difference
01-02/ 2015 12/2016
Verbal Comprehension 32nd 93 Verbal Comprehension 18th 86 -7
Working Memory 13th 80 Working Memory 58th 103 23
Processing Speed 13th 83 Processing Speed 48th 98 15
th th
Perceptual Reasoning 14 84 Visual Spatial 30 92 8
th
Fluid Reasoning 8 79
st
Full Scale IQ 21 88

Table 4. Results of KBIT -2 of Joseph

Scale KBIT-2
Standard Score Percentile
02/2016
Verbal 102 55
Nonverbal 112 79
IQ 109 73
 Case studies 183

Table 5. Results of KETA-3 of Joseph

Scale
KETA-3 Standard Score Percentile
03/2017
Reading Composite 99 47
Math Composite 96 42
Written-Language Composite 98 45

Case 2. David: Autism, apraxia, anxiety In 2015 the processing speed index (PSI) of the
and Hashimoto’s disease WISC IV was given to David with a PSI of 73. The
Kaufmann Brief Intelligence- 2 (KBIT-2) was also
David is an eleven-year old boy with a diagnosis of given in 2015. The verbal scale is composed of
Autism. His mother, a registered nurse, reported that two subtests that assess receptive vocabulary and
at four months of age, David received the t-dap general information (Verbal Knowledge) as well as
vaccine and “went limp” at that time. She noted that comprehension, reasoning, and vocabulary knowledge
he had 104-degree fever and also began showing (Riddles). David had a standard score of 61 in the
signs of hypotonia. He also reportedly had an below average range. The Nonverbal scale uses a
undiagnosed salmonella infection at that time. He was Matrices subtest to measure the ability to solve
diagnosed with Autism and verbal apraxia at two new problems by accessing an individual ability
years, eight months of age. He was also diagnosed to complete visual analogies and understand
with Hashimoto’s Disease in December of 2010. relationships (17). David had a Nonverbal standard
David’s school performance is below average. He score of 66 in the below average range. The IQ
has received ABA therapy, speech therapy, and composite had a standard score of 58 also in the
occupational services for many years. He struggles below average range.
with anxiety, atypical social behavior, and The Wechsler Individual Achievement Test-III
preservation on topics. was given to David in 2015. The examiner noted
severe difficulties academically with severely
impaired scores in early reading, math problem and
Assessment listening comprehension. Spelling was in the low
average range and alphabet writing in the average
range. Word reading and numerical operations were
At the age of 8, David received an extensive
in the moderately impaired range. David made
evaluation of his cognitive abilities in 2015 and
significant gains in reading abilities.
further evaluations in 2016. The evaluation
procedures used included:
Intervention
Clinical observation sessions 

Interview with parents In December 2014, David’s parents contacted Brown
Wechsler Individual Achievement Test-III 
 to discuss using EMCDC to strengthen his cognitive
Wechsler Intelligence Scale for Children- abilities; visual and auditory processing speed,
Fourth Edition (WISC-IV) comprehension, working memory, long term memory,
Wechsler Intelligence Scale for Children- and reasoning skills. According to David’s parents,
Fifth Edition (WISC-V) despite all the support from teachers, occupational
Kaufman Brief Intelligence Second Edition therapist and speech therapist his IQ composite was a
(KBIT-2) 58 showing an intellectual disability. Brown reviewed
Kaufman Test of Educational Achievement- the academic and psychological testing showing an
3rd Edition-Form A intellectual disability with deficits in processing,
184 Carol T Brown

