A B C D E F G H I J K L M N O P Q R S T U V W XYZ

CA

See chronological age.

cachexia

Wasting, weakness, or emaciation. In children with unusually severe failure to thrive (poor growth), cachexia suggests the likelihood of an underlying physical disease.

cadence

The number of steps per minute; one of the measures taken in a gait analysis.

CADeT

See Communication Abilities Diagnostic Test.

CADL

See Communicative Activities of Daily Living.

caffeine

A central nervous system stimulant found in coffee, chocolate, and tea; its usage is of minimal to no therapeutic value in the treatment of attention-deficit/hyperactivity disorder (ADHD).

Caffey-Kempe syndrome

See shaken baby syndrome.

CAI

See computer-assisted instruction.

Cain-Levine Social Competency Scale

A social adaptive scale for school-age children with moderate mental retardation.

calcaneus

Heel bone.

calcaneus deformity

An orthopedic abnormality in which the forefoot is pulled upward and the heel downward; the resulting appearance resembles a heel-walking stance.

calendar age

See chronological age.

Callier-Azusa Scale

An adaptive checklist for use with children who are deaf and blind up to a developmental age of 7 years. The five subscales (motor, daily living, language, perceptual, and so­cialization) involve the observation of spontaneous behavior in structured and unstructured situations over a period of 2 weeks.

calvaria

The roof of the skull, or the cranial vault.

camptodactyly

Fixed flexion contracture of a finger; a physical feature found in a number of syndromes.

Camurati-Englemann syndrome

A rare genetic syndrome with a progressive bone disorder leading to leg pain, weakness, a waddling gait, an asthenic (slender or slight) malnourished habitus (appearance), and, occasionally, compromise of optic and auditory nerve functions. Inher­itance follows an autosomal dominant pattern.

cancellation of rapidly recurring target fig­ures

A test to differentiate dyslexia from other learning disabilities and to detect poor concentration. A diamond and the number 592 must be identified in an array of 140 figures and numbers. Visual discrimination problems may also affect the scores on this test.

cancellation test

A timed test requiring the subject to eliminate a certain letter, number, or shape whenever it appears scattered at random among an array of similar symbols.

Candida albicans

A common yeast or fungus that typically resides on human skin and mucous membranes but that may give rise to thrush (a mouth infection in young babies), candidiasis (a diaper rash), and vaginal yeast infections. Subclinical yeast infections have been alleged to play a role in migraine, depression, fatigue, irritability, attention deficits, hyperactivity, autism, and other neurobehavioral syndromes. A yeast toxin is hypothesized to produce these symptoms; the treatment for this "yeast connection" includes a diet low in sugar and refined carbohydrates, and the antifungal drug nystatin. Support for this approach remains anecdotal; the treatment is unproven and controversial.

candle-drippings

A term describing the shape of nodules protruding into the ventricles (fluid-containing spaces) of the brain in tuberous sclerosis.

candling

See transillumination.

canities

Graving of scalp hair and beard hair.

Cantelli sign

See doll eyes maneuver.

canthus

The corner of the palpebral fissure (eye slit). Each eye has an inner (nasal or epicanthus) and an outer (lateral or telecanthus) canthus. The inner canthal distance is a measurement used to assess the presence of a minor dysmorphic feature—increased inner canthal distance.

cao gio

See coining.

caput succedaneum

Soft-tissue swelling of the scalp when a baby is born in the vertex presentation (head first); the margins of swelling are not limited by suture lines; sometimes referred to just as caput.

Capute Aptitude Test (CAT)

A measure of problem-solving skills in children birth to 2 years of age. The CAT is not intended for use by itself, but, rather, as part of a more comprehensive pediatric neurodevelopmental assessment that in­cludes CLAMS (Clinical Linguistic and Auditory Milestone Scale), a motor evaluation, and a detailed examination for minor dysmorphic features.

carbamazepine (CBZ)

Trade name Tegretol. An anticonvulsant also effective in treating movement disorders and some psychiatric conditions in people with severe developmental disorders. The chemical structure is similar to the tricyclic antidepressants. Carbamazepine is used to treat partial and generalized tonic-clonic seizures; it is not effective in absence seizures. Estimates of complete seizure control using carbamazepine only are 80%. In practice, the beginning dose of carbamazepine is 10 milligrams per kilogram of body weight per day and is gradually increased by increments of 5 milligrams per kilogram of body weight per day to a maintenance dosage of 40 milligrams per kilogram of body weight per day, generally yielding a therapeutic blood level of 4-12 micrograms per milliliter. Children must take the medication three or four times a day, whereas adolescents and adults may only require twice daily dosages. Carbamazepine has not been reported to produce the deleterious effects on cognition and behavior noted in older anticonvulsants such as phenobarbital. Rather, improvements in memory, mood, perceptual and motor speed, and decision making have been described. Side effects include drowsiness and rashes. Blood problems, such as aplastic anemia or leukopenia (i.e., certain types of blood cells are not formed, producing low blood counts), have been described, as has liver damage with jaundice (yellowing of the skin). The use of carbamazepine has increased in light of its successful treatment of seizures and its positive effects on cognition.

cardiac

Relating to the heart.

cardinal points reflex

See rooting reflex.

cardiomegaly

Enlarged heart.

cardiopulmonary

Pertaining to the heart and lungs.

cardiorespiratory

Pertaining to the heart and lungs.

cardiovascular

Relating to the heart, blood vessels, or circulatory system.

caries

Tooth decay and death of bone from bacterial action; dental caries are decayed and rotting teeth secondary to poor oral hygiene.

Carl D. Perkins Vocational and Applied Technology Education Act of 1990 (PL 101-392)

This law amended and re­named the Carl D. Perkins Vocational Educational Act of 1984 (PL 98-524). The purpose of PL 101-392 was to make the United States more productive and competitive in the world economy by more fully developing the educational and vocational skills of all segments of the population. The definition of "special populations" has been expanded to include individuals with disabilities, those who are economically and educationally disadvantaged (including migrant and foster children), individuals with limited English proficiency, those who are in jeopardy of experiencing sex bias, and those in correctional institutions. This law requires that individuals with disabilities, like their counterparts without disabilities, be provided vocational education in the least restrictive environment, and that they be granted equal access to all aspects of vocational programs and placement activities. PL 101-392 is closely aligned and interwoven with PL 101-476, the Individuals with Disabilities Education Act (IDEA) of 1990 to guarantee full vocational education opportunities for youth with disabilities.

carnitine

A chemical found in food and produced in the liver and other tissues that helps in the breakdown of long-chain fatty acids. Carnitine also acts to protect the cell against certain normal breakdown prod­ucts (Acyl-CoA derivatives) that can be toxic to the cell. Carnitine is used in some metabolic disorders (generally, enzyme deficiencies) such as carnitine palmityl transferase deficiency, organic acidopathies, disorders of fatty acid breakdown, acute exacerbations of some aimno acidopathies, and sometimes in acute and chronic valproic acid toxicity. Other postulated uses include nutritional supplementation in chronic renal (kidney) disease or prema­ture babies or in some cases of idiopathic cardiomyopathy (enlarged heart). The function and clinical use of carnitine are under continuing investigation.

carnitine deficiency

1. Systemic carnitine deficiency is characterized by muscle weakness of varying severity and a progressive age of presentation. There is an increase in number and size of mitochondria, and the mitochondria have abnormal morphology (structure and form) and increased inclusions. Although carnitine levels are low in blood, liver, and muscle, carnitine supplementation has resulted in improvement in only one third of people.
2. Muscle carnitine deficiency is an autosomal recessive disorder that presents in childhood with progressive weakness. Blood carnitine levels are normal, but muscle levels are low. Carnitine supple­mentation improves the weakness in about two thirds of cases without increasing muscle carnitine levels.

Carolina Curriculum for Infants and Toddlers with Special Needs (CCITSN)

An approach to providing appropriate intervention strategies for children with developmental delays functioning in the birth to 24-month developmental range; 24 areas are assessed by observation or parent reporting, and the results are used to generate specific teaching interventions.

Carolina Curriculum for Preschoolers with Special Needs (CCPSN)

An upward extension of the Carolina Curriculum for Infants and Toddlers with Special Needs, with a greater emphasis on intervention activities in group settings.

Carolina Picture Vocabulary Test (CPVT)

A norm-referenced test of receptive sign vocabulary for children between 4 and 11-6 years of age who are deaf or have hearing impairments.

carotenemia

A yellow tinge to the skin resulting from an excess of carotene in the blood. This is secondary to a diet high in yellow/orange (vitamin-A-containing) foods. This yellow coloring may be distinguished from jaundice (a yellowing of the skin) clinically, in that it does not involve the whites of the eyes (i.e., pseudojaundice).

carp mouth

The combination of down-turned corners of the mouth (relative over­growth of the upper lip), a thick lower lip, and a short philtrum (indentation in upper lip below nose); carp mouth can be found in a number of syndromes.

Carpenter syndrome

Acrocephalopolysyndactyly. A genetic syndrome with a "tower-shaped" skull from craniosynostosis (premature fusion of skull sutures), polydactyly (extra fingers or toes), syndactyly (webbing of the fingers or toes), and lateral displacement of the inner canthi (i.e., dystopia canthorum) contributing to a "downthrust" gaze appearance and mild obesity. Occasionally, there is mild mental retardation. Surgical correction of the craniofacial malformation is indicated, along with audiological monitoring and speech-language therapy. Inheritance is thought to follow an autosomal recessive pattern.

carpus

Wrist. The wrist is composed of eight small carpal bones arranged in two rows.

carrier

An individual who is heterozygous for a trait. In reference to a disease or genetic syndrome, an individual who is heterozygous has on his or her chromosome pair one normal gene and one abnormal gene that carries the gene for that trait. Although carriers appear normal, the presence of abnormal genes can sometimes be detected by laboratory methods. Disorders transmitted by way of carriers are usually recessive and thus require the mating of two carriers to produce a disease state (i.e., two abnormal genes must be present). Every individual is probably a carrier for a few rare, recessive disorders. Certain population groups have many carriers of particular disease genes, such as Tay-Sachs in Ashkenazic Jewish people or sickle cell trait in African American people or Caucasian people of Mediterranean descent. The carrier state may produce some protection from disease. For instance, carriers of sickle cell trait are protected from malaria.

Carrow Auditory-Visual Abilities Test (CAVAT)

A norm-referenced test with 14 subtests to measure auditory and visual-perceptual, motor, and memory skills for children ages 4-10 years. Test administra­tion time is 1½ hours.

Carrow Elicited Language Inventory (CELI)

A norm-referenced measure of productive use of grammar for children ages 3 through 7-11 with 52 items ranging from 2-word phrases to 10-word sentences. Children are asked to repeat the items, and their responses are scored and analyzed in terms of grammar, structure, error type, and production of verb forms. The inventory is used to diagnose expressive language delays and grammatical disorders.

carrying angle

The angle of the forearm on the upper arm; the angle at the elbow. Absent sex chromosomes increase the carrying angle; extra sex chromosomes decrease the carrying angle.

