http://brain.oxfordjournals.org/content/123/11/2240.full
Much of multiplication and addition is rote skills, subtraction and negatives stem from addition, division stems from subtraction and multiplication.
I've been tossing around a dual-objective game, probably with Tux. One "path" of the game would start with addition of numbers, possibly earlier. Second path would start with addition of bars, shapes, or some uncountable but measure-able object. The goal would be to train both the rote/exact mechanisms and also train the approximation mechanisms because they're so rarely touched on.
I could even arrange the levels in sort of a tree diagram, so I could demonstrate the concept that certain math understanding is based on prerequisites, and you shouldn't be doing it if you can't understand the prereqs.
Probably pretty early I'd bring in dual-question problems. Like I'd say if this bar is 5, how much is this bar, and extend it with multiplication, divisions, etc. I could even have animated tutorials on how the math looks for approximation methods, and tables for rote methods.
I'd probably also include a basic dual-n back option, as short-term memory makes it easier to toss around labels of values.