working memory, comprehension, and perceptual However, this was an increase of 14 points from the
reasoning; she then agreed to begin working with FSIQ of 58 in 2015. Furthermore, he showed average
David using EMCDC. David has received cognitive performance when working with primarily visual
developmental therapy with Equipping Minds information and the VSI demonstrates an area of
Cognitive Development Curriculum from February strength relative to his overall ability (VSI = 97).
2015- May 2017 for 20-30 minute sessions, 5 days a When compared to his fluid reasoning (FRI = 85),
week for 160 hours. working memory (WMI = 74), and processing speed
(PSI = 77) performance, visual spatial skills emerged
as a particular strength.
Results after intervention The language skills assessed appear to be one of
David's lowest areas of functioning. He showed very
In September 2016, David was referred for a psycho- weak performance on the Verbal Comprehension
educational re-evaluation to determine continued Index (VCI = 62). The verbal results are similar to the
special education eligibility and placement. He was 2015 KBIT-2 with a score of 66. Verbal scores
previously identified as a student with an Autism emerged as an area of need when compared to
Spectrum Disorder. He had most recently attended his performance on fluid reasoning (FRI = 85),
private school. With his recent move into the public working memory (WMI = 74), and processing speed
school, a psychological and educational assessment (PSI = 77) tasks. Ancillary index scores revealed
was done in the first month of school. David was seen additional information about David’s cognitive
for one assessment session. Though David had no abilities using unique subtest groupings to better
relationship with the examiner, rapport during testing interpret clinical needs. On the Nonverbal Index
was easy to establish and maintain. He was a willing (NVI), a measure of general intellectual ability that
and cooperative test participant, although quiet at the minimizes expressive language demands, his
beginning. David was generally polite and responsive performance was Below Average for his age (NVI =
to the examiner and worked steadily on those tasks 82). He also scored in the Below Average range on
that were presented to him. During the testing the General Ability Index (GAI), which provides an
situation, David utilized a moderate work pace. He estimate of general intellectual ability that is less
maintained inconsistent eye contact and displayed reliant on working memory and processing speed
decent interpersonal skills. He was persistent on most relative to the FSIQ (GAI = 75). David’s low
tasks and showed some interest in the tasks presented. performance on the Cognitive Proficiency Index
David displayed a normal activity level for his age. (CPI) suggests that he struggles to efficiently
He responded with realistic confidence in his ability, process cognitive information in the service of
not becoming overly upset or frustrated when a learning, problem solving, and higher order reasoning
question or task was perceived as challenging / (CPI = 73). David achieved an average score on the
difficult. David required some encouragement VMI, which measures visual motor integration skills.
throughout testing. He tended to respond with general However, at 10 years of age, David was
or vague responses and benefitted from queries to administered the Kaufmann Brief Intelligence- 2
improve upon his answers. Visual tasks that included (KBIT-2) in September 2016 by Brown who had been
a model were particularly beneficial. Overall, the working with him on a daily basis for over 1.5 years.
results of this evaluation are considered to be a valid The test was given over two days. David exhibited
indication of David’s current potential and general no anxiety and was extremely thoughtful in his
levels of ability. responses. The KBIT-2, measures verbal and
After receiving cognitive intervention with nonverbal intelligence for individuals from 4 to 90
EMCDC for 1.5 years, the WISC-V was given in years of age. The test yields three scores: Verbal,
2016 to assess David's performance across five areas Nonverbal, and an IQ Composite. The Verbal
of cognitive ability. As measured by the WISC-V, his scale is composed of two subtests that assess
overall FSIQ score fell in the Below Average range receptive vocabulary and general information (Verbal
when compared to other children his age (FSIQ = 72). Knowledge) as well as comprehension, reasoning, and
 Case studies 185

