If you can't find the definition on this page  : Glossarist


Ability-Achievement Discrepancy.
A substantial difference between a student’s anticipated achievement, as indicated by intellectual ability, and actual achievement.

Ability Grouping.
The grouping of students based on their achievement in an area of study.

Ability test.
A test that measures the extent to which an individual is capable of performing a task.

Absence Seizure.
A type of epileptic seizure in which the individual loses consciousness for a brief period of time.

Abstract reasoning.
The ability to understand relationships and react to concepts and symbols and not only to concrete objects.

Academic Classes.
Classes in basic subjects such as reading, arithmetic, science, and social studies at elementary level; and English, history, science, and math at secondary level.

Academic Plateau.
The tendency for students with special needs to reach a plateau in academic achievement during adolescence.

Acceleration.
Students may progress through the curriculum at an increased rate.

Accommodations.
Techniques and materials that allow individuals with LD to complete school or work tasks with greater ease and effectiveness. Examples include spell checkers, tape recorders, and expanded time for completing assignments.

Achievement.
The level of a child’s accomplishment in a specific knowledge or skill.

Achievement tests.
Tests that directly assess students' skill development in academic content areas. Achievement tests may be either (1) individually or group
administered; (2) screening or diagnostic in nature; (3) norm-referenced or criterion referenced; and (4) measure single or multiple skills.

Acquired Immune Deficiency Syndrome (AIDS).
Severe manifestation of infection with the human immunodeficiency virus (HIV). The Centers for Disease Control and Prevention lists numerous opportunistic infections and neoplasms which, in the presence of HIV infection, constitute an AIDS diagnosis. In addition, a CD4 count below 200/mm3 in the presence of HIV infection constitutes an AIDS diagnosis.

Acquisition.
The initial learning of information or skills.

Active Learning.
Learning experiences in which the students are physically active.

Active Student Response.
A frequency-based measure of a student’s active participation during instruction; assessed by counting the number of observable responses made to an ongoing academic situation.

Adaptive Behavior.
An individual’s ability to relate to others and cope with the demands of a given environment.

Adaptive Device.
Any piece of equipment designed to improve the function of a body part; also called Assistive Device.

Adaptive Learning Environments Model (ALEM).
Classroom and school management system based on individual learning styles. The Adaptive Learning Environments Model relies on adaptive instruction, in which a variety of instructional methods are adopted and tailored to the needs and learning characteristics of individual students.

Adaptive Physical Education.
A special physical education program developed to fit the abilities of persons with special needs.

Adult Protective Services (APS).
A cooperative program with local prosecutors that protects aged or disabled persons from abuse, neglect or exploitation.

Advanced organizers.
Information presented to students prior to an instructional task as a preview or overview.

Adventitious.
A disability that develops at any time after birth.

Advocate.
Someone with special expertise who represents the cause of a person with disabilities or group of people with disabilities, primarily in legal or administrative proceedings.

Affective disorder.
A broad term used to describe any disturbance involving an individual's emotions; i.e. depression.

Affective Education.
Study of emotions, identifying and dealing with them.

Affective Reactions.
Psychotic reactions marked by extreme mood swings.

Age-Based Norms.
Standards based on the average performance of individuals within an age group.

Agnosia.
A child’s inability to recognize objects and interpret their meaning; typically resulting from damage to the brain.

Agraphia.
The inability to recall kinesthetic writing patterns. The inability to write words or express thoughts in writing.

Albinism.
A congenital condition marked by deficiency in, or total lack of, pigmentation.

Amblyopia.
Amblyopia is a reduction in visual acuity without anatomic damage and usually not corrected solely by glasses. This condition is also called lazy eye. Two common forms of amblyopia are Refractive Amblyopia and Strabismic (eye turn) Amblyopia.

American Sign Language.
A visual-gestural language with its own rules of syntax, semantics and pragmatics; the standard form of sign language used in North America.

Americans with Disabilities Act (ADA).
A civil rights law prohibiting discrimination against people with disabilities in employment, state or local government services, public accommodations and public transportation.

Amniocentesis.
The insertion of a hollow needle through the abdomen into the uterus of a pregnant woman; used to obtain amniotic fluid so as to determine the presence of genetic and chromosomal abnormalities.

Amphetamines.
A group of drugs used to stimulate the cerebral cortex of the brain. Sometimes used to treat hyperactivity.

Amplification Device.
A device that increases the volume of sound.

Anecdotal Record.
An objective, descriptive procedure for recording and analyzing observations of a child’s behavior.

Anencephaly.
Congenital malformation of the skull indicating the absence of all or part of the brain.

Angular Gyrus.
The region of the brain responsible for executing cross-modal associations(i.e. vision and language, hearing and motor, etc.).

Annual goals.
It is the requirement of PL 94-142 that each learning disabled child's education program (IEP) contain annual goals. They are statements, in
measurable terms, of anticipated growth in a student's skill and knowledge as a result of participation in a least restrictive and appropriate educational setting.

Anoxia.
Deficient amount of oxygen in the tissues of a part of the body or in the bloodstream supplying such part.

Anomaly.
Some irregularity in development or a deviation from the standard.

Antecedent.
The event or condition that occurs immediately before a behavior of interest.

Antidepressants.
A class of drugs used to treat depression.

Anxiety.
An abnormal and overwhelming apprehension and fear often marked by physiological signs (i.e. sweating, increased pulse, breathing difficulty).

Aphasia.
The loss or impairment of the ability to comprehend, manipulate, and/or express words in speech, writing or gesture. Usually associated with injury ordisease to the brain centers that control these processes.

Applied Behavior Analysis.
A method aimed at improving socially significant behavior through application of specific psychological principles.

Apraxia.
Problems with voluntary or purposeful muscular movement with no evidence of motor impairment.

Aptitude Test.
A test designed to measure a person's ability to learn and the likelihood of success in future school work or in a specific career.

Aqueous Humor.
Fluid that occupies the space between the lens and the cornea of the eye.

Articulation.
The production of speech sounds resulting from the operation of the vocal organs.

Articulation disorders.
Any disorder or defect in the production of the sounds of language. Refers to the intelligibility of a person's speech. Articulation disorders are considered to be the most common of all speech disorders in school age children and are usually four basic types: 1. omissions; 2. substitutions; 3. distortions; and 4. additions.

Assessment.
The process by which information is gathered about students in order to make educational decisions. It includes both formal testing and observation and is an evaluative, interpretative appraisal of a student's performance in several settings.

Assistive Technology.
Equipment that enhances the ability of students and employees to be more efficient and successful. For individuals with LD, computer grammar checkers, an overhead projector used by a teacher, or the audiovisual information delivered through a CD-ROM would be typical examples.

Association.
Ability to relate concepts presented through the senses (visual, auditory, tactile, or kinesthetic)

Astigmatism.
Blurred vision as the result of an irregular cornea or lens.

Asynchronous Development.
Differing rates for physical, cognitive, and emotional development, also known as dyssynchronous development. For example, a gifted child may be
chronologically 13 years old, intellectually 18, emotionally 8, and physically 11. The discrepancies are greatest for everyone at the chronological age of about 13, but the extremes displayed by gifted children have led some experts to define giftedness itself as asynchronous development. If you tell a gifted child to "Act your age!" s/he could legitimately respond: “Which one?”

At Risk.
General education students who show poor achievement and are likely to drop out of school.

Ataxia.
Poor sense of balance and lack of coordination of the voluntary muscles.

Athetoid Cerebral Palsy.
About 10 percent of children with cerebral palsy have athetoid cerebral palsy. Athetoid cerebral palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are responsible for processing the signals that enable smooth, coordinated movements as well as maintaining body posture. Damage to these areas may cause a child to develop involuntary, purposeless movements, especially in the face, arms, and trunk. These involuntary movements often interfere with speaking, feeding, reaching, grasping, and other skills requiring coordinated movements. For example, involuntary grimacing and tongue thrusting may lead to swallowing problems, drooling and slurred speech. The movements often increase during periods of emotional stress and disappear during sleep. In addition, children with athetoid cerebral palsy often have low muscle tone and have problems maintaining posture for sitting and walking.

Atrophy.
The degeneration of tissue.

Attention deficit hyperactivity disorder (ADHD).
A term used in psychiatric classification systems to describe individuals who show poor attention, impulsivity, and sometimes hyperactivity.

Attention Span.
The length of time an individual can concentrate on a task without being distracted or losing interest.

Audiologist.
Assesses hearing acuity and provides services for auditory training; advises on devices for hearing amplification.

Auditory memory.
The ability to recall words, digits, etc., in a meaningful way; the ability to recall and repeat a sequence of symbols correctly.

Auditory discrimination.
The ability to identify and choose correctly between sounds of different pitch, volume, and pattern. For example, the ability to distinguish between the b and d sounds in the words bad and dad.

Auditory sequential memory.
The ability to recall information presented in the specific order in which it was heard.

Automaticity.
The ability to automatically recall specific rote-memory facts within a brief period of time.

Basal age. The highest level (usually in terms of years and months) on a given test (intelligence, achievement, diagnostic) at and below which the individual passes all items.

Baseline Data.
An objective measure used to compare and evaluate the results obtained during some implementation of an instructional procedure.

Basic sight vocabulary.
A list of words that the student recognizes as a whole without having to decode them.

Behavior disorder.
A broad term that usually includes typical categories of emotional disturbance and social maladjustment.

Behavior modification.
An approach based on the principles of behaviorism (John Watson and B.F. Skinner). It is concerned with behavior that is observable and measurable, and focuses upon the individual's past and present surroundings. It is based on the assumption that behavior is learned and it is possible to change almost any behavior by altering the individual's environment.

Binaural.
The two ears acting together, as in normal hearing.

Bilingual Special Education
The use of a child’s dominant/native language (other than English) in order to provide special education services.

Binocularity.
Using both eyes together as a team-smoothly, equally and accurately.

Binocular Fusion
The blending of separate images from each eye into a single meaningful image.

Binocular Vision
Vision using both eyes working together to perceive a single image.

Biofeedback.
The control of various internal processes, such as brain weaves, heart rate, and so on, through training/conditioning.

Body Image.
The concept and awareness of one's own body as it relates to space, movement, and other objects.

Borderline intelligence. Functioning in the range of one to two standard deviations below the mean on an intelligence test.

Braille.
A system of writing letters, numbers, and symbols with a combination of six raised dots for the purpose of communicating written media to the blind.

Brain Based Teaching.
Application of research from neurology and clinical and cognitive psychology to design and orchestrate lifelike learning experiences that exercise:

the ability to detect patterns and make approximations,
the capacity for various types of memory,
the ability to self-correct and learn from experience through analysis of data
and self-reflection, and
the inexhaustible capacity to create,
so as to optimize the extraction of meaning for the individual learner. Brain
based teaching incorporates integrated curriculum, and is built on these
principles:

The brain is a parallel processor.Learning engages the entire physiology.
The search for meaning is innate in human nature.
The search for meaning occurs through patterning.
Emotions are critical to patterning.
The brain processes parts and wholes simultaneously.
Learning involves both focused attention and peripheral perception.
Learning always involves conscious and unconscious processes.
We have at least two different types of memory: a spatial memory system
and a set of systems for rote learning.
We understand and remember best when facts and skills are embedded in natural, spatial memory.
Learning is enhanced by challenge and inhibited by threat.
Each brain in unique.

Brain Damage.
Any actual structural damage on brain tissue due to any cause.

Brain Imaging Techniques.
Recently developed, noninvasive techniques for studying the activity of living brains. Includes brain electrical activity mapping (BEAM), computerized axial tomography (CAT), and magnetic resonance imaging (MRI).

Brain Injury .
The physical damage to brain tissue or structure that occurs before, during, or after birth that is verified by EEG, MRI, CAT, or a similar examination, rather than by observation of performance. When caused by an accident, the damage may be called Traumatic Brain Injury (TBI).

Brain Lateralization.
Specialization of the brain hemispheres. In right handed people, the right brain hemisphere is more involved with spatial relations, imagery, and non-verbal, non-sequential processing, while the left brain hemisphere is more involved in verbal and sequential processing.

Career education.
A comprehensive effort designed to provide students with the knowledge, skills, and attitudes to problems of daily life, independent living, and vocational independence.

CAT Scan (Computerized Axial Tomography Scan ).
A radiological technique used to examine the structure of the brain. X-rays are sent through the brain at different angles, and the images are
computerized to form a picture of the brain’s structure from any angle.

Cataract.
A reduction or loss of vision that occurs when the lens of the eye becomes cloudy or opaque.

Catastrophic Reaction.
Extreme terror, grief, frustration, or anger without apparent cause. May be triggered by changes in routine, unexpected events, or over stimulation. Children reacting in this manner may throw or break things, scream uncontrollably, or burst into tears.

Ceiling.
Refers to the maximum score attainable on a test.

Ceiling Effect.
Compression of top scores on a test. For example, if a group IQ test can only measure reliably to 130, then a student with an IQ of 160 (if measured by some other test) may only score 130 due to the ceiling effect of the group test. Group intelligence tests often have low ceilings, so a relatively low IQ score, perhaps 115, could be accepted as evidence of potential giftedness.

Central Nervous System (CNS).
The brain and spinal cord.

Cerebral Cortex.
The outer layer of the brain; controls thinking, feeling, and voluntary movement.

Cerebral Palsy. (Also See Athetoid and Spastic Cerebral Palsy)
Cerebral palsy is an umbrella-like term used to describe a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. The disorders are caused by faulty development of or damage to motor areas in the brain that disrupts the brain's ability to control movement and posture. Symptoms of cerebral palsy include difficulty with fine motor tasks (such as writing or using scissors), difficulty maintaining balance or walking, involuntary movements. The symptoms differ from person to person and may change over time. Some people with cerebral palsy are also affected by other medical disorders, including seizures or mental impairment, but cerebral palsy does not always cause profound handicap. Early signs of cerebral palsy usually appear before 3 years of age. Infants with cerebral palsy are frequently slow to reach developmental milestones such as learning to roll over, sit, crawl, smile, or walk. Cerebral palsy may be congenital or acquired after birth. Several of the causes of cerebral palsy that have been identified through research are preventable or treatable: head injury, jaundice, Rh incompatibility, and rubella (German measles). Doctors diagnose cerebral
palsy by testing motor skills and reflexes, looking into medical history, and employing a variety of specialized tests. Although its symptoms may change over time, cerebral palsy by definition is not progressive, so if a patient shows increased impairment, the problem may be something other than cerebral palsy.

Channel.
The routes through which the content of communication flows. It includes both the modalities through which impression is received and the form of expression through which the response is made. Ex: Auditory--Vocal Channel.

Child find.
Requirement that states ensure that all children with disabilities are identified, located and evaluated, and determine which children are receiving special education and related services

Child Study Committee.
Is located in each school building to receive and act upon referrals of students suspected of being handicapped. The membership of this
committee usually consists of at least three persons, including the school principal or a person chosen by the principal, the teacher or teachers, specialists, and the referring source if appropriate.

Child Psychiatrist.
Medical doctor who specializes in the behavior and emotional aspects of infants, children, and adolescents and may prescribe medication as
necessary.

Chorion Villus Sampling (CVS).
A procedure for prenatal diagnosis of chromosomal abnormalities that can be conducted during the first eight to ten weeks of pregnancy

Cleft Palate.
A congenital, reparable split in the palate that affects one’s articulation and speech.

Clinical Psychologist.
Provides psychological and intellectual assessment and addresses issues relating to an individual's mental and emotional health.

Cloze.
A method suggested by Bormuth for determining readability. The teacher selects a passage of 150 words of continuous writing in which every fifth word is omitted (clozed). In its place is a blank line. Since every fifth word is deleted, there will be fifty clozures in the 250 word passage. Each student's response counts for two percentage points (exact words must be given.) Independent reading levels (58-100 percent correct), instructional reading levels (44-57 percent), and frustration levels (43 percent or below) are established for the students.

Coaching.
An instructional method in which a teacher supports students as they perfect old skills and acquire new skills.

Cochlea.
The main receptor organ for hearing located in the inner ear.

Cognitive.
Refers to mental processes such as memory, judgment, and reasoning.

Cognitive Ability.
Intellectual ability; thinking and reasoning skills.

Cognitive Science.
A science investigating how people learn rather than what they learn. Prior knowledge and out-of-classroom experience help form the foundation on which teachers build effective instruction. Also referred to as the study of the mind.

Cognitive Style.
A person s typical approach to learning activities and problem solving. For example, some people carefully analyze each task, deciding what must be done and in what order. Others react impulsively to situations.

Cognitively Guided Instruction.
An instructional strategy in which a teacher assesses what students already know about a subject and then builds on students' prior knowledge. Students typically are asked to suggest a way to represent a real problem posed by the teacher. Guided questions, encouragement and suggestions further encourage students to devise solutions and share the outcome with the class.

Collaboration.
A program model in which the LD teacher demonstrates for or team teaches with the general classroom teacher to help a student with LD be successful in a regular classroom.

Comorbidity.
The coexistence of two or more different disabilities in the same child.

Compacting.
Eliminating repetition, minimizing drill, and accelerating instruction in basic skills or lower level classes so that gifted students can move to more challenging material.

Compensation.
Process in which a person is taught how to cope with his learning problems, how to work around skills or abilities which may be lacking; emphasis is placed on using the individual's strengths. (See Remediation.)

Conceptualization.
The process of forming a general idea from what is observed. For example, seeing apples, bananas, and oranges and recognizing that they are all fruit.

Conceptual Disorder.
Disturbances in thinking, reasoning, generalizing, memorizing.

Conductive Hearing Loss.
Hearing loss caused by obstructions in the outer or middle ear or malformations that interfere with the conduction of sound waves to the inner
ear.

Confabulation.
The act of replacing memory loss by fantasy or by some reality that is not true for the occasion.

Confidential File.
File maintained by the school; contains evaluations conducted to determine whether a child is handicapped, as well as any other information related to special education placement. This is a Limited access file; however, parents do have a right to inspect the file and have copies of any information contained in it.

Configuration.
The visual shape or form of words; may be used as a cue in word-attack skills.

Congenital.
A condition existing at birth or before birth. Congenital does not imply that a condition is hereditary.

Consent.
Requirement that the parent be fully informed of all information that relates to any action that school wants to take about the child, that parent understands that consent is voluntary and may be revoked at any time. See also Procedural safeguards notice and prior written notice.

Consonant digraph.
A combination of two consonants producing a single sound.

Consultation.
Method of servicing children with learning disabilities in which the learning disabilities specialist does not take direct responsibility for teaching the child, but rather provides consultation to the mainstream teacher on educational strategies for the child.

