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

p—

The short arm of a chromosome. Cri-du-chat syndrome is 5p- (a deletion on the short arm of chromosome 5).

PA

See posteroanterior

P&A

See protection and advocacy.

pachygyria (macrogyria)

A condition in which there are few broad gyri (hills) with shallow sulci (valleys and ridges). This anomaly is more common than lissencephaly (smooth, rather than convoluted, brain structure), and the insult producing it can occur later in gestation. The clinical picture includes severe to profound mental retardation with seizures; many people with pachygyria also have spasticity (increased muscle tone). Most cases are sporadic; however, when found with lissencephaly, pachygyria can be familial. Pachygyria can be visualized on a magnetic resonance imaging (MRI) scan.

pachymeningitis hemorrhagica interna

Antiquated name for chronic subdural hematoma.

PAIP

See Preverbal Assessment Intervention Profile.

paired associate learning

(PAL) A learning task used to measure attention; the subject is presented with a series of pairs (of words, letters, symbols, or combinations of these) and is then asked to provide the other item when one of the pair is presented. Numerous standardized and non-standardized test procedures employ this task.

pairing

Associating one stimulus with another; presenting pairs and requiring the subject to learn to give one pair member as the response to the other stimulus pair member.

PAL

See paired associate learning.

palate

Roof of the mouth, composed of an anterior (front) hard palate and a posterior (back) soft palate. Deviations in the shape of the palatal arch, variously described as high-arched, elevated, or steepled, are counted as minor dysmorphic (atypical) features, and can be components in a variety of syndromes; they are independently associated with both microcephaly (abnormally small head) and mid-facial hypoplasia (atypical tissue development).

palilalia

The tendency to repeat one's own words (as opposed to echolalia, the tendency to parrot or repeat the words of others); this has been described in Tourette syndrome.

Pallister mosaic syndrome

See Killian/Teschler-Nicola syndrome.

palmar grasp

Reflex closure on or voluntary prehension of an object or stimulus with the hand.

palmomental reflex

An infant oral-motor reflex in which the stimulus of stroking the palm of the hand produces the response of a wrinkling of the ipsilateral (on the same side) mentalis muscle (an elevation of the angle of the mouth). An intact palmomental reflex in infants reflects normal facial nerve (CN VII) function; an easily elicited palmomental reflex in older children is associated with postencephahtic syndrome or degenerative disorders.

palpation

Examination by means of the hands; to feel the size, shape, and consistency of various body organs.

palpebral fissure

Eye slit; the opening between the upper and lower eyelids. The corners of the palpebral fissures are canthi; the distance between them is the palpebral fissure length (PFL). The most common syndrome with decreased PFL is fetal alcohol syndrome (HAS). Upslanting eves (palpebral fissures that rise going outward from the nasal side) are associated with Down syndrome and many other genetic syndromes; downslanting (from the nose laterally) palpebral fissures are also associated with a number of genetic syndromes. PFL is normally 80%-90% of the inner canthal distance (ICD) measurement; PFL values below 80% of ICD represent shortened PFLs. As with other dysmorphic (atypical) features, isolated findings may be of no significance.

PALS

See Program for the Acquisition of Language with the Severely Impaired.

palsy

Paralysis or weakness.

pandemic

An epidemiological term indicating an epidemic of global magnitude. In actual usage, the term has come to mean physical or mental disorders that affect multiple and often unrelated, although not necessarily global, populations. Thus, acquired immunodeficiency syndrome (AIDS) is a pandemic of an infectious agent; babies exposed to cocaine in utero constitute a pandemic of a lifestyle agent.

papillary ridges

Fingerprints; the three basic patterns of papillary ridges are the loop, the whorl, and the arch. In addition to providing a quantitative means of identifying each individual, gross deviations from the normal patterns of loops, whorls, and arches are often part of specific genetic syndromes. See also dermatoglyphics.

papilledema

A swelling of the head of the optic nerve called the optic disk. This can be seen on visualization of the optic fundus (the back of the eye or retina) and may be an indication of acute brain swelling (increased intracranial pressure), such as in head trauma or a vascular (blood vessel) etiology (cause) such as hypertension (high blood pressure) or leukemia. Toxic levels of certain drugs (tetracycline, dexamethasone, or chloramphenicol) or vitamins (e.g., vitamin A) can also produce papilledema. There often is a history of intermittent blurring of vision. Treatment is specific to the cause, and the optic discs are generally not permanently damaged.

para

Refers to the number of pregnancies carried and delivered; thus, para III describes a woman who has delivered three pregnancies (not necessarily three children, because twins and triplets only represent one pregnancy each). A common, but extremely variable, usage summarizes a woman's pregnancy history with a four-digit number: T—term pregnancies delivered; P—premature pregnancies delivered: A—abortions/miscarriages; and L—living children. Sometimes a fifth digit is placed at the beginning of the number to sum the first three; thus, 6-3-2-1-5 describes a woman who has been pregnant six times, delivered three term and two premature infants, had one miscarriage, and currently has five living children. Occasionally, the brief two-digit coding of gravida/para (where the first number does reflect current pregnancy status) is expanded to a three-digit code: G—gravida; P—para; and A—abortions and miscarriages. Local variations in the usage of these numerical shorthands require clarification before they can be interpreted.

parachute

Anterior parachute response; a postural response (EAR-II) in which the stimulus of being suddenly thrown forward toward the floor from a position of horizontal suspension produces the response of rapid protective extension of both upper extremities. This is one of the last postural responses to emerge before the onset of independent walking. There is also a downward parachute in which the baby is moved suddenly toward the floor in a position of vertical suspension; the response involves a transition from sitting in air to extension of both lower extremities. The downward parachute emerges by 3 months of age with receding flexor habitus (appearance).

paradigm

The constellation of beliefs, values, standards, and techniques shared by members of a scientific community. The many professions and disciplines concerned with developmental disabilities do not share a common paradigm and have actually contested whether such a paradigm exists. Developmental pediatrics takes cerebral palsy as the paradigmatic disorder for the entire spectrum of developmental disabilities (i.e., brain damage, often congenital, represents the key explanation for a variety of cognitive, perceptual, and motor disabilities).

paradoxical directive

A set of psychotherapeutic strategies. Although these strategies have a number of forms, the unifying theme revolves around the therapist overtly advocating the retention of a symptom or dysfunctional behavior with the covert intention that the opposite will occur. Thus, the paradox is that the therapist advocates for no change with the outcome a change in the direction of health.

paragraphia

Insertion of wrong and unintended words in what one writes.

paraldehyde

An anticonvulsant drug given intramuscularly or by rectum as an adjunct to phenobarbital or a benzodiazepine to treat refractory status epilepticus.

paralexia

A disturbance of reading in which letters, words, or syllables arc substituted or transposed.

paralinguistics

Nonverbal communication through, for example, intonation and gestures.

parallel play

Playing independently beside hut not with other children.

paralysis

Loss or impairment of voluntary movement; a neurological impairment.

paraphasia

A disorder of verbal output that includes transposition of letters in a spoken word and, in semantic paraphasia, the substitution of one word for another while the two words remain in the same class. Semantic paraphasia occurs in Wernicke aphasia.

paraplegia

A topographical subtype of spastic cerebral palsy in which only the lower extremities arc involved. Theoretically, a pure paraplegia must be secondary to a spinal cord injury, transection, or tumor and would not therefore be a "cerebral" palsy; it would also lack any associated dysfunction secondary to brain involvement. In fact, many childhood nontraumatic cases of paraplegia represent cases of spastic diplegia (paralysis on both sides of the body) in which lower extremity involvement is more noticeable and upper extremity involvement is very mild. In such mild cases of spastic diplegia, delay in walking and a clumsy gait are observed in the first several years of life, but the upper-extremity fine-motor difficulties associated with handwriting do not become apparent until school age.

paraprofessional

An aide or associate-level staff person who has not completed the educational requirements for licensure or certification as an independent practitioner; different disciplines have different formal educational requirements for paraprofessional status. This nomenclature is falling out of favor in the developmental disabilities field in deference to a team-based approach to service provision.

parasympathetic nervous system

The division of the autonomic nervous system that unconsciously controls life-sustaining processes when the individual is not under stress. The vagus nerve is one of the major components of this cholinergic system. Also characterized as craniosacral or anabolic.

Parent-Infant Interaction Scale

An assessment of parents' interaction with their infants who have developmental delays; the scale addresses caregiver interaction behaviors, caregiver and child social referencing, reciprocity, and caregiver affect.

Parent Perception Inventory (PPI)

A questionnaire that provides a comprehensive measure of a family's coping with the presence of chronic illness or disability in a child.

Parent Stress Index

A 120-item self-report questionnaire designed to assess stress in the parent-child relationship as it emanates from three sources: characteristics of the child, characteristics of the parent, and situational or life-stress. The instrument has been normed in a number of subgroups with means, standard deviations, percentiles, and profiles developed for the various subgroups.

parental child

Usually an older child who assumes responsibility for and functions as a parent for younger children. Situations such as these can be adaptive in large or single-parent families when supported by clear rules and power boundaries. These circumstances are maladaptive when resulting from an abdication of parental responsibility. In families with a parent with mental retardation, the child frequently assumes parenting functions not only for the other children but also for the parent. In families whose firstborn child has a disability, another child frequently assumes a parental-child role in relation to the child with a developmental disability.

parenteral

Describes nutrition administered via an intravenous route.

parietal lobe

The area of the cerebrum between the frontal and occipital lobes. This area contains the somesthetic (sensory) or parietal cortex, which receives messages (intake) from all sensory neurons except those involved with vision and hearing. Damage in this area can produce impairment in sensation or paresthesias (numbness, tingling, or heightened sensitivity).

parity

The status of a woman with regard to childbearing; see also para.

Parkinsonism

A motor syndrome similar to Parkinson disease of older adults (with resting tremors) that can complicate the use of antipsychotic drugs often used to treat severe maladaptive behavior in people with developmental disorders.

parotid duct transposition/ligation

Surgical procedures that redirect or eliminate salivary flow from the parotid gland as treatment for drooling.

partial seizures

Seizures that arise from a specific location on the cortex. These may be manifested by a convulsive movement of part of the body or even disorders of thought or sensation. Partial seizures may be simple or complex.

partial trisomy 10q

Partial trisomy of the long arm of chromosome 10; a chromosomal disorder with growth deficiency, severe mental retardation, microcephaly (abnormally small head), a peculiar facies, camptodactyly (permanent flexion of the fingers or toes), and heart and kidney malformations.

parturition

The birth process.

PAT

See Photo Articulation Test.

