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Complex psychological evaluation and correction methods of disorders in the emotional and personal sphere in children with post-COVID syndrome, considering structural and functional features of the brain

Troitskaya L.A.1, Plotnikova I.A. 2, Semenova N.D.1, Erokhina V.A.1, Plotnikova D.F.3, Avakyan G.G.1

1Pirogov Russian National Research Medical University, 1 Ostrovityanova st., 117997, Moscow, Russia.
2Ural State Medical University, 3 Repina st., 620014, Yekaterinburg, Sverdlovsk Oblast, Russia.
3Limited Liability Partnership “Tich’ I Spich Advance”, 28 Khadzhimukan st., 050059, Almaty, Kazakhstan.

*Corresponding author

*Inga A. Plotnikova, MD, PhD, Department of Pediatric Diseases, Ural State Medical University. inga63@bk.ru ORCID ID: 0000-0002-6909-1487.

Abstract

Introduction: A number of systematic reviews on the PubMed and Scopus databases confirmed that post-COVID syndrome in children is a topical issue and is considered mainly in terms of the influence of social factors. The COVID-19 pandemic by itself and lockdown have created fear and anxiety around the world, leading to short- and long-term consequences for the psychosocial and mental health of children and adolescents. The reviews analyzed studies to understand the major effects of COVID-19 in children with the goal of developing effective treatment strategies. However, such strategies must be designed with consideration of the pathogenetic mechanisms that explain the deleterious effects of COVID-19 on the central nervous system. In the meantime, the evidence for long-term effects on neurodevelopment after COVID-19 should be further investigated. The timing of the resolving of neurological damage or the appearance of nervous dysfunction is still largely unclear, due to the fact that this disease has only recently become known to the world. The present study in this area aims to help in the rehabilitation of children after COVID-19. Purpose of the study. Development of rehabilitation programs for children with postCOVID syndrome, which is based on a comprehensive psychological assessment of the cognitive and emotional sphere, taking into account the structural and functional characteristics of the brain. Materials and methods. 25 children (9 girls and 16 boys) aged from 12 to 17 years were admitted to the hospital, among them 9 children were in a state of moderate severity of acute respiratory infections and indication of family contact with COVID-19 patients. 16 children had mild form of COVID-19 during the 12 months preceding the examination, including 8 children (50%) in the previous 4 months and 8 (50%) in the previous 6-12 months. The control group consisted of 25 students in Moscow (14 girls and 11 boys) aged from 12 to 16 years, who were examined before the pandemic. Examination methods consisted of 2 blocks. In the first block we investigated: kinesthetic, spatial, dynamic,
graphic praxis; auditory-motor coordination; visual, object-constructive gnosis; auditory-verbal, visual memory; voluntary attention; and thinking. The second block of methods were “Eysenck Questionnaire” for studying three individual qualities: introversion - extroversion, neuroticism and deceit, “Lüscher Color Test. Diagnosis of a neuropsychic state,” adapted by V.I. Timofeeva, Yu.I. Filimonenko, which is an assessment of psycho-functional state (determination of the level of unproductive neuropsychic tension or total deviation from the autogenic norm; autonomic coefficient).

Results: Significant differences were found with the neuropsychological tests in the control group, suggesting impairment of memory, attention, visual gnosis, visuospatial function, kinesthetic and dynamic praxis, verbal and non-verbal components of thinking. In 85% of children with post-Covid syndrome, two primary colors are in the last three places of the color gamut in the Luscher test. In 65% of cases, the
presence of gray is at the beginning of the color scheme. Compensatory mechanisms were observed in 55% of cases. Conclusions. Complex
psychological examination in children with post-COVID syndrome has showed that the revealed changes in the emotional and personal sphere have a common pathogenesis with cognitive impairments (auditory-speech memory disorders, insufficiency of optical-spatial gnosis and praxis, verbal and non-verbal intelligence). Disorders of higher mental functions, changes in the emotional and personal sphere and
the nature of neurological complaints indicate the involvement of the mediobasal parts of the brain, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions. When developing neuropsychological rehabilitation programs for children with post-Covid syndrome, it is necessary to observe the principle of unity of diagnosis and correction, which makes it possible to determine the topic of brain damage in the relationship of the cognitive and emotional-personal spheres, to conduct restorative training using the method of “replacement dysontogenesis”, relying on intact functions.

Key words: pediatric neuropsychology, long-term consequences of COVID-19, neurocognitive tests, cognitive functions, disorders in the emotional and personal sphere.