Contingency contract.
A written agreement between a student and a teacher that states what the student must do to earn a specific award.

Contingent Observation.
A type of time-out procedure in which a student is removed from a reinforcing event and can watch but not particiape.

Continuum of Services.
The range of different educational placement options that a school district can use to serve children with disabilities; range from least restrictive to most restrictive.

Continuous reinforcement.
A principle of behaviorism. A schedule by which a reinforcement is given after each response.

Control Group.
In an experiment, those subjects to whom no experimental stimulus is administered, but who resemble members of the experimental group in all respects.

Controlled Substance.
Means a drug or other substance identified under schedules I, II, III, IV, or V of the Controlled Substances Act; does not include a substance that is legally possessed or used under the supervision of a licensed health care provider.

Convergence.
The pointing mechanism by which the eyes are pointed or aimed at a specific target. The mechanism that allows an individual to see a single object at varying distances.

Cooperative learning.
Students work together as a team to complete assignments or activities.

Coordination
The harmonious functioning of muscles in the body to perform complex movements.

Cornea.
The transparent part of the eye that admits light to the interior.

Correlation.
Tendency for two or more variables to change values at the same time. The degree of relationship between or among variables or factors. Evidence of correlation is not necessarily evidence of causation.

Cranial.
Refers to the cranial nerves that control facial movements, such as eye movement, and sensory organs.

Creativity.
The ability to generate novel solutions to specific problems.

Cretinism.
A congenital condition associated with a thyroid deficiency that can result in stunted physical growth and mental retardation.

Cri-du-chat Syndrome.
A chromosomal abnormality resulting from deletion of material from the fifth pair of chromosomes, typically resulting in severe retardation.

Criterion-Based Assessment.
An assessment that measures what a student understands, knows, or can accomplish in relation to specific performance objectives. It is used to identify a student's specific strengths and weaknesses in relation to skills defined as the goals of the instruction, but it does not compare students to other students.

Criterion.
A standard selected as the goal to be achieved in a given test.

Criterion-reference test.
An informal assessment tool that measures whether students have mastered the educational goals stated in instructional objectives.

Cross-Categorical.
Refers to a system in which a teacher addresses more than one handicapping condition within one instructional period.

Cross Dominance
A condition in which the preferred eye, hand, or foot are not on the same side of the body. For example, a person may be right-footed and right eyed but left-handed. Also called mixed dominance.

Crossing the mid-line.
Refers to the movement of the eyes, a hand, or a foot and leg across the midsection of the body without involving any other part of the body....without the individual turning the head.

Cued Speech.
A method of supplementing oral communication through eight different hand signals in four different locations near the chin.

Cultural Pluralism.
The value and practice of respecting, fostering, and encouraging the cultural and ethnic differences that make up society.

Cultually and lingistically diverse students.
Students whose home cultures (and perhaps languages) differ from that of the school. Such students may require special assistance to succeed in general education.

Culture.
The established knowledge, ideas, values, and skills shared by a society.

Culture free assessment.
Measurement tools that are designed to control for cultural influences or biases.

Cumulative Deficit.
The tendency for a deficit between achievement and grade placement to accumulate over the years of school such that secondary students with disabilities demonstrate much larger deficits than students in the lower grades with the same disabilities.

Cumulative File.
General file maintained by the school for any child enrolled in the school. Parents have a right to inspect the file and have copies of any information contained in it

Curriculum-based assessment.
The teacher uses the student's current classroom performance to determine educational needs.

Curriculum Compacting.
Eliminating repetition, minimizing drill, and accelerating instruction in basic skills or lower level classes so that gifted students can move to more challenging material.

Cyanosis.
A lack of oxygen in the blood characterized by a blue discoloration of the skin.

Cystic fibrosis.
A hereditary disease characterized by chronic respiratory and digestive problems. Caused by a generalized dysfunction of the endocrine glands.

Dactylogy.
Finger spelling

Data-driven decision making.
A process of making decisions about curriculum and instruction based on the analysis of classroom data and standardized test data. Data-driven decision making uses data on function, quantity and quality of inputs, and how students learn to suggest educational solutions. It is based on the assumption that scientific methods used to solve complex problems in industry can effectively evaluate educational policy, programs, and methods.

Deaf.
A hearing loss so severe that speech cannot be understood aurally, even with a hearing aid; some sounds may still be perceived.

Decibel (dB).
The unit of measure for the relative intensity of sound on a scale beginning at zero; zero dB refers to the faintest sound a person with normal hearing can detect.

Deciduous teeth.
The first set of teeth.

Declassification.
The process in which a disabled child is no longer considered in need of special education services. This requires a meeting of the CSE and can be requested by the parent, school, or child if over the age of eighteen.

Decoding.
The process of getting meaning from written or spoken symbols.

Deinstitutionalization.
The social movement to transfer individuals with disabilities, especially persons with mental retardation, from large institutions to smaller, community-based settings.

Delusion.
A groundless, irrational belief or thought, usually of grandeur or of persecution; generally a characteristic of paranoia.

Denasality.
Voice disorder caused by too little air escaping through the nose and/or a lack of resonance in the voice.

Dendrites.
The connective tissue that connects one neuron to another.

Denial.
A defense mechanism in which the individual refuses to admit the reality of some unpleasant event, situation, or emotion.

Departmentalized Curriculum.
An approach in which subject areas in schools are taught by different departments or groups of teachers, resulting in the need to change classes and teachers for each subject.

Depth perception.
Judging relative distances of objects, how far or near they are.

Desensitization.
A technique used in reinforcement theory in which there is a weakening of a response, usually an emotional response

Desktop publishing program.
Allows the manipulation of text and graphics.

Developmental Aphasia.
A severe language disorder that is presumed to be due to brain injury rather than because of a developmental delay in the normal acquisition of language.

Developmental Lag
A delay in some aspect of physical or mental development.

Developmental reading.
Reading instruction that is designed to teach reading skills systematically.

Dexedrine.
Trade name for one of several stimulant drugs often given to modify hyperactivity in children.

Diabetes.
A metabolic disorder in which the pancreas is unable to produce a sufficient supply of insulin to enable the body to utilize adequately glucose or sugar.

Diabetic Retinopathy.
Visual impairment caused by hemorrhages on the retina and other disorders of blood circulation in people with diabetes.

Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV).
A classification system published by the American Psychiatric Association for identifying various kinds of disorders in children.

Dilantin.
An anticonvulsant drug commonly prescribed to control epilepsy and other convulsive types of disorders.

Diplegia.
Paralysis of all four extremities, with greater involvement of the lower limbs.

Direct Instruction.
An instructional approach to academic subjects that emphasizes the use of carefully sequenced steps that include demonstration, modeling, guided practice, and independent application.

Direct teaching.
The instructor demonstrates a task, reinforcement is provided for maximum learning, and a system of feedback is provided.

Directionality.
The ability to know right from left, up from down, forward from backward, and direction and orientation.

Disassociation.
The inability of an individual to perceive or see things as a whole.

Discrimination learning.
The process of identifying or detecting differences between or among objects, sounds, symbols, etc.

Discovery Method.
A variety of student-centered approaches to teaching, including the Socratic method, in which the teacher acts as a guide and/or resource. Unlike programmed instruction, the emphasis is not on efficiency in mastering a predetermined body of knowledge, but in developing students' abilities to learn how to learn. Discovery is an assumed method in unschooling.

Disinhibition.
Lack of restraint in responding to a situation. A child exhibiting disinhibition reacts impulsively and often inappropriately.

Distance Acuity.
Clearly seeing, inspecting, identifying and understanding objects viewed at a distance.

Distance Learning.
Using technology such as two-way, interactive television, teacher and student(s) in different locations may communicate with one another as in a regular classroom setting.

Distractibility.
An inability to direct or sustain attention to appropriate stimuli in the environment.

Divergent thought.
Manufacturing several solutions to one problem.

Dolch list.
A listing of 220 words that is broadly used as a basic sight vocabulary list which students are required to learn in order to read at the elementary level.

Double-blind technique.
A technique in which neither the subject nor the experimenter knows whether or not a specific treatment approach has been administered or what the specific treatment approach is.

Down's syndrome.
A condition resulting from a chromosomal defect or abnormality.

Duchenne disease.
Childhood form of muscular dystrophy. A hereditary disorder found exclusively in males. Onset is usually around 2-3 years of age with a
progressive deterioration of muscles, death commonly occurring during the teen-age years.

Due Process.
The application of law to ensure that an individual's rights are protected. When applied to children with learning disabilities, due process means that parents have the right to request a full review of any educational program developed for their child. A due process hearing may be requested to ensure that all requirements of Public Law 94-142 have been met.

Duration recording.
Recording observation data in which the length of time a behavior takes place is noted.

Dysarthria.
A disorder of the speech muscles that affects the ability to pronounce words.

Dyscalculia.
Impaired ability to deal with numerical symbols or simple arithmetic calculations.

Dysfluency.
Interferences or hesitations in the normal flow of speech patterns.

Dysfunction.
Any disturbance or impairment in the normal functioning of an organ or body part.

Dysgraphia.
The partial inability to express ideas by means of writing.

Dyslexia.
The partial inability to read or to make sense out of what is read silently or aloud.

Dysnomia.
Difficulty in remembering names or recalling appropriate words to use in a given context.

Dysorthographia.
A learning disability that affects a child’s ability to spell

Dyspraxia.
The partial loss of ability to perform coordinated movements.

Early intervention (EI).
Special education and related services provided to children under age of 5

Early Intervention Program.
A program specially designed to assist developmentally delayed infants and preschool children. The purpose of this type of program is to help prevent problems as the child matures.

Echolalia.
The repetition of a sound, word, or sentence spoken.

Educable Mentally Retarded.
An educational classification label for an individual whose IQ is between 50 and 70.

Education records.
All records about the student that are maintained by an educational agency or institution; includes instructional materials, teacher’s manuals, films, tapes, test materials and protocols.

Educational Consultant/Diagnostician.
An individual who may be familiar with school curriculum and requirements at various grade levels: may or may not have a background in learning disabilities; may conduct educational evaluations.

Educational Evaluation.
One of the components necessary to determine whether a child is handicapped. Although the specific content of an educational evaluation is
not specified by the regulations, the evaluation generally consists of a battery of tests and/or classroom observation and analysis of class work designed to determine the current levels of achievement in areas such as reading, math, spelling, etc. Perceptual abilities and learning style may also be evaluated.

Educational Psychologist.
Administers and interprets psychological and educational tests, interprets behavior, and consults with parents around educational issues.

Educational Therapist.
Assesses, develops, and implements appropriate remedial programs for learning and behavior problems.

Electroencephalogram (EEG).
A graphic recording of electrical currents developed in the cerebral cortex during brain functioning. Sometimes called a Brain wave test." A machine called an electroencephalograph records the pattern of these electrical
currents on paper.

Eligibility Committee.
Determines (1) whether a child has a handicapping condition which requires special education and, in some cases, related services such as speech and language therapy; (2) identifies the handicapping condition and recommends the special education services (and, where needed, related services) that are needed. It is composed of the special education administrator or a person representing the administrator and school division personnel representative of the disciplines involved in the conduct of the evaluation (e.g., psychologist, educational diagnostician). At least one school division representative must be a person who tested or observed the student.

Emotional Disturbance.
PL 94-142 Definition.Seriously Emotionally Disturbed: The term means a condition exhibiting one
or more of the following characteristics, over a long period of time and to a marked degree, which adversely affects educational performance:
a. An inability to learn which cannot be explained by intellectual, sensory, or
health factors;
b. An inability to build or maintain satisfactory interpersonal relationships with
peers and teachers;
c. Inappropriate types of behavior or feelings under normal circumstances;
d. A general pervasive mood of unhappiness or depression; or
e. A tendency to develop physical symptoms or fears associated with
personal or school problems.

Emotional Shutdown.
A psychological defense mechanism characterized by withdrawal. A gifted student in a hostile or anti-intellectual environment may react this way.

Encephalitis.
Inflammation of the brain; may cause permanent damage to the central nervous system and mental retardation.

Encoding.
The process of expressing language (i.e., selecting words; formulating them into ideas; producing them through speaking or writing). (See Expressive Language)

Encopresis.
A lack of bowel control that may also have psychological causes

Enuresis.
A lack of bladder control that may also have psychological causes.

Epilepsy.
A convulsive disorder of the central nervous system. Types: Grand Mal, Petit mal, Jacksonian, Psychomotor, Momentary.

Equal Protection Under the Law
Legal concept included in the 14th Amendment to the Constitution of the United States, stipulating that no state may deny any person equality or liberty because of that person’s classification according to race, nationality, or religion. Several major court cases leading to the passage of the Individuals with Disabilities Education Act found that children with disabilities were not provided with equal protection if they were denied access to an appropriate education solely because of their exceptionality.

Equity.
The state of educational impartiality and fairness in which all children—minorities and nonminorities, males and females, successful students and those who fall behind, students with special needs and students who have been denied access in the past—receive a high-quality education and have equal access to the services they need in order to benefit from that education.

Error analysis.
The study of student work samples to determine error patterns.

Esotropia.
Deviation of the eye towards the nose.

Ethnocentrism.
The view that the practices of one’s own culture are natural and correct, while perceiving the practices of other cultures as odd, amusing, inferior, and/or immoral.

Etiology.
Cause. Diseases or disorders are frequently characterized according to their etiology.

Event recording.
Counting the number of times a behavior occurs.

Evoked-Response Audiometry.
A method of testing hearing by measuring the electrical activity generated by the auditory nerve in response to auditory stimulation; often used to measure the hearing of infants and children considered difficult to test.

Executive Function.
A term used by cognitive psychologists to describe a person’s thinking about his/her learning process (metacognition).

Exhibition of mastery.
A type of assessment in which students display their grasp of knowledge and skills using methods such as skits, video presentations, posters, oral presentations, or portfolios.

Exogenous.
Refers to a cause of a disability or impairment that stems from factors outside the body such as disease, toxicity, or injury.

Experimental group.
Subjects to whom some experimental stimulus is presented. For example: a specific method of learning how to multiply is presented that is not administered to another group (control group).

Expressive Language.
Communication through writing, speaking, and/or gestures.

Expressive language disabilities.
Inability of the student to express him/her self verbally.

Extinction.
A principle of behaviorism whose purpose is to bring about a decrease in a specific behavior. Reinforcers are removed that have previously followed the targeted behavior.

Eye coordination.
The ability to focus both eyes on a single image.

Eye-Hand Coordination.
The ability of the eyes and hands to work together to complete a task. Examples are drawing and writing.

F Test.
A test of variance between two samples under investigation to determine whether the difference could be due to chance.

Face validity.
Refers to the acceptability of the test by the user in relation to the use to which the test is to be applied.

Facial apraxia.
The inability, or severely impaired ability, voluntarily to move facial muscles in the absence of weakness or paralysis of the muscles.

Facilitated Communication (FC).
A type of augmentative communication in which a facilitator provides assistance to someone in typing or pointing to vocabulary symbols.

Fading.
An operant conditioning technique. Gradually taking away the stimulus so that the targeted behavior operates independently.

FAPE.
Free appropriate public education; special education and related services
provided in conformity with an IEP; are without charge; and meets standards
of the SEA.

Far Point Copying.
Writing while copying from a model some distance away, e.g., copying from
the blackboard.

Fernald Reading Method.
With the goal of teaching literacy skills, a word that a student wishes to learn how to read or write is written on a large card by a teacher. The student traces over and says the word three times. The student then writes the word from memory.

FERPA.
Family Educational Rights and Privacy Act; statute about confidentiality and access to education records.

Fetal Alcohol Effects (FAE).
Term used to identify the suspected etiology of developmental problems experienced by infants and toddlers who have some, but not all, of the diagnostic criteria for fetal alcohol syndrome and have a history of prenatal alcohol exposure.

Fetal Alcohol Syndrome (FAS).
A condition involving low birth weight, developmental delay, and cardiac, limb, and other physical defects; caused by excessive alcohol use during pregnancy. A child is diagnosed with FAS when two or more craniofacial malformations are present and growth is below the 10th percentile for height and weight. One of the leading known causes of mental retardation, many children with FAS have neurological damage that contributes to cognitive and language delays.

FCLD.
Foundation for Children with Learning Disabilities. (Now known as NCL~~The National Center for Learning Disabilities.)

Field of Vision.
The expanse of space visible with both eyes looking straight ahead, measured in degrees; 180 degrees is considered normal.

Figure-ground.
One part of a perceptual configuration stands out while the remainder forms a background. Some people have difficulty in separating the configurations which may cause academic problems.

Fine Motor
The use of small muscles for precision tasks such as writing, tying bows, zipping a zipper, typing, doing puzzles.

Fingerspelling.
A method of communication used by the deaf and the severely hearing impaired.

Fixation.
Quickly and accurately locating and inspecting a series of stationary objects, such as words while reading.

Fluency.
A performance measure that includes both the accuracy and the rate with which a skill is performed; the term is also used to refer to the rate and smoothness of a student’s oral reading and speech skills.

Fluency disorders.
A type of speech disorder characterized by an excessive number of interruptions in the fluency of one's speech.

Flynn Effect.
A rise in IQ of the general population of about 3 points per decade, discovered by James Flynn of New Zealand in the early 1980's. If true, the
average person of 100 years ago would be considered retarded today. A variety of explanations have been offered, either explaining the rise as an artifact of testing or as a real increase in intelligence, but no explantion has gained widespread acceptance. To compensate for the IQ increase, test makers select a new sample for the norm reference on their tests about every ten years

Focus Change.
Looking quickly from far to near and back without blur.

Fonator.
A device used by the hearing impaired to help them hear and learn speech. For an example visit: www.springerlink.com

Fragile X.
What is Fragile X syndrome? Fragile X syndrome is the most common inherited cause of mental impairment, affecting approximately 1 in 3,600 males and 1 in 4,000 to 6,000 females with the full mutation worldwide. It is estimated that 1 in 250 females and 1 in 700 males are carriers of the premutation.It is second only to Down Syndrome as a cause of mental retardation. Both males and females may be affected by a wide variety of symptoms.Fragile X syndrome appears in children of all ethnic, racial and socio-economic backgrounds.

Free Appropriate Public Education (FAPE).
Term used in P.L. 94-142 to mean special education and related services that are provided at public expense and conform to the state requirements and to the individual’s IEP.

Frontal Lobe.
A section of the cerebrum that controls abstract thinking,

Functional Analysis.
Refers to a variety of behavior assessment methodologies for determining the environmental variables that adversely affect behavior.

Functional Communication.
A child’s ability to communicate in his/her environment.

Functional MRI.
A version of magnetic resonance imaging that measures blood flow and can show the activity of the brain during a specific task.

