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

tache cérebrale

Gently stroking the skin with a fingernail to produce a red streak bounded by pale margins (in contrast to dermatograph in which a pale streak is bounded by red margins); this sign is present in meningitis (inflammation of the spinal cord and brain membranes), hydrocephalus (excess fluid in the brain), and a variety of febrile (feverish) illnesses.

tachyphylaxis

A term typically employed when describing a rapid onset of resistance to the therapeutic effect of medication. For example, when the antihistamine diphenhydramine (Benadryl) is used to help get a child to sleep at night, the effect wears off in several weeks.

tachypnea

Rapid breathing with an increased respiratory rate; one of the signs of respiratory distress for a variety of reasons, including pneumonia.

TACL-R

See Test for Auditory Comprehension of Language-Revised.

tactile

Relating to the sense of touch. People who are blind utilize the tactile sensory modality when learning to read braille. Educators have used this modality as an adjunct the more traditional visual and auditory modalities with preschoolers and with students experiencing difficulty learning to read. This may include tracing sandpaper letters or drawing shapes in clay. The Fernald Word Learning Technique is a structured method for incorporating both tactile and kinesthetic modalities with auditory and visual modalities in learning to read.

tactile defensiveness

Tactile hypersensitivity; a sensory integrative dysfunction characterized by observable aversive or negative behavioral responses to certain types of tactic (touch) stimuli that most people would find non-noxious (not painful). Strong, emotional reactions, hyperactivity, and other behavior problems may occur. Sensory integration theory hypothesizes that this affective misinterpretation of tactile experience is the effect of a disorder in the modulation or regulation of tactile sensory input.

Tactile Test of Basic Concepts

An adaptation of the Boehm Test of Basic Concepts that substitutes raised figures for pictures to predict success in kindergarten and first grade.

Tagamet

See cimetidine.

TAL

See tendo Achilles lengthening.

talipes equinovarus

Clubfoot; a (usually congenital) deformity of the foot. The term derives from talus (heel/ankle), pes (foot), equinus (an involuntary foot extension), and varus (inversion/supination of the foot so that only the outer sole touches the ground). This deformity has a polygenic mode of inheritance with a threshold effect; the greater its rate of occurrence in a family, the greater the risk of its recurrence with an increasing severity. Clubfoot is also found in cerebral palsy, spina bifida, arthrogryposis (fixation of joints), and a variety of genetic syndromes. Orthopedic treatment should take into account etiology (cause). The presence of any otherwise unexplained congenital orthopedic deformity in a newborn should lead to the consideration of a possible neurodevelopmental diagnosis.

talus

Ankle bone.

tandem walking

Toe-heel gait; walking in a straight line with the toes of one foot and the heel of the other being in contact at the end of every step. A sensitive indicator of problems with balance.

Tanner stages

A scoring system for rating sexual maturation of male genitalia, female pubic hair, and female breast development that is especially useful in the physical examination of adolescents. There is no stage 0; preadolescent/early childhood sexual maturity ratings are all Tanner I. Tanner V/VI represents the mature adult stage.

TAPS

See Test of Auditory-Pereeptua1 Skills.

tardive dyskinesia

Choreiform (involuntary twitching) movements that can result from the use of neuroleptic (major tranquilizer) medications. These movements occur late (i.e. tardive) in the course of therapy and tend to be limited to stereotypic face/tongue/mouth activities, such as chewing and lip smacking, facial grimacing, blinking, tongue thrusting, and writhing movements of the ringers, hands, and toes. The overall incidence is on the order of l%, and in children the tardive dyskinesia tends to resolve when the drugs are discontinued.

tarsus

The instep of the foot. Tarsi palpebrarum are the edges of the eyelid.

TASH

See The Association for Persons with Severe Handicaps.

TAT

See Thematic Apperception Test.

TAWF

See Test of Adolescent/Adult Word Finding.

Tay Sachs disease

A lipid storage disease characterized by typical development until 4-6 months of age, when progressive loss of motor and other developmental milestones occurs. Classic features include psychomotor retardation, hypotonia (decreased muscle tone), loss or interest in surroundings, poor head control, and apathy. Visual acuity decreases, and the retina (light-sensitive inner back wall) shows a characteristic cherry red spot on the macula. Seizures may occur, as can macrocephaly (abnormally large head) in the final stages. The biochemical defect is a lack of breakdown of a chemical in the brain called a ganglioside by the enzyme hexosaminidase A. The course is one of progressive intellectual and neurological deterioration leading to death in middle childhood. Diagnosis is made by clinical history and measuring the level of the defective enzyme hexosaminidase A in serum. Tay Sachs disease is found most commonly in Jewish families from Eastern Europe. Although there is currently a prenatal screening rest available, there is to date no known treatment. Inheritance follows an autosomal recessive pattern.

Tay syndrome

See IBIDS syndrome.

TCA

See tricyclic antidepressant.

TDD

See Telecommunicating Devices for the Deaf.

TEACCH

See Treatment and Education of Autistic and Communications handicapped CHildren.

Technology-Related Assistance for Individuals with Disabilities Act of 1988 (PL 100-407)

Federal legislation designed to assist states in developing comprehensive and consumer-responsive programs involving technology-related assistance and in expanding the availability of such technology to individuals with disabilities and their families. To give states considerable flexibility in developing and implementing their programs, "assistive technology device" is broadly defined as "any item, piece of equipment, or product system, whether acquired off the shelf, modified or customized, that is used to maintain or improve functional capabilities of individuals with disabilities." Under this law, assistive technology services encompass eight activities related to developing services that arc responsive to the consumer. In addition to the efforts made by the states, the federal government is authorized to assist states in a variety of ways to help them develop their service delivery systems.

Technology-Related Assistance for Individuals with Disabilities Amendments of 1994 (PL 103-218)

Federal legislation that refunded the original legislation, PL 100-407, allowed its extension to states that had not previously enrolled, and strengthened the advocacy and systems change components of the act.

teething

Eruption of teeth through the gums, often associated with drooling, mouthing, irritability, and low-grade fever.

TEF

See tracheoesophageal fistula.

TELD-2

See Test of Early Language Development-Second Edition.

telecanthus

Lateral displacement of the inner canthi (angle of the eyelid slits) giving rise to an increased inner canthal distance can contribute to both pseudostrabismus (false squint or crossed eves) and pseudohypertelorism (false impression of widely spaced eyes).