vocabulary knowledge (Riddles). David had a verbal for measuring academic achievement. It should be
standard score of 69 in the 8th percentile and in the noted that norm-referenced assessments do not test
below average range. This score was similar to his curriculum benchmarks or the amount of instruction
verbal comprehension index score of 62 on the WISC needed to achieve benchmarks. These tests provide a
V and the verbal score on the KBIT -2 in 2015 of 61. measure of David’s academic achievement as
The Nonverbal scale uses a Matrices subtest to compared to same age peers using a standard score.
measure the ability to solve new problems by His test performance can be generalized to similar,
accessing an individual ability to complete visual non-test, age-level tasks.
analogies and understand relationships (17). David In analyzing the results on the Wechsler
had a standard score of 122 in the 56th percentile in Individual Achievement Test-III given in 2015 and
the average range which is a substantial gain of 56 the Kaufman Test of Educational Achievement-
points from the 2015 KBIT-2 with a Nonverbal score 3rd Edition-Form A given in 2016, David made
of 66. As noted on the WISC V, David’s visual spatial significant gains in reading abilities, letter / word
skills emerged as a particular strength with a score of recognition, silent reading fluency, reading compre-
97. The IQ composite had a standard score of 95 in hension, math computation, and math concepts /
the 37th percentile also in the average range. This is applications moving from severely impaired in
the only exam administered by Brown. It is Brown’s 2015 to below average range 1.5 years later.
opinion that the difference in IQ on the 2016 WISC V Spelling moved from below average to the average
(FSIQ-72), 2015 KBIT 2 (FSIQ-58), and 2016 range.
KBIT 2 (FSIQ 95) are a result of the cognitive In conclusion, the academic and cognitive gains
training and having a relationship with the examiner which David has shown indicate strong cognitive
allowing David to complete the test in optimum modifiability in many areas. While the verbal skills
conditions. have not increased at the same rate as the Nonverbal,
Results of standardized achievement testing on nonetheless, there has been progress. Brown would
the Kaufman Test of Educational Achievement-3rd note that whereas the processing scores are in the
Edition-Form A given in 2016 suggest that David is below average range, David is very diligent and
performing within the average range for the area of precise when completing processing exercises. He is
spelling. The areas of letter/word recognition, silent typically 100% accurate but works slowly. Brown
reading fluency, reading comprehension, math was not surprised by the slower processing score.
computation, and math concepts/applications were David continues to increase in his reading abilities,
found to be within the below average range. The writing, and enjoys cognitive exercises which employ
assessment instruments used provide a comprehensive visual logic puzzles.
set of individually administered norm-referenced tests

Table 6. Results of WISC IV, WISC V, and KBIT-2 of David

Scale Scale
Composite
WISC – IV Composite Score WISC –V Difference
Score
01/2015 09//2016
Below
Verbal Comprehension 62
Average
Below
Working Memory 74
Average
Below
Processing Speed 73 Processing Speed 77 4
Average
Visual Spatial 97 Average

Fluid Reasoning 85 Average

KBIT-2 Below
58 Full Scale IQ 72 14
IQ Composite Average
186 Carol T Brown

Table 7. Results of KBIT 2 of David

KBIT-2
Standard Score KBIT-2 09/2016 Standard Score Difference
01/2015
Verbal 61 Verbal 69 8 Below Average
Nonverbal 66 Nonverbal 122 56 Average
IQ Composite 58 IQ Composite 95 37 Average

Table 8. Results of WIAT III of David

Scale Scale
WIAT-III Standard Score KETA-3 Standard Score Difference
01/2015 09/2016
Early Reading Skills 40 Reading Composite 73 33
Word Reading 70 Letter and Word Recognition 77 7
Listening Comprehension 53 Reading Comprehension 71 18
Receptive Vocabulary 66 Silent Reading Fluency 78 12
Expressive Vocabulary 55 Math Composite 73 18
Math Concepts and
Math Problem Solving 51 68 17
Application
Numerical Operations 71 Math Computation 81 10
Spelling 83 Spelling 86 3

Case 3. Kay: General learning disorder and math reasoning, and listening comprehension
were in the low average range. She has been home-
Kay was born six weeks early with respiratory schooled by her mother for her academic career. In
distress syndrome. She weighed less than six pounds, 2013, the Peabody Individual Achievement Test was
walked at 19 months, and began speaking between given. Kay had a standard score of 84 (14th percentile)
30-36 months. Her parents have been concerned about in general information, standard score of 71 (3rd
her cognitive abilities since the first evaluation when percentile) in reading recognition, a standard score of
she was 7 years of age. At that time, her Full-Scale IQ 70 (2nd percentile) in reading comprehension, standard
on the WISC-IV was 72. Kay performed much better score of 67 ( 1st percentile) in total reading, standard
on nonverbal than verbal reasoning tasks. Her Verbal score of 74 (4th percentile) in mathematics, standard
Comprehension Index is 79, Perceptual Reasoning is score of 76 (5th percentile) in spelling, stand score of
94, Processing Speed is 73, and Working Memory 56. 69 ( 2nd percentile) for the total test, a standard score
Kay performs better on nonverbal than verbal skills. of 71 (3rd percentile) in written language, and written
At the age of 15 years, Kay had another expression was in the low range.
educational evaluation. On the Slosson Full – Range
Intelligence test, Kay received a Full –Range IQ score
of 85. The verbal index score was 88, the memory Assessments
index standard score is 80, and the performance index
standard score is 84. All three of these index scores: Universal Nonverbal Intelligence Test
88, 84, and 80 are consistent with Kay’s overall IQ (UNIT)
score of 85. WISC-IV
Academic testing has been done with the Slosson Full Range IQ Test
Woodcock Johnson Test of Achievement III (WJ-III)
Woodcock-Johnson Tests of Achievement -
from 2005- 2016. In April 2005, the WJ-III results
Third Edition (WJ-III)
indicated Kay was in the average range in broad math
Peabody Individual Achievement Test
and math calculations. Oral expression, basic reading,
 Case studies 187