CARS

See Childhood Autism Rating Scale.

case definition

Clinical diagnostic criteria that serve as a template against which to match the presenting signs and symptoms of an individual in determining the nature of his or her illness and the appropriate treatment. In contrast to clinical practice, where a working diagnosis may be sufficient for initiating clinical management procedures, case definition must more clearly delineate operating diagnostic criteria. For epidemiological purposes, the following questions must be answered: When in the prodromal phase does the person actually become a "case"? When in the clinical course is a "case" cured and therefore no longer a "case"? and "Is a subclinical or atypical manifestation of a disease also a "case"? The answers to these questions for any given disease determine who is counted in epidemiological measures of incidence and prevalence.

case history

The cumulative medical, psychological, educational, familial, and social record of an individual.

case identification

Assignment of a diagnosis to a set of signs and symptoms. Epidemiologists study the occurrence and determinants of diseases in groups of people. Thus, they must count the number of identified cases in any investigation of who, where, when, and how people contract specific diseases. Accurate reporting is also essential in plotting disease patterns. Although accurate case identification is contingent on good case definition, other variables in case identification may impede accurate counting of a disease in a population. These include the following: 1) the extent to which people in a community use the medical establishment, 2) the extent to which physicians correctly diagnose their patients, and 3) the extent to which accurately diagnosed cases can be ascertained on a community-wide scale.

case management

A procedure for coordinating multiple service activities to a client or client system. Case management is most effective for clients who need multiple services, long-term service, or both. The case manager coordinates the activities of multiple service providers who are simultaneously serving the needs of one client, thereby helping to eliminate duplication and fragmentation of service. In addition, case management can alleviate the difficulties associated with staff turnover. Case management can occur within a single agency or at the community level, where services are coordinated among agencies.

cast

A molded casing composed of plaster of paris, fiberglass, or plastic, used to immobilize a body part.

CAT

See Capute Aptitude Test. See also Children's Apperception Test.

cat-cry syndrome

See cri-du-chat syndrome.

cat posture

See symmetric tonic neck reflex.

CAT scan

Also called CT scan. See computed tomography.

Catapres

Trade name for clonidine.

cataract

An opacity of the lens of the eye that blocks normal vision. Cataracts can be congenital or acquired and can be associated with congenital infections, such as congenital rubella syndrome, or metabolic disorders such as galactosemia. Cataracts may also be inherited and are part of many genetic syndromes. The decrease in vision in the eye with a large cataract may produce amblyopia (poorer vision in one eye) and strabismus (squint). Small cataracts may not significantly impair vision. Early diagnosis is critical; in infants, surgery, laser therapy, or other methods of removing the cataract should be performed in the first months of life.

CATCH

An acronym for the syndromic association of congenital heart disease (conotruncal defect), atypical fades, thymic hypoplasia (atypical tissue development), cleft lip/palate, and hypocalcemia (low blood calcium) that can occur with chromosome 22 q11 deletions.

catecholamines

A group of chemicals that influences the activity of the nervous system; these chemicals include epinephrine, norepinephrine, and dopamine.

Cattell Developmental and Intelligence Scale

A modification of the Gesell schedules for children 3 months to 30 months of age; it yields a ratio IQ.

caudal regression syndrome

A congenital malformation syndrome that involves varying degrees of agenesis (absence of formation) of the lower extremities, pelvis, sacrum, and spinal cord. Gait disorders, incontinence, imperforate (not open) anus, renal (kidney) agenesis, and abnormalities of the external genitalia are also manifestations of this syndrome, which most commonly occurs in infants of mothers with diabetes. In infants who survive, long-term orthopedic, urological, and neurological management is necessary.

CAVAT

See Carrow Auditory-Visual Abilities Test.

cavus foot

A foot with an extremely high arch (the opposite of flat foot); this painful foot deformity may be part of a syndrome, such as Friedreich ataxia, or an early sign of a spinal cord tumor.

CBC

See complete blood count.

CBP

See Child Behavior Profile.

CBT

Cognitive behavior therapy; see cognitive therapy.

CBZ

See carbamazepine.

CC

See chief complaint.

CCC

See Certificate of Clinical Competence.

CCITSN

See Carolina Curriculum for Infants and Toddlers with Special Needs.

CCPSN

See Carolina Curriculum for Preschoolers with Special Needs.

CCS

See Crippled Children's Services.

CCSPEA

See Classroom Communication Screening Procedure for Early Adolescents.

CDH

See congenital dislocation of the hip; see also developmental dysplasia of the hip.

CEC

See Council for Exceptional Children.

ceiling

The point above which test items are assumed to be incorrect. Testing procedures often include a starting point based on age or grade, a basal, and a ceiling. Ceilings are described specifically for each test and are often a set number of consecutive items answered incorrectly; testing is stopped when that criterion is met. In scoring, items above the ceiling, regardless of whether they have been administered or whether they are correct, are scored as incorrect.

CELF-R

See Clinical Evaluation of Language Fundamentals-Revised.

CELI

See Carrow Elicited Language Inventory.

cell migration

A step in the sequence of embryogenesis in which cells move from their original area to their final anatomical location. This process is complex and subject to damage by teratogens (toxic agents), as occurs in myelomeningocele (protuberance of both the spinal cord and its lining).

cell therapy

Sicca cell therapy.

center-based program

Intervention that focuses on exposing children to an educationally stimulating environment outside the home with the aim of facilitating the development of intellectual and social competence. For young children with special needs, there is often a home-based component to the center-based program. Although center-based program most often refers to early childhood special education (ECSE) programs, the term can also apply to services offered at a centralized location for other populations.

central axis

Midline of the body.

central blindness

Blindness caused by damage to the visual cortex in the occipital lobe. Often visual perception is more affected than actual vision. People with central blindness are not blind in the sense that they have no vision but have visual impairments because their perception of light images is inaccurate and inconsistent. This phenomenon is also known as cortical blindness.

central deafness

A hearing loss resulting from damage to the auditory nerve pathways in the brain stem or cerebral cortex, resulting in the ability to hear pure tones hut not necessarily to understand sounds or speech. An example is Wernicke aphasia (a receptive aphasia with impaired auditory comprehension resulting from damage to Wernicke's area—the posterior first temporal gyrus of the dominant cerebral hemisphere, generally the left). People with this problem often have word-finding problems and paraphasia (transposi­tion or substitution of sounds, morphemes, or words). Central deafness is also known as cortical deafness.

central nervous system (CNS)

The composite system formed by the brain and spinal cord, as contrasted with the peripheral nervous system (the system of nerves running throughout the body). The CNS is the center of control for the entire nervous system and has the additional function of controlling voluntary movement and thought. Developmental disorders reflect chronic impairment to the brain and not to the spinal cord or peripheral nervous system, although impairment of the latter may also be involved, as in myelomeiningocele (protuberance of both the spinal cord and its lining). The CNS receives sensory information from the body and sends out nerve impulses that respond to the input by stimulating muscle contractions. For example, when a teacher asks a student to draw a circle, the sensory input is the verbal instruction that is detected through the eighth, or auditory, cranial nerve. This information goes to the auditory association area where the stimulus is interpreted. A sequence of signals is then sent to the appropriate motor area, from which an impulse is sent to the student's hand. The hand and arm muscles contract to draw a circle. See also cortex.

centration

Focusing on one aspect of a problem when more than one are important.

cephalic index

The ratio of the maximal breadth to the maximal length of the skull; a decreasing value suggests scaphocephaly (projected head), whereas an increasing value indicates brachycephaly (irregular, flat head shape). When not associated with craniosynostosis (premature fusion of skull sutures) or microcephaly (abnormally small head), many varieties of skull shape are racial or normal variants.

cephalocaudal

Literally, "head to tail." In describing the human body, cephalocaudal means going in a head to tail direction. The emergence of voluntary motor control follows a law of cephalocaudal progression, with head control being achieved in the first months of life and independent ambulation occurring late in the first or early in the second year of life.

cephalohematoma

Subperiosteal hemorrhage (bleeding) of the skull often associated with a hairline fracture incurred during delivery. So much blood may be lost into the swelling that a blood transfusion may be required. Unlike caput succedaneum, the swelling is limited by the suture lines of the skull. Calcification of this tumor can take months to resolve; the hard edge with a soft center may give the misleading impression of a depressed skull fracture.

cephalopelvic disproportion (CPD)

A head-pelvis disproportion; a fetal head that is too large relative to the maternal pelvis to safely allow vaginal delivery; prolonged labor is one major sign of CPD.

cerea flexibilitas

"Waxy flexibility" sometimes seen in young children with severe environmental deprivation; an arm or leg passively placed in a given position remains there for a long time. This bizarre behavior is often seen in adults with catatonic schizophrenia.

cerebellar cerebral palsy

See ataxic cerebral palsy.

cerebellar function

The coordination and smoothing out of movements by the most posterior part of the brain. Dysfunction is characterized by dysdiadochokinesia (inability to perform rapidly alternating movements), titubation (staggering gait), intention tremor (trembling that accompanies voluntary movement), and ataxia (unsteady gait).

cerebellar stimulation

A controversial neurosurgical method of treating severe movement disorders (e.g., cerebral palsy) by implanting electrodes in the cerebellum and subjecting that part of the brain to continuous patterned electrical currents. As with other controversial therapies, claims for the success of this method have been extended to include the treatment of seizures, mental retardation, and other developmental disorders.

cerebral gigantism

See Sotos syndrome.

cerebral palsy

A family of syndromes with disordered movement and posture, delayed motor development, and atypical motoric findings on neurological examination. The etiology (cause) of the motor problem is located in the brain, rather than in the spinal cord or peripheral nervous system (the system of nerves running throughout the body). Although the brain injury is usually prenatal and rarely postnatal, cerebral palsy is rarely diagnosed in the first year of life. The full clinical picture only becomes clear in the second year of life. These disorders are all chronic but nonprogressive; with the exception of orthopedic complications, most children with cerebral palsy do not deteriorate functionally as they get older. The incidence of associated deficits in cerebral palsy is quite high: Mental retardation (50%-70%), seizures, and visual and auditory impairments are common. Dysarthria (difficulty pronouncing words), strabismus (crossed eyes or squint), feeding disorders, poor physical growth, asymmetrical growth, and asymmetrical neurological findings are not uncommon. The overall incidence of cerebral palsy is just under 0.5%. As stated, few cases are postnatal in onset, and most cases that were previously thought to be perinatal are now considered to be prenatal in etiology. The types of cerebral palsy are grouped under the following two major headings: 1) the physiological (or neuroanatomical, as defined by the tone and movement pattern); and 2) the topographical (as defined by which parts of the body are more involved).

cerebrohepatorenal syndrome

Zellweger syndrome; a very rare genetic syndrome causing a peroxisomal enzyme deficiency leading to hypotonia (decreased muscle tone), high forehead, flat facies, brain abnormalities, hepatomegaly (liver enlargement), and kidney cysts. Breech presentation, intrauterine and postnatal failure to thrive (poor growth), and death within the first 6 months of life are characteristic. Inheritance is thought to follow an autosomal recessive pattern.

cerebrospinal fluid (CSF)

The fluid that fills the ventricles of the brain and the space around the spinal cord. It can be removed from the body for diagnostic testing by a procedure called a lumbar puncture (LP). CSF may contain white blood cells indicating infection (e.g., meningitis [inflammation of the spinal cord and brain membranes]), red blood cells indicating a hemorrhage (bleeding), or too much protein, as in neurodegenerative diseases or tumor cells (e.g., leukemia, medulloblastoma). CSF examination is often helpful in making diagnoses of central nervous system diseases.

cerebrovascular accident (CVA)

See stroke.