Telecommunicating Devices for the Deaf (TDD)

Communication apparatuses that allow individuals with hearing impairments to receive and send messages via telephone. The sender types in a message that is transmitted via telephone lines to a visual receiver (either a display screen or a receiving typing machine that types the message). TDDs are becoming increasingly available and are routinely used by police and fire departments as well as other public service agencies including libraries, airlines, utility companies, and schools.

telegraphic speech

Highly condensed noun—verb utterances with few to no adjectives, adverbs, prepositions, conjunctions, articles, and auxiliary verbs. Transiently observed in early language development, the presence of telegraphic speech in older children suggests language disorders.

TEMA-2

See Test of Early Mathematics Ability-2.

temperature

A measurement of body heat; often used colloquially as an inaccurate synonym for fever (e.g., "he has a temperature," meaning elliptically, "he has an elevated temperature").

temporal cortex

The area of the brain responsible for the reception and interpretation of sound, including speech; damage to this area of the dominant (usually left) hemisphere can contribute to a wide variety of aphasias (loss of language skills) (e.g., Wernicke aphasia) and other language disorders. See also primary auditory cortex (A1).

temporal lobe

The part of the cerebrum located underneath the frontal and parietal lobes. This part of the brain appears to be related to memory and a variety of autonomic (automatic), motor, and sensory responses.

temporomandibular joint (TMJ)

The hinge at which the lower jaw connects to the skull. In addition to causing local pain or tenderness, TMJ problems have been implicated in nonspecific symptoms such as dizziness, headache, backache, and chronic fatigue. No convincing evidence supports a role for TMJ in the etiology (cause) of developmental disabilities.

tendo Achilles lengthening (TAL)

Any one of a variety of orthopedic surgery procedures used to lengthen a short, tight, or spastic heel cord. The procedure may be a Z lengthening or a sliding lengthening.

tendon

Connective tissue structure that attaches a muscle to a bone.

tendon reflex

See deep-tendon reflex (DTR).

tendon transfer

An orthopedic surgery procedure that realigns abnormal forces at a joint. The procedure corrects posture and improves movement by reinserting a tendon so as to give the contraction of the treated muscle a different impact on posture and movement. The treated muscle need not initially contribute to the original deformity or disorder.

tenotomy

A surgical operation in which a tendon is cut; most tenotomies are orthopedic in nature: however, some eye muscle surgeries also involve tenotomy.

TERA-2

See Test of Early Reading Ability-2.

teratogen

A chemical or physical agent that causes or increases the incidence of congenital malformations. Teratogens are intrauterine toxins (poisons) to the fetus and generally have the biggest impact early in pregnancy. Human teratogens that produce known syndromes include alcohol, hydantoin (Dilantin), trimethadione, thalidomide, valproic acid (Depakene), diethylstilbestrol (DES), warfarin (Coumadin), aminopterin, and isotretinoin (Accutane).

terbutaline

A beta-sympathomimetic drug used to treat preterm labor and prevent premature birth.

test

A historical fact, physical sign, or laboratory value that has diagnostic value.

Test for Auditory Comprehension of Language-Revised (TACL-R)

A language test for children from 3-0 through 9-11 years of age that can also be administered to adults. The TACL-R yields scores for word classes and relations, grammatical morphemes, and elaborated sentences.

Test of Adolescent/Adult Word Finding (TAWF)

A standardized test of word-finding skills for persons aged 12-0 to 80. Naming tasks are organized into five sections: picture naming (nouns), picture naming (verbs), sentence completion naming, description naming, and category naming.

Test of Adolescent Language-2 (TOAL-2)

A language test for children ages 12-0 through 18-5. It yields an adolescent language quotient (ALQ) and 10 composite subscores in listening, speaking, reading, writing, spoken language, written language, vocabulary, grammar, receptive language, and expressive language. Each subtest and an overall composite yields a standard score with a mean of 100 and a standard deviation of 15.

Test of Auditory-Perceptual Skills (TAPS)

A 15-minute battery of auditory-perceptual tasks for children 4-12 years of age. Subtests include auditory number memory, auditory sentence memory, auditory word memory, and auditory interpretation of directions.

Test of Early Language Development-Second Edition (TELD-2)

A norm-referenced measure of spoken language abilities for children ages 2-0 through 7-11 that yields an overall language score and an expanded diagnostic profile. Receptive and expressive language is assessed by 38 items in a variety of semantic (meaning systems)/(language structure) and syntactic tasks. Administration time is 20 minutes.

Test of Early Mathematics Ability-2 (TEMA-2)

A norm-referenced measure of early mathematics performance for children ages 3-0 through 8-11. This 15-rmnute test is used to determine specific strengths and weaknesses in a child's mathematics knowledge.

Test of Early Reading Ability-2 (TERA-2)

A measure of reading ability for children from 3-0 to 9-11 years of age. Items measure knowledge of contextual meaning, alphabet, and conventions. Two equivalent forms allow test-retest comparisons.

Test of Early Written Language (TEWL)

A measure of the emerging written language skills of young children ages 3-7. Test items cover transcription, conventions of print, communication, creative expression, and record keeping.

Test of Language Competence-Expanded Edition (TLC-Expanded)

An instrument to identify language and communication impairments in children ages 5-19. TLC-Expanded includes the following subtests: ambiguous sentences, listening comprehension, oral expression, figurative language, and remembering word pairs.

Test of Language Development-2 (TOLD-2)

Tests measuring several components of spoken language. The primary-level edition is designed for ages 4-0 to 8-11; seven subtests measure different components of spoken language: picture vocabulary, oral vocabulary, grammatical understanding, sentence imitation, grammatical completion, word articulation, and word discrimination. The intermediate edition, for ages 8-6 to 12-11, has six subtests: general, malapropisms, vocabulary, sentence combining, word ordering, and grammatical comprehension. Both editions combine subtests to provide composites of listening (receptive language), speaking (expressive language), semantics (the meaning of words), and syntax (grammar). The TOLD-2 primary edition also includes a phonology (speech sound) composite.

Test of Mathematical Abilities (TOMA)

An instrument designed to identify students significantly above or below their peers in 1) attitude toward mathematics, 2) vocabulary, 3) computation, 4) general information, and 5) story problems. Normative tables are provided for ages 8-6 through 18-11.