Patau syndrome

See trisomy 13 syndrome.

patella

Kneecap.

patent ductus arteriosus (PDA)

A cardiac defect common in premature babies where a fetal structure (the ductus arteriosus [DA]) continues to function after birth. The DA in the fetus shunts blood from the pulmonic (right) side of the heart to the systemic (left) side, bypassing the lungs. In the typical newborn, the ductus closes around the time of birth. In many premature and some full-term babies, the ductus remains open and must be closed medically with a drug (indomethacin) or surgically. The relationship between neurological damage due to hemorrhage (bleeding) and a PDA in premature babies is unclear.

paternal age

Chronological age of the father; age of the biological father at the time of conception of a child. Although advanced maternal age is associated with the incidence of Down syndrome, advanced paternal age is associated with nonchromosomal dominant mutations, such as achondroplasia, Apert syndrome, and Marfan syndrome.

pathognomonic

A sign, symptom, or behavior that is highly characteristic, almost uniquely so, of a given diagnosis. A truly pathognomic individual sign or symptom is rare; most signs and symptoms must be interpreted in context, especially the context of other signs and symptoms. Until one gets to the level of certain laboratory signs, most clinical findings can be imitated or produced by other conditions. A pathognomonic test has a high positive predictive value (true positives/all positives) rate.

patrician foot

The second toe longer than the first—in contrast to the plebian foot, in which each successively numbered toe is shorter.

patterning

Neurological reorganization; a system of physical therapy for the treatment of cerebral palsy. Derived by the neurosurgeon Temple Fay from the phylogenetic principle that ontogeny (the development of the individual) recapitulates phylogeny (the evolution of the species), this approach involves exercises in which the child imitates the movement patterns of fishes, amphibians, and reptiles before assuming an anthropoid (upright) posture. The concept that proficiency at each evolutionary level must he achieved before proceeding to the next level is the source of the myth that it is pathological to walk before one crawls. In an expanded form such as the Doman-Delacato approach (with elements such as fluid restriction, facilitation of cerebral hemispheric dominance, and CO₂ rebreathing), this approach has made controversial claims to be effective treatment for a wide variety of developmental disorders.

PCA

See postconceptional age.

PDA

See patent ductus arteriosus.

PDD

See pervasive developmental disorder.

PDMS

See Peabody Developmental Motor Scales.

Peabody Developmental Motor Scales (PDMS) and Activity Cards

A standardized norm-referenced test that assesses fine- and gross-motor skills in children from birth to 83 months of age. The 170 gross-motor items yield subscores in the following areas: reflexes, balance, nonlocomotor, locomotor, and receipt/propulsion of objects. The 112 fine-motor items yield scores in the following areas: grasping, hand use, eye-hand coordination, and manual dexterity. These scores can then be used to generate a specific instructional program for children with motor delays and disabilities. Administration takes less than 1 hour.

Peabody Individual Achievement Test-Revised (PIAT-R)

A 1989 revision of an individually administered measure of school performance for children 5-18 years of age. Six subtests assess five dimensions: knowledge, reading, mathematics, spelling, and language.

Peabody Picture Vocabulary Test-Revised (PPVT-R)

A 1981 revision of a 1959 edition test of receptive language for subjects from 2-6 to 40-11 years of age. The child or adult must identify the one picture (on each page of four pictures) that best illustrates the target word from a graded list of increasingly difficult words. The content has been revised to include a broad sample of women and ethnic groups engaged in a variety of activities. The PPVT-R is individually administered and untimed, usually taking 8-16 minutes. Two forms, L and M, are provided. The total number of correct responses can be converted to standard scores (with a mean of 100 and a standard deviation of 15), national percentile ranks, and age equivalents. The PPVT-R is sensitive to only one aspect of language (receptive one-word vocabulary) and should not be used as an indicator of global language skills; neither is it interchangeable with general intelligence scores. Although PPVT-R performance correlates well with verbal IQ for children under age 10, the more abstract nature of the items above the 10-year level produces stronger correlations with performance IQ.

pectus

Chest; pectus carinatum is keel chest, pigeon breast, or chicken breast, in which the sternum projects forward; pectus excavatum is funnel breast, in which the sternum appears caved into the chest. Although these anterior (front) chest wall deformities may be cosmetically problematical, it is rare for cardiac or pulmonary functioning to be impaired to a degree sufficient to indicate surgery. Occasionally, these unusual chest shapes are components of a larger malformation syndrome.

PEDI

See Pediatric Evaluation of Disability Inventory.

Pediatric Early Elementary Examination (PEEX)

See Pediatric Neurodevelopmental Examinations.

Pediatric Evaluation of Disability Inventory (PEDI)

A functional assessment parent report instrument for evaluation of chronically ill children and children with disabilities between 6 months and 7 years of age. Functional status and functional change are measured in the areas of skill level, caregiver assistance, and adaptive equipment modification.

Pediatric Examination for Educational Readiness (PEER)

See Pediatric Neurodevelopmental Examinations.

Pediatric Examination of Educational Readiness at Middle Childhood (PEERAMID)

See Pediatric Neurodevelopmental Examinations.

Pediatric Extended Examination at Three (PEET)

See Pediatric Neurodevelopmental Examinations.

Pediatric Neurodevelopmental Examinations

A series of neurodevelopmental examinations intended to generate narrative descriptions of relative strengths, weaknesses, and preferred styles in children with learning disabilities. Four separate examinations cover specific age groups: Pediatric Extended Examination at Three (PEET)—age 3; Pediatric Examination for Educational Readiness (PEER)—ages 4-7; Pediatric Early Elementary Examination (PEEX)—ages 7-9; Pediatric Examination of Educational Readiness at Middle Childhood (PEERAMID)—ages 9-15. Each examination includes a physical and neurological assessment, an evaluation of the maturation of the nervous system (minor neurological indicators), tasks tapping specific areas of development, and systematic behavioral observations. The developmental functions evaluated on these examinations include fine- and gross-motor functions, memory, language, visual/spatial processing, temporal sequential organization, and selective attention. These tests produce neither an overall score nor specific subtest scores; rather, they utilize a descriptive approach in evaluating and managing developmental dysfunctions. They take about 1 hour to administer.

pedigree

An organized system presenting the genealogic history of a family. The pedigree depicts both individuals and generations in a manner that is easily analyzed. The diagram showing a family pedigree is called a genogram.

pedography

An old and simple approach to gait analysis that measures footprints made on a strip of paper. One of the earliest uses of this methodology was recorded in William Osier's Cerebral Palsies of Children (1889).

PEEP

See positive end expiratory pressure.

PEER

Pediatric Examination for Educational Readiness. See Pediatric Neurodevelopmental Examinations.

PEERAMID

Pediatric Examination of Educational Readiness at Middle Childhood. See Pediatric Neurodevelopmental Examinations.

peer tutoring

The practice of students assisting other students who need supplemental instruction. Although the practice may be beneficial to both tutor and tutee, some studies indicate that it is the tutors who learn more and are more satisfied with the experience. This suggests that students should have experience as both tutors and tutees.

peering

See hemianopsia.

peers

Social equals; in developmental terms, people who are similar in characteristics such as age or developmental level. Peers form peer groups, or close associations, with each other, often in the form of play groups at school or in the neighborhood. Children with developmental disabilities are often described as "immature" and as "having poor social skills," making it difficult for them to associate with their peer groups by age or grade. Often younger children or others with developmental disabilities comprise these children's peer groups, since they are more closely equal on a developmental level. Peer groups are important to all children in forming models for identification, because they are relatively free of adult definitions and authority.

PEET

Pediatric Extended Examination at Three. See Pediatric Neurodevelopmental Examinations.

PEEX

Pediatric Earlv Elementary Examination. See Pediatric Neurodevelopmental Examinations.

PEG

percutaneous endoscopic gastrostomy.

pegboard

An item in many infant tests to measure both fine-motor coordination and nonverbal problem-solving ability. Successful completion of pegboards typically occurs in the second half of the second year of life. The most commonly used pegboards are the Wallin A (six round pegs evenly spaced in a straight line along the board) and the Wallin B (six square pegs evenly spaced in a straight line along the board).

pellagra

A syndrome due to nicotinic acid (niacin, vitamin B₃) deficiency that includes dermatitis, diarrhea, and dementia (diffuse brain involvement), sometimes progressing to death. These characteristics are known as the four Ds. Pellagra can occur with the ketogenic diet when supplementary vitamins are not given. In dogs, "black tongue."

pelvic obliquity

The up and down movement of the pelvis in the coronal plane, which divides the body into the front and back; a certain degree of pelvic obliquity is normal during walking and is measured as a component of gait analysis.

pelvic rotation

Movement of the pelvis in the transverse plane, which divides the body into top and bottom; a component of gait analysis. The purpose of pelvic rotation is to swing the leg forward and elongate step length.

pelvic tilt

A slanting of the pelvis away from the horizontal in the sagittal (median) plane; a certain degree of pelvic tilt is normal during walking and is measured as a component of gait analysis. The term pelvic tilt is sometimes used generically to include pelvic obliquity (up and down movement in the coronal plane).

pelvis

The lower end of the trunk formed by a ring of bones including the hips and tailbone; the pelvic inlet is the bony canal through which babies pass to be horn.

pemoline

Trade name Cylert; a long-acting stimulant medication used in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults. It is manufactured in multiples of 18.75 milligrams (18.75 mg, 37.5 mg, and 75 mg). Side effects include headache, stomachache, anorexia (loss of appetite), poor growth, sleep problems, and liver function disturbance; these can usually be managed by titrating the dosage. In contrast to other psychostimulants, abuse potential is quite limited.

Pendred syndrome

A genetic syndrome that associates congenital sensorineural (involving the inner ear or the auditory nerve) hearing loss with goiter (swelling). This syndrome accounts for approximately 5% of sensorineural hearing loss in children. Inheritance is autosomal recessive.

penetrance

The degree of expression of a gene or trait. A trait that is expressed in a frequency of less than 100% has reduced, or incomplete, penetrance. A nonpenetrant gene is one that could produce an abnormal phenotype (appearance) bur clinically does not.

penicillamine

A drug given by mouth to treat lead poisoning and Wilson disease.

People to People Committee for the Handicapped

A self-help, mutual aid organization that provides information and referral regarding entitlements, services, and organizations for people with disabilities. A periodically published resource manual is available through the organization.

PEP

See Psychoeducational Profile.

percentile

Percentile rank. A score reflecting an individual's position relative to others taking the same test. It is obtained by converting an individual score to the percentage of observations falling below that score (or, technically, to the percentage of observations falling below that score plus half of the observations obtaining that score). A score falling at the 35th percentile reflects a score that is higher than that of 34% of others taking the test (see median). A score at the 100th percentile cannot be achieved, since it is impossible to be higher than 100% of people taking the test.

perception

Awareness of an object or event through the sense organs. Perception is a pattern of responses to stimuli. Selection, organization, and interpretation of specific stimuli are partially determined by prior learning, experiences, and interests.

perceptual disorder

An impairment in one of the modalities used for assimilating information (usually visual or auditory). This is not a disorder of acuity. Hearing and vision are normal; the disorder involves a difference in the way the information is processed or perceived. A child with a visual-perceptual limitation has difficulty making sense of things he or she sees; a child with an auditory-perceptual (more often termed auditory processing) impairment has difficulty making sense of information he or she hears.

perceptual-motor

The integration of the modalities used for processing information (usually visual or auditory) with a nonverbal response. For example, auditory-motor integration is required for listening and taking notes, whereas visual-motor integration is required for copying forms or words. In practice, perceptual-motor often seems to be used synonymously with visual-motor, although this is not accurate usage. A perceptual-motor model represents one of the earlier (1950s-1960s) attempts to define learning disabilities. This model hypothesized perceptual skills as underlying academic skills (i.e., a learning disability resulted when perceptual skills were disordered). Programs were devised to train perceptual-motor skills. They were not, however, successful in improving academic skills. Although vestiges of these programs remain, they are not accepted.

perceptual organization factor

See Kaufman factors.

percussion

Tapping; determining the density or solidity of a body part by tapping on its surface as one taps a barrel to determine if it is full.

percutaneous endoscopic gastrostomy (PEG)

An endoscopic rather than intraabdominal approach to the placement of a gastrostomy tube that can be performed under local anesthesia.