Functional-Skills Education.
A model of instruction for students with special needs that stresses functional life skills rather than academic subjects.

Generalization.
The process of forming an idea that applies to a broad range of related topics. Also, refers to transferring behavior to other settings.

Generalized Tonic-Clonic Seizure.
The most severe type of seizure, in which the individual has violent convulsions, loses consciousness, and becomes rigid. Formerly called Grand Mal Seizure.

Genetic Counseling.
A discussion between a specially trained medical counselor and persons who are considering having a baby about the chances of having a baby with a disability, based on the prospective parents’ genetic backgrounds.

Gestalt.
Perceiving of a total object while at the same time observing its component parts and their relationship to each other.

Gifted.
Having superior mental ability or intelligence. A label of potential. The intellect and emotions of gifted students are both quantitatively and
qualitatively different.

Glaucoma.
A condition in which there is excessive internal pressure on the eyeball, causing a hardening of the eyeball.

Grade equivalent.
The method indicating what a given raw score represents in relation to average school achievement.

Grade norm.
The average scores on a given test made by a group of pupils at a given grade level.

Grand Mal Seizure.
See Generalized Tonic-Clonic Seizure.

Graphic Organizer.
Pre-made graphic outline used to organize general information and ideas

Gross Motor.
Skills in which groups of large muscles are involved.

Group Home.
A community-based residential alternative for adults with disabilities, most often persons with mental retardation, in which a small group of people live together in a house with one or more support staff.

Group-Oriented Contingency.
A type of behavior management and motivation procedure in which consequences (rewards and/or penalties) are applied to the entire group or class of students and are contingent upon the behavior of selected students or the entire group.

Guardian ad litem.
Person appointed by the court to represent the rights of minors.

Guided Notes.
A handout that guides students through a lecture, presentation, or demonstration by providing a format that includes basic information and cues students to note key points.

Habilitation.
The process of improving an individual's performance in a given area.

Handicapped.
Any person with any physical and/or mental disability who has difficulty in doing certain tasks such as walking, seeing, hearing, speaking, learning, or working. Federal law defines handicapped children as those who are
mentally retarded, hard of hearing, deaf, speech impaired, visually handicapped, seriously emotionally disturbed, orthopedically impaired, other health impaired, blind, multi-handicapped, or as having specific learning disabilities and who require special educational services because of these disabilities.

Hands-on/minds-on activities.
Activities that engage students' physical as well as mental skills to solve problems. Students devise a solution strategy, predict outcomes, activate or perform the strategy, reflect on results, and compare end results with predictions.

Haptic Sense.
Combined kinesthetic and tactile sense.

Hard of Hearing.
Level of hearing loss that makes it difficult, although not impossible, to comprehend speech through the sense of hearing alone.

Hearing Impaired.
Describes anyone who has a hearing loss significant enough to require special education, training, and/or adaptations; includes both deaf and hard-of-hearing conditions; generally referred to as an auditory impairment.

Hemiplegia.
Paralysis of both extremities on the same side, i.e. left arm and left leg.

Hemophilia.
Rare, sex-linked disorder of the blood, usually hereditary; characterized by a failure of the blood to clot. Found almost exclusively in males, it is transmitted through a recessive gene carried by the mother.

Hepatitis A, B, C, D, G.
Highly contagious condition caused by viral infection.

Hepatitis A is one of five known viruses that cause inflammation of the liver (the others are B, C, D and E). The Centers For Disease Control and Prevention estimate that 150,000 people in the U.S. are infected each year by hepatitis A, a low rate compared to the rate in underdeveloped countries. The vast majority of people recover from the infection within six months without any serious health problems.

Hepatitis B is caused by the hepatitis B virus. The virus is very common in Asia, China, Philippines, China, Africa and the Middle east. In Europe and North America the incidence of known carriers is about 1 in a 1000 people. World wide, it is estimated that there are over 350 million hepatitis B carriers which represents 5% of the worlds population and it is estimated that 10 to 30 million people become infected with the virus each year.

Hepatitis C. The prevalence of Hepatitis C virus (HCV) infection is increasing worldwide. Currently, there are about 200 million people worldwide who are infected with the Hepatitis C virus, 4.9 million of those are in the United States (estimates go as high as 15 million) and 5 million in Western Europe. The prevalence seems to be higher in Eastern Europe than in Western Europe. In industrialized countries, HCV accounts for 20% of cases of acute Hepatitis, 70% of cases of chronic Hepatitis, 40% of cases of end-stage cirrhosis, 60% of cases of hepatocellular carcinoma and 30% of liver transplants.

The incidence of new symptomatic infections has been estimated to be 13 cases/100,000 persons annually. For every one person that is infected with the AIDS virus, there are more than four infected with Hepatitis C. The CDC (Center For Disease Control) estimates that there are up to 230,000 new Hepatitis C infections in the U.S. every year. Currently, 8,000 to 10,000 deaths each year are a result of HCV.

Over the next 10-20 years chronic Hepatitis C is predicted to become a major burden on the health care system as patients who are currently
asymptomatic with relatively mild disease progress to end-stage liver disease and develop hepatocellular carcinoma. Predictions in the USA indicate that there will be a 60% increase in the incidence of cirrhosis, a 68% increase in hepatoma incidence, a 279% increment in incidence of hepatic decompensation, a 528% increase in the need for transplantation, and a 223% increase in liver death rate.

There is no vaccine and no completely effective treatment!

Delta Hepatitis, also called Hepatitis D, is a liver disease caused by the Hepatitis D virus. Symptoms are similar to Hepatitis B and may include fever, lack of energy, nausea, vomiting, abdominal discomfort, and jaundice (yellow color to the whites of the eyes or skin and darkening of urine). Some persons who have Hepatitis D have no symptoms. Up to 20% of Hepatitis D infections are rapidly fatal. Infected persons may recover or may develop chronic, long-term Hepatitis D (carrier) and are at risk for cirrhosis (scarring of the liver) and liver failure.

A substantial proportion of cases of enterically transmitted acute viral hepatitis occurring in young to middle-aged adults in Asia and the Indian subcontinent is caused by the Hepatitis E virus (HEV). It is transmitted mainly by contaminated drinking water and is associated with a high mortality rate (up to 20%) in pregnant women. Chronic forms of hepatitis E are not known.

Hepatitis G virus is clearly a transmissible agent that may be spread in the same manner as other conventional blood-borne viral agents. Studies of recipients of blood transfusion have documented the appearance of HGV RNA after transfusion of blood or blood products in patients previously negative for HGV RNA.

Autoimmune Hepatitis is a condition in which the patient's own immune systems attacks the liver causing inflammation and liver cell death. The condition is chronic and progressive. Although the disease is chronic, many patients with autoimmune hepatitis present acutely ill with jaundice, fever and sometimes symptoms of severe hepatic dysfunction, a picture that resembles acute hepatitis.

Heterogeneous Grouping.
Grouping together students of varying abilities, interests, or ages.

Hertz (Hz).
A unit of sound frequency equal to one cycle per second; used to measure pitch.

Hib Disease (Haemophilus Influenza Type B).A bacterial microorganism that causes several serious, often life-threatening illnesses, including bacterial meningitis.

Higher-order questions.
Questions that require thinking and reflection rather than single-solution responses.

Higher-order thinking skills.
Understanding complex concepts and applying sometimes conflicting information to solve a problem, which may have more than one correct
answer.

Holistic scoring.
Using a scoring guide or anchor papers to assign a single overall score to a performance.

Home Instruction.
A special education service in which teaching is provided by a specially trained instructor to students unable to attend school. A parent or guardian must always be present at the time of instruction. In some cases, the instruction may take place on a neutral sight and not in the home or school.

Human Immunodeficiency Virus.
The virus that causes acquired immune deficiency syndrome (AIDS).

Hydrocephalus.
Hydrocephalus is the excessive accumulation of cerebrospinal fluid (CSF) in the brain, caused by failure of normal circulation, absorption, or both. This results in compression of the brain, and possibly enlargement of the head. Hydrocephalus is usually controlled by surgically implanting a flexible tube called a shunt into the cavities of the brain. The shunt controls the flow of fluid and drains it into another region of the body to be reabsorbed. This reduces the pressure on the brain that could, without treatment, result in permanent brain damage or death.

Hydrocephalus can be caused by a variety of medical problems. It can be present at birth or acquired at any time during a person's life as a result of a brain hemorrhage, meningitis, head injury, tumors, or an unknown cause.

Hyperlexia.
An individual is capable of sight reading but generally has limited understanding of the meaning of what is read.

Hyperopia.
Farsightedness; condition in which the image comes to a focus behind the retina instead of on it, causing difficulty in seeing near objects

Hypermedia.
A computer program in which the user, not the program, determines the sequence of events;the user decides which media (text, voice, video, etc.) to access and when to access them.

Hypertonia.
Muscle tone that is too high, resulting in overly tense muscles.

Hypoactivity.
Sluggish motor activity.

Hypokinesis.
Diminished motor functioning or activity.

Hypoxia.
Severely reduced supply of oxygen to the brain.

IEP Committee.
Writes the Individualized Education Program for the youngster who has been identified by the Eligibility Committee as handicapped. Members are (1 ) a school division employee, other than the student's teacher, who is qualified to provide or supervise special education; (2) the student's teacher(s); (3) the parent or guardian (4) the student, if appropriate; (5) other individuals whom the parents or the school division select.

Illegal drug.
A controlled substance; does not include substances that are legally possessed or used under the supervision of a licensed health-care
professional.

Immaturity.
Group of behavior disorders, including short attention span, extreme passivity, daydreaming, preference for younger playmates, and clumsiness.

Impedance Audiometry.
Procedure for testing middle ear function by inserting a small probe and pump to detect sound reflected by the eardrum.

Implicit behavior.
A behavior that cannot be observed directly (covert behavior).

Impulsivity.
Reacting to a situation without considering the consequences.

Incidence.
The percentage of people who, at some time in their lives, will be identified as having a specific condition. Often reported as the number of cases of a given condition per 1,000 people.

Incidental learning.
Peripheral learning or learning that takes place indirectly.

Inclusion.
Refers to Inclusive education. All students in a school, regardless of their strengths or weaknesses in any area, become part of the school community. They are included in the feeling of belonging among other students, teachers, and support staff. The federal Individuals with Disabilities Education Act (IDEA) and its 1997 amendments make it clear that schools have a duty to educate children with disabilities in general education classrooms.

Individualized Education Plan (IEP).
A written educational prescription developed for each handicapped (including learning disabled) child. Sometimes called an Individualized Education Program. School districts are required by law to develop these plans, in cooperation with parents. An IEP must contain:

the child's present levels of educational performance
annual and short-term educational goals
the specific special education program and related services that will be
provided to the child
the extent to which the child will participate in regular education program with
non-handicapped children
a statement of when services will begin and how long they will last
provisions for evaluating the effectiveness of the program and the student's
performance. This evaluation must occur at least once a year
statement of transition services for students 14 years of age or older.

Individualized Family Service Plan (IFSP).
A requirement of P.L. 99-457, Education of the Handicapped Act Amendments of 1986, for the coordination of early intervention services for
infants and toddlers with disabilities from birth to age three.

Inductive thinking.
Reasoning from the specific to the general.

Inferential Comprehension.
A level of comprehension that requires students to go beyond rote recall of main ideas and details and to draw conclusions from written text.

Inflection.
Change in pitch or loudness of the voice to indicate mood or emphasis.

Informal knowledge.
Knowledge about a topic that children learn through experience outside of the classroom.

Informal Tests.
Task-oriented tests to provide information concerning specific skills. Are not
standardized.

Inquiry.
A process in which students investigate a problem, devise and work through a plan to solve the problem, and propose a solution to the problem.

In-Service Training.
An educational program designed to provide practicing professionals (i.e. teachers, administrators, counselors) with additional knowledge and skills.

Insulin.
A protein hormone produced by the pancreas that regulates carbohydrate metabolism.

Insertion.
In reading, spelling, or math, the addition of letters or numbers which do not belong in a word or numeral.

Instrumental learning.
Trial and error learning.

Insulin.
A hormone secreted by the islets of Langerhans in the pancreas. It acts in the metabolism of carbohydrates.

Integrity.
Complete, unimpaired.

Intellectualization.
A defense mechanism in which the individual exhibits anxious or moody deliberation, usually about abstract matters.

Intelligence.
A general concept of mental ability, often summed up as the ability to learn from experience. The concept was put into a measurable form as intelligence quotient, but theorists such as Howard Gardner believe there are multiple intelligences which traditional IQ tests do not sample. Others counter that multiple intelligences are merely manifestations of an underlying general factor ("Spearman's g"). Pragmatically in schools, intelligence has come to mean whatever intelligence tests measure, regardless of the test's reliability or validity

Intelligence Trap.
A term coined by Edward de Bono referring to what he reports as the tendency of self-ascribed highly intelligent people to be "poor thinkers"
because of their arrogance, prejudice, "intellectualizing," ability to defend many sides of an issue, and their need to display their superior minds (de Bono (1991), I Am Right - You Are Wrong, and (1996), De Bono's thinking course). Only rhetorical and anecdotal support exists, and such claims are at odds with the usually accepted characteristics of the gifted.

Inter-Observer Agreement.
The degree to which two or more independent observers record the same results when observing and measuring the same target behavior(s; generally reported as a percentage of agreement.

Inter-Rater Agreement.
See Inter-Observer Agreement.

Interdiscipinary Curriculum.
A curriculum that consciously applies the methodology and language from more than one discipline to examine a central theme, issue, problem, topic, or experience.

Interdisciplinary Team.
A term sometimes used to refer to the Child Study Team; more often, the term refers to the school-based team that screens potential referrals to the Child Study Team. Also called the Multidisciplinary Team

Interest Inventory.
A test or rating scale designed to assess and individual's preferences for certain activities.

Interindividual Differences.
Differences between two or more people in one skill or set of skills.

Intermittent reinforcement.
A principal of behaviorism. Reinforcement is scheduled on the basis of a specified ratio of responses, but not after every response.

Internet.
A worldwide "network of networks" that allows participants in different electronic networks to share information, transfer files, access news, and communicate through electronic mail.

Interpersonal Skills.
A set of skills that enables one to get along well with others.

Intervention.
Any effort made on behalf of children and adults with disabilities; may be preventive, remedial, or compensatory.

Intraindividual Differences.
Differences within one individual on two or more measures of performance.

Inversions.
In reading, spelling, or math, confusion of updown directionality of letters or numbers, e.g., m for w, 6 for 9, etc.

IQ.
Intelligence quotient. The ratio between a person's chronological age (measured in years) and mental age (as measured by an intelligence test), multiplied by 100.

Iris.
The opaque, colored portion of the eye that contracts and expands to change the size of the pupil.

Itinerant Teacher.
Special Education teacher who is shared by more than one school.

Jacksonian seizure.
Generally begins with jerking in an arm or leg on one side of the body. Usually occurs without loss of consciousness. Named after Dr. Hughlings Jackson of England.

Javits Act.
Federal legislation originally passed in 1988 to provide grant money for gifted and talented programs and research. 1997 appropriations were less than one-hundredth of one-percent of total federal special education dollars, less than, for example, literacy programs for prison inmates.

Juvenile Diabetes Mellitus.
A children’s disease characterized by inadequate secretion or use of insulin and the resulting excessive sugar in the blood and urine; may be managed with diet and/or medication but can be difficult to control. The disease may cause coma and, eventually, death if left untreated or treated improperly; may also lead to visual impairments and limb amputation.

Karyotype.
Chromosome number and composition.

Keratitis.
An inflammation or swelling of the cornea of the eye accompanied by residual scarring.

Kinesthetic.
Pertaining to the muscles.

Kinesthetic Method.
A way of teaching words by using the muscles. For example, a student might trace the outline of a word with a finger while looking at the word and saying aloud the word or its letters, in sequence.

Kinetic reversal.
The transposition of letters within words, or numbers within groups, i.e. sta for sat; 489 for 498.

Klinefelter Syndrome.
A chromosomal anomaly in which males receive an extra X chromosome; associated with frequent social retardation, sterility, underdevelopment of male sex organs, development of secondary female sex characteristics, and borderline or mild levels of mental retardation.

Language.
A system used by a group of people for giving meaning to sounds, words, gestures, and other symbols to enable communication with one another. Languages can use vocal or nonvocal symbols, or use movements and physical symbols instead of sounds.

Language Experience Method.
Individuals or groups of students dictate stories about their experiences to their teacher. Students later use these dictated stories as reading material and in different sentence-building exercises.

Latent.
Dormant, hidden; not manifested but potentially present.

Lateral Confusion.
Tendency to perform some acts with a right side preference and others with a left, or the shifting from right to left for certain activities; also called Mixed Laterality.

Lateral Dominance.
The individual has complete motor awareness of both sides of the body. A
sense of sidedness, left or right.

Laterality.
The tendency to use the hand, foot, eye, and ear on a particular side of the
body. For example, many people use their right hand when eating and their
right foot when kicking.

LD.
Learning disability, learning disabled, learning disabilities.

LDAA.
Learning Disabilities Association of America.

LEA.
Local Education Agency (a school division).

Learned Helplessness.
A tendency to be a passive learner who depends on others for decisions and guidance. In individuals with LD, continued struggle and failure can heighten this lack of self-confidence.

Learner-Centered Classroom.
Classroom in which students are encouraged to choose their own learning goals and projects. This approach is based on the belief that students have a natural inclination to learn, learn better when they work on real or authentic tasks, benefit from interacting with diverse groups of people, and learn best when teachers understand and value the difference in how each student learns.

Learning Disabilities (LD)
Disorders of the basic psychological processes that affect the way a child learns. Many children with learning disabilities have average or above average intelligence. Learning disabilities may cause difficulties in listening, thinking, talking, reading, writing, spelling, or arithmetic. Included are perceptual handicaps, dyslexia, and developmental aphasia. Excluded are learning difficulties caused by visual, hearing, or motor handicaps, mental retardation, emotional disturbances, or environmental disadvantage.

Learning Disorder.
Damage or impairment to the nervous system that results in a learning disability.

Learning Modalities.
Approaches to assessment or instruction stressing the auditory, visual, or tactile avenues for learning that are dependent upon the individual.

Learning Strategy Approaches.
Instructional approaches that focus on efficient ways to learn, rather than on curriculum. Includes specific techniques for organizing, actively interacting with material, memorizing, and monitoring any content or subject.

Learning Style.
The channels through which a person best understands and retains learning. All individuals learn best through one or more channels: vision, hearing, movement, touching, or a combination of these.
 