Introduction

A sudden outbreak of infectious disease caused by SARS-CoV-2 has been officially named a novel coronavirus disease (COVID-19) by the World Health Organization [1]. As of September 2020, there were over 6 million reported cases in the United States [2], including 8.4% in children [3]. According to November 28, 2021, about 261 million people infected with COVID were registered worldwide [4].

In addition to detailed studies of respiratory symptoms associated with COVID-19, the occurrence of neurological and neuropsychoneurological complications of novel coronavirus infection, such as acute demyelinating encephalopathy, meningitis, strokes, etc., has been widely reported in the academic research. [5,6]. It was determined that novel coronavirus infection can worsen previous neurological disorders or cause new neuropsychiatric disorders. Neurological disorders were noted in 36.4% of patients with COVID-19 [6].

Relevance of research

A brief review of neurological conditions, potential mechanisms of their development, and possible outcomes of COVID-19 in the pediatric population was conducted at New York Presbyterian Morgan Stanley Children's Hospital, based on literatures and primary data.

In particular, among children with COVID-19 in the United States, 28% of them experienced headaches [7]. 31–47% of children, who diagnosed with multisystem inflammatory syndrome in New York City, had neurological symptoms, including headache, mental status changes, and encephalopathy [8–10].

A multicenter study of children with multisystem inflammatory syndrome in the USA found that 5% of them suffered from severe neurological complications such as seizures, coma, encephalitis, demyelinating disorders, as well as aseptic meningitis [10].

In a study of 27 children from 8 to 15 years old with multisystem inflammatory syndrome in the United Kingdom, 4 of them experienced neurological symptoms including encephalopathy, dysarthria, dysphagia, cerebellar ataxia and peripheral neuropathy that resulted in proximal limb muscle weakness and decreased reflexes. As the same time according to MRI or CT data, all of them showed changes, which localized in the posterior part of the corpus callosum [11].

In summary, a number of systematic reviews conducted on the basis of PubMed and Scopus data confirm that post-COVID syndrome in children is a topical issues, which is considered mainly in relation to social factors. The COVID-19 pandemic itself and lockdown have created fear and anxiety around the world, leading to short- and long-term consequences for the psychosocial and mental health of children and adolescents. The quality and severity of the impact on juveniles is determined by many susceptibility factors, such as developmental age, educational status, pre-existing mental health conditions, economic disadvantage, or being quarantined due to infection or fear of infection.

A recent narrative review analyzed the main consequences of COVID-19 in children to develop effective treatment strategies [12]. However, such strategies must be designed with consideration of the pathogenetic mechanisms that explain the deleterious effects of COVID-19 on the central nervous system. For example, transcriptomic analysis has shown low but consistent expression of angiotensin converting enzyme 2 (ACE2) [13] and transmembrane serine protease 2 (TMPRSS2) [14] in various regions of the human brain, which are required for SARS-CoV-2 invasion. The effect of the SARS-CoV-2 virus on the blood-brain barrier is an interesting area of research. In particular, the development of microglia over the lifespan may provide insight into the mechanism of neuroplasticity and injury in childhood, keeping in mind that microglia acquire a phenotype consistent with a proinflammatory response [15].

COVID-19 is also associated with cerebrovascular changes due to the interaction of the virus with ACE2 receptors, which were expressed on vascular endothelial cells at different parts of the central nervous system. These changes could initiate vasculitis and disruption of vascular integrity through activation of the coagulation cascade [16]. Vascular problems have also been reported in previously healthy children and young adults [17,18].

In children with multisystem inflammatory syndrome, neurological symptoms have been found in 12–58% of cases [19]. Neuroinflammation can trigger depression and post-traumatic stress disorder by increasing tryptophan degradation, which leads to a subsequent decrease in 5-hydroxytryptamine and serotonin levels, as well as dysregulation of NMDA receptor activity [20]. Guillain-Barré syndrome, a demyelinating disease of the peripheral nervous system mediated by post-infectious autoimmune reactions, has been associated with SARS-CoV-2 and has responded to typical intravenous immunoglobulin treatment [21,22].

The long-term impact on neurodevelopment following COVID-19 requires further study. Time to achieve remission of neurological damage or onset of dysfunction is still largely unclear since this disease has only recently become known to the world.

This research aims to help children recover from COVID-19.