Intervention and Age Equivalent (AE) on the 2016 assessment

where she was 11.8 GE and 18.2 AE in the following
In July 2015, Kay’s parents contacted Brown to areas:
discuss using EMCDC to strengthen her cognitive
abilities; visual and auditory processing speed, Oral language went from a 4.4 GE to >17.6
comprehension, working memory, long term memory, GE for a gain of 13.2 years and >21 AE
and reasoning skills. Kay is 17 years of age. Written expression went from 7.6 GE to 12
According to Kay’s mother, she was struggling to GE for a gain of 4.4 years and >17.6 AE
process information in a one-on-one homeschool Understanding Directions which is similar to
setting. Brown reviewed the academic and working memory went from 4.5 GE to 18 GE
psychological testing showing cognitive deficits in for a gain of 13.5 years and >21 AE
processing, working memory, comprehension, and Math Calculations went from 9.5 GE to 11.2
perceptual reasoning; she then agreed to begin GE for a gain of 1.7 years and 16.8 AE
working with Kay using EMCDC. Kay received Writing Sample went from 8.7 GE to 11.4
cognitive developmental therapy with Equipping GE for a gain of 2.7 years and 16.11 AE
Minds Cognitive Development Curriculum from Story Recall went from 5.6 GE to 13 GE for
September 2015- May 2016 for 30 minute sessions, 5 a gain of 7.4 years and 20 AE.
days a week for 60 hours.
The same examiner has given the test for
numerous years and indicated that gains of this
Results after intervention magnitude had not been seen and is untypical of
someone with Kay’s long academic history of
After completing 60 hours with EMCDC, Kay took learning challenges. The gains correspond with the
the Woodcock Johnson Test of Achievement III as cognitive developmental therapy with EMCDC which
she does every year. In analyzing the results from Kay received during September 2015-May 2015. She
2010-2014, Kay typically made gains of 6 months to had previously been receiving academic tutoring
1 year. At a 9.8 grade level in 2014, Kay’s scores alone. In conclusion, the academic gains which Kay
ranged from 4.2 – 7.0 in the majority of subjects has shown indicate strong cognitive modifiability in
putting her 2 to 5 years below grade level. However, many areas after using EMCDC.
Kay made significant gains in Grade Equivalent (GE)

Table 9. Results of WISC IV for Kay

Scale
WISC –V Composite Score Percentile
12/2005
Verbal Comprehension 79 8 Low
Working Memory 56 .2 Low
Processing Speed 73 4 Low
Perceptual Reasoning 94 34 Average
Full Scale IQ 72 3 Low

Table 10. Results of Slosson for Kay

Scale
Composite Score Percentile
03/2013
Verbal Index 88 8 Low
Memory Index 80 .2 Low
Performance Index 84 4 Low
Full Scale IQ 85 3 Below Average
188 Carol T Brown

Table 11. Results of Universal Nonverbal Intelligence Test (UNIT) for Kay

UNIT
Standard Score Percentile
05/2006
Memory Quotient 89 23
Reasoning Quotient 95 37
Symbolic Quotient 91 27
Non-symbolic Quotient 93 32
Full Scale IQ 91 I