Perez reflex

A primitive reflex in which pressure applied to the spine (vertebral column) in a cephalad direction (from tail to head) causes the infant to flex its arms and legs, elevate its head, and urinate/defecate.

performance test

A set of tasks in which the role of language is minimized. Overt demonstrations of various motor skills, rather than verbal responses, are required. The Leiter International Performance Scale is an example of a performance test; on the Wechsler Intelligence Scales, performance subtests include picture completion, picture arrangement, block design, object assembly, and coding.

perimetry

A test procedure to determine the extent of the visual fields; this can range from confrontation with a flicking finger at the periphery of the individual's line of sight to the use of complex instrumentation to map visual fields. Visual field cuts occur in many cases of hemiplegic cerebral palsy.

perinatal

Pertaining to the period just before, during, and just after birth. Perinatal etiologies (causes) have been equated with obstetrically preventable conditions. However, the majority of perinatal difficulties actually reflect the presence of unsuspected prenatal conditions. The most common perinatal risk factor for developmental disabilities is asphyxia (lack of oxygen). Perinatal death rates are reported for all fetuses or for fetuses above a specified length of gestation (from 20 to 28 weeks), and up to 7-28 days of age.

perineum

The diaper area.

periodicity

Regularly recurrent or intermittent cycle, often related to the presence of a biological clock. Premenstrual syndrome (PMS) is the most commonly recognized behavioral example; however, many children with developmental disabilities exhibit marked behavioral fluctuations in cycles of varying length.

peripheral vision

Sight that utilizes retinal cells outside the macula. Because the macula picks up light stimulation from what one is looking at, the rest of the retina (light-sensitive inner back wall) is, to varying degrees, sensitive to visual stimuli outside one's primary focus of attention—the periphery.

periventricular leukomalacia (PVL)

A lesion of the white matter near the lateral (outside) ventricles (fluid-containing spaces) of the brain caused by necrosis (tissue death). This is most commonly found in premature and low birth weight infants and is thought to be related to an asphyxial (lack of oxygen) insult. In premature infants, the brain vasculature (blood vessels) is thought to be immature and fragile and thus more sensitive to changes in blood pressure and oxygen levels, resulting in damage without other complications. In full-term babies, PVL and asphyxial damage are more often associated with other complications, such as heart disease or infection. There is a range of developmental outcomes for babies with PVL, including mental retardation and cerebral palsy. PVL can be diagnosed by ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Perkins-Binet Tests of Intelligence for the Blind

An intelligence test adapted from the Stanford-Binet Intelligence Scale for people with severe visual impairments. There are two versions of the test: Form U, for children with usable vision, and Form N, for children with nonusable vision.

perseveration

The continuation or repetition of an action or thought after it has become inappropriate. Such fixation may reflect an associated, but opposite, disorder to a short attention span or focus. When a child has difficulty understanding or executing a given direction, he or she may, like a broken record, repeat an earlier correct, but now inappropriate, response. At other times, when a child is asked to do something once, he or she will do it (or some component of it) several times. As a major component of Strauss (minimal brain dysfunction) syndrome, perseveration is considered a key finding in brain damage. More striking examples of perseveration occur in autistic spectrum disorders.

persistent vegetative state (PVS)

A condition in which people with severe brain damage exhibit no recognizable mental function, although they may have periods or wakefulness when their eyes open and move.

person-in-environment

A view of human behavior that sees both behavior and personality development as a function of environmental variables as well as innate psychological and physiological processes. This perspective encompasses the interactive relationships among an individual, relevant others, and the physical, cultural, and social environment. Thus, for a person with a physical disability, a pervasive sense of helplessness and isolation must be assessed to determine whether this is a personality quality or if, in fact, the environment denies physical and social access, making isolation and helplessness the only possible reality.

persona non compos mentis

Term used in the Middle Ages to describe individuals with no apparent mental disability at birth, but who displayed deviant behavior later in life. By the 15th century, the term lunatic replaced the phrase. Non compos mentis, the Latin term for "not of sound mind," is still used to describe those who, due to mental incapacity, are not legally responsible for their actions.

pervasive developmental disorder (PDD)

A poorly defined category of disability that involves problems in social interaction and verbal and nonverbal communication. PDD includes autism as its major diagnostic entity; PDD not otherwise specified refers to children who have autistic features but do not formally qualify for that diagnosis. In the past, the major differential point between the two diagnoses was age of onset, so that autism referred to early infantile autism (before 30 months), whereas PDD had a childhood onset (after 30 months of age). PDD is a pattern of atypical development that can coexist with mental retardation.

pes planus

Flat foot.

PET

See positron emission tomography.

petit mal

A nonspecific term applied historically to absence seizures, hut which has been used for other epileptic events as well. Literally it means "small illness" as opposed to grand mal ("big illness"), used historically to describe generalized tonic-clonic seizures. Sometimes petit mal refers to simple absence seizures with a diagnostic electroencephalogram (EEG) pattern consisting of a 3-per-second spike (a sharp pointed deviation) and wave. The term petit mal is falling out of favor because of its lack of specificity.

Peto

A system of physical therapy to treat cerebral palsy. Originated by Andras Peto, a Hungarian, it focuses on the conscious rhythmic practice of activities of daily living (ADL); it is also referred to as conductive education.

Pfeiffer syndrome

Acrocephalosyndactyly (peaked head and webbed fingers and toes). A genetic syndrome with craniosynostosis (premature fusion of skull sutures) leading to turribrachycephaly (an odd-shaped skull), broad thumbs, big toes, and syndactyly (webbing of the fingers or toes). Neurodevelopmcntal complications are rare. Inheritance is autosomal dominant.

phacomatoses

A group of hereditary neurocutaneous syndromes - disorders with abnormalities involving the skin and the central nervous system. Phacomatoses include neurofibromatosis, tuberous sclerosis, Sturge-Weber syndrome, and ataxia-telangiectasia.

phalanges

The small bones in the fingers and toes.

pharyngitis

Throat infection that may include sore throat, fever, tender cervical (neck) lyrnphadenopathy (disease of the lymph nodes), erythema (redness) of the pharynx, and sometimes exudate (white patches). Most pharyngitis is viral in etiology (origin) and unresponsive to antibiotics; a rapid streptococcus screen or a throat culture is the only reliable way to diagnose streptococcal pharyngitis, which should be treated with antibiotics to prevent rheumatic fever.

pharynx

The throat; this irregular space is capable of considerable change in size and is divided into the nasopharynx (top), oropharynx (middle, behind the mouth), and laryngopharynx (bottom). It is involved in breathing and swallowing, and acts as the principal resonating organ in speech.

phasic bite reflex

The stimulus of pressure on the gums produces the response of rhythmic closing and opening of the jaws. This oral reflex is innervated by cranial nerve V; it is present by 1 month of gestation and disappears by 1 year of age.

phasic reactions

Movement reflexes that coordinate muscles of the limbs in patterns of either total flexion or total extension.

Phelps

A system of physical therapy for the treatment of cerebral palsy; devised by the orthopedic surgeon Winthrop M. Phelps, this all-encompassing program uses Pavlovian conditioning for muscle education, deep massage, bracing, and multisensory (auditory, visual, kinesthetic, and rhyming) stimuli.

phencyclidine

"Angel dust"; a veterinary anesthetic agent used as a street drug; maternal use can produce neurological depression at birth followed by an infant withdrawal syndrome.

phenobarbital

An anticonvulsant that is a member of the barbiturate family; it can be used to control generalized tonic-clonic or simple partial (focal) seizures. Phenobarbital (sometimes familiarly called phenobarb) is generally given twice a day and may initially take 2 or 3 weeks to reach a steady level. Significant side effects include sedation, hyperactivity, a decrease in attention span, and cognitive impairment with a lowering of IQ by about 5-10 points. Phenobarbital can also increase serum levels of liver enzymes. This is not caused by damage to the liver but by an increased production of enzymes. As the impairment of cognition with phenobarbital has been better documented, its use has tended to decrease somewhat.

phenothiazine

A class of antipsychotic drugs that have a calming, antidepressant activity. Side effects include sedation and tardive dyskinesia (slow, rhythmic, automatic movements).

phenotype

The physical characteristics of an individual including morphology, bio-chemistry, and physiology, as determined by the interaction of genes with the environment. For example, a person who is a carrier for a recessive disorder such as cystic fibrosis has one disease gene and one normal gene. He or she, however, is clinically indistinguishable from a noncarrier (one with two typical genes) in terms of lung and intestinal physiology. Thus, the phenotype is the same as an individual without the cystic fibrosis gene.

phenylketonuria (PKU)

An inborn error of metabolism in which the enzyme phenylalanine hydroxylase is absent or nonfunctional, resulting in an increase in the level of phenylalanine, an essential amino acid, in the blood. Treatment involves a diet low in phenylalanine. Untreated PKU is associated with mental retardation, microcephaly (abnormally small head), seizures, athetosis (involuntary twisting of the upper extremities), hand posturing, and behavioral stcreotypies. Poor hair pigmentation has also been noted. The earlier dietary treatment is initiated, the better the developmental outcome. When the diet is started at under 3 weeks of age, there are no discernible defects. When started between 3 and 6 weeks of age, there are mild impairments. Treatment shows little positive effect if begun after about 6 months of age. Infants with PKU appear normal at birth except possibly for some irritability and vomiting. Delayed development is often not noted until 4-6 months of age. Because of the insidious presentation and the importance of early treatment on developmental outcome, PKU is routinely tested for in the newborn nursery using the Guthrie test. In the past, a low phenylalanine diet was used only until 5 years of age. However, recent studies have shown a decrease in IQ scores after beginning a normal protein diet. Recommendations are now being made to liberalize the diet but to continue to restrict the amount of protein intake. Pregnant women with untreated PKU are at risk for having children with mental retardation, microcephaly, and heart disease. These children do not have PKU; rather, their mental retardation is caused by exposure to high phenylalanine levels in utero and is preventable by diet control during pregnancy. Generally, PKU is inherited in an autosomal dominant manner and is most common in people of northern European descent (Scandinavian, German, and English). Children with PKU are frequently blue-eyed, blonde, and fair-skinned with a tendency toward eczema (skin rash).