Multidisciplinary approach

Inclusion of a psychological examination in the diagnosis of children with post-COVID syndrome is dictated by practical necessity. Neuropsychological symptoms reflect “subtle” functional changes in brain tissue. Currently, in psychiatry and neurology, studies of the cognitive and emotional sphere, which based on the neuropsychological method, have become firmly established in the scientific and research practice of medical specialists and psychologists. New research in these areas is relevant for clinical psychology (primarily neuropsychology), pediatrics, psychiatry and neurology [23-26].

The neuropsychological approach is the most promising way to evaluate disorders in the formation of higher mental functions, opening the following possibilities: the study of changes in the structure of mental functions; the relationship between maturing brain structures and developing mental functions; the correlation of the revealed deficit of mental activity with specific brain dysfunctions or immaturity of brain activity.

The theoretical and methodological basis of this study is as follows

  1. Modern ideas of Russian psychology about higher mental functions as complex self-organizing processes, social in their origin, mediated in their structure, conscious, arbitrary in the way of their implementation, presented in the works of \
  2. The theory of systemic dynamic localization of higher mental functions and the concept of three structural and functional blocks of the brain A.R. Luria and his followers E.D. Chomsky, E.G. Simernitskaya, T.V. Akhutina and others [24].
  3. Psychological and neuropsychological concept of ontogenesis as a sequence of qualitative transitions to new stages of development based on the internal reorganization of individual functions, interfunctional connections and the formation of new systems.
  4. Studies by A.M. Prikhozhan, C.D. Spielberger, O.S. Nikolskaya, E.V. Ustinova, E.V. Fadeeva, aimed at studying the emotional and personal sphere of children with developmental disorders and their families [25,26].

Purpose of the study: Development of rehabilitation programs for children with post-COVID syndrome, which is based on a comprehensive psychological assessment of the cognitive and emotional sphere, taking into account the structural and functional characteristics of the brain.

Research objectives

  • Evaluation of cognitive functions: mnestic, speech, optical-spatial and thinking structure in children with post-COVID syndrome in comparison with healthy children.
  • Determination of structural and topological factors that influence the changes in higher mental functions of children who have suffered from COVID-19.
  • Analyzing the role of individual links in the structure of the emotional and personal sphere which is in the implementation of the holistic process of perception, communication, learning and social adaptation in children after disease.
  • Development of a corrective-developmental program aimed at activating the cognitive functions and emotional-personal relations of children with post-COVID syndrome.

    • Organization of the study

    1. Adaptation of existing neuro-psychological tests of the A. R. Luria school to be performed in an online format, without face-to-face presence of children.
    2. Development of a methodology for psycho-emotional and neuro-psychological testing of children in a remote format using digital technologies.
    3. Neuro-psychological testing of children who were receiving round-the-clock treatment in the eighth Children's Hospital in Yekaterinburg [27].
    4. Full-time testing of the emotional and personal state of children who have had COVID 19 in a day hospital setting.

    Materials and methods

    25 children (9 girls and 16 boys) aged from 12 to 17 years were admitted to the hospital, among them 9 children were in a state of moderate severity of acute respiratory infections and indication of family contact with COVID-19 patients. 16 children had mild form of COVID-19 during the 12 months preceding the examination, including 8 children (50%) in the previous 4 months and 8 (50%) in the previous 6-12 months. The control group consisted of 25 students in Moscow (14 girls and 11 boys) aged from 12 to 16 years, who were examined before the pandemic [27].

    First block of techniques: The neuropsychological examination included: assessing visual-spatial gnosis and praxis (Henry Head's test, recognizing the time by a clock without arrows, test for understanding of logical-grammatical constructions); dynamic praxis (fist-edge-palm test); on mnestic functions of memory (auditory-verbal and visual memorization); object gnosis (recognition of realistic images, crossed out, superimposed and unfinished images); assessment of thinking (tests for understanding the meaning of story pictures, "Fourth extra" method, problem solving).

    Second block of techniques: The Eysenck Questionnaire is aimed at the study of three individual qualities of a child: introversion - extroversion, neuroticism and deceit.

    Based on the analysis of the emotional and personality sphere, the approaches to understanding the psycho-physiological nature of fears and anxiety in children; clinical approaches to the assessment of interpersonal relationships and behavior were taken [23-28]. They consist of “Lüscher Color Test. Diagnosis of a neuropsychic state,” adapted by V.I. Timofeeva, Yu.I. Filimonenko, which is an assessment of psycho-functional state (determination of the level of unproductive neuropsychic tension or total deviation from the autogenic norm; autonomic coefficient).