Table 12. Results Woodcock Johnson III Normative Tests of Achievement of Kay

Score after Intervention

GE:5.8 GE:6.8 GE:7.8 GE:9.8 Difference
Grade: 11.8
2010 2011 2012 2014 2016
Oral Language 3.7 3.5 4.6 4.4 17.6 13.2
Brief Achievement 3.2 3.7 4.2 4.6 6.5 1.9
Broad Reading 2.8 3.1 3.9 4.7 6.6 1.9
Broad Math 5.2 5.7 6.3 7 7.2 0.2
Broad Written Language 3.3 4.3 4.8 6.3 8.9 2.6
Brief Reading 2.9 3.3 4.1 4.8 7 2.2
Brief Math 5.1 5.5 6.3 6.6 7.2 0.6
Math Calc. Skills 6 6.4 8.1 9.2 9.2 0
Brief Writing 3 4.1 4.7 5.9 8.1 2.2
Written Expression 3.9 5.1 5.5 7.6 12 4.4
Acad. Skills 3.6 4 5.1 5.5 7.8 2.3
Acad. Fluency 3.6 4.3 4.7 6.4 7.6 1.2
Academic Apps 3.6 4.5 4.7 5.9 6.7 0.8
Academic Knowledge 3.4 3.4 4.5 4.8 7.1 2.3
Letter Word ID 3 3.2 4.2 4.3 7.2 2.9
Reading Fluency 2.4 2.4 3.2 4.3 5.5 1.2
Story Recall 3 8.8 3.7 4.2 6.8 2.6
Understanding Directions 4.1 2.4 5.1 4.5 18 13.5
Calculations 6.4 6.4 9.5 9.5 11.2 1.7
Math Fluency 5.4 6.7 6.6 8.7 7.5 -1.2
Spelling 2.7 3.4 3.7 4.8 6.9 2.1
Writing Fluency 3.9 4.9 4.9 7 13 6
Passage Com 2.7 3.5 3.9 6 6.7 0.7
Applied Prob. 4.2 4.7 4.5 4.8 5.2 0.4
Writing Sample 3.8 5.5 6.7 8.7 11.4 2.7
Story Recall 1.8 17.8 2.7 5.6 13 7.4
Academic Knowledge 3.4 3.4 4.5 4.8 7.1 2.3

Case 4. Steven: Fetal alcohol spectrum growth failure. He has been evaluated by a pediatric
disorder, post-traumatic stress disorder, endocrinologist for growth issues as he has been
below the 10th percentile which was consistent with
autism, mixed receptive-expressive language
the initial neuropsychological evaluation. Steven is on
disorder, specific learning disorder, anxiety
medication for attentional problems and has Lyme
disease. He has a history of strabismus with residual
Steven was adopted from Russia at 5 years of age.
exotropia which was addressed in developmental
He has a history of mild alcohol related neuro-
optometry. The diagnostic conclusions indicated
developmental disorder in addition to psychosocial
 Case studies 189

a mixed receptive-expressive language disorder; Category Test

multi-sensory neuropsychologically-based processing Wisconsin Card Sorting Test
deficits related to an alcohol related neurodevelop- Thematic Apperception Test
mental disorder/static encephalopathy in addition to Minnesota Multiphasic Personality Inventory
multiple learning disabilities in the category of – Second Edition (MMPI-2)
developmental dyslexic disorder. Steven certainly had Adult and Family Sentence Completion
a great deal of anxiety which is very commonly seen Series
in children who have multi-sensory neuro-cognitive Adult Neuropsychological History
deficits. Adult Neuropsychological Questionnaire
Steven’s overall neuropsychological history
Review of Records
indicates that he was evaluated at the age of 10
years of age with a pattern of global weaknesses
Steven’s initial intellectual testing completed in
in receptive and expressive language as well as
2005 yielded a Verbal Comprehension IQ Score of
processing and learning deficits. Many of these
75; Perceptual Reasoning IQ Score of 92; Working
issues were related to mild alcohol-related neuro-
Memory IQ Score of 77; Processing Speed IQ Score
developmental disorder with some quasi-autistic
of 97; Full Scale IQ Score of 81. All of these scores
characteristics in addition to multisensory information
are generally within the Average Range. Gaps and
processing impairments. Subsequent to the neuro-
inconsistencies in nonverbal learning aptitudes and
psychological evaluation, Steven received special
abilities as well as receptive and expressive language
education services throughout his school years and
were evident.
was re-evaluated at the start of his tenth-grade year in
In the updated evaluation in 2012, Steven
January of 2012.
was administered the Wechsler Intelligence Scale
for Children – Fourth Edition and obtained a
Verbal Comprehension IQ Score of 79 (Borderline
Assessments Range); Perceptual Reasoning IQ Score of 88
(Low-Average Range); Working Memory IQ Score
Steven received extensive evaluations of his cognitive of 83.
abilities from 2005-2015. The evaluation procedures Steven also showed ongoing indications of a
used included: mild Autistic Disorder given his difficulties in
relating to others as well as anxiety, stress and
Wechsler Adult Intelligence Scale – Fourth struggles with adapting to change, in addition to
Edition (WAIS-IV) expressive pragmatic language. Steven also had
Childhood Autism Rating Scale – Second definite problems in comprehension and higher-
Edition (CARS) (Higher-Functioning Version) level listening responses in addition to gaps and
Gilliam Autism Rating Scale – Third Edition inconsistencies in attention, memory, learning
(GARS) and overall information processing and problem
Test of Visual-Perceptual Skills – Third solving.
Edition Steven’s overall language abilities indicated
Test of Auditory Processing Skills – Third major weaknesses in comprehension, processing and
Edition expressive semantic-pragmatic-syntactical expression.
Test of Adolescent and Adult Language – Academic-achievement abilities indicated weaknesses
Fourth Edition in reading style, rate and written language with
Wide Range Achievement Test – Fourth relative strengths in mechanical math but difficulties
Edition (WRAT-4) in mental calculations and word problems. Steven
Wechsler Individual Achievement Test – always struggled with expressive writing in addition
Third Edition (WIAT-III) to memory processing and consolidation in both
Wechsler Memory Scale – Fourth Edition auditory and visual spheres. He also had significant
Cognitive Assessment System patterns of executive dysfunction. Over the years,
190 Carol T Brown