phenytoin

Trade name Dilantin; an anticonvulsant that can be used for a number of seizure types: tonic-clonic (grand mal), complex partial (psychomotor), and simple partial (focal). Phenytoin shows the best drug-activity-to-drug-concentration relationship of all the anticonvulsants. Clinically effective levels range from 10 to 20 micrograms per milliliter. Levels greater than 20 micrograms per milliliter produce side effects but no added seizure control. Neurotoxicity (brain symptoms) includes nystagmus (involuntary eye movements), ataxia (unsteady gait), and aggravation of the seizures, hut not drowsiness in lower doses. Permanent damage to brain cells in the cerebellum has occurred with acute or chronic high dosages. Other side effects include allergic responses, gingival (gum) hyperplasia (excessive tissue growth), hirsutism (excessive hair growth), and various nutritional deficiencies such as folate deficiency, biotin deficiency, and vitamin D deficiency. An idiosyncratic encephalopathy (brain damage due to lack of oxygen) has been seen in people with mental retardation with therapeutic phenytoin levels. Another reaction occurring in 2%-5% of people beginning phenytoin therapy consists of a morbilliform (measles-like) rash, fever, and enlarged lymph nodes (glands). This reaction disappears when the phenytoin is discontinued. Phenytoin continues to be used judiciously in clinical practice. It is rarely used in infants because of side effects. It is one of the few medications in which the bioavailability (amount of drug the body receives) varies significantly among different preparations.

philtrum

An infranasal upper-lip depression; the groove in the mid-line of the upper lips. The philtrum may be shortened, elongated, or flattened to contribute to various facies characteristic of diverse syndromes. A long philtrum indicates a short nose, and a short philtrum indicates a long nose.

phobia

An exaggerated and debilitating fear of an object or situation that is based neither on an actual danger nor on an actual threat. Common phobias include claustrophobia (fear of closed places) and nyctophobia (fear of darkness). Phobias can become extremely problematic if the person with the phobia attempts to avoid the feared object or situation. For example, if one cannot ride an elevator due to a phobia, many situations become unavailable. Often phobias impose severe strains on the phobic person's interpersonal relationships. In addition, phobias are particularly refractory (resistant) to psvchotherapeutic intervention.

phocomelia

The congenital absence of the proximal segment of a limb. The hand or foot will sometimes be attached almost directly to the trunk like a flipper. This condition is rare in isolation and can occur as part of another genetic syndrome. Historically there was an international outbreak of tetraphocomelia (limb abnormalities in all four extremities) after the widespread use of the drug thalidomide as a sleeping pill during the first trimester of pregnancy in the early 1960s. See also thalidomide embryopathy.

phonation

Voicing; the voluntary production of sound by moving, air through the vocal tract. It is a function of the vocal cords in the larynx (windpipe).

phoneme

The smallest unit of sound in any particular language. Various languages use phonemes that are not utilized in any other language. The English language designates 44 different phonemes.

phonemic synthesis

See sound blending.

phonetics

A study of the perception and production of all of the speech sounds in language. Phonetics has been applied to the teaching of reading. See also phonic analysis.

phonic analysis (phonics)

A word-arrack skill involving the sound of letters, the division of words into syllables, and the blending of sounds together to form words. Some phonics programs are synthetic, in that letters and sounds are blended to form words. Others are analytic, in that they depend on the analysis of previously learned words. The functional use of phonic skills also includes checking the derived pronunciation in the context from which the word was taken. The word-attack subtest of the Woodcock Reading Mastery Test-Revised requires the generalization of phonics rules to nonsense words, thus testing only applications of phonics skills without relying on or checking against pronunciation of known words. The "back to basics" movement sometimes views phonics as the best approach to reading, almost an end in itself, rather than one of a variety of tools for extracting meaning from print. Students with auditory processing problems often have difficulty mastering phonics, especially synthetic approaches.

phonology

The study of the linguistic system of speech sounds in a particular language.

phoria

A latent tendency for the eyes to deviate from their normal fusion. In the presence of esophoria (convergence of visual lines) or exophoria (divergence of visual lines), optometric tests that stress the eyes' ability to maintain fusion produce esotropia or exotropia.

photic drive

See intermittent photic stimulation.

Photo Articulation Test (PAT)

A test of pronounciation that uses color photographs to test the articulation of all consonants, vowels, and dipthongs. Six articulation age overlays (AAOs) allow comparison of test results with norms.

photoconvulsive response

See intermittent photic stimulation.

photomyoclonic response

See intermittent photic stimulation.

photoparoxysmal response

See intermittent photic stimulation.

photophobia

Extreme sensitivity to light; can be associated with a variety of acute and chronic conditions, such as conjunctivitis (eye inflammation), measles, albinism, meningitis (inflammation of the spinal cord and brain membranes), and encephalitis (brain inflammation).

photosensory seizure

A convulsion induced by visual stimuli, typically flickering light such as a stroboscope, or a television screen. Thus, photic stimulation is one of the techniques used when administering an electroencephalogram (EEG).

phototherapy

The use of "bililights" (special fluorescent light to decrease the degree of jaundice) to lower the level of bilirubin in a newborn baby. The baby's eves are protected with eye patches or goggles; the brightness of the lights would at the very least be extremely uncomfortable if not painful for the baby. This is a fairly common treatment for babies with mild elevations in their bilirubin levels, and its use in the newborn period has, by itself, no long-term developmental implications.

phrenic nerve

A cervical (neck) nerve that innervates the diaphragm, one of the principal respiratory muscles.

phrenology

The pseudoscience of diagnosing personality and other traits by palpating the bumps on a person's head. Phrenology was the historical ancestor of the science of cortical localization, with which the latter is often unfairly equated.

physiatry

See physical medicine and rehabilitation (PM&R).

physical disabilities

A broad category of disabilities that is distinguished from mental or emotional disabilities. Physical disabilities typically involve the motor system and place some limitation on the person's ability to move (about). However, such disabilities can include diseases of any organ system that has significant impact on functional ability. Physical disabilities may overlap with mental disabilities.

physical medicine and rehabilitation (PM&R)

A medical specialty concerned with the management of chronic diseases, especially those that are neuromuscular (e.g., stroke, head injury, arthritis). Diagnostic techniques in PM&R include electromyography and nerve conduction studies. Treatment modalities include heat, ice, physical and occupational therapy, traction, and orthoses (corrective appliances). PM&R specialists are also referred to as physiatrists.

physical therapy (PT)

A discipline that deals with the assessment of gross-motor skills and disorders of movement and posture, and their treatment through a variety of modalities. These modalities include handling and relaxation techniques; a range of exercises (e.g., strengthening, balancing, and increasing or maintaining range of motion to prevent contractures); and adaptive equipment and orthoses (corrective appliances)—all to maximize the motor substrate of development and independent functioning.

physiognomy

An antiquated system of interpreting human character by means of specific facial features. Of ancient origin, it was popularized by Johann Caspar Lavater (1741-1801). In its expanded form, physiognomy can involve the study not only of the face but also of the bumps on the head (i.e., phrenology), the markings on the hands (i.e., palmistry or dermatologlyphics), gait, gestures, and even handwriting (i.e., graphology). In a restricted sense, it can be considered a forerunner or certain aspects of medical visual diagnosis as found in modern syndromology (the identification of genetic and other syndromes) and genetics.

physiological classification

In reference to cerebral palsy, describes the disorder of tone or movement that characterizes each subtype of cerebral palsy, often with an implication of specific brain area involvement. Spastic and extrapyramidal are the two main subgroups in physiological classification. Also known as neuroanatomical classification.

Piaget, Jean (1896-1980)

A Swiss psychologist renowned for his explorations of the cognitive development of children. Concepts integral to his theories include structures (organized patterns for dealing with the environment), adaptation, stages of development, conservation, equilibration, and egocentrism. Piaget was educated at the university in Neuchatel, Switzerland, was director of the Jean Jacques Rousseau Institute in Geneva, and professor at the University of Geneva. In 1955, he established the International Center of Genetic Epistemology in Geneva. In the United States, the Jean Piaget Society publishes a newsletter, the Genetic Epistemologist, and annual conference proceedings. See also stage.

PIAT—R

See Peabody Individual Achievement Test-Revised.

PIBIDS syndrome

IBIDS syndrome plus Photosensitivity (sensitivity to light). See IBIDS syndrome.

pica

Eating dirt or other nonfood objects. Plumbism (lead poisoning) is a major concern. Pica is seen more frequently in children with autism and mental retardation. When a child pulls out his or her hair and cats it (i.e., trichotillomania), a trichobezoar (hair ball) can form in the stomach. In a developmentally typical child, the latter behavior should lead to a child psychiatry referral. A reported association between pica and iron deficiency anemia may be coincidental and secondary to both problems being more common in children of lower socioeconomic background. However, pica may disappear with iron treatment. Worm infestation should also be considered as a possible complication.

Pickwickian syndrome

Reversible cardiopulmonary obesity; hypoventilation syndrome with extreme obesity; this syndrome identities a tendency to sleepiness in people with cardiac and respiratory problems secondary to being severely overweight. It is named after the behavior that Charles Dickens (1812-70) ascribed to "Fat Boy Joe" in The Posthumous Papers of the Pickwick Club (1837).

picsysms

A picture symbol system based on easily recognized line drawing of familiar objects.

pictogram/pictograph

A picture of an item; graphic symbols that resemble the objects they represent. Pictograms have been employed in some of the earliest systems of written language. Pictograms along with ideographs (symbols representing ideas) constitute a form of aided augmentative communication used by individuals who are unable to communicate verbally in all situations.

Pictorial Tests of Intelligence (PTI)

A battery of instruments to measure intellectual ability in 3- to 8-year-old children with multiple disabilities with motor and speech involvement; its six subtests require intact receptive language skills: picture vocabulary, information and comprehension, form discrimination, similarities, size and number, and immediate recall. The examiner presents picture cards that depict four possible answers and asks questions regarding them. The tests require no verbal response and minimal physical responses. Typically the child is asked to point to the answer. However, the cards are designed so the examiner may determine a response from the observation of the eye movements of a child with a physical disability. Testing time is approximately 45 minutes. The test produces standard scores (with a mean of 100 and a standard deviation of 16) and has an excellent norm group and acceptable reliability and validity. The PTI is a useful supplementary nonverbal measure of learning, aptitude for young children with speech and motor disabilities.

picture arrangement

A 12-itern Wechsler Intelligence Scale for Children-Third Edition (WISC-III) performance subtest in which the child places a series of pictures in logical sequence. The 12 series of pictures are similar to comic strips. Individual cards are placed in a specific out-of-order sequence: the child is then asked to rearrange the pictures to tell a story that makes sense. The number of picture cards per set varies from three to five; time limits for the series vary as well. Nonverbal reasoning, visual sequencing, planning ability, and problem-solving strategies arc measured. Anticipation (identifying antecedents and their consequences), visual organization, and temporal sequencing are also involved. Trial and error experimentation is occasionally used, though appreciation of the gestalt depicted by the cards is necessary for success on the subtest. Picture arrangement is timed, which can be a source of anxiety. However, bonus points are awarded for speed on later items. The subtest is discontinued after three consecutive failures.

picture completion

A Wechsler Intelligence Scale for Children-Third Edition (WISC-III) performance subtest consisting of 26 pictures of common objects that are each missing an important element. The child is asked to identify and name or point to the missing component within a 20-second time limit. The subtest evaluates visual discrimination and understanding of part-to-whole relationships. Success depends upon the child's word-finding skills and long-term memory. Attention and visual perception are also required, which may serve cither to mask or accentuate visual retrieval problems. Perception, cognition, judgment, and the extent and quality of a child's experiences may also influence performance. The tune limit places an additional demand on the child. Delayed correct responses may suggest slow processing style or depression, whereas quick hut incorrect responses can reflect impulsivity. The subtest is discontinued after four consecutive failures. Example: picture of a dog without a tail.