Least Restrictive Environment.
A basic principle of PL94-142. Under this principle, handicapped students must be educated with non-handicapped students to the maximum extent possible. The educational setting that most closely resembles a regular school
program and also meets the child’s special educational needs; LRE is a
relative concept and must be determined for each individual student with
disabilities

Learning Trial.
Assessment strategy that consists of three major elements: antecedent (i.e. curricular) stimuli, the student’s response to those stimuli, and any consequent stimuli (i.e. instructional feedback) following the response; serves as a basic unit of analysis for examining teaching and learning from both the teacher’s perspective and the student’s perspective. This is
sometimes called a Practice Trial or Learn Unit.

Left-to right progression.
The appropriate recognition of letter or word sequence. May be affected if laterality is not established.

Legal Blindness.
A person is considered Legally blind when the best corrected visual acuity is 20/200, or the person's visual field is 20 degrees or less.

Lens.
The clear part of the eye that focuses rays of light on the retina.

Lesion.
Abnormal change in body tissue due to injury or disease.

Less Is More.
A principle built on the idea that quality is of higher importance than quantity. It is reflected in instruction that guides students to focus on fewer topics investigated in greater depth, with teachers performing the task of prioritizing subjects as well as specific skills within those subjects.

Licensed Clinical Psychologist.
A psychologist who is competent to apply the principles and techniques of psychological evaluation and psychotherapy to individual clients for the purpose of ameliorating problems of behavioral and/or emotional maladjustment.

Licensed Clinical Social Worker.
A social worker who, by education and experience, is professionally qualified to provide direct diagnostic, preventive and treatment services where functioning is threatened or affected by social and psychological stress or health impairment.

Licensed Professional Counselor.
A person trained in counseling and guidance services with emphasis on individual and group guidance and counseling; assists individuals in
achieving more effective personal, social, educational, and career development and adjustment.

Likert Scale.
A scale commonly used to assess a respondent's attitude toward an item, and issue or a situation. Consists of (1) Strong Disagreement to (5) Strong Agreement.

Linguistic Approach.
Method for teaching reading (decoding skills) which emphasizes use of Sword families. For example, the child is taught to read at and then
subsequently is taught to decode words such as "cat," "bat," "sat," "mat," etc. Early stories adhere strictly to the words which have been taught previously and so may sometimes seem nonsensical, e.g., "Sam sat on a mat. The cat sat on a mat. The cat is fat," etc.

Local Education Agency.
Agency that assumes responsibility for providing public education for all pupils within its jurisdiction.

Locus of Control.
The tendency to attribute success and difficulties either to internal factors such as effort or to external factors such as chance. Individuals with learning disabilities tend to blame failure on themselves and achievement on luck, leading to frustration and passivity.

Longitudinal Study.
A research study that follows one subject or group of subjects over an extended period of time, usually several years.

Long-term Memory.
Memory for learning material over a relatively long retention interval (typically regarded as an hour or more).

Lovaas Therapy.
Lovaas Therapy" derives its name from O. Ivar Lovaas, PhD, a psychologist who has researched methods of applied behavior analysis for over 30 years. Lovaas gained more mainstream recognition from the 1987 publication of a study he conducted with children with autism. Based upon his research, Lovaas concluded intensive behavioral intervention (including the use of discrete trials) offered much hope for improving the outcomes of children with autism. Forty-seven percent of children in the study ultimately gained normal
functioning such that they were virtually indistinguishable from their peers (Lovaas, 1987). A follow-up study of these same children in 1993 concluded the results were sustained (McEachin & Lovaas, 1993).

While Lovaas is due credit for the rigor and value of his work, ABA professionals emphasize behavioral intervention in any form is not the
domain of any one professional or group. Therefore, "Lovaas Therapy" is an appropriate term only when specifically referring to Lovaas' work, methods and protocols. Otherwise, the broader terms "applied behavior analysis" or "ABA" should be used.

Low vision.
Visual impairment severe enough so that special educational services are
required.

Low-Incidence Disability.
A disability that occurs relatively infrequently in the general population; often used in reference to sensory impairments, severe and profound mental retardation, autism, and multiple disabilities.

Macrocephalic.
A condition characterized by an unusually large head and generally the presence of mental retardation.

Macular Degeneration.
A deterioration of the central part of the retina, which causes difficulty in seeing details clearly.

Magical Thinking.
Primitive and illogical mode of thinking meant to meet someone's fantasy rather than the reality of a situation.

Maintaining Attention.
Keeping focused on a particular activity while interference, such as noise, is present.

Mainstreaming.
The practice of placing handicapped children with special educational needs into regular classrooms for at least a part of the children's school programs.

Malocclusion.
Improper positioning or closure of the teeth resulting in either an overbite or underbite.

Manifestation Determination.
A review of the relationship between a student’s misconduct and his/her disability conducted by the IEP Team and other qualified personnel; required by the IDEA amendments of 1997 when school officials seek to discipline a student with disabilities in a manner that would result in a change of placement, suspension, or expulsion in excess of 10 days.

Manipulative.
Any physical object (e.g., blocks, toothpicks, coins) that can be used to represent or model a problem situation or develop a mathematical concept.

Mapping.
An instructional strategy to help students organize ideas for writing; students draw a map showing the relationship between the main topic and key words.

Matrix Sampling.
An assessment method in which no student completes the entire assessment but each completes a portion of the assessment. Portions are allotted to different, representative samples of students. Group (rather than individual) scores are obtained for an analysis of school or district performance

Maturation Lag.
Delayed maturity in one or several skills or areas of development.

Mean.
A measure of the average of a group of scores.

Mean length of response.
The average number of words a child normally uses together.

Median.
The point of distribution of scores above which and below which fifty percent of the scores fall.

Mediated Instruction.
Any instructional procedure that includes the use of media.

Mediation.
Procedural safeguard to resolve disputes between parents and schools; must be voluntary, cannot be used to deny or delay right to a due process hearing; must be conducted by a qualified and impartial mediator who is trained in effective mediation techniques.

Medical services.
Related service; includes services provided by a licensed physician to determine a child’s medically related disability that results in the child’s need for special education and related services.

Megavitamin Therapy.
The technique of administering extremely large doses of vitamins for the purpose of improving certain emotional or behavior disorders.

Meningitis.
Inflammation of the membranes (arachoid, dura mater, and pia mater) surrounding the brain and spinal cord.

Meningocele.
A form of spina bifida that is characterized by a tumor-like sac along the individual's backbone.

Mental Age.
The age for which a given score on a mental ability test is average or normal. The term is most appropriately used at the early age levels where mental growth is rapid.

Metacognitive Learning.
Instructional approaches emphasizing awareness of the cognitive processes that facilitate one's own learning and its application to academic and work assignments. Typical metacognitive techniques include systematic rehearsal of steps or conscious selection among strategies for completing a task.

Milieu Teaching Strategies.
A variety of strategies used to teach speech and language that naturally occur during real or simulated activities in the home, school, or community environments in which a child normally functions; characterized by dispersed
learning trials, following the child’s attentional lead within the context of normal conversational interchanges, and teaching the form and content of language in the context of normal use.

Milieu Therapy.
A clinical technique designed to control a child's environment and minimize conflicting and confusing information.

Minimal Brain Dysfunction (MBD).
A broad and unspecific term formerly used to describe learning disabilities.

Mixed Cerebral Dominance.
A condition characterized by the failure of one side of the brain to be dominant over the other in the motor control activities. Example: An individual preferred use of the right arm and left foot. Could affect speech and writing.

Mixed Laterality.
The use of either hand, foot, or eye to perform tasks. Usually caused by the fact that laterality has not been fully established.

Mnemonics.
A technique of improving memory by using artificial aids or assistive technology.

Modality.
A pathway of learning.

Mode.
The most frequently occurring score in a total group of scores.

Model Program.
A program that implements and evaluates new procedures or techniques in order to serve as a basis for development of other similar programs.

Modeling.
Providing examples for individuals to imitate.

Modifications.
Substantial changes in what the student is expected to demonstrate; includes changes in instructional level, content, and performance criteria, may include changes in test form or format; includes alternate assessments.

Modified Self-Contained.
Closely approximates the self-contained class; however, students receive
instruction from a regular education teacher for some part of the school day.

Monoplegia.
Paralysis of one limb (arm or leg).

Monozygotic Twins.
Identical twins coming from one ovum in the mother.

Montessori Method.
An educational philosophy based on the ideas of Italian physician/educator Maria Montessori (1870 - 1952). Although originally developed with students labeled "mentally defective" her tremendous successes led her approach to be widely embraced, especially in upper class pre- and elementary schools world-wide. Montessori saw students' learning as the result of innately self-motivated activity. The teacher's job, then, is to supervise and guide rather than transmit knowledge. Many private and a few public schools in the U.S. call themselves "Montessori," however there is no official body to regulate use of the name and actual teaching practices vary considerably.

Morpheme.
The smallest element of a language that carries meaning.

Mosaicism.
A type of Down's syndrome.

Motor.
Pertaining to the origin or execution of muscular activity.

Motor Aphasia.
The individual knows what he or she wants to say but cannot say the words because of an inability to coordinate the muscles due to disease of the speech center.

Multi-Categorical.
A special education classroom model in which students with more than one handicapping condition are assigned to a special education teacher.

Multicultural Education.
An educational approach in which a school’s curriculum and instructional methods are designed and implemented so that all children acquire an awareness, acceptance, and appreciation of cultural diversity and recognize the contributions of many cultures.

Multi-Factored Assessment.
Assessment and evaluation of a child with a variety of test instruments and observation procedures; required by IDEA when assessment is for educational placement of a child who is to receive special education services.

Multidisciplinary Team.
In education, a group made up of a child's classroom teacher and several educational specialists that evaluates the child's handicap and prepares an Individualized Education Plan for the child.

Multimodal.
A distribution of scores or measures that has three or more peaks or modes.

Multiple disabilities.
Disability category under IDEA; concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.) that cause such severe educational problems that problems cannot be accommodated in special education programs solely for one of the impairments; does not include deaf-blindness.

Multiple Intelligences Theory.
A theory advanced by Professor Howard Gardner of Harvard University; it states that actual intelligence is made up of several independent
intelligences that can function individually or cooperatively. To date, Professor Gardner has defined eight such intelligences: Linguistic,
Logical/Mathematical, Visual/Spatial, Bodily/Kinesthetic, Musical, Naturalist, Interpersonal, and Intrapersonal.

Multiple Sclerosis.
A chronic, slowly progressive disorder of the central nervous system characterized by the hardening or scarring (sclerosis) of the myelin sheath, the protective covering on certain nerve fibers.

Multisensory Learning.
An instructional approach that combines auditory, visual, and tactile elements into a learning task. Tracing sandpaper numbers while saying a number fact aloud would be a multisensory learning activity.

Muscular Dystrophy.
A group of diseases that gradually weakens muscle tissue; usually becomes evident by the age of four or five.

Myelomeningocele.
A protrusion on the back of a child with spina bifida, consisting of a sac of nerve tissue bulging through a cleft in the spine.

Myopia.
Nearsightedness; results when light is focused on a point in front of the retina, resulting in a blurred image for distant objects.

NCLD.
National Center for Learning Disabilities.

Near Point Copying.
Writing while copying from a model close at hand, e.g., copying from a textbook.

Near Vision Acuity.
Clearly seeing, inspecting, identifying and understanding objects viewed within arm's length.

Neologism.
Made-up word that only has meaning to the child or adult.

Neonatal.
The time usually associated with the period between the onset of labor and six weeks following birth.

Neural Tube Defect.
A birth defect occurring in the brain or spinal cord causing extensive damage to the fetus; many times results in death at birth or soon after.

Neuroleptics.
Agents or drugs that modify psychotic behavior; in general, the term is synonymous with antipsychotics.

Neurological Examination.
Testing of the sensory or motor responses to determine if there is impairment of the nervous system.

Neurologic Impairment.
Any physical disability caused by damage to the central nervous system (brain, spinal cord, ganglia, and nerves).

Neurologist - medical doctor who assesses for potential damage to the brain and may provide medication to assist in enhancing brain function.

Neuropsychological Examination.
A series of tasks that allow observation of performance that is presumed to be related to the intactness of brain function.

Neuropsychologist.
Psychologist who assesses for possible impaired areas of the brain that might be affecting verbal and non-verbal functions in learning and social skills on the behavioral level. Provides interventions to help maximize cognitive strengths and minimize weaknesses.

Neurosis.
An emotional disturbance or behavior disorder due to unresolved unconscious conflicts.

Neurotransmitters.
Chemicals that transmit messages across the synaptic gap between dendrites in order to excite other neurons in the brain and nervous system.

Noncategorical.
Refers to a system of grouping handicapped children together without reference to a particular label or category of exceptionality.

Nonverbal Learning Disabilities
Learning disabilities that are associated with non-linguistic mental functions (i.e. kinesthetic coordination, social/emotional deficits).

Normal Curve.
A mathematically derived curve depicting the theoretical probability or distribution of a given variable (such as a physical trait or test score) in the general population.

Normalization.

The idea that individuals with disabilities should, to the maximum extent possible, be physically and socially integrated into the mainstream of society

Norm-referenced Tests.
Tests in which a student's performance on a specific test is compared with that of other students.

Norm-Referenced Test.
See Standardized Test.

Norms.
Statistics that provide a frame of reference by which meaning may be given to test scores. Norms are based upon the actual performance of pupils of various grades or ages in the standardization group for the test. Since they represent average or typical performance, they should not be regarded as standards or universally desirable levels of attainment. The most common types of norms are standard scores such as stanines or deviation IQ, percentile rank, grade or age equivalents.

Numeral.
A digit that has been written down.

Numeration.
The ability to count or understand a series of numbers and the logical, sequential connection between them.

Nystagmus.
A rapid, involuntary, rhythmic movement of the eyes that may cause difficulty in reading or fixating on an object.

Obsessive Compulsive Personality.
A personality disorder characterized by unusual, inappropriate, or excessive concern with conformity to rigid standards.

Obturator.
A prosthetic device designed to improve one's speech by covering an opening in the palate or by helping to close the nasal passage.

Occipital
The portion of each hemisphere of the cerebrum that deals with vision and visual perception; located in the rear of the head, behind the parietal lobe.

Occupational Therapist.
Treats for restoration or improvement of impaired motor or sensory functions in order to improve ability to perform tasks for independent living.

Ochlophobia.
An abnormal, irrational fear of crowds.

Ocular Mobility.
The eye’s ability to move.

Ombudsman.
An official appointed to investigate complaints and speak for individuals with grievances.

Open-Ended Question.
A question that has many avenues of access and allows students to respond in a variety of ways. Such questions have more than one correct answer.

Open-Ended Task.
A performance task in which students are required to generate a solution or response to a problem when there is no single correct answer.

Open-Response Task.
A performance task in which students are required to generate an answer rather than select an answer from among several possible answers, but there is a single correct response.

Operant Behavior.
Behavior affected by its consequences; i.e., a child's whining (operant) may be observed as decreasing or stopping completely if ignored or punished (consequences).

Ophthalmologist.
A physician who specializes in the diagnosis and treatment of diseases of the eye.
 

Oppositional Defiant Disorder.

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment
by Jim Chandler, MD, FRCPC

What is it?
ODD is a psychiatric disorder that is characterized by two different sets of problems. These are aggressiveness and a tendency to purposefully bother and irritate others. It is often the reason that people seek treatment. When ODD is present with ADHD, depression, Tourette's, anxiety disorders, or other neuropsychiatric disorders, it makes life with that child far more difficult. For Example, ADHD plus ODD is much worse than ADHD alone, often enough to make people seek treatment. The criteria for ODD are:

A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present:
1. Often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults' requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful and vindictive

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
How often is "often"?

All of the criteria above include the word "often". But what exactly does that mean? Recent studies have shown that these behaviors occur to a varying degree in all children. These researchers have found that the "often" is best solved by the following criteria.

Has occurred at all during the last three months-
   * is spiteful and vindictive
   * blames others for his or her mistakes or misbehavior

Occurs at least twice a week
    * is touchy or easily annoyed by others
    *  loses temper
    *  argues with adults
    * actively defies or refuses to comply with adults' requests or rules

Occurs at least four times per week
    * is angry and resentful
    * deliberately annoys people

What causes it?
Like most psychiatric illnesses, there are three main causes: environment, genetics, and medical problem

Environment

    If the mother is smoking during her pregnancy, the child is 2-3 times more likely to end up with ODD or CD when he is older.
    No one knows for certain. The usual pattern is for problems to begin between ages 1-3. If you think about it, a lot of these behaviors are normal at age 2, but in this disorder they never go away. It does run in families. If a parent is alcoholic and has been in trouble with the law, their children are almost three times as likely to have ODD. That is, 18% of children will have ODD if the parents are alcoholic and the father has been in trouble with the law.  

How can you tell if a child has it?

ODD is diagnosed in the same way as many other psychiatric disorders in children. You need to examine the child, talk with the child, talk to the parents, and review the medical history. Sometimes other medical tests are necessary to make sure it is not something else. You always need to check children out for other psychiatric disorders, as it is common the children with ODD will have other problems, too.

Diseases that look like ADHD and ODD
There are a number of sleep disorders which can look like ODD or make it worse. This information is in the ADHD pamphlet. Click here to go there.
 

Who gets it?
A lot of children! This is the most common psychiatric problem in children. Over 5% of children have this. In younger children it is more common in boys than girls, but as they grow older, the rate is the same in males and females.

ODD rarely travels alone - Comorbidity
It is exceptionally rare for a physician to see a child with only ODD. Usually the child has some other neuropsychiatric disorder along with ODD. The tendency for disorders in medicine to occur together is called comorbidity. Understanding comorbidity in pediatric psychiatry is one of the most important areas of research at this moment.

Common patterns of comorbidity
ODD plus ADHD
If a child comes to a clinic and is diagnosed with ADHD, about 30-40% of the time the child will also have ODD. Here are some examples of how this looks across ages.

Pre School Marianne
Marianne is now 4 years old. Her parents were very excited when she turned four that perhaps that would mean that the terrible twos were finally over. They were not. Her parents are very grateful that the Grandparents are nearby. The grandparents are grateful that Marianne's aunts and uncles live nearby. Marianne's Aunt is grateful that this is her niece, not her daughter. Why? Marianne requires an incredible combination of strength, patience, and endurance.

Marianne begins her day by getting up early and making noise. Her father unfortunately has mentioned how much this bothers him. So she turns on the TV, or if that has been mysteriously disconnected, bangs things around until her parents come out. Breakfast is the first battleground of the day. Marianne does not like what is being served once it is placed in front of her. She seems to be able to sense how hurried her parents are. When they are very rushed, she is more stubborn and might refuse it altogether. It would be a safe bet that she would tell her Mom that the toast tastes like poop. This gets her the first “time out” of the day.