Test of Nonverbal Intelligence-2 (TONI-2)

A language-free measure of intelligence, aptitude, and reasoning that requires no reading, writing, speaking, or listening on the part of the subject. The test includes two equivalent forms for people ages 5-0 through 85-11 (including individuals with severe speech impairments, brain injury, and deafness or hearing loss). Each item presents a set of figures in which one or more components is missing. The individual must identify one or more problem-solving rules that define the relationship among the figures and then select a correct response. The test is typically administered individually but can be given to small groups of as many as five individuals by an experienced examiner. Administration usually takes 10-15 minutes. The TONI-2 yields standard scores (with a mean of 100 and a standard deviation of 15) and percentiles.

Test of Practical Knowledge (TPK)

A reading level of ninth grade or beyond is required for this test, which assesses knowledge believed to be necessary for daily functioning. The three areas assessed are 1) personal knowledge relating to day-to-day independent living, 2) social knowledge relating to understanding of social interaction and community service, and 3) occupational knowledge assessing knowledge relating to job situations. The TPK can be administered individually or in groups via a silent-reading multiple-choice format. The test is not suitable for students with severe disabilities, non-English-speaking students, or students who lack motivation.

Test of Pragmatic Language (TOPL)

An individually administered, norm-referenced test for children 5-0 to 13-11 years of age that measures ability to use pragmatic language (i.e., language used socially to achieve goals and emphasizing not only what is said but why and for what purpose it is said). Administration time is 45 minutes; the test can be used as a criterion-referenced assessment for older individuals.

Test of Pragmatic Skills-Revised Edition (TOPS-R)

A test to assess the use of language by children ages 3-0 to 8-11 to signify conversational intent through four guided play interactions. The test probes the conversational intentions of requesting information, requesting action, rejection/denial, norming/labeling, answering/ responding, informing, reasoning, summoning/calling, greeting, and closing conversation. This is a standardized assessment instrument, but is typically administered on the floor in order to create a "nontesting" environment for the child.

Test of Reading Comprehension-Revised (TORC-R)

A test of silent-reading comprehension for students ages 7-17 years. Four subtests are combined to determine a basic comprehension score that is expressed as a reading comprehension quotient. These subtests include general vocabulary (the ability to identify words that are related to a common concept), syntactic (language structure) similarities (the understanding of meaningfully similar but syntactically different sentences), paragraph reading (the ability to answer questions related to paragraphs), and sentence sequencing (the ability to build plausible relationships among sentences). Supplementary subtests measure reading the vocabularies of mathematics, science, and social studies; reading directions; and sequencing sentences.

Test of Variables of Attention (TOVA)

Formerly, Minnesota Computer Assessment (MCA). An objective, standardized, visual continuous performance task used in the diagnosis and medication management of children and adults with attentional disorders. This is a non-language-based, 23-minute, fixed-interval computerized test with negligible practice effects.

Test of Visual-Motor Skills (TVMS)

A 26-item design copying test for children ages 2-13 years. The TVMS was developed to measure how well the child translates with his or her hand what is visually perceived.

Test of Visual-Perceptual Skills (TVPS)

A nonmotor multiple choice (by pointing) response measure of the following visual skills: discrimination, memory, spatial relationships, form constancy, sequential memory, figure-ground, and closure; the 16 items in each subtest yield perceptual ages, perceptual quotients, and percentile ranks.

Test of Word Knowledge (TOWK)

An assessment of receptive and expressive vocabulary for children 5-17 years of age with an administration time of under 1 hour.

Test of Written Language-Second Edition (TOWL-2)

A test of language components, including conventional (punctuation, capitalization, and spelling), linguistic (word usage and vocabulary), and conceptual (maturity and effectiveness) for children ages 7-6 through 17-11 using both contrived and spontaneous formats. Five subtests are provided in the contrived format: 1) vocabulary—a stimulus word is read by the student and is then used in a composed written sentence; 2) spelling, 3) style—the student writes dictated sentences, with each sentence scored for each subtest; 4) logical sentences—sentences are read and rewritten to eliminate the illogical element; and 5) sentence combining—several sentences are read and combined into one written sentence. The spontaneous format requires the student to view a picture and write a story that is then scored for thematic maturity, conceptual vocabulary, syntatic (language structure) maturity, contextual spelling, and contextual style.

Test of Written Spelling-2 (TWS-2)

An assessment of spelling that may be administered individually or to groups in grades 1-12. The TWS-2 assesses the student's spelling of words whose spellings are readily predictable in sound-letter patterns; words with spellings that are less predictable; and both types together. Administration time is 20 minutes; the TWS-2 yields a spelling quotient.

testing of limits

Modification or deviation from standard test administration procedures to gain additional information about a child's abilities. Testing of limits techniques include providing additional information, presenting or accepting information in an alternate form, encouraging the child's own problem-solving strategies, eliminating time limits, and asking probing questions. These techniques should only be used after the entire test has been administered in its standardized form. Successes obtained through testing of limits are not added to the child's score, although the information obtained from testing of limits procedures can often be helpful in clinical and psychoeducational settings. Such testing can validate or threaten future test results if retesting is likely to occur within a short time period.

Tests of General Educational Development (GED)

A measure for determining whether an individual meets requirements for a certificate of high school equivalency. A successfully completed GED is generally accepted as the equivalent of a high school diploma.

tethered cord

A dysraphic condition like myelomeningocele (protuberance of both the spinal cord and its lining) in which the spinal cord's natural movement upward during the growth of the bony spinal column is impeded. This can occur because of a tumor, scar tissue, or catching the spinal cord on a bony spur, resulting in traction on the cord and damage to the nerve cells. A tethered cord is suspected when there is loss of motor skills, sensation, or sphincter function. Diagnosis is made by computed tomography (CT) scan or magnetic resonance imaging (MRI). Treatment is generally surgical in nature with the goal being to loosen the traction on the cord and to restore neurological function.

tetraphocomelia

Cleft palate syndrome. Roberts-SC phocomelia syndrome, SC syndrome, pseudothalidomide syndrome, hypomelia-hypotrichosis-facial hemangioma syndrome; a genetic syndrome with hypomelia (shortness) of all four extremities (arms or legs), cleft lip and palate, and mental retardation. Inheritance follows an autosomal recessive pattern.

tetraplegia

An old term for quadriplegia (paralysis of all four extremities [arms or legs]).

tetrasomy 12p

See Killian/Teschler-Nicola syndrome.