Certificate of Clinical Competence (CCC)

A post-master's certification in audiology (CCC-A) or speech-language pathology (CCC-SP).

certificate of high school equivalency

A formal document certifying that an individual has met the state requirements for high school graduation by attaining satisfactory stores on the tests of the general equivalency diploma (GED) or other state-specified examinations. These certificates are often accepted in the same manner as high school diplomas.

certification

A recognition of qualification to perform certain professional tasks and duties. Certification is less stringent than licensing and requires only the attainment of specified education or experience standards with no accompanying assessment or monitoring of competence. Certification through a professional organization implies just the opposite: attainment of a level of competence.

ceruminosis

Impacted cerumen (ear wax). Ceruminosis can contribute to hearing impairment; it is especially common in people with a narrow external ear canal, which occurs in Down syndrome. Drills are used to liquefy the wax.

cervical

Relating to any necklike structure, as in cervical vertebrae, which support the head upon the body, or cervical cancer, which is located in the neck (cervix) of the uterus.

cervical auscultation

A clinical technique that uses a stethoscope to listen to the sounds of swallowing. Aspiration is thought to be associated with sounds that are less sharp or that have a bubbling quality. The technique is of limited application.

cesarean section

The delivery of a fetus by an incision through the abdominal wall into the uterus; it is usually performed because of specific indications such as fetal distress, breech presentation, bleeding, cephalopelvic disproportion, or "repeat C-section." (This last indication is no longer considered obligatory). In general, a history of cesarean section does not affect a baby's risk for later developmental disability; more important to consider are the reasons for performing the section and the baby's postnatal course.

C4b protein

A plasma protein that is low in the presence of autoimmune diseases. This protein may also be low in people with autism, suggesting a possible auto­immune mechanism in the etiology of autism.

Chaddock sign

Stimulating the skin in the region of the external (lateral) mallcolus causes the big toe to extend; it may be considered a sign of pyramidal tract involvement and a variation of the Babinski sign.

chaining

The linking together of two or more responses into a single complex behavioral sequence by a training program that twins each successive response into the stimulus for the next response in the sequence.

chalasia

A transient, benign form of gastroesophageal reflux; postprandial regurgitation (spitting up after meals) in early infancy, usually successfully treated by upright positioning, thickened feedings, and smaller feedings.

CHAMPUS

See Civilian Health and Medical Program of the Uniformed Services.

Chandler Movement Assessment of Infancy-Screening Test (CMAI-ST)

A 10-minute screening version of the Movement Assessment of Infants (MAI).

channeling

Continued growth of an infant along any given percentile of the growth curves for length, weight, and head circumference. A failure of channeling involves switching or crossing growth curves to a lower percentile.

chaotic family

A family characterized by chronic and severe lack of structure and organization. Individuals in such a family function autonomously with little commitment to or support from the family unit. A child with developmental disabilities in this type of family often experiences understimulation and isolation, owing to inability of the family to work together to meet the child's constant and special needs.

Chapter 1 of the Education Consolidation and Improvement Act of 1981 (PL 98-211)

A mandated program of compensatory education for children with educational disadvantages in schools with concentrations of children from low-income families; formerly known as Title 1 of the Elementary and Secondary Education Act. Federal grants are made through state education departments to local school districts based on the number of children from families in poverty. Services are then provided based on the extent of the student's educational deprivation. The law allows for a range of services, including instructional services, purchase of materials and equipment, teacher training, construction, and social and health services.

Charcot-Marie-Tooth syndrome

Peroneal muscular atrophy (wasting), HMSN I (hereditary motor and sensory neuropathy). A genetic syndrome of progressive distal muscle atrophy and progressive sensorineural hearing loss. Prevalence rates are estimated at 4 per 100,000. Inheritance follows an autosomal dominant pattern with high penetrance expression. Lemieux-Neemeh syndrome is Charcot-Marie-Tooth syndrome with the addition of chronic nephritis (kidney disease). Jean M. Charcot (1825-1893) and Pierre Marie (1853-1940) were French neurologists; Howard M. Tooth (1856-1925) was an English neurologist.

CHARGE association

Acronym representing the congenital malformations of coloboma (absence of part of the eye or retina), heart disease, choanal atresia (nasal blockage), retarded growth and development with mild to profound mental retardation, genital anomalies, and ear anomalies and deafness. Mental retardation and visual and auditory problems frequently impair cognitive functioning.

Chédiak-Higashi syndrome

Chédiak-Steinbrinck-Higashi syndrome. A rare genetic syndrome with partial albinism leading to reduced visual acuity; immune defects in the white blood cells then contribute to recurrent infections, progressive cranial and peripheral neuropathy, and occasional mental retardation. Therapy includes diligent and aggressive treatment of the recurrent infections; nonetheless, most affected persons do not survive childhood. Inheritance is autosomal recessive with a high frequency of consan­guinity noted in the families of affected individuals.

chelion

Corner of the mouth.

chemotherapy

Treatment with chemicals or drugs: usually refers to highly toxic substances used to treat cancer.

cherry red spot

A red patch seen on the retina in children with various neuronal storage diseases, such as Tay-Sachs disease. The lipid compounds that cannot be broken down or excreted are found in the neuron, giving it a grayish color. The red spot is an area that does not contain any nerve cells and therefore is red (the normal color), not gray.

cherubism

A genetic disorder that causes swelling of the mandible (jaw) along with a "heavenward" glance to produce a cherubic or angelic appearance. Articulation disorders may result from oral structural problems. Inheritance follows an autosomal dominant pattern with variable expression and incomplete penetrance in females; thus, males with the syndrome are more affected than females with the syndrome.

chi square

A frequently used statistic that is employed in the following two ways: 1) to test whether observed results are of such dimensions that they could not have occurred by chance alone, and 2) to test the possibility of a relationship (termed association) between two variables. The chi square is an easy-to-use and powerful statistical tool when appropriately applied.

chickenpox

See varicella.

chief complaint (CC)

The principal symptom or subjective concern leading to a self-referral for diagnostic assessment and treatment. Often the final diagnosis is one commonly associated with the chief complaint, but sometimes this diagnosis is one rarely associated with this symptom. A caveat of diagnosis is that "uncommon presentations of common disorders are more common than common presentations of uncommon disorders."

chignon

An artificial caput succedaneum or subcutaneous edema (swelling) of the scalp often secondary to vacuum extraction of a newborn.

Child Behavior Profile (CBP)

A group of standardized and normed questionnaires that includes the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Direct Observation Form (DOF), and the Youth Self-Report Form (YSRF). The CBCL can help in the diagnosis of attention disorders, depression, and other childhood behavior problems and psychopathology.

Child Find

Organized efforts to locate children with developmental disabilities or children who are at risk for develop­mental disabilities. Two federal enactments have given such efforts increased importance: 1) PL 93-380, the Education of the Handicapped Act Amendments of 1974, requires states to develop and implement systematic procedures for locating all individuals with disabilities from birth to age 21. The mandate particularly focuses on children not enrolled in school programs in order to facilitate an accurate child count for planning intervention programs and to document the need for additional early intervention programs. 2) PL 94-142, the Education for All Handicapped Children Act of 1975, and its amendments, list specific features of a free and appropriate public education (FAPE) in the least restrictive environment (LRE), the provision of services to all children with disabilities from birth, and the locating of unserved children.

child life specialist

A professional who interacts with hospitalized children with a major focus on providing materials, guidance, and an appropriate environment for play activities; there is an additional emphasis on meeting the child's emotional needs and on psychiatric adjustment to hospitalization.

Childhood Autism Rating Scale (CARS)

A 15-factor diagnostic instrument for autism that rates children's behavior in the presence of an adult and during independent play.

Children with Special Health Care Needs (CSHCN)

Category includes children eligible for Supplemental Security Income (SSI) benefits, for services under Part H of IDEA, foster children, and children previously covered under CCS (Crippled Children's Services) because of developmental disabilities and chronic illness.

Children's Apperception Test (CAT)

Three oral response projective tests measuring the traits, attitudes, and psychodynamics involved in the personality development of children. The measures are used to assess personality in children ages 3-10 years for clinical and diagnostic purposes. The CAT-A consists of 10 pictures or animals in a human social context; the child is asked to tell a story about the pictures. The CAT-H is composed of 10 pictures of human figures in situations of concern to children. The CAT-S is a supplemental form presenting 10 animal figures in family situations that are common but not as universal as those depicted in the two other forms. The picture plates resemble pieces of a jigsaw puzzle, so that children who do not relate stories can manipulate the test items in play techniques. Administration for each form of the test takes approximately 30 minutes.

Children's Version of the Family Environment Scale (CVFES)

A downward extension of the Moos Family Environment Scale to elementary school-age children; subjects respond to 30 questions by selecting one of three pictures that best represents their family; scores are generated for cohesion, expressiveness, conflict, independence, achievement orientation, intellectual-cultural orientation, active-recreation orientation, moral-religious emphasis, organization, and control. Caution should be used in interpreting these results in children with attention and learning problems.

chloral hydrate

A nonbarbiturate, non-benzodiazepine sedative-hypnotic; a relatively safe sleep-inducing drug often used to prepare children for surgery or other procedures such as an electroencephalogram (EEG).

chloride-deficient formula

In 1978 and 1979 two soy-based infant formulas (Neomullsoy and CHO-free) lacked adequate dietary chloride and produced serious illness (i.e., metabolic alkalosis) in a small number of children. It has been hypothesized that subclinical metabolic abnormalities due to these formulas may be associated with later neurodevelopmental disability for infants who had used these formulas in 1978 and 1979. Research data do not support more than a very mild impact on learning.

chlorpromazine

Trade name Thorazine. A phenothiazine drug used to treat severe behavior disorders in children. Side effects include tardive dyskinesia (slow, rhythmic automatic movements), photosensitivity, and blood and liver chemistry problems.

chondrodysplasia punctata

Conradi-Hunermann svndroine; a genetic syndrome with asymmetric shortening of limbs, scoliosis (spinal curvature), and a characteristic facies with saddle-nose deformity and malar hypoplasia (under­growth of the midface with cheekbones flat or depressed). Growth problems such as failure to thrive (poor growth) and short stature are common. Mild to moderate mental retardation and cataracts can occur. Incidence is estimated at 2.5 per million. Inheritance follows both autosomal dominant and autosomal recessive patterns. The autosomal recessive form is more severe and usually results in death before 1 year of age; autosomal dominant forms have a milder course. There is also an X-linked form lethal in males.

chondroectodermal dysplasia

Ellis-van Creveld syndrome; a genetic syndrome with short arms and legs leading to short stature, polydactyly (extra fingers or toes), and nail hypoplasia (atypical tissue development). Mental retardation is occasional. Congenital heart disease and abnormalities of the teeth and mouth are frequent. Many affected individuals die in early infancy from cardiorespiratory problems. Inheritance follows an autosomal recessive pattern with a consanguinity rate of 30%.

chorda tympani section

A surgical procedure that disrupts parasympathetic innervation to sublingual and submandibular glands as a treatment for drooling; it is usually performed bilaterally (both sides of the mouth) and combined with a tympanic neurectomy.