Steven has been receiving special education services take ADHD medication. Psychologically, Steven
through his school district and has made gradual is a hands-on visual assimilative learner and is
progress. much more reality-based. Steven does much better
with hands-on mechanical aptitude skills. He has
developed better social reciprocity but still has some
Intervention food selectivity as well as some subtle self-
stimulatory behaviors. There are times that he can
In October of 2014, Steven’s parents contacted Brown be rather rigid and inflexible in his thinking and easily
to discuss using EMCDC to strengthen his cognitive overstimulated.
abilities; visual and auditory processing speed, There were certainly some indications of ongoing
comprehension, working memory, long term memory, “performance anxiety” which impacts testing. Steven
and reasoning skills. According to Steven’s parents, continued to work very hard at all times but had
he was finishing his senior year in high school and the most struggles with higher-level language
continuing to struggle in social awareness, math processing and lengthy and sequential memory,
sense, communication skills, executive functioning, learning and recall which are longstanding issues and
and academics. Brown reviewed the academic and directly related to his low-grade Alcohol-Related
psychological testing showing cognitive deficits in Neurodevelopmental Disorder in addition to his mild
processing, working memory, comprehension, and autistic patterns.
perceptual reasoning; she then agreed to begin Steven was administered the Wechsler Adult
working with Steven using EMCDC. Steven received Intelligence Scale – Fourth Edition and showed
cognitive developmental therapy with Equipping a more stable pattern in his overall intellectual
Minds Cognitive Development Curriculum from abilities which are now within the Average Range
January 2015-May 2015 for 60 minute sessions 5 although he has a 21-point discrepancy between
days a week for 60 hours. Steven also did 15-20 verbal comprehension and perceptual reasoning
minutes of primitive reflex integration therapy and 60 which indicates an ongoing language weakness
minutes of sound therapy on a daily basis for a few pattern. He also has ongoing weaknesses in his
months. expressive communications as he is not always clear
and connected in his semantic-pragmatic-syntactical
expression.
Results after intervention As a general summary statement, there is no
question that Steven has improved on a global
After completing cognitive developmental therapy perspective in terms of neurocognitive or neuro-
with EMCDC, his parents stated that Steven showed psychiatric functioning. He is much more alert,
reduced anxiety, increased eye contact, more social oriented, interactive as well as motivated to do
awareness, had a sense of humor and math sense. His well with a lessening of the neurocognitive effects
overall language and language arts abilities have of a fetal alcohol spectrum disorder in addition
improved with cognitive therapy, and he is definitely to his autistic spectrum disorder which has always
improved in his overall high school performance been at the “higher-functioning spectrum.” In terms
even though there are some gaps and inconsistencies of pure academic-achievement abilities, Steven is
in memory, learning and overall speech and language at the middle school level in overall reading,
and pragmatics. Steven did begin a job working reading comprehension, spelling and written language
at a plant nursery where he can use his landscaping and mathematics. This certainly is a significant
skills. improvement as it shows that he has enough
Further testing was done in July 2015. Steven neurocognitive and academic skills in order to
remembered the examiner quite well and was very function at the technical-vocational training level
polite and cooperative. He displayed very good as his strengths are in the areas of hands-on
attention, concentration and focus as there were no visual assimilative learning which is his area of
major difficulties evident. Steven no longer needs to interest.
 Case Studies 191