In the mornings she goes to pre-school or goes off with her grandmother or over to her aunts. Otherwise Marianne's mother is unable to do anything. Marianne can not entertain herself for more than a few moments. She likes to spend her time purposefully annoying her mom, at least so it seems. Marianne will demand over and over that she wants something. For example, playdough. She knows it must be made first. So her mom finally gives in and makes it. Marianne plays with it about one minute and says, " Let’s do something" . Her mother reminds her that they are doing something, the very thing that Marianne has been demanding for the last hour. " No, Lets do something else"

So after Marianne's mother screamed so hard she was hoarse when her husband came home, Marianne gets to go out almost every morning. At preschool she is almost perfect, but will not ever do exactly what the teacher wants. Only once has she had a tantrum there. Marianne gets along with the other children as long as she can tell them what to do.

Her grandmother and Aunt all follow the same “time out” plan. This means she goes to a certain room until she calms down. The room is empty now at Marianne's grandmother. Marianne broke the toys, and they were removed. She banged the furniture around and it was removed. What sets Marianne off is not getting to do what Marianne wants. She screams, tells people she hates them, and swings pretty hard for a four old. After a half hour it is usually over, but not always. Marianne will usually tell her mom or Grandmother about these tantrums. The story is always twisted a little. For example, Marianne will tell her Grandmother that her mom locked her in her room because she was watching TV. Her grandmother used to believe these stories, and Marianne could tell the whole story of how she was watching this show, and her mom just came in and dragged her to her room. Now it turns out that Grandma doesn't think much of TV anyways, and so this made a certain amount of sense to her. This led to more than one heated argument between the Grandma and her mom. Of course there was almost no truth to this at all. It took the tables being turned for the Grandma to really believe that her Granddaughter could set up an argument like this. Marianne came home and told her mom that Grandma let her eat four cookies and an ice cream cone for a treat and that she was very full. Marianne's mom doesn't think much of treats, and could see how this might happen and thought she would have to talk to her mom. Finally they both realized what Marianne was doing.

Most of the afternoon with Marianne is spent chasing her around trying to wear her out. It doesn't seem to work, but it is worth a try. When she is at her aunts, she tries to wreck her cousin’s stuff. When is she good? When there are no other cousins around and she has the complete attention of her Aunt or Grandpa.

Marianne loves the bedtime battle. She also loves to go to the Mall. But she never gets to go there or hardly anywhere else. She acts up so badly that her family is very embarrassed. Her mother shops and visits only when Marianne goes to preschool. It is hard to know who is more excited about Marianne going to school next year, her mother or Marianne!

Elementary School Ryan
Ryan is 10. Ryan's day usually starts out with arguing about what he can and can not bring to school. His mother and his teacher have now made out a written list of what these things are. Ryan was bringing a calculator to school and telling his teacher that his mother said it was alright. At first his teacher wondered about this, but Ryan seemed so believable. Then Ryan brought a little (Ryan's words) knife. That lead to a real understanding between the teacher and Ryan's mother.

Ryan does not go to school on the bus. He gets teased and then retaliates immediately. Since it is impossible to supervise bus rides adequately, his parents and the school gave up and they drive him to school. It is still hard to get him there on time. As the time to leave approaches, he gets slower and slower. Now it is not quite as bad because for every minute he is late he loses a dime from his daily allowance. Once at school, he usually gets into a little pushing with the other kids in those few minutes between his mother's eyes and the teacher's. The class work does not go that badly now. Between the daily allowance which is geared to behavior and his medicine, he manages alright. This is good for everyone. At the beginning of the school year he would flip desks, swear at the teacher, tear up his work and refuse to do most things. Looking back, the reasons seem so trivial. He was not allowed to go to the bathroom, so he flipped his desk. He was told to stop tapping his pencil, so he swore at the teacher.

Recess is still the hardest time. Ryan tells everyone that he has lots of friends, but if you watch what goes on in the lunch room or on the playground, it is hard to figure out who they are. Some kids avoid him, but most would give him a chance if he wasn't so bossy. The playground supervisor tries to get him involved in a field hockey game every day. He isn't bad at it, but he will not pass the ball, so no one really wants him on his team.

After school was the time that made his mom seriously consider foster care. The home work battle was horrible. He would refuse to do work for an hour, then complain, break pencils and irritate her. This dragged 30 minutes of work out to two hours. So, now she hires a tutor. He doesn't try all of this on the tutor, at least so far. With no home work, he is easier to take. But he still wants to do something with her every minute. Each day he asks her to help him with a model or play a game at about 4:30. Each day she tells him she can not right now as she is making supper. Each day he screams out that she doesn't ever do anything with him, slams the door, and goes in the other room and usually turns the TV on very loud. She comes up, tells him to turn it down three times. He doesn't and is sent to his room. She calculated that she has made about 1500 suppers since he was five years old. Could it be that they have gone through this 1500 times? She decides this is not a good thought to follow through. After supper Ryan's dad takes over and they play some games together and usually it goes fine for about an hour. Then it usually ended in screaming. So Ryan's grandmother had the bright idea of inviting them over for desert at about 8:00 pm most nights. But what about days when there is no school? Ryan's parents try very hard not to think about that.

High School Tasha
Tasha is 15. She is in ninth grade and from her marks, you would say there is no big problem. She is passing everything, but her teachers always comment that she is capable of much more if she tried. If they gave marks for getting along with others, it would be a different story. Tasha's best friend is currently doing a 6 month sentence for vandalism and shoplifting. Tasha and Sylvie have been friends since fall, if you can call it that. Since Tasha has almost no other friends, she will do anything to be Sylvie’s friend. At least that is what her parents think. Tasha thinks it is "cool" that Sylvie is at the Shelbourne Youth Centre. One sign of this friendship was that Tasha almost always gave her lunch money to Sylvie. Why? Because Sylvie wanted it. Tasha thought that Sylvie was her friend, but everyone could see that Sylvie was just using her. What seemed saddest to Tasha's parents is that Tasha could not see this at all. But this was nothing new. She would make a friend, smother them with attention, and that would be the end of it. Or, the friend would not do exactly what Tasha wanted and there would be a big fight, and it would be over. But mostly Tasha complained that everyone bugged her. What seemed to save Tasha was the nursing home. Somewhere along the way Tasha got involved working there. To hear the staff there talk about her, you would never guess it was the same girl. Helpful, kind, thoughtful - they couldn't say enough good about her. In fact her parents joked that maybe if they all moved to the nursing home, it would stop the fighting at home. They figured it out when another teenager volunteered to help one of the same afternoons as Tasha. Unfortunately the "other" Tasha came out. She was tattling, annoying, disrespectful and hard to get along with. Tasha could get along with any one, as long as they weren't her age, a teacher, or a relative!

These examples stress some of the common features of this comorbid combination. Extremely major social problems with relatively little academic problems are common. Recent research suggests that all things being equal, girls with ODD plus ADHD have significantly worse social problems than boys with ODD plus ADHD (2). Tasha in the above example illustrates this.

ODD plus Depression/Anxiety
This is the other common combination with ODD. If you look at children with ODD, probably 15-20% will have problems with their mood and even more are anxious. (1) Here are some examples of how this can present

Preschool -Arriane
Arriane is 4. She has not been an easy child. Her mom does not like to compare children, but it is hard not to! Her brother is easy to get along with, excited, and energetic. She expected to have arguments with Arriane about doing a chore or task, but she ends up having an argument with Arriane about doing something fun! Arriane's first response to almost any activity is "No, I don't want to". Her mother has learned that if she can get Arrianne out the door and to pre-school, for example, she does quite well once she is there. That is, as long as everything is going her way. It does not take much of a problem for Arriane to lose her temper. Two days ago she was called to preschool when another boy bumped Arriane and she dropped her cheese and cracker on the carpet. Arriane belted the child and screamed "I hate you, I hate this place, I hate it!" until her mother came. Of course the next day she was back again and things were going alright. Arriane's mother has some unusual memories, or at least she thinks so. She remembers last fall when they took Arriane horseback riding for the first time. Arriane's face showed true joy for a whole hour. Her mother did not know whether to cry or not, as she could not remember such an expression on her child's face before for more than a few moments. That memory makes her hopeful that somehow she can bring that joy back to Arriane.

It is not an easy task. The combination of being irritable and oppositional tests everyone's patience. She did not realize how stressful it was until she started bringing Arriane to a babysitter so she could go out and visit her friends. Finally she did not have to be thinking about how to keep Arriane from losing it every minute. She is finally coming to the decision that try as she might, she can not make Arriane's life as smooth as Arriane wants it.

Elementary School Rick
Ricky is 11 years old. Ricky spends a lot of time in his room doing legos and making models. Then, all of a sudden there is a scream and stuff gets thrown around. If his parents are so unwise as to go up there, they will get to hear Ricky say that he hates this world, hates legos, and hates this stupid model. Then he will usually look up and say something awful to his parents. That is why they just leave him up there. He comes home from school crabby and throws his homework down and goes up plays in his room. His parents realize that he needs to get out and do something, but the only thing they can ever get him to do is go lift weights at the YMCA. Ricky's father has absolutely no interest in lifting weights, but he has done a pretty good job of convincing Ricky that he likes to go. That gets him out of the house about three times a week. As far as playing with other kids, unless his cousins come over, he won't play with anyone. His parents used to ask why and the answer was because no one likes me. Sad to say, it is not hard to figure out why Ricky would have that idea. When a friend comes over, he is so demanding and insists that the child do things just the way Ricky wants. Usually Ricky ends up sulking part of the time when he doesn't get his way. So now, his mom invites friends over for Ricky, but she plays right along side of the friend and Ricky. At least they aren't scared off that way. At school, it is even worse. Everyone seems to know how easy it is to get Ricky to loose his temper. It happens almost every day. He bangs the desk, takes a swing at someone, swears, or kicks them. He is usually caught, and since he is so irritable anyway, the teachers hear a fair amount of defiance. Amazingly, he does pretty well in school once he gets going on something. This year he has changed classes. His old teacher was humble enough to admit that Ricky had pushed her too far and she could not take it any longer. She said she just could not remain professional. Ricky's mom knows how that could happen. Sometimes she just takes off for a walk when Ricky is driving her nuts. She knows she shouldn't leave him alone at home, but she figures if she doesn't go out in the woods for a walk there would be far greater dangers awaiting Ricky at home than if he was there alone. Ricky mostly wishes people would just stop bugging him. Once in awhile, right before bed, Ricky will ask him mom if it hurts to die or what it is like to be dead. She can't tell if he means it or is just saying that to bug her. She is afraid to even think about it.

High School Justin
Justin is now 18. Things are going great for Justin this year. He is back in school, off drugs, and actually is getting along with his parents. In fact, he actually missed them when they went away. He has been helping his Dad put up dry wall after school. Both he and his parents are grateful for his recovery, but they wished they could have picked it up earlier, like when he was 12 or 13. That's when things really started to get worse. Justin had always had a hot temper and still does, but then it was unreal. At age 12 his parents would not let him go to a dance. He broke all the windows in their car. He lasted two months in 8th grade before he was suspended for fighting. Justin lost the few friends he had by getting kicked off the hockey team. He swore at a judge during a probation hearing and got two months in the Youth Centre which was extended to six months after he tried to attack a guard. All the while he was so irritable and never happy. When he came home from the Youth centre he wanted to be able to drive. They said no, and he decided that was it and went out to hang himself in the barn. His parents still remember those words, "You'll all be f-ing better off without me and if you come after me I'll f-ing kill you, too". That horrible day was the turning point. It took five mounties to get him to go to the hospital. It took a careful evaluation to figure out that he wasn't just oppositional , stubborn, and hot headed. He was very depressed, too. Now after 6 months of medical and non-medical interventions, he is 100% better. Justin admits that if he had to go back to living the way he was, he'd start thinking of suicide.

These examples show how very difficult the combination of ODD and depression can be for the family and the child. Often the depression gets mixed in the midst of dealing with the aggression and defiance. I commonly run across children like Justin who have been oppositional and depressed but no one ever notices the depression until they make a suicide attempt. Looking for depression in ODD youth is very important, (see treatment section)
What happens to children who have this when they grow up?
There are three main paths that a child will take.

First, there will be some lucky children who outgrow this. About half of children who have ODD as preschoolers will have no psychiatric problems at all by age 8.(19)
Second, ODD may turn into something else. About 5-10 % of preschoolers with ODD will eventually end up with ADHD and no signs of ODD at all. (19) Other times ODD turns into conduct disorder (CD). This usually happens fairly early. That is, after a 3-4 years of ODD, if it hasn't turned into CD, it won't ever. What predicts a child with ODD getting CD? A history of a biologic parent who was a career criminal, and very severe ODD.
Third, the child may continue to have ODD without any thing else. However, by the time preschoolers with ODD are 8 years old, only 5% have ODD and nothing else.
Fourth, They continue to have ODD but add on comorbid anxiety disorders, comorbid ADHD, or comorbid Depressive Disorders. By the time these children are in the end of elementary school, about 25% will have mood or anxiety problems which are disabling. (14) That means that it is very important to watch for signs of mood disorder and anxiety as children with ODD grow older.

Will children with ODD end up as criminals?

Probably not unless they develop conduct disorder (see below) Even then many will grow out of it. Life may not be easy. People with ODD who are grown up often do best if they can work for themselves and stay away from alcohol. However their tendency to irritate others often leads to a lonely life.

What is the difference between ODD and ADHD?

ODD is characterized by aggressiveness, but not impulsiveness. In ODD people annoy you purposefully, While it is usually not so purposeful in ADHD. ODD signs and symptoms are much more difficult to live with than ADHD. Children with ODD can sit still.

What difference does it make if you have ADHD or ADHD plus ODD?

A lot! Children and adolescents with ADHD alone do things without thinking, but not necessarily oppositional things. An ADHD child may impulsively push someone too hard on a swing and knock the child down on the ground. She would likely be sorry she did this afterward. A child with ODD plus ADHD might push the kid out of the swing and say she didn't do it.

My child has been diagnosed with ODD. I don't like to say this, but no one can stand him. Is this common?

Unfortunately, it is quite common. In comparison to ADHD alone, children and adolescents with ODD plus ADHD or just ODD are much more difficult to be with. The destructiveness and disagreeableness are purposeful. They like to see you get mad. Every request can end up as a power struggle. Lying becomes a way of life, and getting a reaction out of others is the chief hobby. Perhaps hardest of all to bear, they rarely are truly sorry and often believe nothing is their fault. After a huge blow up, the child with ODD is often calm and collected. It is the parents who look as they are going to lose it, not the child. This is understandable. The parents have probably just been tricked, bullied, lied to or have witnessed temper tantrums which know no limits.

My father in law says the whole problem is my husband and I. My daughter convinced him that she is a victim of uncaring parents. How often does this happen?
Too often! Children and adolescents with ODD produce strong feelings in people. They are trying to get a reaction out of people, and they are often successful. Common ones are: inciting spouses to fight with each other and not focus on the child, making outsiders believe that all the fault lies with the parents, making certain susceptible people believe that they can "save" the child by doing everything the child wants, setting parents against grandparents, setting teachers against parents, and inciting the parents to abuse the child. I frequently see children with ODD in which teachers and parents and sometimes others are all fighting amongst each other rather than with the child who is causing all the turmoil in the first place.

Conduct disorder
 

n some ways, conduct disorder is just a worse version of ODD. However recent research suggests that there are some differences. Children with ODD seem to have worse social skills than those with CD. Children with ODD seem to do better in school. (1). Conduct disorder is the most serious childhood psychiatric disorder. Approximately 6-10% of boys and 2-9% of girls have this disorder.

Here is the Definition.

A.  A repetitive and persistent pattern of behavior in which the basic rights of others or major society rules are violated. At least three of the following criteria must be present in the last 12 months, and at least one criterion must have been present in the last 6 months.
Aggression to people and animals
often bullies, threatens, or intimidates others

often initiates physical fights

has used a weapon that can cause serious physical harm to others (a bat, brick, broken bottle, knife, gun)

physically cruel to animals

physically cruel to people

has stolen while confronting a victim ( mugging, purse snatching, extortion, armed robbery)

Destruction of property
has deliberately engaged in fire setting with the intention of causing serious damage

has deliberately destroyed other's property other than by fire setting

Deceitfulness or theft
has broken into someone else's house, building or car

often lies to obtain goods or favors or to avoid work

has stolen items of nontrivial value without confronting a victim (shoplifting, forgery)

Serious violations of rules
often stays out at night despite parental prohibitions, beginning before 13 years of age

has run away from home overnight at least twice without returning home for a lengthy period

often skips school before age 13

B. The above problem causes significant impairment in social , academic, and occupational functioning.

So how are ODD and CD related?
Currently, the research shows that in many respects, CD is a more severe form of ODD. Severe ODD can lead to CD. Milder ODD usually does not. The common thread that separates CD and ODD is safety. If a child has CD there are safety concerns. Sometimes it is the personal safety of others in the school, family, or community. Sometimes it is the safety of the possessions of other people in the school, family or community. Often the safety of the child with CD is a great concern. Children with ODD are an annoyance, but not especially dangerous. If you have a child with CD disorder in your home, most likely you do not feel entirely safe. Or, you do not feel that your things are entirely safe. It is the hardest pediatric neuropsychiatric disorder to live with as a sibling, parent, or foster parent. Nothing else even comes close. It is worse than any medical disorder in pediatrics. Some parents have told me that at times it is worse than having your child die.

Conduct Disorder and comorbidity

It has been common in the past for people to think that conduct disorder is just the beginning of being a criminal. Up until the last few years, children with conduct disorder were often "written off". It is now clear that this is true only with a minority of cases. It is very easy to focus on the management of the CD child and forget to check the child out for other neuropsychiatric disorders. A careful examination of children with CD almost always reveals other neuropsychiatric disorders. Some of the most exciting developments in this area of medicine involve understanding these phenomena. It is called comorbidty, that is the tendency for disorders to occur together.

It is very common to see children with CD plus another one or two neuropsychiatric diagnoses. By far the most common combination is CD plus ADHD. Between 30-50% of children with CD will also have ADHD (1). Another common combination is CD plus depression or anxiety. One quarter to one half of children with CD have either an anxiety disorder or depression (3). CD disorder plus substance abuse is also very common. Also common are associations with Learning Disorders, bipolar disorder and Tourettes Syndrome. It is exceptionally rare for a child to present for evaluation by a pediatric psychiatrist to have pure CD. Here are some examples of the comorbid presentations.

Looking for comorbid disorders in every child with conduct disorder is absolutely essential. Many of the treatments of these children depend on what comorbid disorder is also present.