TEWL

See Test of Early Written Language.

texture

A qualitative gradation of food used in assessing and treating feeding and its disorders; texture involves both viscosity (thickness or thinness) and consistency (smoothness or coarseness).

TFC

See three-finger crease.

thalamotomy

A neurosurgical procedure (brain operation) sometimes used in treating dystonia (impaired muscle tone) and cerebral palsy.

thalidomide embryopathy

Fetal thalidomide syndrome. Reduction deformities of the limbs with a shortening or absence of several to all bones in the extremities (arms or legs) sometimes leading to phocomelia. Many other organ systems can be involved. Etiology (cause) is maternal ingestion of thalidomide during the first 1-1½ months of pregnancy.

The Arc

Formerly Association for Retarded Citizens of the United States (ARC-US). The Arc is a national network of state and locally based parent—professional cooperatives that provide a range of services to individuals with mental retardation. The association defines its mission as that of conducting programs that promote the general welfare of people with mental retardation. Services provided by each local unit are dependent upon local financing. The acronym usually begins with a regional designation such as SLARC (St. Louis Association for Retarded Citizens) or MARC; (Missouri Association for Retarded Citizens). In 1991, the national association changed its name to The Arc.

The Association for Persons with Severe Handicaps (TASH)

An organization of professionals in partnership with people with disabilities, their families, and others involved in education, research, and advocacy on behalf of individuals with severe cognitive impairments and their families. The association publishes a newsletter and a quarterly journal.

The Association for Retarded Citizens of the United States

See The Arc.

thelarche

The onset of breast development in adolescent females.

Thematic Apperception Test (TAT)

A commonly used projective technique originally published in 1943 by Henry Murray. The test utilizes over 24 picture cards, some depicting everyday life experiences and others that are more bizarre and ambiguous in form. Different combinations of cards, selected for age and sex, are used with male and female adults and hoys and girls. The subject is asked to tell a story about the picture, indicating what is currently happening, how the story ends, and what the characters are thinking and feeling.

thenar (radial) longitudinal crease

A crease on the palm of the hand; the "lifeline" of palmistry. ( Thenar refers to the fleshy mass over the ball of the thumb.)

therapeutic handling

Optimal techniques for transporting, positioning, and physically interacting with children and adults with motor disorders or hypersensitivity to such handling; goals include both relaxation and maximizing the individual's independence.

therapeutic range

A term usually used in reference to treatment with a drug, the therapeutic range is the upper and lower blood levels (concentrations generally expressed in micrograms of drug per milliliter of serum [the blood without the cells]) within which a desired effect is achieved without undesirable side effects. These ranges are specific to each drug and are commonly used with anticonvulsants, antibiotics, antidepressants, and asthma medications. In certain cases, levels above the therapeutic range will be more effective without undue side effects. Many medications do not have reliable therapeutic ranges, and therefore levels are not routinely determined.

thermoregulation

The body's ability to control its temperature, a function of the autonomic nervous system. Severe damage to the brain centers involved can produce episodic hyperpyrexia (fever) or poikilothermic behavior (fluctuation of body temperature in response to environmental temperature). Thermoregulatory disorders are common in babies born severely prematurely and in people with profound mental retardation.

thioridazine

Trade name Mellaril; a phenothiazine used to treat hyperactivity and severe behavior disorders in people with mental retardation; it has an appetite-increasing effect and at therapeutic levels adversely affects (lowers) IQ.

third-degree relative

A first cousin; someone who has one eighth of his or her genes in common with the index case (identified patient).

13q-

Deletion of part of the long arm of chromosome 13; a chromosomal disorder with mental retardation, microcephaly (abnormally small head), a peculiar facies, eye abnormalities, and hypoplastic (short to absent) thumbs.

thoracic

Relating to the thorax (chest); the curve of the thoracic spine is concave forward; when exaggerated, it produces kyphosis ("round shoulders").

thoracolumbar sacral orthosis (TLSO)

A brace to treat scoliosis (spinal curvature).

three-finger crease (TFC)

The distal transverse palmar crease.

three jaw chuck draw

A phase describing a primitive form of grasp similar to the manner in which a drill head holds its bits.

tibia

Shinbone; the larger of the two leg bones; see also fibula.

tibial torsion, internal

Toeing in, due to a leg problem and not a foot problem.

tic

Repetitive twitching, often in the face or upper trunk. Examples include eye blinking, grimacing, and shrugging. There are also vocal tics such as sniffing, coughing, or clearing of the throat. Gilles de La Tourette syndrome is a disorder expressed by severe motor and vocal tics.

TIE

See Touch Inventory for Elementary School-Aged Children.

time-out (TO)

A behavioral procedure in which the subject is temporarily (usually only for minutes) removed from the environment where the environmental stimuli are precipitating undesirable behaviors.

tine test

A screening skin test for tuberculosis that involves four small pinpricks that are then observed for a local reaction 2-3 days later. The tine is one of the four prongs used to administer the test.

tinea

Ringworm; a fungal infection.

Title I of the Elementary and Secondary Education Act of 1965

The federal government's first effort to provide compensatory education services for educationally disadvantaged and low-income students; see Chapter 1 of the Education Consolidation and Improvement Act of 1980.

Title I Program

See Chapter 1 of the Education Consolidation and Improvement Act of 1980.

Title V of the Social Security Act of 1935

Federal legislation that established the Crippled Children's Service (CCS), the first categorical health care program for children, and the Maternal and Child Health Bureau. PL 99-272, passed in 1985, changed the CCS to the Program for Children with Special Health Care Needs.

Title XIX of the Social Security Act of 1935, as amended in 1965

Medicaid. A federally supervised, state-administered medical assistance program. This entitlement has financial (income) qualifications for eligibility.

titubation

Head bobbing with a to-and-fro movement of the body that is often due to cerebellar damage or disease in the vermis (central part of the cerebellum).

TLC-Expanded

See Test of Language Competence-Expanded Edition.

TLSO

See thoracolumbar sacral orthosis.

TMH

Trainable mentally handicapped; see trainable mental retardation.

TMJ

See temporomandibular joint.

TMR

See trainable mental retardation.

TO

See time-out.

TOAL-2

See Test of Adolescent Language-2

tobacco

See maternal smoking during pregnancy.

tocolytic

Any pharmacological agent used to postpone the process of labor.