Picture Story Language Test (PSLT)

A writing test used in the differential diagnosis of learning disabilities, mental retardation, emotional disturbance, reading disability, and dyslexia. Children ages 7—17 years of age arc asked to write the best story possible about a picture. Five scores are derived: total words, total sentences, words per sentence, syntax (grammar), and abstract-concrete meaning.

piebaldness

Depigmentation pattern of skin similar to a pinto horse; can be inherited as autosomal dominant or recessive and may be associated with sensorineural (involving the inner ear or the auditory nerve) deafness.

Pierre Robin sequence/syndrome

A combination of mandibular hypoplasia (micrognathia [small jaw]), soft palate cleft, and glossoptosis (forward displacement of tongue) to produce a "shrew" facies. The major medical problem with this syndrome is upper airway obstruction and early failure to thrive. It occurs in otherwise normal individuals but may also be part of Stickler syndrome or trisomy 18. Inheritance is polygenic-multifactorial. Recurrence risk is 5%.

Piers-Harris Children's Self Concept Scale (The Way I Feel About Myself)

A self-report instrument for children fourth through twelfth grade to quantitate self-attitude. Eighty statements are scored yes or no; the raw scores yield percentile and stanine norms and six factor scores. The scale can be administered individually or to groups of children in 20 minutes.

PIMRA

See Psychopathology Instrument for Mentally Retarded Adults.

pincer grasp

A fine-motor milestone in the evolution of infant prehension; tins stage is characterized by the ability to grasp overhand a small object (e.g., pellet, raisin) between the tips of the first two (thumb and index [pointer]) ringers. This mature pincer typically occurs at 10 months of age; an immature pincer or tripod grasp can be observed a month or two earlier.

pinna

External ear. Pinnal abnormalities are examples of minor dysmorphic (atypical) features that can be normal variants, familial traits, or components of genetic syndromes. Significant ear malformations include folded ("lop-eared"), protuberant ("jug-handle"), posteriorly rotated, low set, and excessively rounded.

pitch

The quality of sound that depends on the frequency of the vibrations producing it. The greater the frequency, the higher or more acute the pitch; the lower the frequency, the lower the pitch and more grave the tone.

PKU

See phenylketonuria.

PL

Abbreviation for Public Law; see specific PL entries.

placement

An out-of-home living situation for people with long-term care needs due to physical, cognitive, emotional, or social disabilities. Thus, a young adult with mental retardation may be "placed" in a group home to provide a protected, yet semi-independent (according to the person's maximum capabilities), long-term living situation. The person is encouraged to live as typical and independent a life as possible under the protection and support of one of a variety of living arrangement options. May also refer to the educational setting in which a student is "placed" (see least restrictive environment [LRE]).

placenta

The afterbirth; an organ that exists during pregnancy and links the mother and the fetus. The placenta assumes many of the functions of the lungs, kidneys, liver, and endocrine system in place of the undeveloped fetal organs. Chronic placental dysfunction can contribute to undergrowth of the fetus and low birth weight infants.

placenta previa

A placenta that is implanted low in the uterus so that it partially covers the cervical opening; during labor, such a placenta tends to separate and cause bleeding that, if excessive, can threaten the lives of the mother and the baby.

placental abruption

See abruptio placenta.

placing

A primitive reflex in which tactile (touch) stimulation of the dorsum (top) of foot and/or hand or the anterior (front) aspect of the relevant extremity (arm or leg) results in a complex response of flexion and extension ("placing" of the extremity on top of the stimulus). Lower-extremity placing is present at birth, but upper-extremity placing does not emerge until 3 months of age. Absence or asymmetry of the response is significant.

plagiocephaly

A deformation of the skull characterized by obliquity with one side more developed anteriorly (toward the front) and the other side more developed posteriorly (toward the back). This asymmetry can be produced by prolonged lying of the head turned to one side. Also known as asynclitism of the skull.

PLAI

See Preschool Language Assessment Instrument.

plantar grasp

See grasp reflex.

plantigrade

Normal standing/walking posture of the foot with weight-bearing evenly distributed across the sole and feet in a flat position against a surface with ankles flexed at 90 degrees. Human gait is bipedal plantigrade progression.

plateau

A level or leveling off; a period of relative stability and decreased change following a period of normal to increased change. The implications of this latter developmental acceleration can be positive (e.g., a recovery spurt after injury) or negative (e.g., a deterioration associated with degenerative disease).

play

Voluntary activity engaged in for pleasure (not work) that nevertheless serves other social, emotional, and learning functions. Different theories of play generate diverse stages (with overlapping ages) depending on whether the focus is on the type of social interaction, the toys or games played with, or the level of imagination and degree of creativity involved. Despite the absence of any agreement on the definition and stages of play activities in infants and children, the observation of play can be very informative. An experienced childlife worker or preschool teacher can accurately discriminate the steps in the evolution from solitary, parallel, and mirror play to cooperative play and can reach both quantitatively and qualitatively valid conclusions regarding the child's development.

play audiometry

See behavioral observation audiometry.

play therapy

A method of examination and treatment used with children. The child is observed as he or she plays freely with a selection of toys designed to help him or her address emotional concerns and traumatic past experiences. Play therapy is often used with children who have been abused and with those who have language disorders. In psychotherapy or speech-language therapy, the strategy is based on the premise that play is the child's natural medium of self-expression, allowing him or her to more easily and directly convey thoughts, feelings, and experiences than would be possible through strictly verbal methods.

pleiotropy

The situation in syndromology (the identification of genetic and other syndromes) when one genetic cause produces multiple effects; the identification of the full syndrome is the result of a process of "lumping." The process of syndrome identification pulls together the diverse pleiotropic effects of a single genetic disorder.

pleuritis

Pleurisy; inflammation or infection of the pleura (linings of the lung and chest); symptoms include chest pain, fever, and cough. Treatment is of the underlying cause and is symptomatic.

PLS-3

See Preschool Language Scale-3.

plumbism

See lead poisoning.

PMA

See postmenstrual age.

PMH

Profound mental handicap; See profound mental retardation.

PM&R

See physical medicine and rehabilitation.

PMR

See profound mental retardation.

pneumonia

Lung infection; symptoms include fever, cough, tachypnea (rapid breathing) and dyspnea (difficult breathing). The infection can (and usually is) localized to one side or to one lobe (part) of the respiratory system. "Double pneumonia" is a vague lay term that probably means there is some involvement of both lungs. Recurrent right middle lobe pneumonia is often associated with swallowing problems and aspiration.

PNF

See proprioceptive neuromuscular facilitation.

Pohl

A system of physical therapy for the treatment or cerebral palsy; this approach focuses on one joint or muscle action at a time.

pointing

A gesture that can be used to indicate wants (expressive) and identification (receptive). As receptive language milestones, pointing to pictures and body parts typically begins to emerge at 18 months of age.

Poland anomaly

A unilateral detect or the pectoralis muscle (upper anterior [front] chest wall) and the ipsilateral (on the same side) hand (i.e., syndactyly). There are no associated developmental disabilities.

poliomyelitis

Polio; infantile paralysis. A viral infection of the central nervous system that can produce a permanent paralysis usually affecting the lower extremities more. The most common source of contagion is respiratory droplets, and most cases are extremely mild. Treatment is supportive and preventive; immunization (vaccination) of all infants with trivalent oral polio vaccine (TOPOV) is recommended. Localized recurrence of muscle weakness can occur decades after initial involvement and is referred to as post-polio weakness.

poliosis

Localized depigmentation of hair seen in a variety of syndromes such as tuberous sclerosis. The white forelock of Waardenburg syndrome is the most famous example of this phenomenon.

polydactyly

Extra fingers and/or toes (more than five per extremity [arm or leg]); this can be an isolated finding, a familial trait, or a component of a genetic syndrome.

polydipsia

Excessive consumption of fluids. It can be due to diabetes insipidus (nonsugar diabetes). kidney disease, or an acquired habit (i.e., psychogenie water drinking).

polygenic

A disorder or trait determined by many genes on different chromosomes or on different parts of the same chromosome. Each gene has a small additive effect. Polygenic disorders are not caused by environmental factors.

polyhydramnios

Hydramnios; an excessive amount of amniotic fluid (more than 2 liters) during a pregnancy. This is associated with a high incidence of fetal abnormalities, especially in relation to the central nervous system (e.g.. anencephaly [no brain or absent top of skull]) and high alimentary tract obstruction (e.g.. esophageal atresia).

polyribosyi ribitol phosphate (PRP-D)

Haemophilus influenzae type B and diphtheria toxoid conjugate vaccine. The PRP (polyribosyl ribitol phosphate) vaccine is meant to reduce the incidence of Haemophilus influenzae infections, especially bacterial meningitis (inflammation of the spinal cord and brain membrane). Sometimes referred to as Hib (Haemophilus influenzae type B) vaccine. Other Hib vaccines include Hboc and PRP-OMP.

polysemy

Condition when a single word has two or more meanings.

polysomy

Presence of more than two chromosomes of the same kind. A trisomy (three chromosomes of the same number) is a polysomy. Polysomies of chromosomes other than the sex chromosomes are generally lethal or cause multiple congenital malformations and mental retardation. Children with polysomy or multiple X chromosomes may have milder problems, such as language delays and poor social development. The sex chromosome abnormalities, including abnormal numbers of X or Y chromosomes, are associated with a variety of developmental abnormalities, ranging from mild specific cognitive deficits, such as language disorders, to more severe global cognitive problems with mental retardation.

polytherapy

The use of more than one therapy (usually drugs). This is generally used in reference to seizure treatment that involves two or more anticonvulsant agents. The rationale behind polytherapy is better seizure control; however, it has some disadvantages and is not the preferred treatment for an uncomplicated seizure disorder. Chronic toxicity of anti-convulsants is greater with multiple drug therapy, and polytherapy can sometimes aggravate seizures. The cumulative effect of multiple agents often includes an impairment of the sensorium (wakefulness) and decreased cognitive performance. Thus, polytherapy is avoided where possible.