chorea

Literally, "dance." In the field of neurological dysfunction, chorea refers to a pattern of movement disorder characterized by spasmodic, irregular, unpredictable, involuntary, and purposeless movements also including large central twitches or jerking movements. Mild iso­lated chorea may be seen in the choreiform (involuntary twitching) syndrome; with more severe motor delay and chorea, the resulting type of extrapyramidal cerebral palsy is usually described as choreoathetoid. Choreiform movements are quicker and less fluid than athetoid movements.

chorea minor

Sydenham chorea (chorea major refers to chorea of a hysterical nature). A transient chorea that follows rheumatic fever.

choreic hand

When the arms are extended horizontally, the wrists flex and the wrist and finger joints are overextended; exaggerated spooning.

choreiform syndrome

The presence of mild choreiform (involuntary twitching) movements in the outstretched arms of boys standing at attention with their eyes closed. In late school-age and early adolescent boys, this was originally thought to be a marker for future (or present) juvenile delinquency and thus was named a "syndrome." This association has not held up well, and the neuromotor finding is considered a nonspecific sign of minor motor dysfunction.

choreoathetosis

One of the physiological subtypes of extrapyramidal cerebral palsy in which involvement of the basal ganglia produces a movement disorder with features of both chorea and athetosis (invol­untary twisting of the upper extremities). Prior to the era of exchange transfusion for Rh incompatibility, basal ganglia involvement was most commonly seen fol­lowing bilirubin encephalopathy (brain damage due to lack of oxygen) or kernicterus. Many of these children had a relatively pure motor disability with few associated deficits. Most cases of basal ganglia involvement are subsumed under more diffuse asphyxic brain damage, so that these children have associated deficits of increased severity. A choreathetoid cerebral palsy with prominent superimposed rigidity is sometimes referred to as a tension athetosis.

chorioretinitis

An inflammation of the back of the eye or retina characterized by pigmentary changes and scarring in the retina. Chorioretinitis is common in some intrauterine infections such as toxoplasmosis, cytomegalovirus (CMV), and congenital rubella. These congenital infections can be associated with mental retardation, impairments of vision and hearing, and failure to thrive (poor growth).

Chotzen syndrome

See Saethre-Chotzen syndrome.

chromosomal aberration

An abnormal number or structure of chromosomes that may produce an abnormal phenotype. A trisomy such as Down syndrome is an ex­ample of an abnormal number of chromosomes (47), usually producing mental retardation as well as other physical defects. An example of a chromosomal abnormality that has no physical manifestations is a balanced translocation where two chromosomes of different numbers exchange pieces but no genes are lost.

chromosomal abnormality

See chromosomal aberration.

chronic sorrow

Chronic grief; parental response to a child's chronic disability or illness. This grief can be quite variable and can progress through stages of helplessness, hopelessness, and dependency. This sorrow or grief tends to be acutely reactivated with each new developmental stage that the child would normally experience were it not for the disability or illness (e.g., entering school, adolescence, leaving home).

chronic subdural hematoma

A collection of bloody fluid under the dura (outer layer of the brain) produced by trauma to the head. Chronic subdural hematomas are most common in adolescents, and there is not generally a history of head trauma. Clinical presentation includes headaches and changes in personality and alertness. This can progress rapidly to loss of consciousness and seizures. Diagnosis is by magnetic resonance imaging (MRI) or computed tomography (CT) scan. Treatment involves removing the fluid to relieve the pressure on the brain. Subdural effusions (fluid under one of the meningeal layers) in infants can be acute or chronic and are commonly associated with nonaccidental trauma (abuse). Clinical symptoms in infants are less specific and include failure to gain weight, irritability, lethargy, and vomiting. CT scans often reveal not only a subdural hematoma but also an associated skull fracture. In infants, repeated removal of the fluid with a needle can sometimes eliminate the need for surgery. Prognosis in subdural hematoma is correlated with the amount of underlying brain damage. The prognosis tends to be worse in children who have been abused. Residual neurological signs are related to the area of the brain that has been damaged.

chronological age (CA)

The actual age of an individual derived from his or her date of birth. Chronological age is expressed in years, months, and days. It is used in psychometrics as a comparison standard for various measures of performance and is the denominator in the equation for determining an intelligence quotient by the ratio method: mental age (MA)/CA x 100 = IQ.

Chun Gun

A sophisticated, high-intensity light source; the instrument is used in the transillumination of an infant's head to detect structural brain abnormalities.

CIBI

Continuous intrathecal baclofen infusion. See baclofen.

cicatrix

A scar.

ciliary reflex

Eyelash reflex; an infant reflex in which touching an eyelash (stimulus) produces bilateral blinking (response).

cimetidine

Trade name Tagamet; an H₂-receptor antagonist that suppresses gastric acid production. It is often used in the treatment of gastroesophageal reflux.

CIP

See Comprehensive Identification Process.

circumduction

A circular movement; in a hemiplegic gait, the involved leg, instead of being flexed directly forward, is extended, abducted, and dragged ahead through an outward semicircle with increasing flexion and adduction.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)

A federally funded health insurance for the dependents of active and retired military personnel. Health care services are purchased by CHAMPUS from private non-military providers when such services are not available or not accessible through the military system.

CLAMS

See Clinical Linguistic and Auditory Milestone Scale.

Clancy Scale

A 54-item questionnaire to identify autism in children. The items are grouped into 14 categories that reflect an expansion and refinement of the nine diagnostic points checklist. The 14 descriptors include difficulty with peer relationships, acting as if deaf, resistance to learning, lack of realistic fear, resistance to change in routine, preferring to communicate with gestures, inappropriate laughter, lack of cuddliness as a baby, hyperactivity, poor eye contact, unusual object attachment, spinning of objects, repetitive and sustained odd play, and standoffish manner.

class within a class (CWC)

A service delivery model in which students with mild disabilities are educated in the general classroom using a collaborative educational program provided by general and special education teachers. Programs include 1) collaborative curriculum development in which teachers of students with learning disabilities and general education teachers write curricula and plan teaching strategies, 2) a service delivery model that places teachers of students with learning disabilities in the general classroom to promote collaboration between general and special educators, and 3) development of a curriculum to provide students with learning disabilities instruction in learning strategies and study skills.

classification

The process of grouping and defining the criteria for group inclusion or exclusion.

Classroom Communication Screening Procedure for Early Adolescents (CCSPEA)

A language screening instrument for underachieving upper elementary students prior to entering junior high school. CCSPEA assesses the ability to scan an assignment for answers, follow oral and multipart written directions, use metalinguistic and metacognitive skills, and match vocabulary items with definitions/synonyms.

clavicle

Collar bone.

claw grasp

Three- or four-finger grasp or jaw chuck; an advance in the radial (thumb and forefinger) rake that is not yet a pincer (two-finger) grasp.

CLD

See Council for Learning Disabilities.

cleft lip

An embryonic defect that presents in the newborn with varying degrees of failure of the upper lip to fuse appropriately. It can be associated with cleft palate, hypertelorism (widely spaced eyes), speech disorders, recurrent otitis media (middle-ear infection), and conductive (involving the middle and outer ear) hearing loss. Etiology (cause) is genetic with a polygenic pattern and varying recurrence risks; about one third of cases of cleft lip are part of another syndrome that may have other associated features and a more definable recurrence rate.

cleft palate

A congenital defect in which the palate (bony roof of the mouth) has not closed or fused in the midline during fetal development. Cleft palate is associated with feeding and swallowing problems, failure to thrive (poor growth), aspiration, recurrent ear infections, and hypernasal dysarticulate speech. Cleft palate has multi-factorial inheritance; cleft palate with cleft lip also has multifactorial inheritance, but is pathophysiologically distinct from isolated cleft palate. Clefting can occur as an isolated oral cavity malformation or as part of many genetic and teratogenic (causing malformation) syndromes.

cleidocranial dysostosis

Scheuthauer-Marie syndrome; a genetic syndrome with variable expression of bone defects (i.e., dysostosis) affecting the clavicle (cleido), delayed eruption of teeth, and late ossification or the skull (cranial) sutures. Because of incomplete clavicles, people can often approximate their shoulders in front of their chest. One of the earliest signs noted may be late closure of a large anterior (front) fontanel (soft spot). Cognition is normal; audiological and dental monitoring is indicated. Inheritance follows an autosomal dominant pattern; however, one third of the cases represent fresh mutations.

client

A social-work term denoting an individual, family, group, or community receiving services. In contrast to the medical term patient, the term client highlights the elements of mutuality, self-determination, and the aspect of being an informed consumer of the helping process.

Client Assistance Program

The state agency responsible for providing legal, administrative, and other assistance to individuals seeking and receiving vocational rehabilitation services.

Clinical Evaluation of Language Fundamentals—Revised (CELF-R)

A revised and restandardized (1987) version of the CELF that is designed to identify children ages 5-16 years who lack basic language skills. The CELF-R consists of 11 sub-tests for ages 5-7 and 8-16 that provide receptive, expressive, and total language scores. Five supplementary subtests are available for additional diagnostic information. Norms include standard scores by age for subtests as well as composite scores, percentile ranks (by age) for sub-tests, and composite scores and age-equivalent scores for total language scores. A screening version is also available.

Clinical Linguistic and Auditory Milestone Scale (CLAMS)

A test of early language development (birth to 2 years of age) that uses a parent or caregiver interview and yields an expressive language quotient (ELQ) and a receptive language quotient (RLO). Although normative data have been published to allow use of the CLAMS as a screening test, the instrument is intended for use in a more comprehensive diagnostic approach (CAT-CLAMS).

clinical psychology

A branch of the study of human behavior concerned with testing, diagnosing, researching, and treating mental disorders and interpersonal problems.

clinician

A professional who is directly involved with the examination, diagnosis, and treatment of patients or clients.

clinodactyly

Lateral or medial turning of a finger; a physical feature found in a number of syndromes; clinodactyly (in-turning) of the fifth finger is a common nonspecific minor dysmorphic (atypical) feature.

clock-training

Pseudo toilet training where the caregiver, rather than the child, is trained. The child is placed on the toilet/potty at regular intervals to catch bowel movements. This reflects more a caregiving refinement than an early stage of genuine bowel regulation. Children do not need long periods of repetitious exposure to the potty to accustom them to its use. When successful, clock-training decreases the expense for diapers and the caregiver's need to clean the child.

clonazepam

Trade name Klonopin; an anticonvulsant medication; also used to treat hypomanic states, self-injurious behavior, and severe maladaptive behavior in persons with severe mental retardation. Clonazepam is dosed three to four times a day and has good seizure control; seizures decrease over the first month of treatment in 30%-50% of persons treated for the disorder. Side effects include sedation, ataxia (unsteady gait), dysarthria (difficulty pronouncing words), emotional irritability, and weight gain. Clonazepam is useful in treatment of Lennox-Gastaut syndrome, but its efficacy in infantile spasms is debated.

clonidine

Trade name Catapres; an anti-hypertensive drug (used to treat high blood pressure) that is also used to treat Gilles de la Tourette syndrome and as an adjunct for attention-deficit/hyperactivity disorder (ADHD). Clonidine can be given in delayed release transdermal (absorbed through the skin) dosage form. The main side effect is tiredness.

clonus

Rapidly alternating muscle contraction and relaxation, leading to repetitive flexion and extension.