Table 13. Results of WISC IV for Steven

Scale Scale
Composite
WISC – IV Composite Score WISC –IV Difference
Score
01/2012 07/2015
Verbal Comprehension 79 Verbal Comprehension 76 -3
Working Memory 83 Working Memory 80 -3
Processing Speed 94 Processing Speed 106 12
Perceptual Reasoning 88 Perceptual Reasoning 97 9
Full Scale IQ 81 Full Scale IQ 89 8

Case 5. Bryant: Post traumatic Language retrieval and processing: Difficulty

concussion syndrome recalling vocabulary
Extreme physical and mental fatigue: Mental
At 18 years of age Bryant experienced a head injury fatigue is like the fogginess but manifests
during a rugby game. The doctors recommended itself in fatigue-like symptoms. For example,
antidepressants and extended rest. As the symptoms during reading Bryant would have to fight
increased, he tried various treatments over the next off an intense desire to sleep and could no
four years from acupuncture to chiropractic longer concentrate on whatever was being
treatments. However, the symptoms were not read.
alleviated. He then took one year off and had given Depression
up. At this time, he was 23 years of age.

Intervention
Assessment
In October of 2016, Bryant contacted Brown to
Interview with learner discuss using EMCDC to strengthen his cognitive
Learning Screening Checklist deficits as a result of Post Traumatic Concussions
Primitive Reflex Checklist Syndrome. According to Bryant he has tried
numerous interventions over the last 5 years with little
Below is a list of the most prominent symptoms relief. Brown agreed to have an EMCDC mediator
Bryant experienced after the concussion. begin working with Bryant using EMCDC. Bryant
received cognitive developmental therapy with
Fogginess: One of my most prominent EMCDC from September 2016-April 2017 for 30-60
symptoms is what can only be described as a minute sessions 5 days a week for 100 hours. Bryant
feeling of fogginess. When in this state, it is also did 15-20 minutes of primitive reflex integration
hard to complete most mental tasks. It felt as therapy and 60 minutes of sound therapy on a daily
if my neurons were trying to fire and make basis during this time.
connections but didn’t have a clear pathway
to do so according to Bryant.
Difficulty with concentration and attention: Results after intervention
Within this state Bryant had a difficult time
concentrating on tasks and paying attention Decreased fogginess: After working with
for extended periods of time. EMCDC, the periods and intensity of
Poor working memory: Difficulty following fogginess have significantly decreased. The
multiple step directions exercises we focused on strengthened those
Long term memory retrieval: Difficulty connections and helped my brain work
remembering names of people around its deficits according to Bryant.
192 Carol T Brown