Todd paralysis

The transient paralysis of a body part involved in a focal seizure; it may continue for several (always less than 24) hours after the seizure is complete.

toe walking

equinus gait; walking on the balls of the feet with the heels not touching the ground. When associated with spasticity (increased muscle tone), tight calf muscles, shortened heel cords, and brisk deep-tendon reflexes, toe walking is a sign of spastic cerebral palsy, most commonly diplegia (paralysis on both sides of the body). Toe walking is also frequently seen in children with autism. A motor or other developmental disorder should he suspected when toe walking persists for longer than 3 months. As a normal variant, toe walking should raise the examiner's index of suspicion for developmental disorders of language.

Tofranil

See imipramine.

token

A term in behavioral psychology meaning an object that can be later exchanged for another reinforcer/reward.

token economy

A comprehensive behavior modification program involving the use of tokens, such as points, ships, stars, play money, and so on. The tokens are earned for prespecified behaviors and may be turned in at a later time for tangible items such as food or favored activities.

token test

A screening test for receptive language in children from 3-0 to 12-5 years of age. The technique of using tokens of different shapes, sizes, and colors to assess receptive language abilities was derived from work with adults who have aphasia (loss of language skills).

TOLD-2

See Test of Language Development-2.

toluene embryopathy

A teratogenic (causing malformation) syndrome that includes low birth weight, microcephaly (abnormally small head), developmental delay, and facial features similar to those of fetal alcohol syndrome. Etiology (cause) is maternal substance abuse with the solvent methylbenzene (found in spray paint) during pregnancy.

TOMA

See Test of Mathematical Abilities.

tone reducing ankle foot orthosis (TRAFO)

A brace used to treat equinus deformity or posture in spasticity (increased muscle tone).

tone/tonus

The degree of involuntary muscle contraction or passive resistance that persists during voluntary relaxation. Tone can be described as normal, hypertonic (increased), hypotonic (decreased), or atonic (absent).

tongue protrusion reflex

An oral-motor reflex innervated by cranial nerve XII, in which a tactile (touch) stimulus to the anterior (front) tongue produces the response of tongue protrusion between birth and 6 months of age. Diminution of this reflex permits the introduction of solids.

tongue thrust

Forceful, intermittent protrusion of the tongue, often associated with a generalized increase in extensor tone. It is of concern because it can interfere with feeding and speech.

tongue-tie

Hypertrophic lingual trenulum, ankyloglossia; a short lingual frenulum that restricts the movement of the tongue, especially at the tip. This is a common finding in children, and, except in extreme cases, rarely affects speech. Once a common office procedure, clipping the frenulum is no longer routinely recommended.

TONI-2

See Test of Nonverbal Intelligence-2.

tonic bite

An exaggerated version of the bite reflex in which the jaw clamps shut with minimal oral stimulation.

tonic-clonic seizure

See generalized seizure.

tonic labyrinthine response

A primitive reflex in which neck extension (stimulus) produces shoulder retraction ("surrender posture" or hands above shoulders/in air posture) and lower extremity extension. Persistence or exaggeration of this reflex reflects serious underlying neuromotor disability.

tonic seizure

A seizure type classified under minor motor seizures or Lennox-Gastaut syndrome. This is characterized by brief spells of muscle tightening. These generally occur during sleep and are resistant to anticonvulsant therapy.

tonic spasms

Sudden extension of the entire body, often on the basis of an overactive labyrinthine reflex; this postural extensor thrust is not a true seizure.

tonsillectomy

The surgical removal of the tonsils; often an adenoidectomy (surgical removal of the adenoids) is accomplished at the same time—a T&A. Indications for T&A have tended to become more restrictive or conservative. Recurrent otitis (ear infection) or some degree of cardiac or respiratory compromise are considered necessary to justify the risk of severe postoperative bleeding. The fact that tonsillar tissue normally begins to involute (spontaneously grow smaller) by early in the second decade of life should also be taken into account prior to deciding on surgery.

tonsillitis

An infection/inflammation of the tonsils (masses of lymphoid tissue in the throat/oropharynx). Tonsillitis is distinct from (although often associated with) pharyngitis (throat infection/inflammation). The presence of a runny nose (rhinitis) can suggest a viral etiology (cause) to a throat infection that will not benefit from antibiotics.

tooth grinding

Bruxism.

top-down processing (conceptually driven)

A term found in cognitive psychological theory referring to processing that is affected by what an individual brings to a stimulus situation. For example, when a word is unclear or unknown in a sentence, the reader utilizes expectations based on context and past experience (top-down), rather than relying on a detailed analysis of the word (see bottom-up processing). In most circumstances, perception involves the interaction of bottom-up and top-down processing.

TOPL

See Test of Pragmatic Language.

topographical classification of cerebral palsy

Describes which of the four extremities are significantly involved in cerebral palsy; such a classification is typically used only with spastic cerebral palsy because most extrapyramidal cerebral palsy involves all four extremities fairly equally. Topographical subtypes include monoplegia, hemiplegia (paralysis of half the body), triplegia, diplegia (paralysis on both sides of the body), quadriplegia (paralysis of all four extremities), and paraplegia.

topography

In psychoanalysis, the division of mental function into three regions: the conscious, the unconscious, and the preconscious.

TOPS-R

See Test of Pragmatic Skills-Revised Edition.

TORCH

See STORCH.

TORC-R

See Test of Reading Comprehension-Revised.

torsion dystonia

See dystonia muscularum deformans.

torticollis

Stiff neck, wry neck; a spasm or tightening of neck muscles leading to the head being turned to one side.

torus palatinus

A benign donut-shaped bony swelling over the posterior (back) portion of the hard palate; this represents a normal anatomical variant without any developmental significance.

total communication

An educational approach employed with individuals with hearing impairments in which all communication methods available to the individual are utilized. Finger spelling, oral and written language, speech reading, and sign language are among the techniques incorporated to enhance receptive and expressive communication. Synthesizing all sensory modalities and communicative abilities facilitates both the acquisition of language and social development, particularly with children who have congenital or prelingual (occurring before the development of speech and language skills) hearing loss.

total parenteral alimentation (TPA)

See total parenteral nutrition.

total parenteral nutrition (TPN)

Total parenteral alimentation (TPA), hyperalimentation; parenteral refers to feeding not through the alimentary canal, typically by the intravenous route. TPN would provide all the nutritional requirements to build and maintain body tissue and expend energy through an intravenous catheter in cases where the intestine's ability to absorb food has been acutely or chronically compromised.