    Results and discussion

    In the main group, 12% of children had pneumonia, 8% with acute bronchitis, and 80% of them suffered acute respiratory infections with pulmonary syndrome. Eighty-four percent of children had a fever for 4 to 7 days (t 38.2-39.6 °C), while the remaining 16% were at normal body temperature. Familial contact with patients with new coronavirus infection was noted in all patients, and positive nasopharyngeal swab analysis for SARS-CoV-2 RNA by PCR in 58% of children. Peripheral oxygen saturation (SpO2) of 92-94% was in 25% of them. Severe concomitant pathology in a state of compensation before the acute illness was in 1 child of 13 years (bronchial asthma, condition after liver transplantation for congenital biliary atresia, chronic hepatitis B) [27].

    44% of patients had no neurologic complaints. 54% of children self-reported that they had nervous system complaints after a coronavirus infection. One patient reported short-term amnesia. Five children were diagnosed by a neurologist for the first time after the infection, including 2 children with cerebroasthenic syndrome, 1 child with vegetative dystonia syndrome, 1 child with attention deficit syndrome, and 1 child with radiculopathy [27].

    Results of neuropsychological diagnostics: When evaluating and analyzing the obtained results, age standards for performing tests were taken into account. The severity of the disorders was determined using a point system from 0 (no disorders) to 3 points (presence of a pronounced defect). The difficulty level of the techniques included in the neuropsychological examination was determined by the possibility of independent and correct performance by the majority (>75%) of adolescents in the control group at the corresponding age group [27].

    Analysis of the neurodynamic component of mental activity: Voluntary attention. Low pace of task completion, rapid exhaustion, distractibility, impaired concentration of attention in patients of the main group compared to children in the control group (p <0.001), according to the number of errors when performing tests in the Schulte Table method (Fig. 1). This indicates insufficient activation of the energetic component of activity. Lesions were assumed in the brainstem, limbic structures, reticular formation, or medio basal frontotemporal regions of the brain.

    Figure 1: Neurodynamic component of mental activity.

    - Mnestic functions in children of the main group.

    Significant statistical differences were revealed in the control group in the auditory-verbal direct memory test (1) (p=0.002) (Fig. 2). The nature of errors in memorizing 10 words included an increase in the latency period, verbal paraphasias ("'friend' instead of 'brother', 'pie' in place of 'cake'); verbal perseverations; lack of regulation and control.

    When performing the test “Memorization of two phrases” (semantic memorization), the influence of heterogeneous interference, volume reduction and order disruption of representation, changes in the grammatical structure of speech (by gender, number, case) were observed.

    The lesion was in mediobasal frontotemporal parts of the brain with the formation of the leading temporal neuropsychological syndrome (T2).

    Figure 2: Mnestic functions of different modalities - auditory verbal and visual memorization: direct memorization (1), memorization of two phrases (2) and visual memorization (3) of the main and control groups.

    Optical-spatial gnosis

    The success of performance in performing opto-spatial gnosis tests was significantly different in the main and control groups. In Figure 3: 1 - recognition of crossed-out images (p=0.265), H=2.659<Hcr; 2 - recognition of superimposed images (p=0.434); 3 - recognition of underdrawn images (p<0.001), H=18.377 >Hcr.

    The test for identifying unfinished images, which requires the realization of a complete image, allows us to assess the formation of a holistic strategy of information processing. In result, simultaneous agnosia was revealed. Affected areas were the temporo-parietal-occipital regions of the brain.

    Figure 3: The study of optical-spatial gnosis

    Graphic praxis.

    A battery of neuropsychological methods was used to study visual-spatial gnosis and praxis, including copying (houses, figures with re-coding), a test for understanding logical-grammatical relations, recognizing time using a “blind” clock. Children in the main group made the following types of errors: topological (changes in the general scheme of the figure), metric (errors in estimating distances, angles and proportions), coordinate errors in the arrangement of an object (top-bottom and right-left). In Figure 4: 1 – recognition of time using a “blind” clock, (p <0.001); 2 – understanding of logical-grammatical constructions (p=0.5); 3 - copying a figure with 180º rotation; (p=0.265); 4 – copying a perspective drawing (house) (p=0.002).

    The impairment of visual-spatial perception indicates weakness of the temporo-parietal-occipital regions of the brain, which may lead to difficulties in learning geometry and stereometry in children.

    Figure 4: The studying result of visuospatial function

    Study of motor functions (kinesthetic and dynamic praxis).