closure

A law of gestalt perceptual psychology asserting that mental processes tend to produce completeness and symmetry; for example, a circle that is missing a few degrees of its circumference is perceived as a circle rather than an arc.

cloudy cornea

Haziness of the normally translucent cornea of the eye. Cloudy cornea is a sign that can occur in congenital syphilis, mucopolysaccharidosis, and mucolipidosis.

cloverleaf skull syndrome

Also known as kleeblattshädel syndrome; a syndrome of premature synostosis (closure) of the cranial sutures producing upward and lateral outpouchings of the skull in a three-leaf clover outline; hydrocephalus (excess fluid in the brain), developmental delay, and early death are associated features.

cloze technique

A procedure for teaching and assessing reading comprehension based on the construct of perception and closure as defined in gestalt psychology. In general, using this technique, in a reading selection of 250 words, every 10th lexical word would be deleted and the reader would be asked to fill it in. This requires various reading skills, including context clues, knowledge of linguistic patterns, and general reading comprehension.

clubbing

A convex curvature of the nail and top of the digit found in chronic disease, especially pulmonary disease.

clubfoot

See talipes equinovarus.

clumsy child syndrome

An age-inappropriate difficulty in performing skilled motor movements. This may include both fine- and gross-motor movements. Mild motor delay may be an early sign of later clumsy child syndrome. Developmental apraxia (inability to perform purposeful movements) may be synonymous with clumsy child syndrome, but the latter usually refers more specifically to problems with fine-motor skills. In school-age children, developmental disorders of written language or dysgraphia (impaired writing) represent prominent symptoms. Clumsy child syndrome is sometimes referred to as minimal cerebral palsy.

cluttering

Speech that is so excited and rapid that words run together with syllables omitted; the fast rate and irregular clustering of phrases lead to difficulties with intelligibility. Cluttering can occur in isolation or be associated with disorders in articulation, language, learning, and attention.

CMAI-ST

See Chandler Movement Assessment of Infancy-Screening Test.

CMMS

See Columbia Mental Maturity Scale.

CMV

Cytomegalovirus. See fetal cytomegalovirus syndrome.

CNS

See central nervous system.

coarse facies

A facial appearance characterized by swelling of the lips, thickening of the subcutaneous (inner) tissue, and broadening of the nose; this can develop as a side effect of chronic phenytoin (Dilantin) treatment.

Cobb angle

A measure of the degree of curvature in scoliosis (spinal curvature), using horizontal lines to vertebral bodies as drawn on X rays. Angles of 20-40 degrees suggest mild scoliosis; angles of 40-60 degrees suggest moderate scoliosis; and angles of greater than 60 degrees suggest severe scoliosis.

cocaine baby

See infant of drug-addicted mother; infant of substance-abusing mother.

cochlear implant

An electronic device that is placed in the skull and that, in combination with a hearing aid worn on the body, enhances the detection of sound by a person who cannot use conventional hearing aids. Implantation of the device is the easiest part of using a cochlear implant. Thereafter, intense work is required to learn speech detection. In the ideal situation, the cochlear implant allows detection of speech by a person who might only have been able to read lips. As technology improves, the addition of more channels to the implant will also improve the quality of speech detection.

Cockayne syndrome

A genetic degenerative syndrome with cachectic (starvation) dwarfism, premature senility, retinal degeneration, sensorineural hearing loss, mental retardation, and skin photosensitivity. The lack of subcutaneous (inner) fat contributes to a wizened, sunken-eyed appearance. The life span is considerably shortened for affected individuals. Inheritance follows an autosomal recessive pattern.

cocontraction

Simultaneous contraction of all the muscles around a joint (agonists and antagonists) to produce stability.

Coffin-Lowry syndrome

A genetic syndrome with severe mental retardation, coarse peculiar facies (bulbous nose, anti-mongoloid slant, pouting lower lip), tapering fingers, and short stature. Inheritance points toward an X-linked semidominant pattern with many sporadic cases.

Coffin-Siris syndrome

Fifth digit syndrome; a syndrome characterized by hypoplastic (short to absent) fifth-digit nails, microcephaly (abnormally small head) with coarse facies but very full lips, intrauterine and postnatal growth deficiency, mental retardation, and hirsutism (excessive hair growth) combined with sparse scalp hair growth. Inheritance appears to be autosomal recessive; however, confirming evidence is still scanty.

cognate

A blood relative through the mother's side of the family.

cognitive behavior therapy (CBT)

See cognitive therapy.

cognitive style

1. The preferred method for approaching a learning or problem-solving situation. Cognitive style is often described in terms of modality, such as visual, auditory, or kinesthetic, referring to the preferred method of acquiring information.
2. The preferred method of information processing (i.e., whether the individual prefers information presented in a part-to-whole, linear fashion or, conversely, in a whole-to-part, simultaneous fashion). Current theories and descriptions of cognitive style are drawn from earlier work in perception and decision-making styles such as field dependence-independence, leveling-sharpening, and repression-sensitization. Most individuals, although indicating a preference, can use a variety of styles. Cognitive style in an individual with a disability, however, is often a reflection of an innate neurological profile. In this case, the choice is not based on the most efficient method for the situation, but on the limited options available to the learner. Learning style theories expand the cognitive style concept to include environmental variables.

cognitive therapy

Also termed cognitive behavior therapy (CBT); a psychological treatment based on a cognitive model of emotional functioning. In contrast to drive-based and conflict-motivated models of emotional functioning, cognitive models assert that emotions and behaviors are mediated by specific cognitions in response to an event. Emotional disorders, such as depression, are seen as the outcome of learned, habitual, dysfunctional thinking processes and patterns that have become so automatic in their mediational function that they are no longer in conscious awareness. The automatic filtering of events through the learned, habitual, yet dysfunctional, thinking processes leads to a distorted interpretation of the event and thus a distorted emotional response. In the case of depression, these distortions are negatively loaded and lead to a negative emotional response. Cognitive therapies aim to expose both the content and process of dysfunctional thinking and, once exposed, to remove or replace them with more functional processes leading to less-distorted and less-toxic emotional outcomes.

Cohen syndrome

A genetic syndrome with a peculiar facies (e.g., open mouth, short philtrum [indentation in upper lip below nose], prominent incisors, micrognathia [small jaw]), mental retardation, hypotonia (decreased muscle tone), short stature, obesity of mid-childhood onset, and long slender fingers and toes. Inheritance follows an autosomal recessive pattern.

coining

Cao gio; an Asian folk medicine practice of rubbing the involved area of the body with a coin. This dermabrasion technique can produce welts and superficial bruises that may be misinterpreted as signs of child abuse.

colic

Also known as evening colic, 3 months' colic. A condition of unknown etiology (cause) occurring in infants in the first 3 months of life during which time they exhibit restlessness, crying, and apparent pain at a regular part of the day (usually every evening). Colic may be ameliorated with drugs, but the condition spontaneously resolves as the babies begin their fourth month; it has no long-term or developmental implications. However, in a colicky, irritable infant who cries and refuses to be comforted at all hours of the day after the first 3 months of life, brain damage may be suspected, especially if the infant cry is shrill and high pitched.

collateral

A small side branch.

Collier sign

Supranuclear lid retraction, "posterior fossa (furrowed) stare"; may contribute to a hyperalert appearance and suggests a midbrain lesion (as in the diencephalic syndrome).

coloboma

A cleft, slit, gap, or fissure in any eye structure. Retractive errors and retinal detachments are potential complications of certain types of coloboma. Iris colobomas are readily visible to inspection; retinal colobomas require ophthalmological examination to be detected. Colobomas are often part of a larger genetic or malformation syndrome. Iris colobomas suggest the need for chromosome analysis.

colon

The large intestine; the part of the digestive tract that connects the small intestine to the rectum. The colon is mainly responsible for the absorption of water from fecal material.

color blindness

A sex-linked inability to discriminate colors (either red-green or all colors), occurring in 8% of boys and 0.5% of girls. The presence of color blindness does not relate to the occurrence of learning disabilities. See also Ishihara test.

colostomy

A surgical operation and its result in which the large intestine is brought through the abdominal wall to empty into an appliance that has a plastic bag; the procedure is used to treat cancer, obstruction, and incontinence related to rectal dysfunction that may be secondary to spinal cord damage or dysfunction.

Columbia Mental Maturity Scale (CMMS)

A multiple-choice test measuring global intelligence and requiring no verbal and little motor response, for use in nonverbal children or in children with physical disabilities who are between 3-6 and 10 years of age. A card of symbols is presented to the child, who must identify which of the pictures is different, according to color, shape, use, or symbol. Administration time is less than 20 minutes. The results generate an IQ with a mean of 100 and a standard deviation of 16. Because minimal motor response is required, the test helps in assessing children with severe physical impairments.

columella nasi

The lower margin of the nasal septum. A short columella contributes to an apparent flat nose in a number of syndromes.

coma

A stare of decreased consciousness, with unresponsiveness even to painful stimuli.

common sense

The ability to demonstrate knowledge of information thought to be widely understood. Generally, common sense is a compilation of cultural traditions or folk knowledge constituting a body of shared and relatively standardized interpretations of a variety of phenomena—from natural occurrences to social behavior—and containing solutions to everyday problems. As opposed to "book knowledge" or "school smarts," common sense is pragmatic and relies heavily on problem-solving skills applied to "real life." Occasionally, parents and teachers are baffled at a child's solid common sense but simultaneous failure in the classroom. Many people with learning disabilities and attention disorders appear to lack common sense. Knowing to "come in out of the rain" and to "look before one leaps" are the type of "givens" common sense is assumed to make obvious to everyone.

Communication Abilities Diagnostic Test (CADeT)

An informal norm-referenced test of language development for children ages 3-9 years that uses stories, board games, and conversational context to assess syntax (grammar), semantics (the meaning of words), and pragmatic language.

Communication and Symbolic Behavior Scales (CSBS)

A norm-referenced assessment of language for children whose functional communication ages are 9 months to 2 years. A caregiver questionnaire, direct sampling of verbal and non-verbal communicative behaviors, and observation of relatively unstructured play activities generate 16 communication scales and 4 symbolic behavior scales.

communication board

An apparatus on which letters, numbers, and commonly used words are represented to assist individuals for whom oral expression is difficult or impossible. There are several types of boards, including 1) a direct-selection hoard, with a one-to-one correspondence between what the sender wants to express and the elements the board provides; 2) an encoding board, requiring the acquisition of input techniques before the device can be used; and 3) a scanning board on which message elements are presented, with matching components indicated by a prearranged signal (i.e., arm, hand, or eye movement), thus requiring a minimum amount of physical control by the user.

communication disorder

A problem with hearing, language, and/or speech, including articulation, voice, and fluency.