Increased concentration and attention: Bryant research with learners with neurodevelopmental
reports having a much easier time holding disorders such as Fetal Alcohol Syndrome and Autism
attention and concentrating on specific tasks. as well as Post Traumatic Concussion Syndrome
Increase in working memory: Able to follow using the Equipping Minds Cognitive Development
multi-step directions Curriculum (EMCDC). When implementing the
Long term memory: Able to store EMCDC, it is essential to implement the program
information and retrieve information much with fidelity using mediated learning. The success of
easier the doctoral research with EMCDC and the case
Increased stamina and energy: His stamina studies suggest that cognitive skills can be developed
and energy has significantly improved while in the classroom or clinical setting through a human
performing cognitive task. mediator which will increase verbal, nonverbal, IQ,
Enjoying reading and learning and impact academics.
Spending extended time outside without
being symptomatic
Ethical compliance
The authors have stated all possible conflicts of
Discussion interest within this work. The authors have stated all
sources of funding for this work. If this work involved
In the case studies, Brown examined the effects of
human participants, informed consent was received
EMCDC, a holistic cognitive development program,
from each individual. If this work involved human
with children and adults in a one-on-one setting.
participants, it was conducted in accordance with the
Brown utilized clinical observations of the learners,
1964 Declaration of Helsinki. If this work involved
examination and analyzation of the psychological
experiments with animals, it was conducted in
and educational documents, and interviews with
accordance with the related institutions’ research
the parents, the learners, and teachers. Cognitive
ethics guidelines.
and academic gains were demonstrated in all of
the case studies. The results are consistent with
the results of Brown’s doctoral research with learners
with a Specific Learning Disorder and the four-year References
case study with Marie who had Down syndrome.
Family members, therapists, and teachers were [1] Tan O, Seng A. Cognitive modifiability in learning
and assessment: International perspectives. Singapore:
included in the therapy sessions and instructed how to Cengage Learning, 2008.
interact and instruct using mediated learning. This [2] Feuerstein R, Feuerstein R, Falik L. Beyond smarter:
suggests that a comprehensive intervention program Mediated learning and the brain’s capacity for change.
which addresses numerous cognitive functions and New York: Teachers College, 2010.
includes parents and other professionals in the [3] Feuerstein R, Feuerstein R, Falik L, Rand Y. The
learner’s life allows more opportunities for Feuerstein Instrumental Enrichment Program.
Jerusalem: ICELP Publications, 2006.
modification. [4] Brown C. Equipping minds: Applying a biblically
based curriculum for improving working memory.
Dissertation. Louisville: KY: Southern Baptist
Conclusion Theological Seminary, 2016.
[5] Kozulin A, Lebeer J, Madella-Noja A, Gonzalez F,
Jeffrey I, Rosenthanl N, et al. Cognitive modifiability of
While the case studies showed cognitive gains in children with developmental disabilities: A multicenter
each learner, case reports lack the strength of a study using Feuerstein’s Instrumental Enrichment-Basic
controlled quantitative research study. However, Program. Res Dev Disabil 2010;31:551–9.
single case research is accepted in neurorehabilitation [6] Feuerstein R, Lewin-Benham A. What learning looks
scientific literature for neurodevelopmental disorders. like: Mediated learning in theory and practice, K–6.
New York: Teachers College Press, 2012.
The case histories suggest the importance of further
 Case studies 193

[7] Feuerstein R, Falik L, Feuerstein R. Changing minds [13] Brown C. Equipping minds for Christian education:
and brains. New York: Teachers College Press, 2015. Learning from neuroscience for Christian educators.
[8] Mentis M, Dunn-Bernstein M, Mentis M, Skuy M. Christian Educ J 2016;13(1):147-68
Bridging learning: Unlocking cognitive potential in and [14] Brown C. Equipping minds for Christian education or
out of the classroom. Thousand Oaks, CA: Corwin, learning from neuroscience for Christian educators. In:
2009. Maddix M, Bevins D, eds. Neuroscience and Christian
[9] Johnson K. Maintaining brains every day DVD. URL: formation. Charlotte, NC: Information Age Publishing,
http: www.pyramidofpotential.com. 2016:153-170.
[10] Bloomberg H. Dempsey M. Movements that heal: [15] Jaeggi S, Buschkuehl M, Jonides J, Perring W.
Rhythmic movement. Sunnybank Hills, Australia: Book Improving fluid intelligence with training on working
Pals, 2011. memory. Proceed Natl Acad Sci 2008;105:6829–33
[11] Joundry P, Joundry R. Sound therapy: music to recharge [16] Jaeggi S, Buschkuehl M, Shah P, Jonides J. The role of
your brain. Sydney, Australia: Success Stream Books, individual differences in cognitive training and transfer.
2009 Mem Cogn 2014;42(3):464-80.
[12] Brown C. Equipping minds cognitive development [17] Kaufman A, Kaufman N, Kaufman Brief Intelligence
curriculum. Danville, KY: Self-Published, 2015. Test, 2nd ed. Bloomington, MN: PsychCorp, 2004.

Submitted: April 22, 2017. Revised: May18, 2017.

Accepted: May 25, 2017.

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