Touch Inventory for Elementary School-Aged Children (TIE)

A brief 10-minute, 26-question inventory to assess tactile (touch) defensiveness. It can be administered alone or as part of a comprehensive sensory integration assessment.

Tourette syndrome

See Gilles de La Tourette syndrome.

TOVA

See Test of Variables of Attention.

tower

A visual-perceptual motor milestone in infancy and early childhood in which the child is requested to imitate stacking blocks; a tower of 2 blocks can usually he completed by 15 months of age, and a tower of 10 blocks by 3 years. The qualitative aspects of the motor grasp and release can also be evaluated during this task. Tower-building block tasks are commonly included components in many infant tests.

TOWK

See Test of Word Knowledge.

TOWL-2

See Test of Written Language-2.

toxemia of pregnancy

EPH ( Edema, Proteinuria, and Hypertension) complex that, untreated, will progress to seizures; this preeclampsia-eclampsia syndrome occurs in the last trimester of pregnancy and is associated with high fetal and maternal morbidity and mortality.

TPA

Total parenteral alimentation; See total parenteral nutrition.

TPBA

See transdisciplinary play-based assessment.

TPK

See Test of Practical Knowledge.

TPN

See total parenteral nutrition.

trachea

Windpipe.

tracheoesophageal fistula (TEF)

A congenital malformation in which the esophagus opens into the trachea (windpipe) and leads to aspiration. TEF is part of the VATER association, Down syndrome, and other malformation syndromes.

tracking

Grouping students on the basis of ability. Being assigned to specific classes at the secondary level based on academic ability also influences student friendships, extracurricular activities, and attitudes.

traction response

A test for tone that can be elicited in premature infants at 33 weeks' gestation; the stimulus involves grasping the infant by both hands and pulling to sit. The response includes flexion at the neck, elbows, knees, and ankles. Hypotonia (decreased muscle tone) is suggested by head lag and lack of limb flexion.

trade name

Brand name, proprietary name; the particular formulation of a drug that is copyrighted or patented by a pharmaceutical manufacturer.

TRAFO

See tone reducing ankle foot orthosis.

train

A visual-perceptual motor milestone that requires the child to imitate the construction of a four-block (at 24 months of age) or five-block (at 30 months) structure.

trainable

See moderate mental retardation.

trainable mental retardation (TMR)

An outdated term to describe people with moderate mental retardation whose IQ scores fall below 50 and above 34.

trainable mentally handicapped (TMH)

See trainable mental retardation.

trait

An inherited or acquired characteristic that is consistent, persistent, and stable.

tranquilizer

An antianxiety drug; there are two groupings: major tranquilizers, which include the antipsychotic neuroleptics; and minor tranquilizers, which include the anxiolytic (antianxiety) drugs such as diazepam (Valium), chlordiazepoxide (Librium), and meprobamate (Miltown).

transdisciplinary

Describing a team approach to the diagnosis and treatment of developmental disabilities. Such a team goes beyond the interdisciplinary model, in that one or more of the professionals on the team cross the traditional discipline boundaries. For example, both the pediatrician and the occupational therapist may assess and comment on a child's cognitive level. Thus, with the transdisciplinary approach, an individual professional can incorporate parts of the interdisciplinary team interaction.

transdisciplinary play-based assessment (TPBA)

A set of criterion-referenced informal assessment scales for children functioning developmentally between the ages of 6 months and 6 years. A videotaped play interaction session is scored by multiple professionals to observe four domains: cognitive, social-emotional, communication and language, and sensorimotor. The outcome focuses on intervention planning.

transduction

Reasoning by association. In psychology, reasoning from the particular to the particular, with co-occurrence being taken for a causal relationship.

transfer

A visual-perceptual motor milestone in which the infant can get both hands to the mid-line and pass a grasped object from one hand to the other; it is typically present by 5 months of age.

transfer

The modification that occurs in one behavior, resulting in changes in a similar behavior (i.e., transfer of learning), or a behavior reinforced in the presence of one stimulus event occurring in the presence of a different one (i.e., transfer of training).

transient tachypnea of the newborn (TTN)

Wet lung; a self-limited breathing disorder in newborns that typically has no long-term developmental sequelae.

transillumination

A method of examining the head of a newborn or young infant; a light source (either a cuffed flashlight or a high-intensity "Chun Gun") is placed against the baby's head in a darkened room and the amount of surrounding lucency (light transmission) is observed. A marked increase in craniolucency suggests underlying impairments such as hydrocephalus (excess fluid in the brain), subdural effusion (fluid under one of the meningeal layers), porencephaly, cerebral atrophy (wasting), or hydranencephaly (excess water on the brain due to an absence of cerebral hemispheres).

transitional feeding

A stage of infant feeding when breast milk and/or infant formula no longer adequately meets the child's nutritional needs and must be supplemented hy the introduction of smooth or semisolid food.

transitional object

An object that is transitional between mother and child, such as a security blanker or thumbsucking.

transverse plane

An anatomical plane that divides the body into an upper and a lower half.

transverse tongue reflex

An oral motor reflex innervated by cranial nerve XII, in which a tactile (touch) stimulus to the lateral (outside) surface of the tongue produces the response of tongue movement toward the side of the stimulus. This reflex is present by 7 months of gestation and disappears by 9 months of age.

trauma

A wound or injury.

trazodone

Trade name Desyrel; an anti-depressant that can be used in the treatment of aggressive behavior.

Treacher Collins syndrome

Mandibular dysostosis, Franceschctti-Zwahlen-Klein syndrome. An extremely variable genetic syndrome involving anomalies (malformation, deformation, disruption, or dysplasia) of structures embryologically derived from the first branchial arch. The dysmorphology (atypical features) spectrum includes malar hypoplasia (undergrowth of the midface with cheekbones flat or depressed), downslanting palpebral fissures (antimongoloid slant), lower-lid defects (e.g., absent lower eyelashes), a large fishlike mouth, a receding chin, and malformations of the external pinna (ear). Mental retardation is present in only 5% of cases, but learning disabilities occur in almost 50%; these latter may be due in part to chronic obstructive apnea (temporary cessation of breathing) in childhood. Neurocognitive impairments are more common in the presence of microcephaly (abnormally small head). Plastic surgery is usually indicated. Named after the British ophthalmologist Edward Treacher Collins (1862-1932). Inheritance follows an autosomal dominant pattern with 100% penetrance; 60% of cases are fresh mutations.