Communicative Activities of Daily Living (CADL)

A test of the knowledge and use of functional language in daily life activities. Originally developed for use with people with aphasia (loss of language skills), this instrument has subsequently been normed for use for people with mental retardation. Simulated life activities, such as label reading, transportation, ability to tell time, and understanding of common signs, are assessed to determine the functional language and adaptive skills needs of the person with mental retardation.

communicology

Speech-language pathology.

compensation

An adjustment or series of adjustments to counteract or mitigate the effect of some anomaly (malformation, deformation, disruption, or dysplasia), impairment, or disability. Both the difficulty and the adjustment can be neural, motoric, psychological, physical, or social in nature, and may not be readily apparent. Seeking achievement in other areas, working harder than others, or implementing bypass strategies to circumvent weaknesses are examples of compensatory techniques. Because developmental disabilities are permanent and can vary in expression over the life span, compensatory techniques are necessary to facilitate daily function and may vary in response to changing needs. The more that is known about the individual's difficulty, the easier it may be to identify strengths and devise compensatory techniques.

compensation

A theory of recovery from brain damage that suggests that the functions of a damaged circuit may be assumed by other circuits and pathways, as opposed to true recovery of the original damaged circuits.

compensatory methodology

Accomplishing instructional objectives by circumventing weaknesses and utilizing strengths of the student. Commonly used in reference to educating students with disabilities, such as those who are deaf, blind, or have learning disabilities.

complete blood count (CBC)

A battery of tests of the blood, including hemoglobin (oxygen-carrying red blood cells), hematocrit (the volume of packed red cells), red and white blood counts, red cell indices, and a differential white blood cell count (percentages of different white blood cells).

completion test

A test that requires the subject to fill in blank spaces of test items such as incomplete sentences.

complex partial seizure

A type of partial seizure that includes altered consciousness and often automatisms (robotic behaviors, such as running, fumbling with objects or clothing, or lip smacking). A complex partial seizure is often preceded by a simple partial seizure. Recognition of this fact helps to diagnose the seizure type, warns the person that he or she is about to have a seizure that alters consciousness, and may help to localize the brain focus of the seizure. Frequently, seizures with automatisms begin in the temporal lobe. Complex partial status epilepticus is rare; complex partial seizures can generalize to tonic-clonic seizures. Complex partial seizures are treated with carbamazepine (Tegretol), phenobarbital, valproic acid (Valproate), phenytoin (Dilantin), primidone (Mysoline), or mephobarbital (Mebaral).

Comprehensive Identification Process (CIP)

A screening test for children from 2½ to 5½ years of age who are not participating in an organized preschool program. Motor, cognitive, and speech-language areas are assessed. Administration time is approximately 1 hour for relatively skilled personnel; 30% of children are subsequently referred for further testing.

Comprehensive Test of Visual Functioning (CTVF)

An assessment device for visual function in children ages 8 to 16-0 that includes subtests on visual acuity, visual processing/figure-ground, visual tracking, reading word analysis, visual/letter integration, visual/writing integration, non­verbal visual closure, nonverbal visual reasoning/memory, spatial orientation/memory/motor, spatial orientation/motor, visual design/motor, and visual design/memory/motor.

computed tomography (CT)

Computed axial tomography (CAT) scan; a radiological technique in which rays are passed through the brain (or other body part) to produce a picture that shows the body part in cross section. Serial sections that look at different areas of the brain are possible. Head CT scans are used to delineate location of brain damage secondary to tumor, stroke, congenital malformations, or infection. A CT scan can be completed in 30 minutes. It does, however, require stillness; thus, many younger children must be sedated.

computer-assisted instruction (CAI)

The use of computer programs to teach people with and without developmental disabilities.

conative

Volitional, as opposed to cognitive.

concave

A hollowed-out, or depressed, surface; often used in descriptions of corrective lenses and spinal curvatures.

concentric power

The ability to resist force as the muscle is shortened.

concept

A regularity in events or objects designated by some label. For example, the concept of chair includes easy chairs, desk chairs, straight-backed chairs, and so forth. The concept of chair is itself part of a concept called furniture. Concepts may be described as nonverbal or verbal. Nonverbal concepts are groups of ideas that go together and are easier to picture than to describe. For example, to understand fractions, it might be easier to picture a pizza being divided than to explain it in words. Verbal concepts refer to associated ideas that are readily described through language (e.g., friendship). Concrete concepts refer to objects that can be seen or felt, such as the concept of dog. Abstract concepts refer to ideas, rather than objects. For example, democracy, evaporation, and creativity are examples of abstract concepts. Students with learning disabilities can have difficulty understanding concepts if they are presented by a method not suited to their cognitive strengths. For example, students with language impairments are helped by a visual representation of a concept; abstract concepts are often stumbling blocks for such students.

concordant

A term used in twin studies meaning that both twins have a certain trait.

concrete operations

Piagetian stage in cognitive development in which induction (logical thinking) emerges but is limited to what is immediately perceived. This approach remains prominent from 6 to 12 years of age.

concretism

A style of thinking and behavior in which an individual views each situation as new and unique, with a failure or inability to see fundamental similarities and relationships between situations that others recognize as similar or analogous. In concretism, general knowledge, problem-solving strategies, and comparable components are neither generalized nor assimilated into a cognitive structure to be assessed at a later date. Concretism is characteristic of some individuals with mental retardation.

concussion

Transient neuronal dysfunction that immediately follows head trauma with or without retrograde (before the injury) amnesia (impaired memory); it is less severe than contusion. Associated symptoms may include drowsiness, vomiting, seizures, and other neurological findings.

conditioned dysphagia

A learned difficulty with food acceptance and feeding that results from an aversion to swallowing.

conditioned reflex

A learned response to a neutral stimulus; the linking of a neutral stimulus to a stimulus that elicits an un­conditioned reflex response.

conduct disorder

A persistent behavior pattern of violating others' rights and ignoring age-appropriate social standards. Specific behaviors include lying, theft, arson, running away from home, aggression, truancy, burglary, cruelty to animals, and fighting. This disorder is distinguished from oppositional defiant disorder by the increased severity of the behaviors and their occurrence independent of an event occasioning opposition. Attention-deficit/hyperactivity disorder (ADHD) is frequently associated with or misdiagnosed as conduct disorder. There is a marked male predominance in incidence.

conductive deafness

Hearing loss because of an inability to transmit sound from the air to the tympanic membrane (ear drum) in order to activate the auditory nerve (cranial nerve VIII). This is generally the result of a problem with the outer or middle ear; the inner ear is usually normal. Causative factors range from congenital malformations of the outer ear to fluid in the middle ear because of an ear infection. Some causes of conductive losses can be treated and cured.

conductive education

A school of physical therapy for cerebral palsy; see also Peto.

co-negativity

Specificity.

confabulation

Fabrication; differs from lying in that the subject believes what is being said; observed in adults with organic brain syndromes and in children with attention disorders.

confidence interval

See error of measure­ment.

confidentiality

A legal and ethical professional practice principle whereby such professionals may not disclose or discuss information regarding a client or patient; including the diagnostic and treatment services rendered, without the express written consent of the client or patient. This restriction includes the identity of the client or patient, records, opinions, or behaviors. Violation of this principle is considered malpractice. Confidentiality, however, may be set aside when there is danger of suicide, homicide, or child abuse (i.e., when there is a clear and present danger of harm to self or others).

confusion reflex

See flexor withdrawal reflex.

congenital

Present at birth; either genetic or acquired in utero due to teratogens (toxic agents) or mechanical factors.

congenital cytomegalic inclusion disease

See fetal cytomegalovirus (CMV) syndrome.

congenital dislocation of the hip (CDH)

See developmental dysplasia of the hip.

congenital rubella

See fetal rubella syndrome.

congenital vertical talus

Rocker-bottom foot; a rigid flat foot that has a high asso­ciation with other congenital anomalies and genetic syndromes, CNS disorders (especially myelodysplasia), congenital hip dislocation, and arthrogryposis (fixa­tion of the joints).

Conners Rating Scales

A group of normed questionnaires to assess hyperactivity and inattention. The Conners Parent Rating Scale (CPRS) and the Conners Teachers Rating Scale (CTRS) are used for children 6—14 years of age; the shorter Conners Parent Rating Scale-Revised (CPRS-R) and Conners Teachers Rating Scale-Revised (CTRS-R) are used for children 3-17 years of age. These instruments are used both for diagnostic pur­poses and to monitor the response to stimulant drug therapy for hyperactivity.

Conradi-Hunermann syndrome

See chondrodysplasia punctata.

consanguinity

Having a common ancestor; a blood relationship. Rare recessive disorders are more likely to occur from a consanguineous relationship, since the two people involved tend to carry similar genes. Throughout history, laws have prohibited consanguineous marriages because of the knowledge that these marriages produced a greater number of children with mental retardation and deformities.

consensual light reflex

The contraction of a shaded pupil (protected from the light) when the other pupil is stimulated by light.

consequent stimulus event (CSE)

The effect produced in the environment by an operant behavior. The CSE always follows the operant and serves to strengthen, weaken, or maintain the behavior. CSEs that strengthen operant behaviors are called reinforcers and may be positive or negative. Positive CSEs strengthen the operant by immediately following it with a reward. Negative CSEs strengthen an operant by immediately following it with the removal, or avoidance, of something a person does not like. During the initial stages of learning, it is important that the CSE follow the operant immediately. A delay may prevent the association of the CSE with the operant, and the CSE may then not have any effect on the operant. A CSE that weakens a behavior is called a punisher or aversive stimulus event (ASE). Negative reinforcement and punishment are often contused but are quite different. Punishment serves to weaken undesirable behavior by presenting an ASE after the behavior occurs; negative reinforcement serves to strengthen desirable behavior by removing an ASE after the desirable behavior occurs. Reinforcers and punishers may be primary (unlearned or unconditioned) such as food or physical pain, or secondary (learned or conditioned). Secondary reinforcers or punishers usually require pairing with a primary or an established reinforcer or punisher to become effective. For example, a frown becomes effective through an initial pairing with a "time-out."

conservator

A court-appointed person who maintains responsibility for and power over the financial affairs of another individual who has been legally judged incapacitated. In terms of finances, a person may need a conservator only when he or she has a physical impairment and thus is unable to negotiate financial matters easily or in a timely manner. A person who is mentally incapacitated (by illness, accident, or mental retardation), however, may have a conservator for financial matters and a guardian to oversee other areas of life decision making.

consolability

An infant's capacity to quiet following a period of crying. The degree of intervention necessary to help the infant to quiet may reflect the ability to regulate state changes.

contagion

The spread of disease from one individual to another.

contagious

Relating to the spread of a disease from one individual to another. Different infectious diseases have greater or lesser degrees of contagiousness; some spread rapidly, whereas others can only be spread by prolonged intimate contact. Developmental disabilities are not contagious.

contextual clues

A word attack skill using the relationship of words to their uses in phrases, sentences, and paragraphs to help decode unknown words. Closure activities (filling in missing words) arc often used both to teach and to rest the use of contextual clues. For example: "The ____ man shouted and stomped his foot" (from Woodcock-Johnson Psycho-Educational Battery-Revised).

contiguous gene syndrome

The presence of multiple anomalies due to deletions of gene(s) next to each other on the same chromosome. For example, WAGR syndrome, an acronym for the combination of conditions including Wilms' tumor (a malignancy of the kidney), aniridia (absent irises), genitourinary abnormalities, and mental retardation, is caused by a deletion of chromosome 11p. This deletion is in a similar location as the deletion in Beckwith-Weidemann syndrome, which also includes Wilms' tumor and genitourinary abnormalities.

contingency

A term from behaviorist learning theory that refers to the conditions in which a consequent stimulus event (CSE) occurs. The contingency is what the child must do before the CSE is presented. For example, a teacher might want a student to write the three times table (the operant behavior) with 100% accuracy in order to receive 15 minutes of free time. The contingency would be writing the three times table with 100% accuracy.