POMR

See problem-oriented medical record.

population

A group of people with similar characteristics. Most references to population indicate a specific group, such as those with learning disabilities or those with Down syndrome. Research generally studies the characteristics of a particular group as compared to the general population, which is a larger, more heterogeneous group. Often the effect of an intervention on a particular population is studied. It is important to clearly define the characteristics of a group in a research protocol in order to make the research results generalizable to others in that population.

porencephalic cyst

A cavity in the brain caused by focal damage and repair to brain tissue. Porencephalic cysts may be caused by vascular (blood vessel) abnormalities such as hemorrhage (bleeding) or infectious insults. The injury may occur prenatally or postnatally. The cyst can mimic a brain tumor and cause hydrocephalus. Neurological impairments are generally asymmetrical and contralateral (opposite). Normal development can occur even with large porencephalic cysts. Porencephaly must he differentiated from schizencephaly, in which the brain formation is abnormal. Porencephalic cysts are common in premature infants following a parenchymal intraventricular hemorrhage (grade 4 IVH).

port-wine stain

Purple, sometimes raised, and irregular skin lesion; can be a component of Sturge-Weber syndrome. Also known as nevus flammeus.

Portage Project/Portage Early Education Program

A home-based early education program with a focus on parental involvement for preschool children with disabilities; it has its own assessment instrument (i.e.. Developmental Sequence Checklist), which is used to generate an individual curriculum by selecting one of four to seven ways to teach each of the 580 skills contained in the assessment. It is named for Portage, Wisconsin, the site of the original program.

Porteus Maze Test

An intelligence test for children 3 years of age to adult; it is composed entirely of paper-and-pencil mazes and has been used as a measure of attention as well as of visual-perceptual motor ability. There are two additional versions, the Maze Test Extension and the Extension Supplement, to control for practice effects.

positive end expiratory pressure (PEEP)

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

positive reinforcement

See consequent stimulus event (CSE).

positive support

A complex postural response in which pressure on the feet produces varying degrees of lower-extremity extension and body support.

positron emission tomography (PET)

A technique used to look at brain function with radioactively labeled compounds. PET scans can localize areas of abnormal functioning such as in focal seizure disorders. Although PET is primarily a research procedure, it has demonstrated potential in evaluating brain function in children with developmental disabilities.

postconceptional age (PCA)

Chronological age (CA) plus gestational age according to obstetrical history of mother's last menstrual period (LMP); thus, a 4-week-old (CA) infant born at 28 weeks' gestation has a PCA of 32 weeks. PCA (dependent on maternal history) is more accurate than postmenstrual age (PMA) (dependent on physical examination) in extremely premature infants.

postconcussion syndrome

Headache, dizziness, irritability, nervousness, poor concentration, and behavioral and cognitive impairment may follow a brain injury with transient loss or consciousness. Parents may report that a child's personality changed or that hyperactivity and an attention disorder began after a specific head injury. Most of the minor head injuries experienced by toddlers learning to walk have no such neurodevelopmental sequelae.

posteroanterior view (PA)

Descriptive of an X ray taken so that the beam goes from the back of the body to the front.

postictal

Occurring after a seizure, including behavior such as somnolence (sleepiness), confusion, ataxia (unsteady gait), and poor coordination. Often there are mild abnormalities in a neurological examination. Occasionally, temporary blindness, aphasia (loss of language skills), or paralysis (i.e., Todd paralysis) may be seen. The postictal period generally lasts several hours.

postmaturity

When a pregnancy continues longer than 40 weeks, placental insufficiency contributes to the baby's looking thin and wasted, with dry, peeling skin, and meconium staining of the skin and nails; length and head circumference may be increased.

postmenstrual age (PMA)

Chronological age (CA) plus gestational age according to a clinical examination scale; thus, an 8-week-old (CA) infant born at 28 weeks' gestation has a PMA of 36 weeks.

postnatal

Occurring after birth; pertaining to the individual's life cycle after the conclusion of the perinatal period. Etiologies (causes) that are postnatal are typically acquired.

postprandial

After eating.

posttraumatic amnesia

Memory loss for the period of "clouded consciousness" that follows a closed head injury; it ends when the individual remembers waking. Also referred to as anterograde amnesia.

posttraumatic stress disorder (PTSD)

A psychological syndrome that follows an extraordinary stress or trauma such as rape, incest, or cult abuse. Symptoms of this disorder may include sudden, intrusive vivid visual or auditory memory flashbacks, hyperalertness, difficulty concentrating, feelings of numbness, and inability to participate in intimate relations. Children with PTSD may appear to have developmental delays and often first present for diagnosis in such a clinic. Long-term psychotherapy is the indicated treatment.

postural drainage

A variety of techniques used to help clear mucus from the respiratory tract. It is employed in people with chronic respiratory problems (e.g., asthma, cystic fibrosis, cerebral palsy with limited mobility that increases vulnerability to recurrent respiratory infections). Postural drainage can be performed or supervised by a physical therapist.

postural-ocular movement disorder

See vestibular-bilateral disorder.

postural response

Early automated responses III (EAR-II); previously IAR II (Infantile Automated Responses II). A group of reflex patterns that appear after birth, become prominent after 6 months of age, and facilitate the development of voluntary movement. They include the Landau, righting, equilibrium, and propping reactions.

poverty

A chronic low standard of living that undermines the health, morale, and self-respect of an individual or group of individuals. The term is relative to the general standard of living in a society, the distribution of wealth, and social expectations. Although developmental disabilities occur in individuals of all economic strata, they are more common in the lower economic levels of society, where their impact is intensified by family educational level and limited access to resources.

PPD

See purified protein derivative.

PPI

See Parent Perception Inventory.

PPVT-R

See Peabody Picture Vocabulary Test-Revised.

practice effect

An improved performance or score on a test as a result of repeated exposure to the test items, either from practice or drill on such tasks or, more frequently, from the recent administration of the same version of the test. Most test manuals indicate the period of time needed to elapse to minimize practice effects on readministering the test; other tests provide alternate versions to be used when frequent administration of the same instrument is desirable.

Prader-Willi syndrome

(PWS) Prader-Labhart-Willi syndrome; a genetic syndrome with three phases: 1) infancy with hypotonia (decreased muscle tone) and failure to thrive; 2) childhood with almond-shaped eyes, decreased palpebral fissure (eye slits) length, hypogonadism (small testicles), hypoplastic (short to absent) scrotum, hyperphagia (ravenous appetite) with central obesity but small hands and feet, cognitive impairments (two thirds of the cases with mental retardation, one third with learning disabilities and language impairments); and 3) young adulthood with increased severity of childhood symptoms coupled with severe behavior and emotional symptomatology and, occasionally, thought disorders. This syndrome may reflect a hypothalamic dysfunction secondary to a deletion of the long arm of chromosome 15 (q1l-ql3) on the paternal contribution to the chromosome 15 pair (see also Angelman syndrome). Without adequate dietary management, life expectancy is limited by heart failure and Pickwickian symptoms secondary to obesity. Sometimes referred to as HHHO syndrome (Hypotonia-Hypogonadism-Hypomentia-Obesity syndrome).

pragmatics

The effective use of language appropriate to a given context. For children to achieve communicative competence, they must acquire a repertoire of socially acceptable strategies for controlling or influencing the behavior of their listeners, including informing, requesting information, taking turns in conversations, adjusting what they are saying to their listener's linguistic ability, and responding to requests for clarification. Pragmatics may be described as one more level of rules after phonology (speech sound), syntax (grammar), and semantics (the meaning of words). However, a broader interpretation includes the integration of structural, conversational, and social rules. Thus, a different set of pragmatic strategics would be necessary in the classroom than at home. Assessment is often done informally and may need to he repeated in various settings. Two formal instruments designed to assess pragmatics arc the Test of Pragmatic Skills and the Communicative Activities of Daily Living (CADL).

praxis

Skill in planning nonhabitual purposive movements; apraxia is the absence of such skill. Praxis is a final common pathway for a variety of brain functions.

preauricular pit

A small indentation near the front of the ear; 1 in 200 children with preauricular pits will have a profound hearing loss. See Melnick-Fraser syndrome.

preeclampsia

The preconvulsive stage of toxemia of pregnancy.

prehension

Physical grasp; the manner in which the hand takes an object (e.g., pincer grasp, radial rake).

prelinguistic vocalizations

The guttural sounds, cooing, and babbling that an infant uses before words. Despite a lack of verbal content, such prelinguistic vocalizations exhibit an orderliness and sequentiality that allow them to be used to monitor early expressive language development. A decrease in such vocalizations—the "quiet baby"—suggests the presence of a developmental disorder.

Premack principle

If a high-frequency behavior is made contingent upon a low-frequency behavior, the low-frequency behavior will increase in frequency. Also known as Grandma's rule: "You can't have dessert unless you finish eating your broccoli." In a classroom setting, an example of the Premack principle is allowing a child to color after his mathematics is finished. A broader application of this principle structures a student's academic day so that a difficult task is followed by an easier or more enjoyable one.

prenatal

Preceding birth; pertaining to the gestational period from conception to the beginning of the perinatal period.

prenatal diagnosis

Identification of a fetal problem before birth. Techniques such as ultrasound and amniocentesis are used to look at the structure of the fetus, the fetal chromosomes, and any fetal or genetic syndrome or disorder that can be identified by a biochemical test (e.g., Tay-Sachs disease).

preoperational stage

A Piagetian stage of cognitive development in which the child begins to internalize and manipulate symbols and images in an egocentric fashion. This stage is prominent from 2 to 6 years of age.

presbyopia

Farsightedness with advancing age; it often corrects or improves the myopia (nearsightedness) of the preceding years.

Preschool Language Assessment Instrument (PLAI)

A nonstandardized test used to assess a variety of language skills: labeling objects and actions, role playing, responding to conversational interactions, describing object functions, solving problems, and defining.

Preschool Language Scale-3 (PLS-3)

A language test for children from birth to age 6-11 that yields total language, auditory comprehension, and expressive communication scores. Administration time is 30 minutes. A normed Spanish-language version is available.

Preschool Screening System

A screening test for children between 2½ and 5½ years of age. Subtests include gross- and fine-motor, vocabulary, and speech and language skills. Administration time is approximately 20 minutes.

presentation

That which characterizes the part of the baby that comes out first during delivery. There are three main types of presentation: vertex (head first), face (chin first), and breech (sacrum first). A transverse presentation usually involves the shoulder coming out first. The most common vertex presentation is left occiput anterior (LOA).

presentation

The chief complaint, signs, and symptoms present when an individual first comes to a physician's attention.

preservation of sameness

Resisting change; a nonspecific sign of mental retardation or brain damage. In its mildest forms, it is similar to a typical child's bedtime ritual; in its more severe forms, the child may throw-prolonged tantrums if a book's shelf space is altered. Its frequent occurrence in autism tends to be out of proportion to the degree of associated mental retardation.