Treatment and Education of Autistic and Communications handicapped CHildren (TEACCH)

A North Carolina network of autism-related services that has published much research in autism.

tremor

Shaking, trembling; an extrapyramidal type of cerebral palsy whose chief characteristic is involuntary motor oscillations. This is exceedingly rare as an isolated finding and is most often part of a mixed cerebral palsy picture with rigidity.

Trendelenburg gait

Gluteus medius gait; a lurching gait associated with hip abnormalities and weaknesses of the abductor muscles on the involved side.

Trendelenburg sign

When a child stands on one leg, the opposite side of the pelvis should rise: when it falls, congenital hip dislocation or muscular weakness on the opposite side should be suspected.

triangular facies

A facial appearance associated with a number of different syndromes (e.g., Russell-Silver svndrome); the appearance results from disproportionate rates of growth of the calvarium (upper skull) and facial bones. Hydrocephalus (excess fluid in the brain) can contribute to a triangular facial appearance.

trichoglyphics

Patterning of hair follicles; usually expressed as hair whorl patterns. Abnormal trichoglyphics are associated with underlying abnormalities of brain development.

trichorrhexis nodosa

Poorly pigmented brittle hair found in some metabolic disorders.

trichosis

An abnormality of hair. See also hypertrichosis, hypotrichosis.

trichothiodystrophy

Brittle hair and sulfur deficiency seen in BIDS, IBIDS, and PIBIDS syndromes.

tricyclic antidepressant (TCA)

Drugs that block the re-uptake of the ncurotransmitters norepinephrine and serotonin in the brain, and thus alleviate depression in people without organic brain damage. Major side effects include sedation, heart problems, and tardive dyskinesia (slow, rhythmic automatic movements). These antidepressants can serve as second- and third-level drugs in the treatment of attention-deficit/hyperactivity disorder.

trigeminal nerve

The fifth cranial nerve; cranial nerve V provides sensation to the face and movement to the jaw for chewing.

trigonocephaly

A triangular-shaped skull with one of the apexes (extremities) of the triangle being the mid-forehead. It results from the premature fusion of the metopic suture (mid-forehead) and can contribute to the appearance of hypotelorism (decreased distance between the eyes). A cosmetic deformity, it rarely exhibits any developmental consequences. In the presence of a more generalized craniosynostosis (premature fusion of skull sutures) or microcephaly (abnormally small head), the risk of developmental disability would be increased.

trimester

A time period of 3 months. The term trimester is usually used when describing the thirds of a pregnancy. Common features and certain predictive pathologies (conditions) in the developing fetus are noted by their occurrence in the first, the second, or the third trimester of a pregnancy.

trimester bleeding

Maternal bleeding during pregnancy, indicating a potential problem with the pregnancy. First trimester bleeding (during the first 3 months of the pregnancy) is related more to problems with the baby (e.g., congenital defects leading to a threatened miscarriage), whereas third trimester bleeding (during the last 3 months of the pregnancy) suggests a problem with the placenta (e.g., previa or abruptio).

triplegia

Literally, "three paralysis"; a topographical subtype of spastic cerebral palsy in which three extremities (arms or legs) are seriously involved and one extremity is relatively spared. Most cases of triplegia represent the overlapping occurrence of a diplegia (paralysis on both sides of the body) with a hemiplegia (paralysis of half the body).

triploidy

The state of having three times the haploid number of chromosomes.

trisomy

The state of having three of a given chromosome instead of the usual pair. Trisomy 21, usually called Down syndrome, is an example.

trisomy 4p

A trisomy for all or most of the short arm of chromosome 4. A chromosomal disorder with growth deficiency, severe mental retardation, a peculiar facies, and seizures. Inheritance patterns are unclear; however, when the disorder is suspected, prenatal diagnosis can he made through chorionic villi sampling, amniocentesis, or percutaneous umbilical blood. Treatment is symptomatic for congenital defects and includes special education.

trisomy 8 mosaicism

A chromosomal disorder with a peculiar facies (thick lips, deep-set eyes, and jug-handle cars), mental retardation, and camptodactyly (permanent flexion of the fingers or toes). Inheritance patterns are unclear; however, when the disorder is suspected, prenatal screening from amniotic fluid in the second trimester is available. Treatment aims at correcting anatomical deformities and special education.

trisomy 9 mosaicism

A chromosomal disorder with severe mental retardation, growth deficiency, a peculiar facies, joint contractures, and congenital heart disease. Inheritance patterns are unclear; however, when the disorder is suspected, prenatal screening from amniotic fluid is available. Treatment aims at correcting anatomical deformities and includes special education.

trisomy 9p

A trisomy for all or part of the short arm of chromosome 9. A chromosomal disorder with mental retardation, growth deficiency, a peculiar facies, and short fingers and/or toes. Although rare, if a parent is a carrier of a balanced translocation, recurrence risks are high. When de novo (new) cases occur, there is no apparent recurrence risk. Treatment is symptomatic and includes special education.

trisomy 13 syndrome

Patau syndrome, D₁ trisomy syndrome. A chromosomal disorder secondary to the presence of an extra chromosome 13 (D group). Findings include microcephaly (abnormally small head), incomplete development of the forebrain, severe mental retardation, clefting, hyperconvex nails, and polydactyly (extra fingers or toes). Less than one child in five with this syndrome survives the first year of life. Advanced maternal age is a contributing factor in the occurrence of this syndrome. Incidence is estimated at 1 in 8,000. Although inheritance patterns are unclear, when the syndrome is suspected, prenatal diagnosis can he made through chorionic villi sampling or amniocentesis. Occasionally, ultrasound indications of a decreased ratio of head to trunk circumferences indicate the need for prenatal screening. Treatment is symptomatic.