contingency contracting

A specific type of behavior modification program. A teacher makes a contract with a student, who agrees to perform a specific behavior, such as finishing an assignment, in return for an agreed-upon reward.

continuous performance test (CPT)

A research technology to quantitate attention span, concentration, and impulsivity by having the subject identify a specific letter sequence in a rapidly changing stream of randomized letters; error score and reaction time are electronically calculated.

continuous positive airway pressure (CPAP)

A type of assisted ventilation used in newborns with respiratory distress.

continuum of developmental disabilities

An approach to the major categories of developmental disabilities that focuses on their similarities (as opposed to the spectrum that emphasizes their differences). In many cases of a given developmental diagnostic category, associated findings suggest one or more other developmental diagnoses, thus, children whose primary diagnosis is mental retardation often exhibit some motor findings common to children with cerebral palsy; children with cerebral palsy often have varying degrees of mental retardation; and children with severe learning disabilities have a variety of motor and cognitive abnormalities.

continuum of reproductive casualty

The entire range of fetal and maternal disorders associated with pregnancy, labor, and delivery; in 1956 Benjamin Pasamanick described this continuum as a risk factor in later developmental disabilities.

contracture

A permanent muscular or other soft-tissue contraction (fixed increased resistance to passive stretch) due to tonic spasm or shortening. Contracture at a joint prevents movement through the full range of motion. Contractures arise earlier in spastic cerebral palsy and later in extrapyramidal cerebral palsy. Contractures may be prevented by physical therapy, positioning, and bracing; they may be treated by serial casting and surgery. Congenital contractures occur in arthrogryposis (fixation of the joints).

contraindication

Prohibition; a reason not to do something; any symptom or special circumstance that renders a treatment or surgical procedure inadvisable. Contraindications may be relative or absolute. For example, surgery may be delayed until the individual is in an optimal nutritional state; elective procedures in infants are usually not carried out until the baby weighs 10 pounds. In the area of developmental disabilities, tics and Gilles de la Tourette syndrome represent relative contrainidications to the use of methylphenidate for attention-deficit/hyperactivity disorder (ADHD).

contralateral

On the opposite side of the body. Because motor nerve fibers from the brain cross the midline, the right brain controls motor movements on the left side of the body; similarly, the left brain controls motor move­ments on the contralateral, or right side, of the body.

contrecoup injury

An injury that occurs when the force of a blow to one side of the body causes damage to the other side of the body: this is especially common in head injuries because the brain is constrained within the skull.

contusion

A head injury (more severe than a concussion) that results in bleeding into the brain. Associated symptoms may include loss of consciousness, vomiting, skull fracture, seizures, papilledema (edema and inflammation of the optic nerve), and neurological residua.

conversation board

See communication board.

convex

Rounded, bulging outward; often used in the description of corrective lenses and spinal curvatures.

convulsion

A violent involuntary muscular contraction that can be due to a neurological seizure disorder. Recurrent seizures define epilepsy.

cooing

The first stage of infant vocalization consisting of vowel sounds. It may be present near birth in the form of short, squealing sounds, and should be easily noticed by 3 months of age. By 6 months of age, cooing evolves into fairly musical play with complex vowel patterns, the absence or significant delay of this vocalization pattern, as seen in the quiet baby, should be considered an early marker for developmental disorders, especially mental retardation or language disorders. Since cooing is preprogrammed, it is not dependent on external auditory stimuli and will occur on tune in children deaf from birth.

Cooperative Preschool Inventory-Revised

A brief screening test for school readiness in children of 3-6 years of age, with an administration time of 15 minutes. The instrument has been used principally to measure the effects of early intervention programs in low socioeconomic populations.

Coopersmith Self-Esteem Inventory (CSEI)

A measure of an individual's feelings and attitudes about him- or herself. There are two forms of the measure: Form A comprises five subscales with 58 items that address general self, social self, peers, home-parents, school-academic, and a lie scale. Form B is briefer and is not divided into subscales. Norms are provided for children ages 9-15 and for young adults.

co-positivity

Sensitivity.

coprolalia

The obsessive and compulsive use of obscene words; this symptom occurs late in the course of Gilles de la Tourette syndrome. Related findings in Tourette syndrome include copropraxia (obscene gestures) and coprographia (obscene drawings and writings).

corectopia

A pupil that is not centered in the iris.

cornea

The transparent, clear anterior (front) covering of the eye.

corneal light reflex test

See Hirschberg test.

Cornelia de Lange syndrome

Brachmann-de Lange or de Lange syndrome; typus degenerativus amstelodamensis, A syndrome of mental retardation, hirsutism (excessive hair growth), microcephaly (abnormally small head), very short stature of prenatal onset with micromelia (small extremities), thin downturning and long upper lip, and a small nose with anteverted nares (nostrils). The hirsutism is especially prominent with the bushy eyebrows that tend to be confluent across the midline (synophrys). The degree of mental retardation tends to be severe, with marked speech and language problems and occasional hearing impairments and autistic features. Recurrence risk is negligible, bur rare cases of autosomal dominant inheritance have been reported. Duplication of part of the long arm of chromosome 3 can produce a phenotype similar to de Lange syndrome. Named after the Dutch pediatrician Cornelia de Lange (1871-1950).

coronal plane

An anatomical plane that divides the body into an anterior (front) and posterior (back) half.

corporal punishment

A form of punishment in which physical pain or discomfort is administered. Although it is not uncommon for schools and school systems in the United States to condone and administer corporal punishment, little is known about its effectiveness due to the lack of research in this area. Research has, however, indicated negative side effects related to corporal punishment. The use of punishment has been demonstrated to produce strong emotional side effects in children, sometimes resulting in behavior more deviant or disruptive than the original. Instances of aggressive behavior directed toward the punisher, innocent bystanders, and inanimate objects have been demonstrated after corporal punishment was applied. Any behavior that provides escape from the punishment (e.g., lying, hiding, cheating) is negatively reinforced, and may become part of a child's repertoire. Corporal punishment also provides a model of aggressive behavior that is imitated by young children. The adult administering the punishment may be teaching the student that it is acceptable to hurt others if you are an adult or if you do not get caught. Some consider corporal punishment justified only when the individual's behavior is potentially more damaging to him or her than the punishment (e.g., a young child who is about to touch a hot stove, or self-injurious behavior of some youth with severe disabilities).

corpus callosum

The portion of the brain that connects the two hemispheres. Agenesis (absence of formation) of this connection or surgical severing to control seizures often affects the ability to exchange information between the hemispheres. People with such "split brains" tend to give different responses to a stimulus depending on which side of the body receives the stimulus. For example, if an object is presented to the left side of the brain, then the response is a verbal calling of the object name. On presentation to the right side, the individual reports seeing nothing, but is able to select that object from other objects. Congenital absence of the corpus callosum can be associated with other abnormalities of the central nervous system and cognition.

cortex

Gray matter; the outermost, halt-inch-thick layer of the cerebrum, or largest and topmost division of the brain; this surface is marked by numerous gyri (hills) and suici (valleys and ridges). Localization of specific functional areas on the cortex can be by Brodmann numbers, von Economo lettering, or neuroanatomical nomenclature.

cortical blindness

Also known as central blindness. Visual impairment secondary to damage to the occipital cortex in the presence of an intact visual system including an eyeball, lens, retina, and optic nerve pathway. Cortical blindness following head trauma may be transient.

cortical deafness

See central deafness.

cortical thumb

Fisting with the thumb flexed inside the clenched palm. This is often regarded as a sign of abnormal hypertonicity (increased muscle tone); however, cortical thumbing can be normal in the first 3 months of life, during which time fisting is itself normal. A frequently used synonym is cerebral thumb.

cost contingency (response cost)

A form of punishment in which the student loses something of value he or she has previously earned or is normally given. For example, detention is the loss of free time as a result of undesirable behavior. This form of behavior modification has been more successful with children who have attention-deficit/hyperactivity disorder (ADHD) and do not respond to other forms of behavior management in the same way as other children. Children with ADHD often focus on the reinforcer rather than the task being reinforced. For cost contingency to be effective, the loss must be immediate and related to a specific behavior. For example, the child might lose 1 of 10 tokens with the explanation, "You were looking out the window." Care must be taken that this be perceived by the child as a way of helping him or her control attention and not as a punitive action.

costa

Rib.

Cotrel Dubousset procedure

A modification of the Harrington rod for the ortho­pedic surgery treatment of scoliosis (spinal curvature).

Council for Exceptional Children (CEC)

Founded in 1922, CEC is the world's largest professional organization concerned with exceptional (exceptional in any respect, as in children who have learning disabilities, physical impairments, or special gifts). The organization is divided into special interest groups including divisions on physical disabilities, behavior disorders, mental retardation, communication disorders, learning disabilities, visual impairments, talented and gifted, early childhood education, special education administration, career development, technology and media, and educational diagnostic services. The CEC sponsors national and state conventions and issues two periodicals: Exceptional Children and Teaching Exceptional Children.

Council for Learning Disabilities (CLD)

Originally formed in 1968 as the Division for Children with Learning Disabilities, within the Council for Exceptional Children (CEC). With the realization in the early 1980s that adults also have learning disabilities, the name was changed to its present form, and the CLD also became a separate and independent organization, rather than a division of CEC. The official journal of the CLD is the Learning Disability Quarterly.

cover/uncover test

A screening test for strabismus (squint); the patient fixates (stares at) a light or other interesting toy or object, and each eye is alternately covered and uncovered; the deviation (inward or outward) of either eye under any of the test conditions yields information useful to the diagnosis of strabismus; this technique can be used in infants as well as adults. This test is also known as the crossed patch test.

cowlick

An accessory hair whorl producing an unusual upward sweep of hair. An example of a minor dysmorphic (atypical appearance) feature.

coxa

The hip.

Coxsackie virus

A group of ribonucleic acid (RNA) viruses associated with a range of disorders, including colds, aseptic meningitis (inflammation of the spinal cord and brain membranes), and cardiac disease.

CPAP

See continuous positive airway pressure.

CPD

See cephalopelvic disproportion.

CPK

See creatine phosphokinase.

CPT

See continuous performance test.

CPVT

See Carolina Picture Vocabulary Test.

crack

A street term for an inexpensive form of freebase cocaine; see also infant of substance abusing mother.

cracked-pot sound

See Macewen sign.

Craig Lipreading Inventory

A measure of single phonemes and more complete language pattern discernment. The test has been broadly used to assess the lipreading performance of people with deafness. The inventory may be presented by an examiner or a filmed version with soundtrack can be used, permitting the use of the test for lipreaders alone or for people who have residual hearing. Because many factors, including hearing loss, educational experience, and mental age, contribute to lipreading competency, tests of this skill are best used to compare groups, rather than to attain established norms.

cranial nerve

Any of the set of 12 pairs of nerves that exit from the base of the skull. The nerves are numbered with Roman numerals in addition to their names.

craniectomy

Excision of a portion of the skull. In the presence of craniosynostosis (premature fusion of skull sutures), the reopening of sutures by a morcellation procedure (bit-by-bit removal of a linear strip of bone, and treating the edges so they do not grow together again) is more for cosmetics (see Crouzon syndrome).

craniofacial dysostosis

See Crouzon syndrome.

craniosynostosis

Also termed craniostosis. Premature closure (fusion or ossifica­tion) of the skull sutures, thus slowing or stopping the growth of the skull and presumably inhibiting further brain growth and contributing to the evolution of developmental disabilities. Continued brain growth is the major inhibitor of suture closure, so that most occurrences of craniosynostosis reflect primary arrest of brain development. In the absence of signs of increased intracranial pressure, surgical intervention (i.e., craniectomy) to allow the skull to continue to grow is rarely helpful other than cosmetically (see also Crouzon syndrome). When only selected sutures, as opposed to all sutures, prematurely fuse, total intracranial volume is most likely to be within the normal range.

crawling

Locomotion in quadriped; regional variations in usage do not clearly distinguish crawling from creeping. Delayed crawling (past the age of walking), so that the child walks before crawling, has little significance as an isolated finding.

creatine phosphokinase (CPK)

An enzyme; an elevated CPK level may indicate muscular dystrophy.