Pre-Speech Assessment Scale (PSAS)

A nonstandardized rating scale for pre-speech behaviors (e.g., feeding, oral motor, respiratory-phonatory items) in children from birth to 2 years of age.

prevalence

A rate reflecting the number of cases of a disorder existing in a given population at a specific time (also known as point prevalence) or over a defined period of time (also known as period prevalence). Prevalence rates are affected by both the rate of occurrence of the disorder as well as the duration of the condition. Whereas an increasing prevalence rate might reflect an actual increase in the rate of occurrence of the condition, it might also reflect improved medical treatment with longer survival. For example, the availability of better medical care and healthier living conditions should increase the total number of people with mental retardation in the population at any given time—an increased prevalence rate. Period prevalence represents the sum of the point prevalence at the beginning of the time period and the incidence during that time period.

prevention

Measures that decrease the incidence or limit the progression of a disease or its sequelae. There are varying classifications of the different levels of prevention; because these were originally developed as part of the epidemiology of acute infectious diseases, they do not always translate smoothly to such chronic neurological disorders as developmental disabilities. The earliest level of prevention for developmental disorders is premarital genetic counseling for members of families or groups considered at risk. Maternal immunization (vaccination) status, nutrition, and other prenatal care will be paralleled by infant immunization, nutrition, and pediatric care. Genetic and metabolic screening can be accomplished prenatally or postnatally. Dietary, pharmacological, surgical, and other therapies can minimize the occurrence or impact of associated impairments; psychological and educational interventions facilitate optimal development and decrease secondary emotional disabilities.

Preverbal Assessment Intervention Profile (PAIP)

A standardized Piagetian assessment of sensory-motor prelinguistic (occurring before the development of speech and language skills) behavior that can be used with individuals of all ages with severe, profound, and multiple disabilities.

primary auditory cortex (A1)

Brodmann areas 41 and 42; Heschl's gyrus. This area is responsible for the reception of sound; although input from the contralateral (opposite) ear is predominant, the temporal lobe of each hemisphere receives input from both ears.

primary process

A psychoanalytic term referring to primitive, irrational, wishful thinking or thought dominated by unconscious emotions and instinctual drives. When counseling parents of children with developmental disabilities, too much focus is often placed on the cognitive content (secondary process) of the information communicated, to the exclusion of the emotional impact (primary process).

primary visual cortex (V1)

Brodmann area 17; the occipital pole and the calcarine fissure; the striate cortex in each hemisphere receives input from the contralateral (opposite) visual field of both eyes.

primidone

Trade name Mysoline; an anti-convulsant used in tonic-clonic seizures. The drug is generally helpful in people with identifiable organic brain disease. Primidone is broken down into phenobarbital in the body. Both primidone and phenobarbital blood levels can he obtained; however, they are useful only for compliance, as they do not always correspond to either seizure control or toxic side effects. Primidone should be started at a low dose, because marked sedation can occur with high initial doses.

primigravida

A woman pregnant for the first time. First pregnancies may need closer observation than later pregnancies and may be associated with slightly increased risks for both mother and child.

primipara

A woman who has delivered one live child.

primitive reflex

Early automated responses I (EAR-I). A group of reflex patterns present at birth that tend to be suppressed or integrated into more functional voluntary movement patterns. These patterns originate in the brain stem and may persist in the presence of cortical or other brain damage that interferes with the evolution of voluntary movements; they may also reappear in older children and adults after severe brain injury. They play an obvious clinical role in the examination of infants under 6 months of age. Most of the patterns involve the overriding impact of head position and movement on the tone, movement, and posture of the four extremities (arms or legs). EAR-1 includes the Moro, Galant, asymmetrical tonic neck, symmetrical tonic neck, tonic labyrinthine (extension of all four extremities), stepping, crossed extension, and placing reflexes.

p.r.n.

See pro re nata.

proband

See propositus.

probe

A test for generalization in operant language training.

problem-oriented medical record (POMR)

An approach to record keeping with a focus on a defined list of problems. Notes are written in a SOAP structure: S—subjective data; O—objective data; A—assessment; and P—plan.

problem solving

Often used to refer to nonverbal cognitive abilities in infants and young children; this stream of development is measured by visual-perceptual-motor items (e.g., playing with toys) on infant tests.

procedure

Surgical operation.

procedural knowledge

A construct of the way in which certain information is represented in memory. Procedural knowledge is composed of productions and represents knowing "how" to do something. A student may be able to tell you that he or she lives at 472 Wilson Street, bur may nor know "how" to get there. Procedural knowledge is dynamic in that it results not simply in recall but in a transformation of information. For example, the result of doing a mathematics problem (2 X 10 = 20) produces an output (20) that is different from the input (2 X 10). Once well learned, procedural knowledge operates in a fast, automatic fashion (for example, print is decoded by skilled readers with little awareness of the process). The two main types of procedural knowledge are pattern-recognition and action-sequence; although learned differently, both types are intimately related in performance.

prodrome

An early symptom of a disease, usually before the specific disease shows sufficient other symptoms to allow it to he diagnosed; prodrome can refer to a grouping of symptoms that collectively represents the first stage of a disease before the full-blown syndrome shows itself.

profound mental handicap (PMH)

See profound mental retardation.

profound mental retardation (PMR)

Mental retardation in which the IQ level is below 25. Adults with PMR often need assistance in adaptive skills and may reside in intermediate care facilities.

progeria

Hutchinson-Gilford syndrome; a rare condition with premature aging and shortened life expectancy; cognition remains unaffected.

progestin

A hormone used to treat women with developmental disabilities when they exhibit behavior disorders associated with menstrual irregularities or premenstrual syndrome (PMS); long-acting injections of progestin (Depo-Provera) are also used for contraception.

prognathia

A protuberant jaw; can be a normal variant, a familial trait, a minor malformation, or part of an identifiable syndrome.

prognosis

Prediction; description of the probable course and outcome of a given disease or therapy. More accurate prognoses provide the principal rationale for increased diagnostic refinement.

Program for the Acquisition of Language with the Severely Impaired (PALS)

A language assessment instrument that uses caregiver interviews and environmental observations first to identify communication partners, communication content, and communication behaviors. The Diagnostic Interview Survey is then used with nonspeaking or minimally verbal clients. The Developmental Assessment Tool is the more formal third step in this individualized evaluation program.

programmed learning

A self-instructional method that presents subject content in a predetermined sequence that allows students to check their progress, determine what part of the sequence they may not have effectively learned, go back in the sequence as necessary, and proceed at their own pace. Programmed learning is presented in the form of workbooks or computer programs.

progressive encephalopathy

Degenerative disease; "progressive," in this context, refers to progressive deterioration or a progressively downhill course.

projective test

A technique that uses vague, ambiguous stimuli to elicit the subject's characteristic mode of perceiving the world; the individual projects his or her feelings into the unstructured test item. Examples include the Rorschach test and the Thematic Apperception Test (TAT).

prompt

An action that increases the probability of a target behavior by reducing the amount the subject has to do to complete it; prompts can range from verbal cues to physically guiding the subject through the motions of the desired response.

pronation

Forearm movement that turns the palm downward.

prone

Anatomical position in which the person is lying face downward on his or her abdomen (opposite of supine).

pronominal

reversal Confusion between first- and second-person pronouns (and not the genders of third-person pronouns); probably related in part to echolalia (repetition of what is heard), in part to the phenomenon of referring to self by name or by third-person pronouns, and in part to egocentrism. Mixing up the case of pronouns—"I, me; he, him; she, her; and they, them"—does not count as pronominal reversal. Pronominal reversal occurs in autism and other language disorders.

prophylaxis

Prevention.

propositus

The index case, or proband. The person in a family who first comes to the attention of professionals with an identified trait, possibly leading to identification of that trait or others within a family. For example, the child with mental retardation who is diagnosed with tuberous sclerosis, leading to an evaluation of the family for tuberous sclerosis, is the propositus.

propping

See protective extension.

propranolol

Trade name Inderal; a beta-adrenergic blocker drug with many cardiovascular applications. It has investigational uses in the treatment of behavior disorders, such as aggression and self-injurious behaviors, in people with severe developmental disabilities.

proprietary name

Trade name.

proprioception

Position sense. This sensory function is evaluated during neurological examinations by having individuals close their eves, lift their toes up and down, and identify the direction in which the toes have moved.

proprioceptive facilitation

Therapeutic activities that treat neuromuscular dysfunctioning by stimulating the proprioceptive system; proprioceptive facilitation techniques include heavy joint compression, stretch, resistance, tapping, and vibration.

proprioceptive neuromuscular facilitation (PNF)

A system of physical therapy for the treatment of cerebral palsy, devised by a physician (Herman Kabat) and two physical therapists (Margaret Knott and Dorothy Voss). The approach uses spiral and diagonal mass movement patterns and heavy resistance isotonic exercises.

pro re nata (p.r.n.)

As needed; whenever necessary; as the occasion arises.

prosody

Voicing patterns of speech determined by rate, inflection, and rhythm. Prosodic variations include shouting, rising versus falling pitch, angry voice, and wheedling tone. The babbling of babies reflects the prosody of the parent language before actual words are uttered. Until 8-9 months of age, the babble-jargon of babies around the world sounds relatively the same. In the typical 9-month-old, the prosody of the parent language becomes apparent. For example. Chinese babies begin to include the rhythmically rising and falling pattern of the Chinese language, whereas Hispanic babies show the rhythm patterns of spoken Spanish.

prosthesis

Artificial body part (e.g., artificial leg, glass eye).

protection and advocacy

(P&A) A system of stare agencies established through federal legislation (Section 1 1.3, Developmental Disabilities Assistance and Bill of Rights Act of 1975 [PL 94-103]) to protect and advocate for the rights of people with developmental disabilities. P&A agencies are independent of other governmental agencies or units to ensure that they arc able to freely serve the interests of their clientele. Duties and activities of the P&A staff may include negotiation, administrative or legal intervention on behalf of individuals seeking services, or securing and protecting people's rights and privileges as citizens. Public dissemination of information concerning the rights of individuals with developmental disabilities through publications, presentations, and workshops is a further responsibility of P&A systems. Education, employment, transportation, housing, recreation, facility accessibility, and the entitlement of people with developmental disabilities to these services are of interest to the protection and advocacy system. The specific name of agencies varies from state to state.

protective extension

Propping reactions; a subgroup of upper-extremity postural responses (EAR-II) concerned with maintaining an upright position. This group of reflexes includes anterior (front), lateral (outside), and posterior (back) propping, and the anterior parachute response.

protective services

Provision of services ranging from mandated monitoring to alternative placement for people in danger of harm from others or themselves, or who are no longer physically or cognitively able to care for themselves. Thus, children who are in danger of abuse or neglect, or who have mental retardation or other disabilities, may receive protective services.

protocol

A list of rules; research and treatment protocols detailing how research or therapy is to be conducted (i.e.. the research/treatment methodology).

protopathic

Relating to the indistinct peripheral (noncentral) sensation of pain and temperature.

proximal

Closest to the center.

proximal transverse palmar crease

A flexion crease on the palm of the hand; the "head line" of palmistry.

PRP-D

See polyribosyl ribitol phosphate.

pruritus

Itching.