    For the study of kinesthetic praxis, we used two-handed tests with visual control, and dynamic praxis, which was the “fist-edge-palm” technique. The analysis of the children's performance of these tests was carried out according to the following parameters: serial organization of movements, retention and assimilation of the motor program, the presence of perseverations and errors in the serial organization of movements. The severity of dynamic praxis disorders in children of the main group significantly exceeded that in the control group (p <0.001). In Figure 5: 1 - p=0.365; 2 - p=0.002.

    The lesions were localized in convexital frontal parts of the brain under dynamic and regulatory apraxia. Kinesthetic apraxia results as a symptom of inferior parietal syndrome.

    Figure 5: Study of motor functions

    Study of thinking structure (verbal and non-verbal components).

    When assessing verbal thinking, the following methods were used: composing a story based on story pictures (p <0.001), “Fourth extra” (p = 0.5). When assessing nonverbal thinking, tests for performing mathematical actions and operations; solving arithmetic problems (p=0.435) were used (Fig. 6).

    The topical lesion in verbal thinking deficiency is prefrontal regions. For insufficiency of nonverbal thinking the damage location is in the temporo-parietal-occipital regions of the brain.

    Figure 6: Study results of thinking

    Study results of the emotional and personal sphere

    Analysis of the study of the emotional and personal sphere in children with post-COVID syndrome using the Eysenck technique

    Some children from the main group fall into the category with passive action, which correlates with a high level of neuroticism combined with introversion and deceit. Their lack of self-confidence can lead to withdrawal from communication, isolation, and complexes. Such children are afraid of making a mistake, to cause anger or displeasure of adults. Therefore, they may not answer the question even when they know the correct answer, and their deceit is associated with the desire to please the experimenter. In addition, these children may show aggressive behavior, which is a defense against their anxiety and self-doubt. In unfavorable circumstances, these children may develop depression and phobias, i.e. unmotivated fears (of darkness, heights, enclosed spaces, etc.).

    Analysis of the study results of the emotional and personal sphere in children with post-COVID syndrome using the M. Lüscher color test

    The core of M. Lüscher's concept comes from the assertion that all people (and more widely living organisms) live and act in approximately the same color environment. Therefore, a number of typical life situations occur when certain color tones dominate. For instance, we see the blue color of the sky in the vast majority of cases, being passive and inactive; red color (fire, blood, mature food, etc.), is generally combined with high activity of the subject, etc.

    According to the principles of higher nervous activity, constant combination of certain colors with typical life situations leads to the association of color as an element of life situation, psychophysiological state, energy mobilization, and behavior stimulated by a given situation.

    Figure 7: Basic colors of the Lüscher test.

    The record of the subject's choices is made in conventional numbers: gray - 0, dark blue - 1, green - 2, orange-red - 3, yellow - 4, purple - 5, brown - 6, black - 7 (Fig. 7).

    1. If at least one of the primary colors is in the last three places of the color scheme, then it and the subsequent colors indicate a state of anxiety. The method of alarm compensation is determined by the characteristics of the color in the first position.
    2. If, in the presence of anxiety, one of the primary colors is in first place, then compensation is considered more successful than in the case of an additional one, which indicates the inadequacy and failure of compensatory behavior.
    3. The presence of gray, brown or black at the beginning of the color range indicates a negative view of life. If one of these colors stands on second or third place, it itself and all the colors to the left of it are considered as compensation.

    Among children with post-COVID syndrome the two main colors stand in the last three places in 85% of cases. In 65% of cases, the presence of gray is at the beginning of the color scheme. Compensatory mechanisms are traced in 55% of cases.

    Changes in the structure of the emotional sphere are a consequence of insufficiency of the limbic structures and the medio-basal frontal and temporal regions of the cerebral cortex. Lesions of medio-basal cortical sections are a part of the first (energetic) block. Damage to this cortical zone leads to the disruption of modally nonspecific factors, manifested in other disorders of mental functions.

    Medio-basal sections of the temporal cortex are part of the limbic, which is characterized by very complex functions. These include regulation of the level of wakefulness, emotional states, memory processes, consciousness, etc. The lesion of temporal parts of the brain causes distinct emotional disorders, which are classified in the psychiatric literature as affective paroxysms (in the form of attacks of fear, sadness, horror), accompanied by violent autonomic reactions. These paroxysms usually precede (as an aura) general convulsive epileptic seizures. Long-term shifts in affective tone are also common. The nature of emotional disorders to a certain extent depends on the side of the lesion [23,26].