CD plus substance abuse

Sadly, this is very common. In my clinic, every child with CD is assumed to be abusing substances until proven otherwise. Compared with children who do not have CD, children who have CD are three times more likely to smoke cigarettes, 2.5 times more likely to drink, and five times more likely to smoke pot. As far as having a problem from drug use, children with CD a 5.5 times more likely to be addicted to cigarettes, six times more likely to be alcoholics, 7 times more likely to be addicted to pot. (16)This is certainly the most common comorbidity and often goes along with the one's below.

Terry
When Terry was 9, he told his mom that he wanted to buy lunch instead of bring it. His mom at that point still believed that some of what Terry said was innocent of any other purpose, and so she let him. She did notice that he was very hungry when he came home from school. He said the lunches were small and for an extra 75 cents he could get seconds. She believed this. Two weeks later the principal called to report that Terry was caught with cigarettes on the playground. Terry's mom was amazed, as she did not smoke and neither did her husband. Not only that, but he had a whole pack. Well, it took a lot of "interrogation" to get the story out. The lunch money went to buy cigarettes from a boy in Jr. High. Terry then smoked a few of those and then sold the rest at a big profit. His parents remembered that two years later when he was found drunk in the locker room at Jr. High. Now his parents are lots wiser. Terry still thinks his parents are totally unreasonable. The rule is you get your allowance and phone privileges as long as those random urine drug screens are normal. If he doesn’t cooperate, then they are assumed to be positive. So he ended up poor and lonely for a few weeks, but now that is under control. As far as cigarettes go, if he can buy them, he can smoke them outside. If he is caught drinking or around people who are drinking, good-bye allowance and phone. Terry hates it and can't wait until he moves out so he can finally do what he wants.

ADHD plus CD
When these two disorders are present, usually the ADHD symptoms are much more severe than when ADHD is present without CD (1) .

Stephen
Stephen is now 14. When his mother thinks back to his infancy, she could actually see it coming at age 18 months. At that age he got up in the middle of the night, put a chair up to the door, opened it and went walking outside. The Mounties found him a while later and brought him home. If only that had been his only contact with them!

Stephen's mother hated school almost as much as Stephen did. Almost every day there were calls from the school about Stephen. In grade primary he tried to stab a child with scissors. He was swearing at his teachers by grade one. On Grade two it was stealing lunch money. Every time they seemed to get one problem under control, he was into something else. Everyone seemed at a loss about what to do except her brother, who took him Irish mossing every chance he could. It didn't matter what the weather was like, Stephen was out there. His uncle said that by the time he was ten, he could do the work of a grown man. There was no fear in Stephen. Cold weather, big swells, nothing bothered him. He refused to do any homework from fourth grade on. Up until that grade, his teachers let him go out for a walk around the building every hour or so, but when a set of keys went missing and were "discovered" by Stephen a few days later, the walks ended. Still, compared to the last few years, this was easy.

Stephen was suspended from 7th grade after two weeks when he threw a match into a boy's locker. Why? The boy called him stupid. He was out for a week, then after only two more days, he was thrown out for making death threats against the teacher. His parents tried home school and they thought they were getting somewhere. Until they got a call from the bank. They were overdrawn. When it all came out Stephen had stolen the cash card and figured out the password and had taken out $500 dollars. They still don't know how he did it. Before they could even sort that out, Stephen was arrested for vandalizing the school. He would have only received probation, but after giving the judge the finger, he was sent to the Shelbourne Youth Centre. It was the staff there that finally figured it out. This guy could not sit still for anything, he said the first thing that came to his mouth, and was constantly getting in bigger trouble for it. He saw the doctor, ADHD was diagnosed, and he was given medication for this in the Youth Centre. But what will happen in two months when he gets out? His motherShe spends a lot of sleepless nights thinking about that.

CD and depression

Charlene

Charlene is 14, too. Her life didn't start out quite so difficult. In fact, her mom swears that until she was almost 10, there were no problems. That is hard for everyone to believe now. Her mom remembers thinking that Charlene was certainly starting the teen years early. At age 11 she was having a tantrum about not being able to go out with her boyfriend who was 15. You could hardly blame her. By the time Charlene was 11, she looked like she was 15 or 16. Unfortunately, she did not have the maturity of a 16 year old. She ran away from home at age 12 for a week before they could find her. She brought a bottle of rum to school and got drunk. But more than this, she was absolutely unbearable to live with. She had become super defiant, and would fight her parents or anyone else for no reason at all. She never seemed happy, just angry. Unless she was with her friends, which by age 13 or 14 were 18 or so. Her parents kept asking themselves, "what had happened to their old daughter?” She was failing in school mostly because she was never there. She was never where she told her parents she said she was. The first clue came when she came home high on something and told her parents she was going up stairs to bed. They heard a crash and came in the bathroom to find her trying to cut herself with a broken mirror. Charlene wanted to die. Her boyfriend of two months had left her. For a few weeks she just hung around the house and lay on her bed and listened to music. Her parents let her out one night to go to her girlfriend's house. They got a call later that night that Charlene had admitted to taking a half a bottle of Tylenol.

It is not uncommon that a mood disorder along with CD gets missed. There are usually so many pressing problems to sort out and so many different stressors, that it isn't until suicide is tried or talked of that many families, physicians, and other health professionals consider comorbid depression. Recent studies of teenagers who have committed suicide have found that these children are about three times more likely to have CD and 15 times more likely to abuse substances.(15) Suicide is worth worrying about in CD.
CD plus Tourettes, OCD, and ADHD

Marc

Marc is now 12. He has seen more doctors, nurses, and psychologists than most people will see in a lifetime. His father worried that maybe his son could have Tourette's like him, but he never dreamed it could get like this. When he was 4 he was thrown out of pre-school for fighting. Because of his reputation, he was the first child where the school approached the parents about getting a teacher's aide in grade primary rather than the parents approaching the school. Lucky for Marc, he never seemed to have all of these problems at once. Usually he would have a tic, especially blinking, which would last a few weeks or so. Then he would have to touch things, and then that might go away, too. The tics and OCD were nothing compared to his behavior. His temper was incredible. The usual pattern was that the excitement of being around other kids would get him so wound up that he was literally bouncing around. This usually led to pushing, fighting, and punishment. He resisted this and usually ended up being sent home as they could not deal with him. He attacked him sister. He attacked his mother and broke her arm. That led to living with different relatives and now a foster home. No one seemed to be able to manage him. The new foster parents were actually being bothered the most by his poor sleep and a nearly constant vocal grunting tic. They brought him to yet another doctor to see if they could do anything about this. He was placed on some medicine for the tic and amazingly, he behavior improved quite a bit. For the first time his parents are hopeful that maybe he can come home again.

Diagnosing Conduct Disorder

Conduct disorder is diagnosed like all things in pediatric psychiatry. The child and the caregivers will be interviewed together and separately to go over the history and check out all other possible comorbid conditions. Usually there are school reports, too. The child is examined to look for signs of many disorders. This usually includes some school work, some parts of the physical exam, and getting the child's perspective on things. Occasionally, there are lab tests and x-rays to do. There is no lab test that shows these problems.

Prognosis and Course of Conduct Disorder

Perhaps about 30% of conduct disorder children continue with similar problems in adulthood. It is more common for males with CD to continue on into adulthood with these types of problems than females. Females with CD more often end up having mood and anxiety disorders as adults. Substance abuse is very high. About 50-70% of ten year olds with conduct disorder will be abusing substances four years later. Cigarette smoking is also very high. A recent study of girls with conduct disorder showed that they have much worse physical health. Girls with conduct disorder were almost 6 times more likely to abuse drugs or alcohol, eight times more likely to smoke cigarettes daily, where almost twice as likely to have sexually transmitted diseases, had twice the number of sexual partners, and were three times as likely to become pregnant when compared to girls without conduct disorder (6).

Looked at from the other direction, by the time they are adults, 70% of children no longer show signs of Conduct disorder. Are they well? Some are, but what often happens is that the comorbid problems remain or get worse. That is, a girl with CD and depression may end up as an adult with depression, but no conduct disorder. The same pattern can be true of CD plus bipolar disorder and other disorders. Here are some examples that illustrate this.

EXAMPLES

Trisha- ADHD plus CD as a child which eventually disappears
Age 4-12 Classic problems with aggressiveness towards others, hyperactivity, and impulsiveness along with running away and shoplifting

Age 12-16 ADHD symptoms become less prominent. Continued fights with teachers, shoplifting, and lying

Age 16-24 Fighting decreases, returns to school and succeeds.

Age 25-35 No sign of psychiatric problems.

Reggie- ADHD plus Conduct Disorder leads to similar problems as an adult (the minority of cases)
Age 3-7 Reggie shows lots of aggression and hyperactivity.

Ages 7-12 Besides being hyperactive, Reggie lies, cheats, steals, and eventually forces a child to take of their clothes

Ages 13-18 In and out of trouble with the law, and more involved with alcohol, Reggie quits school at age 16.

Age 18-24 Reggie has spent two years of the last six behind bars. He successfully stays off drugs and alcohol, but meets old friends, quits his job, and is back bootlegging again.

Sarah - CD with more and more signs of mood disorder. Eventually CD disappears
Age 4-12 Sarah slowly gets into more and more trouble with everyone. She starts to get irritable

Age 12-18 Sarah continues to have troubles with gambling, shoplifting, and vandalism. Occasional thoughts of suicide

Age 18-24 Sarah is hospitalized twice for depression, eventually recovers and seems to settle down

Age 24-50 A few more hospitalizations for post partum depression but no CD features.

Mitchell -Learning problems, CD, and drug abuse leads to schizophrenia
Age 4-12 Trouble in School, zero social skills, and constant conflict with family and peers

Age 13-18 Using drugs and occasionally hears voices and sees things. Goes away when he is clean

Age 18-30 Slowly but surely he gets the substance abuse under control. The hallucinations and unusual thoughts continue on and require medical treatment.

Jeff - CD plus ADHD leads to mania
Age 4-11 typical ADHD.

Age 12-14 Totally out of control. Assaults everyone, gets drunk, pulls fire alarms, attacks father, steals a car all in the space of a week. Diagnosed by a psychiatrist who visits the youth prison as manic.

Age 14-20 At least 10 episodes of mania and or depression. Hyperactivity and CD not present except while manic.

Long term outcome of ODD/CD

ODD/CD and Personality Disorder
This is one of the "labels" psychiatry uses to describe people who have traits in their personality that cause them major problems. These are not things that come and go but last for decades. A person's personality starts to form as a teenager, and that is when we see personality disorders start to form. We have all met people with these types of problems. They fit into a few big categories that have lots of different names.

One group is people who are strange, different, and keep to themselves. This is called cluster A. Another group is people who are dramatic, have lots of mood problems, are forever getting into trouble, and whose lives are quite mixed up. This is called cluster B. They are often very difficult to get along with over the long run. Another group are people who are withdrawn, scared, and have to do things a certain way. This is called cluster C. When any of these problems screw up people's relationships, ability to work, get them in trouble with the law, or make them miserable, we call it a personality disorder.

Recent studies have shown that children who have certain psychiatric problems are much more likely to get personality disorders as adults. Children who have multiple psychiatric problems are even more at risk. Children who have ODD are about four times more likely to have a personality disorder when they grow up, that is about a 15% chance. If they already have some signs of personality disorder as a young teenager, they are 25 times as likely to have a personality disorder as adults. What this tells us is that the longer these problems go on in childhood and as teenagers, the more likely they are to lead to personality disorders as adults. (17)

There are two types of Personality Disorder in Cluster B which are especially associated with ODD/CD. These are Borderline Personality Disorder and Antisocial Personality Disorder.

Borderline Personality Disorder is called this because patients have many traits from different psychiatric disorders. They have very unstable moods, like bipolar disorder. They often have strange experiences, like people with schizophrenia. Their relationships with others are usually quite unstable. They often don’t have much of a sense of who they really are or where they are going. They often cut themselves. Most of the people with this problem are female. If you have ODD/CD and are female, you have approximately a 15% chance of getting this. (24)

Antisocial Personality Disorder is basically a continuation of Conduct Disorder. People with this problem continue to not respect the rights of others or their property. They continue to get in fights or worse. They often are stealing or cheating. Usually they are involved with the law. They have extremely high rates of substance abuse and high rates of suicide and other unnatural causes of death. This is primarily a male diagnosis. Almost 20% of teenagers with ODD/CD with have Antisocial Personality Disorder as a result. (24)

How bad are Personality Disorders?
If you have a personality disorder as a teenager, by the time you are a young adult, here are the chances that these bad things will happen to you:

Make a suicide attempt- 6-10%
Serious assault on another 25-35%
Not get as far in school as you should have been able to 25%
Difficulties with interpersonal Relationships 20-30%
Ending up with other Psychiatric problems 35-40%
Having at least one of the above bad outcomes 70-80%
Having at least two of the above bad outcomes 50% (25)
This seems really bad. Do people with personality disorders ever get better?
Yes, some personality disorders are much more likely to improve over time. After 15-25 years, only about 10% of adults who had Borderline Personality Disorder continue to have it. That means 90% got over it. Antisocial Personality disorder tends to improve, too. However, about 25% of people with Antisocial Personality Disorder die prematurely. Of those that do not die, most are better, but few have recovered completely.(26)

-ODD leading to personality disorder

Tina

When Tina was four or five, she pretty much controlled the house. Somehow she had figured out exactly what she could get away with. She also was able to figure out where her parent's weak points were. More amazingly, she figured out where the weak points in their marriage were. This got so bad that her parents went to marriage counseling and finally adopted a policy of "united we stand, divided we fall" in regards to Tina. This certainly helped keep Tina in line in her elementary school years. Tina also had ADHD, but it was never too severe. She only had to take medication for a few years at the end of elementary school. As she became a teenager, she began to have problems. The loss of a boyfriend led to cutting her wrists. She always was in some sort of turmoil with her friends or the youth group. People were always trying to "save" her. The school counselor and the youth group leader both "knew in their hearts" that Tina needed a lot of attention and special care and encouraged her parents to be more understanding on her sensitive nature. Tina's grandfather said that he "knew in his heart" that Tina needed a swift kick in the rear. As the teenage years went on these problems just continued. She got involved in some minor crimes like shoplifting, tried vomiting to lose weight, and smoked pot. Each time she made such a big deal about the whole thing that her parents could hardly stand it. When she was 18, she moved in with an older guy who she thought "really understood her". They have been separated about six times so far. Her life continues in turmoil.

This points out the fact that sometimes, even with great parenting, things don't turn out so well. However, many times with aggressive intervention things go more like this-
Richard -
Richard was always hyper and always quite the con artist. The neighborhood mom's never really trusted him. He got referred after he hit the teacher hard enough to knock her down in second grade. We did everything. He took medications for his ADHD. The parents followed through with every type of intervention for ODD. He was very involved in cadets as a teenager. When he was about 19, I met his mother in a store. She wanted to tell me how well he turned out. He was still a bit of a hot head and was still on meds for ADHD, but he was working and had a steady girlfriend. He was hoping to join the militia. Richard had turned out just fine.


Families and CD

It is not unusual to see signs of stress in the parents and other siblings when a child has CD. One of the hardest questions is figuring out whether or not difficulties in the family are causing CD or whether the stress of CD is causing family problems. Often it is impossible to determine this or there are reasons to suggest both the CD is casing the family problems and the family is causing the CD to be worse. . CD is a very difficult problem to live with. It would be very unusual to see a family where it was not causing grave distress. This obviously needs to be addressed in any treatment plan.

Some of the things parents have told me about their conduct disordered child are noted below.
"If you have a child with CD, everyone will initially assume it is your fault. You will be blamed by everyone for what the child does. You may know all about Family and children services, probation, youth court, residential homes, RCMP procedures, and mental health services. "

"You will often have the feeling that no one knows what they are doing with your child and they are just trying to pass the buck to someone who does. "

"You can end up divorced, depressed, alcoholic, hopeless, or all of these from dealing with such a child. It will often make or break your faith in yourself and your faith in God."

"You can see yourself where the child's problems are leading, but can be unable to do anything about it or find anyone else who can do anything about it."

Don't give up! There is a lot to that can be done!

What can be done?

As far as ODD goes, the same feelings you can have about children and adolescents with ODD have probably influenced the research community. This is the most common psychiatric diagnosis in children. It persists into adulthood. One would think a lot of research would be done on this condition. That is not the case. A search of the medical literature for the last 3 years show 293 articles on ADHD in children, 276 on depression in children, but only 19 on ODD.

The same is not true for CD. There is a lot of research on different treatment methods for this problem. There are hundreds of psychological techniques which have been tried, but none have been found to be always successful. They involve behavior modification, working with families, and tight supervision. the best results have been found with what is called multisystem therapy. What that means is, do a lot of different things at the same time. As far as this pamphlet goes, it means you should not rely on just one type of intervention. Ideally, you should use a little of all of them. Overall, since CD is usually just a very severe form of ODD, all of the below can be useful in CD. At the end of this section are some other suggestions for CD.

Treat Comorbid disorders

CD plus ADHD
Treating the comorbid disorders is absolutely key. Recent studies have shown that treating CD plus ADHD with stimulants helps the conduct disorder and the ADHD symptoms. This effect appears independent of how bad the ADHD is (4) Since 60-70% of children who go to a clinic for help with CD also have ADHD, this is extremely important. Serious consideration should be given to medically treating all children with CD plus ADHD. Although this type of medical intervention does not make the children "normal", it can make a big difference. It often means that the non-medical interventions will work much better.

CD plus depression
Recent work also suggests that treating depression in the context of CD be effective (5)While Prozac was used in this study, most likely other drugs in that same family would be effective. See details depression and its treatment in the Depression handout.

CD plus Substance abuse, movement disorders, bipolar disorder, psychosis, Pervasive Developmental Disorders
Although there is not as much data on these areas, it is a good idea to always vigorously treat any disorder comorbid with CD. The importance of treating comorbid conditions can not be overstated.

Non-Medical Strategies for ODD and CD
Containment
The essence of this group of interventions is to make it impossible for ODD to "work." That is, it is a way of making sure all these attempts to irritate and annoy others and to cause fighting between others are not successful. There are three elements to this.

1. Come together
The most common thing I see in children with ODD (except for aggressiveness) is that a lot of the suffering that the child inflicts on others is blamed on others. Children and adolescents with ODD convince mothers that fathers have mistreated them. They convince parents that the teachers are treating their child unfairly. They convince teachers that the parents are bad, etc. You have to come together and never believe anything the child with ODD tells you about how others treat them. In order to do this, all parties need to talk directly with each other without the child as an intermediary. Mothers need to talk face to face with fathers. Parents need to talk with teachers and with principals. Sometimes Parole officers, parents, teachers and others have to all sit down together for the purpose of making it impossible for the child to play one person or group off against another. Here are some concrete suggestions.