trisomy 18 syndrome

Edwards syndrome, E trisomy. A chromosomal syndrome secondary to the presence of an extra chromosome 18 (E group). Findings include clenched hands with overlapping fingers, rocker-bottom feet, short sternum, heart disease, severe mental retardation, and failure to thrive (poor growth). Only 10% of children with this syndrome survive the first year of life. Incidence is noted as 1 in 3,000 births. Although inheritance patterns are unclear, when the syndrome is suspected, prenatal diagnosis can be made through amniocentesis by the second trimester. Occasionally, ultrasound indicates the need for prenatal screening. Advanced maternal age is a contributory factor in the occurrence of this syndrome. There is no treatment available.

trisomy 21

See Down syndrome (DS).

trochlear nerve

The fourth cranial nerve. Cranial nerve IV innervates one of the muscles of the eye; damage will produce mild convergent strabismus (squint), diplopia (double vision) or downward gaze, and a compensatory head tilt.

truancy

Unjustifiable absence from school without parental knowledge or consent. Unjustifiable absence with parental consent can lead to charges of educational neglect. Truancy and other forms of sociopathic behavior are common outcomes for children with attention-deficit/hyperactivity disorder (ADHD) or learning disabilities that are inadequately treated.

true negative rate

Specificity.

true positive rate

Sensitivity.

T-score

A standard score based on a distribution with a mean of 50 and a standard deviation of 10. The differential aptitude tests use this scale.

TTN

See transient tachypnea of the newborn.

tuberous sclerosis syndrome

Adenoma sebaceum, Bourneville disease, epiloia; a genetic neurocutaneous (of the nervous system and skin) syndrome of multiple raised skin lesions that may vary in color from white to yellow to brown (predominantly on the face), café an lait spots, renal (kidney) cysts, tooth enamel defects, mental retardation, and seizures resulting from growths in the cortex and white matter of the brain. Occasionally, malignant brain tumors occur. Incidence is estimated at between 1 in 10,000 and 1 in 50,000. Inheritance is autosomal dominant, with most cases (85%) representing de novo (new) mutations. Treatment includes anticonvulsants for seizures and surgery/plastic surgery for dermatological (skin) involvement.

Turner syndrome

XO syndrome; a genetic syndrome in girls with one X chromosome missing. It is characterized by short stature; pterygium colli (a webbed neck) with a low posterior (back) hairline; widely spaced nipples on a shield-shaped chest; congenital lymphedema with residual puffiness on the tops of the ringers and toes; and ovarian dysgenesis (failure of the ovaries to develop normally) leading to sexual infantilism with amenorrhea (lack of periods), infertility (sterility), and absent secondary sexual characteristics (e.g., lack of breast development). There is also cubitus valgus (an increased carrying angle at the elbows) and occasional other skeletal (50%). cardiac (35%), and renal (kidney) abnormalities (60%). Frequent abnormalities of the pinnae (earlobes) are associated with the presence of a progressive sensorineural (involving the inner ear or the auditory nerve) hearing loss that often does not begin until the second decade of life. There is an increased incidence of otitis (ear infections) contributing to decreased speech and language abilities; however, overall, girls with Turner syndrome have a low prevalence of speech-language disorders compared to the rate in other sex chromosome anomalies (malformation, deformation, disruption, or dysplasia). Mental retardation is rare (less than 10%), attention-deficit/hyperactivity disorder (ADHD) occurs, and there is a strikingly distinctive neuropsychological profile with disordered spatial function, poor right—left directionality, impaired shape copying, dysgraphia (impaired writing), dyscalculia (impaired mathematical skills), and lowered performance IQ scores. The brain localization for this pattern remains the subject of much debate. Most (95%) XO nondisjunctions are lethal early in gestation; many (40%) XO phenotypes (appearances) are mosaics. Turner syndrome is the only sex chromosome abnormality identifiable at birth. It was named after the American endocrinologist Henry Turner (1892-1970). Incidence occurs on the order of 1 in 5,000 births, or 1 in 2,500 phenotypic females; it is sporadic, with minimal recurrence risk. Prenatal diagnosis is available. Treatment is symptomatic, with recent focus on both growth hormone and cyclic estrogen replacement therapy to more completely normalize psychobiology for affected individuals. See also Noonan syndrome.

turribrachycephaly

See acrocephaly.

TVMS

See Test of Visual-Motor Skills.

TVPS

See Test of Visual-Perceptual Skills.

twin

Either of two offspring produced from one pregnancy. Two separate, abnormal conception processes can produce twins. Monozygotic twinning (mono meaning one) results from a single fertilized egg that duplicates itself. Although this duplication process occurs in all pregnancies, typically only one of the duplicates survives. The children resulting from this type of process are called identical twins. The second type of twinning process, dizygotic twinning (di meaning two), results from the production and fertilization of two separate eggs during the conception process. Both fertilized eggs are nurtured during a single pregnancy, resulting in fraternal twins. Fraternal twins can be either the same or opposite sex. Although most twin births produce typical children, twinning is nonetheless an atypical process in that the uterus of the human female is built for one fetus. Thus, many twin pregnancies are complicated by prematurity, infants smaller than expected for the length of the pregnancy, and a greatly increased number of birth complications including premature rupture of membranes, preeclampsia, toxicity, hypertension (high blood pressure), and fetal distress. In addition, one twin is usually smaller in utero and postnatally is much slower to grow. Twin pregnancies, therefore, are at greater risk for pre- and perinatal birth trauma leading to developmental disabilities.

two group approach

In the study of mental retardation, the careful separation of organic brain damage from cultural-familial retardation; the former group fits into a difference approach and the latter into a developmental approach. With the increasing identification of medical etiologies (causes) for people with mild mental retardation, this theory may receive increasing support, although with a significant reapportionment between the two groups.

two-point discrimination

A component of the neurological assessment of sensation; difficulty in discriminating whether the skin has been touched at one or two close points is interpreted as a sign of parietal lobe dysfunction.

TWS-2

See Test of Written Spelling-2.

tympanic membrane

The ear drum; a pearly gray glistening membrane with a triangular area of reflected light; the tympanic membrane is examined visually with an otoscope for signs of otitis media (middle-ear infection).

tympanic neurectomy

A surgical procedure that disrupts parasympathetic innervation to the parotid gland as a treatment for drooling. It is usually performed bilaterally and is combined with a chorda-tympani section.

tyrosinemia

An inborn error of metabolism in which the defect is in the metabolism of tyrosine. There are two types: 1) type 1, affecting liver, kidneys, and growth; and 2) type 2, or oculocutaneous tyrosinemia, causing mental retardation, microcephaly (abnormally small head), and corneal clouding.