    Complaints noted in children with post-COVID syndrome during classical neurological examination (taste and smell disorders were 32%; headaches - 12%; myalgia -8%; numbness or tremor of the hands - 8%; hand sweating -8%; dizziness or “darkening in the eyes” when tilting the head - 12%; weakness, fatigue, decreased tolerance to physical activity - 20%; memory impairment, decreased academic performance - 28%; mood swings, irritability - 8%, weather dependence - 8%, dyssomnias, weakness in legs, attention deficit, hyperkinesis - 4% each, persistent tremor of one hand in one case) also indicate the insufficiency of medio-basal parts, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions.

    Approaches to psychological correction of cognitive impairments in children with post-COVID syndrome

    Neuropsychological rehabilitation is a complex medical-psychological-pedagogical impact on the defect, taking into account its mechanism, providing appeal to the patient’s personality, to the patient's small social groups (therapeutic group, family, work team), aimed at the restoration of higher mental functions as the main task, the solution of which allows to achieve the ultimate goal, the psychological rehabilitation of the patient, i.e. restoration of his personal and social status [29].

    The main principles of correctional and developmental work are the following [30]:

    1. The principle of unity of diagnosis and correction
    2. The principle of normativity of development
    3. “Bottom-up” correction principle
    4. Principle of systematic development of mental activity
    5. Activity principle of correction

    The development of rehabilitation programs for children with post-COVID syndrome, which is based on a comprehensive psychological assessment of the state of the cognitive and emotional spheres, taking into account the structural and functional features of the brain, requires multidisciplinary coverage and in-depth study of theoretical foundations and principles. We have outlined the main contours of this approach, which is the development of a correctional and developmental program. This program is aimed at activating the cognitive functions and emotional and personal relationships of children with post-COVID syndrome.

    In developing effective treatment strategies for cognitive and emotional disorders as consequences of COVID-19 in children, we relied on both foreign scientific studies in recent years and Russian heritage. In the first case, we are talking about cognitive rehabilitation of children with an emphasis on cognitive remediation [31]. In the second case, we are talking about the Russian heritage – psychological and pedagogical [32, 33]. Thus, in the context of developing correctional-developmental programs that activate cognitive functions and correct emotional-personal relations of children with post-COVID syndrome, we rely on the theory of P.Ya. Galperin [33] about the “third type of learning”, about “cognitive motivation”, about the orientation basis of the child’s actions that determines learning. P.Y. Halperin's provisions are easily "read out" from the texts of authors who offer cognitive remediation programs for children before the "era" of COVID-19 and for children with post-COVID syndrome. It is about the principles of learning, about the so-called "strategic monitoring", directing the child's activity in the right direction, about reproducing the skill and transferring it into real, everyday life - in other spheres, and on other material [34, 35].

    The correctional and developmental program, the contours of which we are developing, is basically developmental training that links together affective, cognitive and behavioral components, and includes various kinds of motivational reinforcements.

    For example, speech function in ontogenesis is realized in three modalities: auditory-verbal, visual, and kinesthetic. Children with post-COVID syndrome were found to have impaired auditory-speech perception, which led to dysgraphia and dyslexia. To eliminate these defects, it is necessary to build a rehabilitation training program based on preserved functions through visual perception and kinesthetic praxis. In other words, to eliminate agrammatisms in writing, it is necessary to remove the use of dictations (auditory analyzer), and switch the training to visual perception (using tables and rewriting texts).

    Conclusions

    1. Comprehensive psychological diagnostics of children with post-COVID syndrome showed that the revealed changes in the structure of emotional and personal sphere have a common pathogenesis with cognitive impairments (disorders of auditory-speech memorization, insufficiency of optical-spatial gnosis and praxis, verbal and non-verbal intelligence).
    2. Disorders of higher mental functions, changes in the emotional and personal sphere and the nature of neurological complaints indicate insufficiency of medio basal parts, reticular formation, brain stem, basal ganglia, which provide energetic activation of brain activity and modally nonspecific brain functions.
    3. When developing neuropsychological rehabilitation programs for children with post-COVID syndrome, it is necessary to observe the principle of unity of diagnosis and correction, which makes it possible to determine the topic of brain damage in the relationship between the cognitive and emotional-personal spheres, to conduct rehabilitation training using the method of “replacing dysontogenesis”, with reliance on preserved functions.

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