Ask to sit down with the principals and teachers regularly.
Make it school and home policy to never rely on information your child with ODD gives you about what others have done.
Do not include the child in these discussions.
Sit down with all caregivers (grandparents, uncles, baby-sitters, parents, etc.) to make sure they understand ODD and they follow the above policy.
2. Have a plan
That is, a plan to deal with all of this oppositional and defiant behavior. If you react on the spur of the moment, your emotions will guide you wrongly in dealing with children and adolescents with ODD. They will work to provoke intense feelings in everyone. Everyone needs to agree on what happens when the child with ODD does certain things. What do we do if she disrupts class, annoys others incessantly, fights, has a major temper tantrum, states she is going to kill herself or run away?

You need a behavior modification or management plan.
Is that what "1-2-3 Magic" is?
Yes, that is a good example. For behavior modification to work, the program must have certain properties:

1.A few important behaviors need to be targeted. Rather than targeting "being good," you might try no hitting and no swearing.

2. The behavior must be clear cut and not fuzzy. Things like "listen when I tell you something" won't work, because it is too unclear. A better idea would be, "Sit down and look at me when I ask you to listen."

3. It must be consistent. There is no bending of rules in this sort of thing: no difference between the baby-sitter, mom, or dad.

4. The rewards and punishments need to be geared to the individual.

5. The rewards should not be money or things that are bought, but rather should be privileges which you can grant or activities which the child can do. Behavior Modification should not require a bank loan.

6. There needs to be an even mix of negative and positive reinforcers. The program should not be like candyland, but it also should not be out of Dorchester Prison. A typical Positive one would be a later bedtime on the weekend or a choice of dinner. A typical negative one would be going to your room or no TV.

7. It should be simple and straightforward so that your child easily understands it. If your child can read, it should be written down. If possible, your child should sign it and agree to it.

Almost every book on ADHD contains many good examples of these programs. I have some, all the family resource centers do, and so do libraries and book stores.

Here are some examples of good and bad behavior modification programs:
Jim never comes home when he is supposed to. This drives his parents nuts and they would like to kill him when he finally does come home. The behavior they want is to have Jim come home on time.

The good parents

The positive reinforcer (the carrot) would be if he comes home on time for 5 days, he can have a friend stay over and they can stay up late. The negative reinforcer (the stick) would be that if you are more than 5 minutes late, you will not be able to go out by yourself the next day. You will have to go out with the parent when it is convenient for the parent.

The Candyland parents

If you come home on time, we will pay you five dollars or you will be able to stay up as late as you want at our house that night. If you don't come home, nothing bad will happen.

The Dorchester Prison Parents

If you are one minute late, you will be grounded for a week to your room.

I tried all of these. It worked for a while and then it stopped working. What happened?
Behavior Modification doesn't work for everyone. Sometimes you have to keep changing it all the time. It works best when you find the perfect reinforcers, positive or negative. A lot of people just do not have anything they are willing to try that hard for. Also, some people are so severely impaired they just can not benefit from this.

3. Decide what you are going to ignore
Most children and adolescents with ODD are doing too many things you dislike to include every one of them in a behavior management plan. The key caregivers have to decide ahead of time what sort of thing will just be ignored.

4. Try very hard not to show any emotion when reacting to the behaviors of children and adolescents with ODD.
The worst thing to do with a kid with ODD is to react strongly and emotionally. This will just make the child push you that same way again. You do not want the child to figure out what really bugs you. You want to try to remain as cool as possible while the child is trying to drive you over the edge. This is not easy. Once you know what you are going to ignore and what will be addressed through Behavior Modification, it should be far easier not to let your feelings get the best of you.

If these interventions work, then hopefully the dialog can proceed like this:
Ann comes in and says, as she watches you folding the wash, "I need my red sweater washed and dried by 7:30 tonight"

You do not reply but think a moment. This was the sort of thing you and your husband decided to ignore. You respond, "Are you hungry?"

or this:

Ann comes in and says, as she sees you folding the wash, "Aren't you done with that yet? I need that sweater right NOW!" Ann throws her books on the floor and knocks over a glass of milk.

You respond, "let's see, that sure sounds like being disrespectful to me. I guess "the plan" says that means no TV tonight."

instead of this:
Ann comes in and says, as she sees you folding the wash, "Aren't you done with that yet? I need that sweater right NOW!" Ann throws her books on the floor and knocks over a glass of milk.

Mom throws the clothes down, glares at Ann, and replies the way she really feels, "Why you inconsiderate #$%*! Take this sweater and wash it yourself! (Throws sweater at Ann) and these socks! (throws socks at Ann) and these pants!" (throws them, too).

Dad comes home later and Ann tells him that Mom "lost it" when she just asked about how the wash was coming!

The Good of Containment
especially helpful for dealing with less aggressive behavior.

Supports all who are dealing with child

Can lead to the child abandoning his efforts at annoying others and choosing to do more reasonable things with his time.

The Bad of containment
Time consuming

Must have a lot of patience

Doesn't work as well with severe aggressiveness

Make sure that you are as healthy and strong as you can be
Children and adolescents with ODD will find the weakness in the family system and exploit it. Is there tension between father and mother? They will aim to worsen this. Trouble with the in-laws? These children and adolescents will try to exploit this. Are you out of shape and exhausted after work? That's when they will be most trying. Are you worried or depressed about something? They will try to figure it out and torment you. Dealing with a child with ODD is very exhausting and trying. It will take about 1/3 to ¼ of all your emotional, mental, and physical resources. If you knew that you would be chopping wood for four hours every day, You would make sure you got enough rest, a good diet, and had plenty of time to relax. The same holds double for dealing with ODD in the long term. You have to take care of yourself in ways you would not have to if your child did not have ODD. This includes things like:

1. Find a baby-sitter and go out weekly away from this child and your home with your spouse or significant other.

2. Make sure you have plenty of time to piss and moan about the difficulty of this to your spouse or friends.

3. Get adequate exercise. There is nothing better to blow off steam than exercise that is fun.

4. Get enough sleep

5. Eat well and don't try to go on a big diet.

6. Don't try to do too much. Remember, caring for a kid with ODD is a big job!

7. Get help if your marriage is in trouble

8. Do everything you can to stop drinking if you or your spouse has a drinking problem

9. Make sure you have some hobby you enjoy and can do when things get rough.

Limit Television
Television is a major force in our lives. Study after study has shown that Television is filled with violence, drug and alcohol use, and sexuality. The average child spends at least 2-3 hours a day watching this stuff. Many children spend 4-6 hours a day watching this. It should not be any wonder then that children who watch a lot of TV are more violent, are more likely to do drugs, and are preoccupied with sex. In a child with a problem like ADHD or ODD, this is clearly something that needs to be done. The American academy of Pediatrics recommends the following: (16)

Limit all media use to no more than 1 to 2 hours per day.

Monitor their children's use of the media.

Coview television with their children.

It also goes without saying that it is impossible to limit children's viewing if the parents are watching Television or playing video games all day and night. Turning off the TV is the most effective but radical solution to a host of child psychiatric problems. My advice is to be radical and do it!

Eliminate or reduce video and Computer games
Anyone who has ever seen a child play nintendo can see that there is a very potent force at work here. Unfortunately, the vast majority of computer and video games are violent and are becoming more graphic, not less, in their depiction of violence. As mentioned above, large amounts of television viewing can cause increased psychiatric problems for children. Although there is a less research on games, the same trend is there.

About 33% of children play computer or video games. (11) As anyone who has a child knows, these games can be very addictive. One out of five children from grades 5-8 are as addicted to computer games as an alcoholic is to alcohol. (10) The earlier children start playing these games, the more likely they are to get addicted. Children who play lots of video and computer games aren't as nice to others. Children who play violent games are more physically aggressive and are not as intelligent.(12) Unfortunately, the question remains whether or not children who are aggressive and have problems are attracted to these games or whether the games make them that way. With TV, the evidence suggests that violence on TV makes more violent kids. Given that video and computer games are a much more powerful medium than TV, I think it is quite safe to assume that they are having a detrimental effect on children.

Medical Interventions
ODD and CD are usually co-morbid with other problems. If your child has another co-morbid condition, you should look at the handout for information on the medical and non medical treatment of that disorder

When do you consider medications?
There are three reasons to consider this
1. if medically treatable CO-morbid conditions are present (ADHD, depression, tic disorders, siezure disorders, psychosis)

2. If non-medical interventions are not successful.

3. When the symptoms are very severe.

Which drugs do you use?
In choosing drugs for ODD, I look for drugs that have been proven safe in children, have no long term side effects, and have been found in research studies to be effective in extremely aggressive children and adolescents or in Comorbid conditions which children with CD often have. Each drug has certain problems that need to be watched for. The current medical literature suggests three basic principles when using psychiatric drugs in children. 1) Start low, 2) Go slow, and 3) Monitor carefully

What do you mean by Start low?
This means that you do not start any of these drugs at the usual dose, or the maximum dose. When you have pneumonia, it can be a real emergency. You want to give people plenty of medicine right away, and if there are problems, then you reduce it. Unfortunately, many people use this same strategy in the medical treatment of ODD. The problem is that big doses can cause big problems, and when the problems affect your mind and personality, this usually means trouble for the person taking the medicines. So I start with the lowest dose possible. For example, if I use a drug called Clonidine, for a boy about 60 lb., I know that the dose that will probably work for most boys that size is two pills a day. If I gave him that to start out with, I might win and it would work. But if he happens to be sensitive to that drug, he could have big problems. Although they would be reversible problems, it would probably make most children and adolescents and or parents never want to take the drug again. So what do I do? I start with a half of a pill a day, about 25% of the usual dose. That way if the child is sensitive to the drug, it causes little problems. I also find that many children respond to drugs at very low doses, far below the usual recommendations.

What do you mean, go slow?
ODD is not an acute illness. Less than 10% of the people I see with this need to be treated very quickly. Most people whom I see with this problem have had it for years. As a result, there is no need to increase the dose quickly. By going slowly, it is a lot easier to manage any side effects because things don't happen suddenly. Also, it is easier to find the lowest effective dose.

What do you mean, monitor?
For each of the medical treatments for ADHD, there are specific side effects which need to be checked regularly. Some common ones (see individual drugs below) are monitoring weight so that people are gaining weight, watch for tics, watch for depression, checking blood pressure and pulse, checking blood tests and EKGs, and making sure parents know what the side effects are of the different medications. In this way, if there is a problem, we can pick it up early and avoid the horror stories, some of which are true, about the medical treatment of this problem.

If the child has any diagnosis besides CD or ODD first try the drugs for that condition.
If that fails, or they don’t have a comorbid disorder then-


Drugs which are used for Violence, Oppositionality, and aggression regardless of diagnosis
These are drugs which have been tested in adults and children who are violent and aggressive for a variety of reasons - from ADHD to brain damage, to Conduct Disorder, and of course ODD.

First choice-
Atypical Antipsychotics
These drugs were first used for schizophrenia, and that is how they got this name. They are now commonly used for many conditions where people are not psychotic. As you can see, these are not benign medications. All of them can have serious side effects. As a result, they are not used for small problems.

Risperidone (Risperidal)
This drug was initially developed to be a safer drug for adult schizophrenia. It was then found to be effective in children with schizophrenia and other psychoses. Then it was found to be helpful in some children with Tic disorders. Based on those findings it has been used in Conduct Disorder and ODD. (20). In 2006, a large study of the use of this drug in over 500 children with ODD and/or CD found that it was much better than placebo and that this improvement was still present 6 months later (28) These studies are probably the most exciting news for the medical treatment of CD in 20 years. Risperidone is called Risperidal and comes in a variety of sizes; 25mg, .5 mg, 1mg, 2mg and liquid. It also helps Tourettes and psychosis. Usually this is given twice a day. This drug usually shows an effect within hours of a dose. There are more studies done on this drug than all the other atypical antipsychotics combined.

Olanzapine (Zyprexa)
This drug was recently approved for mania in adults. It has been studied less in children. However the early reports are positive. (14) The usual dose is about 5-15 mg a day. It comes in 2.5 mg, 5mg and 10 mg. It is also called Zyprexa. It is more expensive than Risperidone and in adults is associated with more weight gain. This can be given once a day.

Quetiapine (Seroquel)
This drug is a little different than the above drugs as it seems to cause very little problems with things like tremor and stiffness. In adolescents it can lower the blood pressure so the dose has to be increased slower. The dosage range is 200-800 mg a day. There are only a few articles on its use in children and adolescents, but these have been quite positive for mood disorders. (15) I do not know of any study on using in CD. It comes in a 25mg and 100 mg size and has to be given twice a day. It is called Seroquel.


Side Effects of the Atypical Antipsychotics
Weight Gain.
This is the biggest problem with these drugs in children. Not all kids gain weight, but a fair number can get 10-30lbs or more. In the long term drug trial of Risperidal, the average weight gain was 3.2 kg, and after 4 months, most children did not gain any more weight during the 6 month study. (27) Obviously this is something we watch very carefully. Overall Zyprexa causes the most weight gain, then Seroquel, followed by Risperidal. This is sometimes very hard to manage. It is key to weigh children everytime and start with a diet at the first sign of weight gain. There should also be a weight above which alternative drugs are tried. There is some data to support the use of a drug called Topamax for this. This is covered in the Bipolar handout. (click here)

Stiffness, restlessness, and tremor –
these occasionally happen with these drugs, too, but to a much less extent than with the older antipsychotics. This is called drug induced Parkinsons. There can also be a sudden stiffening of the body which is quite terrifying. There is an antidote to this. This is reversible if the dosage is reduced or the drug is stopped. Overall it is most common with Risperidal, then Zyprexa, and least common with Seroquel. In the large study of Risperdal in ODD and CD,1.2% had an episode of dystonia over the 10 months, and about 1/1000 had signs of drug induced Parkinsons. (27)

Elevated Cholesterol and Triglycerides
It was thought that only those people who were gaining weight got this, but now it is clear that it can happen with children who do not gain a lot of weight. Zyprexa is the most likely to cause this, followed by Seroquel, and least likely is Risperidal.

Diabetes
This can come out of the blue or be worse on these medications. Zyprexa is the most likely to cause this, followed by Seroquel, and least likely is Risperidal. In the large study of Risperidal, not one child out of over 500 developed Diabetes over the 10 months. (27)

Tardive Dyskinesia
This is a movement disorder where people can have chewing movements of the mouth, grimacing, head movements, trunk movements and hand movements. The movements are not jerky but smooth and rhythmic. Risperidal is the most likely to cause this, and the other two are very unlikely to cause it. In the large study of Risperidal, not one child out of over 500 developed this problem. (27)

How do you tell if a child has this movement disorder?
There is a physical exam tool called the AIMS or Abnormal Involuntary Movement Scale which is used to check for dyskinesias. The scale describes all the different kinds of movements in the dyskinesia family. (click here to go to a copy of this and the instructions.) These were very common with the older antipsychotics, but are less common with the newer drugs. In adults, with the older drugs, these movements can last for months or even years after the drug is stopped. In children taking these newer antipsychotics, the movements almost always disappear within a few months of stopping the drug. Certain things make tardive dyskinesia more likely.

Low IQ - children with mental retardation are at higher risk

Dyskinetic movements to start with - If you have some of these movements before you even take the drug, you are more likely to get Tardive Dyskinesia.

Taking an antipsychotic for a longer time

Taking Risperidal instead of Olanzepine. In a recent study, no children on Olanzepine ever got Tardive Dyskinesia even though they were on the drug longer than the children on Risperidal.

How common are dyskinesias in children who are not on any drugs?
About 4% of children have these movements.

How common is Tardive Dyskinesia with atypical antipsychotics in children?
It is impossible to know for sure. A recent study with many children who had mild or borderline mental retardation showed that after a year on atypical antipsychotics at a dose of about 3-4 mg a day, 4 out of 46 (8.5%) had Tardive Dyskinesia. (17)

How do you manage this problem?
Before I ever put a child on an atypical antipsychotic drug, I do an AIMS examination. I recheck it every three months. If I see evidence of new dyskinesias, I discuss with the family what to do. There are a number of things to consider:

How bad is the Tardive Dyskinesia? If it is very mild, it probably isn't worth doing much about, however if it is worsening, it is a bigger concern.

How severe is the disorder we are treating? A slight chewing movement is better than being totally out of control with Conduct disorder.

Sexual Side effects
Risperdal (risperidone) can increase a hormone in the body called Prolactin. This hormone is normally involved in breast feeding. As a result it can lead to breast enlargement (called gynecomastia), a milk like substance coming out of the breasts (called galactorhea), and irregular periods. While only girls get galactorrhea and mentstral problems, boys can get gynecomastia.

This sounds horrible! How often does this happen?
In a recent study of 504 mentally retarded children ages 5-15 who took Risperdal for a year, 22 boys and 3 girls developed gynecomastia, or about 5%. (21). In a study of 527 children with various IQs, 15 developed one of these sexual side effects. The nine boys developed gynecomastia and amongst the girls, some developed breast discharges, lactation, breast pain or their period stopped. (27)

That sounds like a lot!

The problem is that gynecomastia is quite common in adolescent boys normally. It occurs in about 1/3 of boys. (22)

Does it go away?

In this study, the gynecomastia disappeared while the child was on risperidal in 8 of the 25 who had this side effect. Usually, when the medication is stopped, the gynecomastia disappears, but there have been rare cases where it doesn’t. (21)

Galactorrhea sounds bad, too

Only one of the 85 girls in the first study developed galactorrhea. This always resolves when the drug is stopped. The menstral irregularities also usually return to normal if the drug is stopped. (21)

What about the other drugs?

Other drugs in the category almost never cause this side effect.

How can you tell who is going to get this?

You can’t. Even measuring the prolactin level doesn’t predict who will get this. (23)

The bottom line…………..

Sexual side effects are pretty rare, not medically serious, but psychologically devastating to children if they occur and have not been told about it before hand.

Neuroleptic Malignant Syndrome
This is a rare reaction to antipsychotic medication where people are very ill and have a fever, stiffness, and they are not thinking clear. It can be very serious and has even caused deaths. But it is very rare. With the older drugs, it was found in about 3-4 cases out of 1000. With the newer drugs it is harder to say. Risperidone is the most prescribed antipsychotic for children and adults in Canada. In all the world's literature, there are 8 clear cases of Risperidone causing this syndrome in adults (6) I am not aware of any cases in children or adolescents with the newer drugs, but there have been cases with the older drugs. Since the 1960's, 77 cases in children with the older drugs have been published. That would make it very, very, very rare, and rarer still with the newer drugs (7) However, if a child is suddenly started showing these changes while taking these medications, it should be considered.