Credé maneuver

A technique for manually expressing urine from the bladder of paralyzed individuals.

credibility

The degree to which information provided is trustworthy and believable. This is an especially important consideration when evaluating a child for some types of developmental disabilities, since diagnosis is partially based on developmental history as given by parents and other significant caregivers. Individuals are characterized as good or bad historians based upon the quality and consistency of the information they are able to provide.

creeping

Locomotion in prone; regional variations in usage do not clearly distinguish creeping from crawling.

cretinism

See hypothyroidism, congenital.

crib-o-gram

An instrument used to assess hearing in premature and newborn infants by recording movement in response to loud sound stimuli. The instrument has high false-positive and high false-negative rates and only detects profound bilateral hearing loss.

cri-du-chat syndrome

5p— syndrome, cat-cry syndrome; a genetic syndrome with poor growth and a mewing catlike cry in infancy, microcephaly (abnormally small head), a rounded, moon facies with hypertelorism (widely spaced eyes), epicanthal folds, and downward slanting of the palpebral fissures (eye slits). The level of mental retardation is severe to profound. Most cases represent spontaneous partial deletions of the short arm of chromosome 5, but 10%-15% are secondary to a parental balanced translocation with an increased recurrence risk. Incidence is estimated at 1 per 20,000.

Crippled Children's Services (CCS)

Federally subsidized state programs for the diagnosis and treatment of children with developmental disabilities, especially those with physical disabilities and other medical complications. In some states, this program has been renamed Children with Special Health Care Needs (CSHCN). See also Children with Special Health Care Needs.

crisis

A debilitating mental or emotional state elicited in response to an event perceived to be so threatening that the usual coping skills are insufficient and ineffective. A crisis can often be the decisive turning point or culmination of a series of events when it forces a response to a situation that cannot persist indefinitely because of its stressful nature. Thus, the possibility of seeking assistance and initiating therapy is enhanced. For example, the birth of a baby with a disability is a major family crisis. Feelings of guilt, blame, anger, and resentment are typical, as well as concern regarding the child's health. In some cases, when the disability or defect is readily apparent, there is tremendous disappointment at not having pregnancy result in a "normal" child. Parents are often isolated from outsiders and each other while they face a frightening and exhausting period. Education, support, and un­derstanding for the family can help to alleviate the impact of the crisis and allow the family to determine a level at which they will be able to function.

criterion

A predetermined level of performance to he achieved; a targeted standard.

critical period

A time period early in the life of an organism when learning essential to normal adult functioning must occur. There is an implication of irreversibility; if this temporal gate is missed due to environmental deprivation or deviance, the organism will never be able to later achieve that learning. This concept is derived from ethology (the study of animal behavior) and probably does not have a human equivalent. Sensitive periods and plasticity probably better characterize human development. Biologically, there are critical periods in brain development, but these are mostly prenatal.

cross-categorical

The grouping together of students with disabilities without reference to a particular label or category of exceptionality. Rather than considering each category of special education as distinct, common characteristics are emphasized and student instruction is viewed from this perspective. Since categories of disabilities are not mutually exclusive and children with varying conditions are not always easily differentiated from each other, placement in a common class is advocated by some educators as a viable and practical alternative. Furthermore, assessment and treatment procedures for various categories often overlap, illustrating considerable commonality among some categories. Other educators are opposed to such grouping and advocate separate placement for students with different disabilities. These educators are concerned that individual needs will be overlooked, and they view diversity as an impediment to instruction.

crossed extension

A primitive reflex in which a noxious stimulus applied to one foot produces a flexion/extension response in the other foot. Absence or asymmetry of the response is abnormal and indicates damage to the motor system of the side that does not respond.

crossed extension pattern

The simultaneous forward movement of one arm and the contralateral (opposite) leg in creeping, crawling, and walking.

crossed patch test

See cover/uncover test.

croup

An acute viral respiratory syndrome characterized by a creaky, honking cough; the differential diagnosis includes epiglottitis (inflammation of the epiglottis), laryngotracheobronchitis (inflammation of the wind pipe), and spasmodic laryngitis, with the first of these representing a life-threatening medical emergency. The asphyxia (lack of oxygen) sometimes occurring with epiglottitis can produce brain damage or death.

Crouzon syndrome

Craniofacial dysostosis. A genetic syndrome with premature craniosynostosis) fusion of skull sutures) leading to brachycephaly (irregular, flat head shape), mid-face hypoplasia (atypical tissue development), and shallow orbits with exophthalmos or proptosis (a pop-eyed look). The nose is parrot beaked with a relative prognathism (a prominent jaw). The head and face in Crouzon syndrome resemble their appearance in Apert syndrome, but Apert syndrome has a 100% occurrence of neurocognitive problems, whereas in Crouzon syndrome, such problems are absent unless increased intracranial pressure is left untreated. One third to half of all cases have a conductive (involving the middle and outer ear) hearing loss. Inheritance follows an autosomal dominant pattern, with, however, extremely variable expression; about one quarter of cases represent spontaneous mutations. Recurrence risk is either zero or 50%.

crown-rump length

The distance from the top of the head to the bottom of the buttocks; one of the standard measures of fetal size.

cry

A prelinguistic vocalization pattern that can be reflex (e.g., birth cry), communicative (e.g., pain, anger, exercise, hunger, fatigue, fretfulness), or pathological (e.g., colic). Tears do not usually accompany crying until 6 weeks of age. Prolonged primitive crying may reflect underlying brain damage or mental retardation, and certain cry patterns can point toward specific diagnoses: a shrill, high-pitched cry suggests cerebral irritability (e.g., encephalitis [brain inflammation], meningitis [inflammation of the spinal cord and brain membranes], hydrocephalus [excess fluid in the brain]), a mewing cat cry suggests cri-du-chat syndrome (this cry disappears in older children), a bleating lamb cry suggests Cornelia de Lange syndrome, and a hoarse cry is noted in hypothyroidism. Sound spectrographic analysis has confirmed the specificity of these cry patterns.

cryptophthalmus

Hidden eye. The absence of a palpebral fissure (eye slits), and, by extension, the absence of eyelashes and eyebrows. Cryptophthalmus can be associated with mental retardation, genital anomaly, and ear and kidney defects (Fraser syndrome).

cryptorchidism

Undescendcd testes; may he unilateral or bilateral. This can be an isolated finding or a component of an identifiable genetic syndrome. Treatment can be medical (with hormones) or surgical (orchiopexy).

crystallized ability

A term from the Horn-Cattell theory of intellectual processing. Crystallized ability refers to intellectual functioning or tasks utilizing previous training, education, and acculturation. A measure of crystallized ability may represent individual differences in knowledge, including verbal abilities; in the information on which judgment, sophistication, and wisdom are based; and in the types of reasoning based on previously learned procedures. The Woodcock-Johnson Psycho-Educational Battery-Revised (WJ-R) Test of Cognitive Ability is based upon the Horn-Cattell theory. The Kaufman Assessment Battery for Children (K-ABC) also provides, to some extent, a frame­work for assessing crystallized and fluid abilities. See also fluid intelligence.

CSBS

See Communication and Symbolic Behavior Scales.

CSE

See consequent stimulus event.

CSEI

See Coopersmith Self-Esteem Inven­tory.

CSF

See cerebrospinal fluid.

CSHCN

See Children with Special Health Care Needs.

ctenoid

A specific electroencephalographic (EEG) finding with 14- and 6-per-second positive spikes (sharp pointed deviations); ctenoids are not pathognomonic (indicative) but are slightly more frequent in people with learning, behavior, and attention disorders.

CTLSHO

Cervical-thoraco-lumbar-spinal and hip orthosis, or in-chair orthosis for scoliosis (spinal curvature).

CTLSO

Cervical-thoraco-lumbar-spinal orthosis; see also Milwaukee brace.

CTVF

See Comprehensive Test of Visual Functioning.

cubitus valgus

Increased carrying angle, as seen in Turner syndrome.

cued speech

A system of manual cues used in conjunction with speech reading. The system was developed in 1967 at Gallaudet College in Washington, D.C. Cued speech was designed to lessen ambiguity experienced by individuals with severe and profound hearing impairments using speech reading to understand spoken language. Since many sounds appear visually similar, cued speech attempts to avoid phoneme confusion by providing a visual element to speech reading. Twelve hand signals or cues comprise the system: four cues are hand positions that differentiate between groups of vowel sounds; eight cues, based on Arkan Sign Language hand shapes, are used to visually discriminate between groups of consonants.

cultural bias

The use of material that is familiar to one social or economic group but remote from the experiences of another group. For example, there is evidence to suggest that items on most intelligence tests are more familiar to Caucasian, middle-class children than to their lower-class and/or ethnically different peers, resulting in measurably higher performance by the Caucasian middle-class children.

cultural sensitivity

Knowledge of cultural differences and the corresponding usage of verbal and nonverbal behavior that optimizes interactions with people from a different cultural background.

custodial care

Institutional placement with no therapeutic service components as part of the care.

cutaneous

Relating to the skin.

cutaneous facilitation

Skin stimulation as a component of neuromuscular therapy; such stimuli include light-moving touch, fast brushing, and applying ice to skin.

CVA

Cerebrovascular accident. See stroke.

CVFES

See Children's Version of the Family Environment Scale.

CWC

See class within a class.

cyanosis

A blue tinge or color to the skin, especially noted peripherally in the lips and fingernails; it can occur with cold, shock, disease of the heart or lungs, and seizures. The blueness derives from decreased oxygen leading to an increase of reduced hemoglobin (oxygen-carrying red blood cells).

cybernetics

The study of regulating mechanisms in closed systems, particularly the flow of information and feedback loops in those systems.

Cylert

Trade name for pemoline.

cynotrichous

Straight, curly, or wavy hair as found in Caucasian races.

cystic encephalomalacia

A brain condition characterized by the formation of cystic cavities (holes) in the white matter of the brain. Generally a result of severe asphyxia (lack of oxygen), cystic encephalomalacia can be found after viral encephalitis (brain inflammation). The brain-stem nuclei and the thalamus tend to be affected initially, with further damage extending to the basal ganglia and the cerebral cortex. The brain damage can be seen on ultrasound and on computed tomography (CT) and magnetic resonance imaging (MRI) scans. The outcome of this type of insult is usually cerebral palsy with mental retardation. Spastic quadriplegia is the most common type of cerebral palsy associated with cystic encephalomalacia.

cytomegalovirus (CMV)

See fetal cytomegalovirus syndrome.