PSAS

See Pre-Speech Assessment Scale.

pseudarthrosis

False joint; this can occur as a complication of surgery after a fracture fails to heal properly or secondary to some other underlying disease (e.g., neurofibromatosis).

pseudobulbar palsy

Impaired swallowing, talking, and chewing secondary to brain damage. The oral motor control (cranial nerves X and XII) of the lips, tongue, mouth, larynx (windpipe), and pharynx (throat) typically resides in the medulla oblongata (part of the brain stem). Damage to these centers produces a bulbar palsy; when a similar pattern of dysfunction occurs as a result of more diffuse brain involvement, it is referred to as pseudobulbar palsy and is sometimes associated with the more severe degrees of cerebral palsy. More accurately, suprabulhar paresis.

pseudohypertelorism

The misleading appearance of (ocular) hypertelorism (widely spaced eyes) when it is not really present. Epicanthal folds and an increased inner canthal distance can contribute to this illusion, but a normal interpupillary distance corrects this impression.

pseudohypoparathyroidism

Albright hereditary osteodystrophy; a genetic syndrome with short stature, short extremities (arms or legs), short hands and feet, obesity, mental retardation, and seizures.

pseudostrabismus

An appearance of strabismus (squint) when it is not really present. A normal interpupillary distance misleadingly looks short because of an increased inner canthal distance, telecanthus, or epicanthal folds.

pseudostupidity

Interpretation (i.e., by professionals) at a more complex level than required.

PSLT

See Picture Story Language Test.

psychiatric disorders

Disorders of five separate classes: behavior, affect, cognitive, interpersonal, and somatic. Current diagnostic schemas (e.g.. Diagnostic and Statistical Manual of Mental Disorders [4th edition] [DSM-IV]) approach diagnosis by classifying disorders on the dimension most symptomatically affected. Current classification schemas by symptom groups avoid the issue of etiology (cause), thus giving little guidance to appropriate treatment.

psychoanalysis

A system for diagnosing and treating mental disorders based on the pioneering work of the Viennese neurologist Sigmund Freud (1856-1939). The approach relies heavily on the use of tree association and dream interpretation to reveal and resolve unconscious conflicts between repressed instincts and defense mechanisms. There are no significant psychoanalytical contributions to the understanding of developmental disabilities.

Psychoeducational Profile (PEP)

A norm-referenced instrument used to plan individualized educational intervention for children with autism; seven developmental and five pathological areas are investigated.

psychogenic

Disorders or conditions that are nonorganic in origin, stemming instead from an individual's mind or psyche.

psychogenic pain

Recurrent severe pain with no known organic origin; often in response to external stressors.

psychogenic water drinking

Excessive fluid intake (usually water) that docs not result from kidney or other medical disorders but is a behavioral reflection of extreme emotional need. The inadequate nurturance that characterizes deprived children in foster care is a typical setting for this behavioral symptom.

psychometry

Psychological testing; the science and practice of testing and quantifying a variety of psychological parameters; often restricted to IQ testing.

psychomotor

Pertaining to voluntary (psychically determined) movement; refers to the relationship between the brain and the muscles. The term psychomotor retardation is used (sometimes with contradictory meanings) in describing various emotional and/or physical states.

psychomotor retardation

See psychomotor.

psychopathology

Behavioral, emotional, or personality dysfunction within an individual.

Psychopathology Instrument for Mentally Retarded Adults (PIMRA)

A 56-item inventory to assess symptoms of psychopathology in adults with mental retardation. Both self-report and informant versions (divided into eight subscales of seven items each) are available for purposes of diagnosing schizophrenia, anxiety, somatization, personality disorders, adjustment disorders, depression, psychosexual disorders, and poor mental adjustment.

psychosocial deprivation syndrome

Reversible hyposomatotropinism (condition of inadequate secretion of pituitary growth hormone). A severe disorder of parenting that produces bizarre behavior in the child along with short stature that is secondary to deficient pituitary growth hormone. Abnormal behaviors include drinking from toiler bowls, eating from garbage cans, polydipsia (consuming liquids to excess), polyphagia (eating to excess) alternating with food refusal and food hoarding, insensitivity to pain, encopresis (fecal incontinence), and an unusual wake-sleep cvcle. All the behaviors are readily corrected when the child is placed in a nurturant environment, but it may take months for the growth hormone levels to return to normal. Transient developmental delay is the rule.

psychosomatic

Describes functional disorders with no detectable organic cause but due, rather, to emotional conflict or stress. The three most common psychosomatic symptoms in children are headaches, stomachaches, and leg pains. They can be precipitated by problems at home or in school but also typically have strong family histories to model or imitate. The female predominance seen in somatization disorder is less striking in young children. In the presence of similar degrees of stress at school, psychosomatic complaints do not seem to be as frequent in children with mental retardation or language-based learning disabilities. Psychosomatic disorders are not imaginary.

psychostimulant

See stimulant.

psychotropic

Describes drugs for modifying the intensity of feelings or modifying behavior or experience.

P 300

A late component of the auditory evoked response (AER) that may be absent or reduced in patients with autism; the consistency and specificity of this finding remain unclear.

PT

See physical therapy.

PTI

See Pictorial Tests of Intelligence.

ptosis

A falling of any organ so that it is located below its normal position. Without further specification, ptosis often refers to a drooping eyelid. Ptosis can be a congenital minor malformation or acquired and is often due either to a problem with the muscle of the eyelid or the oculomotor nerve (cranial nerve III). Ptosis is commonly found in a number of syndromes such as fetal alcohol syndrome, neurofibromatosis, and Sturge-Weber syndrome.

PTSD

See posttraumatic stress disorder.

puberty

The age period during which secondary sexual characteristics and the ability to reproduce mature (11-15 years, with girls developing earlier than boys); the onset of physical changes that are part of the broader phenomenon of adolescence. Puberty is sometimes early, but more often late, in people with significant mental retardation, but this varies with the specific etiology (cause).

pubis

See symphysis pubis.

PL 88-164

See Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963.

PL 89-10

See Elementary and Secondary Education Act (ESEA) of 1965.

PL 89-313

See Elementary and Secondary Education Act Amendments of 1965.

PL 89-750

See Elementary and Secondary Education Act Amendments of 1966.

PL 90-247

See Elementary and Secondary Education Act Amendments of 1968.

PL 91-230

See Education of the Handicapped Act of 1970.

PL 91-517

See Developmental Disabilities Services and Facilities Construction Act of 1970.

PL 93-112

See Rehabilitation Act of 1973.

PL 93-380 See Education Amendments of 1974.

PL 94-103

See Developmental Disabilities Assistance and Bill of Rights Act of 1975.

PL 94-142

See Education for All Handicapped Children Act of 1975.

PL 95-56

See Elementary and Secondary Education Act Amendments of 1978.

PL 95-602

See Rehabilitation, Comprehensive Services, and Developmental Disabilities Amendments of 1978.

PL 98-199

See Education of the Handicapped Act Amendments of 1983.

PL 98-211

See Chapter 1 of the Education Consolidation and Improvement Act of 1981.

PL 98-221

See Rehabilitation Act Amendments of 1983.

PL 99-372

See Handicapped Children's Protection Act of 1986.

PL 99-457

See Education of the Handicapped Act Amendments of 1986.

PL 99-506

See Rehabilitation Act Amendments of 1986.

PL 100-146

See Developmental Disabilities and Bill of Rights Act Amendments of 1987.

PL 100-407

See Technology-Related Assistance for Individuals with Disabilities Act of 1988.

PL 101-336

See American with Disabilities Act (ADA) of 1990.

PL 101-392

See Carl D. Perkins Vocational and Applied Technology Act of 1990.

PL 101-476

See Individuals with Disabilities Education Act (IDEA) of 1990.

PL 101-496

See Developmental Disabilities Assistance and Bill of Rights Act of 1990.

PL 102-569

See Rehabilitation Act Amendments of 1992.

PL 103-218

See Technology-Related Assistance for Individuals with Disabilities Amendments of 1994.

pulses

A numerical system to monitor treatment efficacy in cerebral palsy: P = general conditions; U = upper limbs; L = lower limbs; S = special senses/speech; E = excretory functions; and S = cerebration. Each item/letter is scored from 1 (no disorder) to 4 (needs maximum help); higher scores indicate greater dependency.

punishment

In behavioral terms, reducing an operant behavior by following it with something negative—an aversive stimulus event (ASE), or punisher. Punishment may be divided into five types: reprimand, cost contingency, negative practice, overcorrection, and corporal punishment. Punishment is often considered first as a way to eliminate undesirable behavior. However, there are pitfalls to this approach. Punishment can lead to avoidance behavior such as sneaking cheating, or lying. In addition, children pay attention to what is done rather than what is said (e.g., spanking a child for hitting is not likely to teach that hitting is wrong). Punishment has a short-term, rather than a long-term, effect when appropriate behaviors are not taught or reinforced at the same time. If punishment occurs frequently and across enough school settings, the student will come to view the whole school experience as aversive, a situation unconductive to learning. In addition, children with learning disabilities or attention-deficit/hyperactivity disorder (ADHD) may not clearly link cause and effect. For example, the impulsive child who hits another child simply to gain attention with no malice intended does not perceive this as a punishable event. Because he or she intended no harm, punishment is confusing and is unlikely to prevent another incident. In addition, the child with a learning disability who finds that his or her best efforts do not allow completion of work and is therefore consistently kept in from recess eventually learns not to try. Thus, punishment may effectively teach the wrong lesson.

Pupil Rating Scale-Revised

A teacher questionnaire used to screen for learning disabilities with students ages 5-14 years of age. A five-point scale is applied to items in five separate areas: auditory comprehension and memory, spoken language, orientation, motor coordination, and personal social behavior. Administration time is 10 minutes.

Purdue pegboard

A 50-hole pegboard in which pins and pin-collar-washer assemblies are to be placed; the number correctly placed in a fixed time period is a measure of fine-motor coordination.

Purdue Perceptual Motor Survey

An instrument used to assess the perceptual-motor skills required for academic learning in children 6-10 years of age.

pure tone audiometry

A method of assessing hearing using a machine that generates pure-tone stimuli, calibrated in decibels, to earphones; it can be used to screen for significant hearing loss and to diagnose the degree of hearing loss to cither ear for both bone and air conduction.

purified protein derivative (PPD)

A skin test for tuberculosis that involves the subcutaneous (inner) injection of tubercular material that is then observed for an inflammatory response 2-3 days after injection.

PVL

See periventricular leukomalacia; see also leukomalacia.

PVS

See persistent vegetative state.

PWS

See Prader-Willi syndrome.

pyknic body type

Round, fat, short.

pyknodysostosis

A genetic syndrome with dwarfism, increased bone density, abnormalities of the terminal digits, and a dolichocephalic skull (long front-to-back diameter) with a peculiar facies. About one fifth of cases exhibit mental retardation. Inheritance is autosomal recessive. The artist Henri Toulouse-Lautrec (1864-1901) is believed to have had pyknodysostosis.

pyrexia

Fever. Aspirin is an antipyretic.

pyridoxine (vitamin B₆ deficiency)

Symptoms include seizures and hyperirritability in newborns with a familial pyridoxine dependency.