Psychiatric symptoms
These drugs can make a child very anxious, depressed, and even can make them more violent. This is all reversible upon stopping the medication. No drug is more or less likely to do this. My experience is that it affects younger children more often.

How are these drugs really used?
Joey is a terror!
At age 4 Joey was thrown out of two preschools for biting and hitting. Grade Primary started off bad with a suspension in the first month for throwing rocks and at a child's face. He is involved with anger management at school, family therapy through the mental health centre and yet there are still major problems. Like it is dangerous to take him anywhere children are. It isn't so dangerous for Joey, just for the rest of humanity. Joey was put on Risperidal and within a few days he was a lot less violent. He eventually gained 5 lbs, but that was manageable. Every summer I try to cut it down and within a few days, he is unmanageable. This is a typical case - some side effects, but a good effect.

Alysha inflates
At age 12, Alysha had been on Ritalin for 5 years already for her ADHD. She wasn’t moody, but was becoming more and more violent with other kids. The stimulants didn’t help, nor did all the parenting. She was in a foster home three days out of seven and even they couldn’t handle her. She started on Risperidal. When the dose got up to 1mg a day, her foster mom and her biological mom agreed that it was true, Alysha was actually worse on this drug. When I mentioned how the drug could make her worse, they told me Alysha couldn’t be worse. Now she was super irritable, smashing even more and hoarse from screaming. So we stopped the drug and Alysha went back to her old very violent self. So we tried Zyprexa instead. It worked wonders. No one could believe the difference. Alysha gained a pound a week for 6 months. That’s over 25 pounds. That is a lot when you only weighed 80 to start with. No diet was helping. After discussing the case with her family, we switched to Seroquel. It did nothing. Now she is back on Zyprexa and is taking a new drug, Topamax, to help her lose weight. Here the benefit barely outweighs the side effects.

Jonathan looks like Grandpa
Jonathan is now 11. He has Tourettes, but the tics have never been that bad. He always had a hot temper but this year it is unbelievable. He smashed his hand in the sink over nothing. He threw a shovel through a car window. At anger management class, he got mad and trashed the office. So, since something had to work right away and he had tics, we started him on Risperidal. It worked like a charm, in three days he was back in school actually using the strategies properly that he learned in anger management. But he slowed down. His gait was shuffling a little, he fell easily, and his hands shook. His teacher said he sat "like a statue". When I examined him, he was stiff and had all the signs of drug-induced parkinsons. Cutting down the dose improved the stiffness, but his temper got worse. Now on Seroquel, there is no stiffness, and less temper, but still not as good as on Risperidal. Here it takes some changes to get a good balance between side effects and benefit.

Medications for Brandon
Brandon is 10. His life has been hard since conception. Exposed to alcohol and smoking in the womb, exposed to abuse as a preschooler, plagued with ADHD and learning disabilities, his biggest problem is that he will not stop bugging people and if he doesn’t get his way, he "flips" which means things wrecked and people get hurt. Stimulants did nothing. Risperidal only sedated him. Zyprexa made him, as he said, "crazy for food", but no better. Seroquel did nothing. So he was started on the next class of medications - mood stabilizers.

Second Choice
Older Mood Stabilizers
(Epival, Lithium)

These drugs were all used initially for bipolar illness. They have since been tried in people who are violent from brain damage, personality disorders, and children with ODD and CD. Lithium has been tested the most. There are only a few studies using Epival. If there are signs of bipolar illness or a strong family history of bipolar illness, these are the drugs to start with. Otherwise, they are for when the atypical antipsychotics don’t work or are not tolerated. (20)

Lithium can prevent suicide (click here to go to the details of this in the Suicide handout)

Lithium
Although we refer to lithium as a drug, it is actually a naturally occurring element. In some places in the world it is present to a significant degree in the drinking water. It has been used in adults for bipolar illness for almost 40 years. Approximately 80% of adults with bipolar illness will respond. The response is less when there is a mixed picture or rapid cycling. In some children and adults, it can make a normal life possible again. This drug will often stop or reduce cycling, get rid of mania and hypomania, and sometimes get rid of depression, too. It is not clear exactly how it affects the different parts of the brain to accomplish this. However, it is not an easy to use drug. It has numerous side effects. It has been used in children for a number of years.

Nuisance side effects
Occasionally this drug can cause nausea, vomiting, diarrhea, shakiness, and balance problems.

Psychologically serious but medically non serious side effects
This drug can cause or worsen acne. It can cause weight gain. It can, in some cases cause bedwetting. It can cause or worsen psoriasis.

Medically serious side effects -
Lithium can damage the kidneys. The most common problem is that it makes a person make lots of weak urine, so they need to urinate all the time. Other changes can also occur more rarely. To be used safely, blood tests for the kidneys and urine tests are done on a regular basis. With regular monitoring, these changes can almost always be detected before they become serious.

Lithium can affect the thyroid glands. It can make the thyroid gland reduce the amount of hormone it puts out. This is another thing that can be managed by monitoring blood tests. If it is severe, and the drug is helping a lot, then a person can be given thyroid pills.

Lithium, at high levels, can affect the brain. If a person has high levels of this drug in them, it can make them confused, cause coordination to be poor, and make thinking slower. For this reason, the level of the drug needs to be monitored regularly.

If you become dehydrated from the flu, diarrhea, or other causes, and you keep taking your lithium, your body will save it up and the level will go higher and higher. This is the main danger of this drug. Anyone who is taking this drug needs to talk to the prescribing physician if they are getting dehydrated so they can figure out what to do. Usually, the drug is stopped temporarily.

Certain drugs can make the amount of lithium in your blood go very high.

You should not take Lithium if you are planning on getting pregnant. It has been reported to cause certain defects in the heart of the fetus.

So why would you ever give this drug?
Because what you are treating is a lot worse than the above. You don't treat mild conditions with Lithium. Bipolar disorder is not mild. If it has worked in other family members it is especially worth considering.
Because most people do not have any of these major side effects.
Because if people know what can go wrong, and the doctor knows, and things are carefully monitored, you can pick up any problems before they get serious.
Lithium can save a child's life from suicide.
Lithium comes in a couple of forms and sizes. The blood level determines the dose. So you have to take it for a few days, then check the blood level, adjust the dose, and check the blood level again. Once the level is in the proper range, then it is usually only checked every month.

When the drug works, it is usually within 2 weeks for mania or 4-6 weeks for depression. However, sometimes it takes much longer to see the full effect. It is very cheap.

Here are some examples from the bipolar handout
Example:

Annette is 14. She has been admitted for depression following a week of hypomania. She has had one previous admission for depression. Her pediatric psychiatrist wants to treat her depression without risking her switching into mania. So he feels Lithium is a good choice. Before he starts the drug, blood tests for kidney function and thyroid function are checked. She starts taking 150mg twice a day and after a few days of this it is increased to 300 mg twice a day. Four days later a blood level is checked. It is .4 . The level should be 8-1.0. The doctor increases the dose to 450 mg twice a day and checks a level in another five days. It is .9. Annette has a little nausea and a tiny bit of tremor, but otherwise has no side effects. After four weeks, she is still very depressed. An antidepressant, Paxil, is added. Over the next two weeks she recovers from her depression. For the first month, she gets her lithium level checked weekly. Then it is twice a month for a few months, then every month. After she has been on the drug 3 months, other lab tests are checked. Annette takes the drug for 6 months, but at that point feels that she no longer needs it and thinks it is causing her acne. Against everyone's advice, she stops it. One month later she is again hypomanic, but her acne is better.

This example points out the reality of Lithium use in pediatrics. The medical side effects are a breeze to manage compared to compliance issues. Many children with bipolar illness do not have a lot of insight into their illness. Frequently after a few months they become non-compliant. Usually it is for trivial reasons from an adult's perspective. The biggest problem with lithium is that people don't like to take it long term. In fact, a big part of the counseling for this disorder is devoted to just this issue.

Jordan is 12. He first started to show signs of mania when he was 8 or 9. At 10 he got very depressed and was given an antidepressant. He became quite manic and almost had to be hospitalized. Now he is swinging from being depressed to mania every few days, and sometimes every few hours. He can't stay at school. He talks, writes, and sings about suicide. Since he almost took a fatal overdose of Tylenol last month, his parents are watching him very closely. He still wants to die sometimes, but not right now. Everyone in the family says he is just like his Uncle Terry. His uncle suicided at age 20. His aunt from BC called Jordan's mom to tell her about how well she did on Lithium.

With strong suicidal urges, a bipolar disorder, family history of a good response to lithium, and manic symptoms on an antidepressant, Jordan is a good candidate to try Lithium.

Valproic Acid, Divalproex, (Epival)
This mood stabilizer has been used for years to treat epilepsy. Over the last five years it has been found to be very effective in bipolar illness in adults, especially in mixed bipolar illness and rapid cycling bipolar illness. It is not clear how this, or other anticonvulsant drugs work for bipolar illness. It has been tested some in pediatric bipolar illness. Based on this, it has been tried in boys with CD. About 53% were improved with a high dose compared to 2% improved on a very low dose, suggesting it can be quite effective. (29)

Nuisance side effects
Occasionally this drug will cause nausea, tremor, vomiting, or diarrhea. It can be sedating in some people. It can affect balance. It can make a person temporarily lose some of their hair, but that will come back.

Medically serious side effects -
Ovaries
-Teenage women who have bipolar illness or epilepsy and take this drug are more likely to have cysts on their ovaries. They also may be more likely to have a disorder called Polycystic Ovary Syndrome. This means you have irregular periods (or none), extra hair, and sometimes obesity and acne. The male hormones are elevated. This disorder can make people infertile.

So does Epival cause Polycystic Ovary Sydrome?
.One group of researchers found that 80% of women under age 20 who were put on this drug developed Polycystic Ovary Syndrome (1).However it is not exactly clear. This is because women who have Polycystic Ovary Sydrome and are not on Valproate can show features of bipolar disorder, too. Nevertheless, there is a good chance that Epival can cause Polycystic Ovary Syndrome, especially in women under age 20. (2).

What can you do about this possible Risk?
Right now, monitoring is the best approach. Some people recommend that any teenage girl who is going to be put on Epival should have a pelvic ultrasound done first along with some blood tests for male hormones. These tests should be repeated in a year. If there is no change, you can be quite positive that the child is not developing Polycystic Ovary Syndrome. (2).

Weight gain
- In women under age 20 with epilepsy, 82% gained a substantial amount of weight. The same question comes up as before. Is it the epilepsy or the drug? In this case, it is more clear. Probably it is the drug.

Liver –
this drug can damage the liver in rare cases (2 out of 100,000) so the liver tests need to be checked regularly, like every four months or so.

Blood-
this drug can rarely reduce blood counts (2 out of 10,000) (10)

Pregnancy
- It can cause serious birth defects if it is taken during pregnancy.

The drug comes in 250mg and 500 mg pills called Epival. You can start taking nearly the full dose right away. The dose in milligrams is usually ten times the weight in pounds each day. Blood levels are checked at regular intervals.
Overall, this drug is much, much easier to use than Lithium. The side effects, outside of weight gain, are usually mild. If there are mixed features, signs of epilepsy or brain damage, it is my first choice.
Note
None of the mood stabilizers are as safe as we would like. When weighing the risks of the medication you need to balance the risk of the untreated condition versus the risk of the medication. In severe cases, the risk of the disorder far exceeds the risk of the medication. In very mild cases, it is best to try to get by without these drugs. In between requires a lot of thought and conversation between families and doctors.

And when mood stabilizers don’t work, even when added to atypical antipsychotics -
Third line drugs for ODD/CD
Clonidine
This drug was originally developed for treating blood pressure and it is very safe. It turns out to be useful for a lot of things. Tics, severe ADHD, detoxifying Heroin addicts, menopausal flushing, and sometimes autism with hyperactivity or severe aggression are the usual indications. The good thing about this is that it never aggravates tics, works when autism is present, and works in very aggressive children and adolescents who never sleep. It is safe for pre-schoolers and comes in a pill called dixarit that is sweet tasting and looks exactly like smarties. As a result, children and adolescents will easily take it. It also comes in a larger size. It is also used in autism, preschoolers, and very aggressive children and adolescents with ADHD and insomnia.

And the bad side?
About one out of every 10 to 20 people who take this will become depressed. It comes on within about 3-4 days and after the drug is stopped, it can take 3-4 days to clear. However, if you are not watching for this, you might think the child is depressed for another reason, and never stop the drug, thus leaving the child depressed. With careful monitoring, you will always pick this up if it appears.

This drug also has an effect on the heart. It can lower the pulse and blood pressure. To be cautious, I check an EKG before I start the drug and once the child is on it. I also check their blood pressure and pulse at every visit.

It will make some children sedated, but usually by cutting back the dose you can avoid this.

New and other mood stabilizerss
This includes three drugs at present, Gabitril, Tegretol Lamictal (Lamotrigine) Neurontin (gabapentin) and Topamax (Topiramate).

They are being used a fair amount in children as they have been tested for epilepsy in children. There is evidence that they are effective in adults with bipolar disorder but there are still no reports in the literature of careful trials of these drugs in children and adolescents. They are occasionally used in ODD/CD if all else fails. There are no good studies to show that they work.

So why use them?

Because nothing else has worked.

More non-Medical Interventions
Enlist others to help you
Caring for a child with ODD can take a lot out of anyone, especially if you are one of the main people the child is trying to aggravate. Some children with ODD and more children with ODD plus other psychiatric problems can require an incredible amount of patience, energy, and determination. Often this is more than any one or two human beings can provide. There is no natural law that states that all children can be managed by one or two reasonable parents. Many children are born who require three to five full-time parents. You may have one!

What you should do is everything you can to share the parenting.
First think who in your family can take care of this child reasonably well for an hour? a day? a weekend? a week? Often there are cousins, aunts, uncles, good friends, fathers, mothers, or Grandparents who can take a disturbed child for a while, but not a long while. By putting a few of these together, you can get a little breathing space. Obviously, all this is doubly true for the child with CD.

My family lives in New Brunswick, and my husband's family hates us.
The next step is to try what is available publicly. Daycare for little kids? After school programs for older children and adolescents? Big brother and big Sisters?

The last step is respite foster care on a regular basis. In some cases, this is the best way to go, as it will give you a chance to catch your breath and not go crazy.

The most common mistake people make in this situation is to think they should be able to do it all themselves. They then either end up giving up the child or getting so mad at the child that it would have been better if they had given it up the child to someone else. Don't be proud. Get some help.

Discover what your child is truly interested in.
Not what he is interested in for the sole purpose of aggravating people, but truly interested. Although some children do not have any interests, many do. If this can be encouraged, it can supply a direction for all the energy the child is putting into aggravating others. When you try to stop some of the ODD misbehavior, you want to make sure there is a direction you can push him in which he might enjoy. Children with ODD will often do their best not to wreck something they really like. That desire to want to have things work out is a great place to start, as it can be very hard to find things to praise in children and adolescents with ODD. It also might be a situation in which you can interact with the child in a setting that is far more rewarding than the usual show downs. The same holds true with CD. Obviously it requires a lot of supervision and creativity, but there often is something the child likes. In my experience with severe CD children on our ward and in the community, I am often quite touched by how normal they can be in certain settings. For example, a child may do just great swimming, but require 1:1 supervision in the locker room.

Hospitalize the child.
Some children with ODD plus a few other psychiatric diagnoses or CD are just totally out of control. They have everyone fighting with each other, are controlling the family, and are causing so much chaos that caregivers can only concentrate on surviving each minute. Sometimes putting the child in the child psychiatric ward can do wonders. You get some rest, and most importantly have some time to figure out what to do next with the assistance of the child psychiatric ward staff. The down side is that in Nova Scotia there is only one ward, and it is in Halifax. It is hard to get into and makes visiting and follow up care difficult.

Other non medical Strategies for CD
Safety
Before you can think about doing anything for the child, you and everyone else in the child's environment must feel safe. You can not say, "no" if you are afraid you might be seriously hurt if you do. A child will not learn to get along with others if the other children are so afraid of him they will not cross him or her.

A safe home
Every child deserves a safe home, but so does every parent! If your child is big enough to be dangerous and you can not enforce rules without fear for your safety, then the first thing to do is address this. Sometimes other interventions can make a big difference right away. Usually they will not. That means that at least for awhile, the child may have to leave your home. This might mean foster homes, hospitals, our residential centres. While this can be a hard thing to do, it is really the only choice at times. The rest of your family should not have to live in fear. The child should not learn the intimidation always works, which is often the lesson the child with CD is learning in a home where the parents are afraid.

A safe school
After a safe home, this is the most important thing. Other children and teachers need to feel safe in the presence of this child. This usually means lots and lots of supervision is necessary. Often it means expulsion and suspensions. Sometimes this can lead to out of home placement just so the child can be in a safe academic environment

A safe community
If the child with CD is committing crimes all over your town or village, that will also make any improvement in him impossible. Some parents, officers, and judges are eager to give a child many "chances". It is better to jump on these problems early and have an appropriately severe probation, etc., so that everyone is safe. This teaches the child that actions have consequences and gives people in the community confidence to work with the child.

Treating the child
In many children with CD, the safety issues are never resolved. Often it is because some person or group keeps wanting to give the child one more try or doesn't think that safety is the most important thing. All treatments will fail if everyone does not feel safe. Here are some principals of treatment.

Look at the whole picture
It is easy to get overly involved in one aspect of children such as these. The fact is, there are usually many parts of their problems.

Family - Many of these children have grown up in abusive homes and/ or may never have had a strong relationship with anyone. These issues can be addressed through counseling.
Learning - Children with CD frequently have learning disorders. They need to be assessed and appropriate extra help needs to be given with school work.
Neuropsychiatric - many children with CD also have some other major psychiatric problem. These need to be vigorously treated.
Social Skills - most children with CD have a very difficult time getting along with others. This needs to be addressed. . Click here to go to the section on this topic in the ADHD handout
If these problems are addressed, the child with CD has a chance to become one of those who grows out of it. Without intervening like these, the chances are far less.
Treating the caregivers
This is the most difficult psychiatric disorder of children. It is still often blamed on the parents or caregivers. The suggestions for taking care of yourself above need to be followed, but a few more are also necessary.

Full time parenting
If you are the full time parent with a child like this, it is a full time job. That means that either both parents/caregivers work part time or one works and the other doesn't. Don't expect to both work full time outside the home.. It won't work. You won't spend every minute with the child, but by the time you address all the needs of the child and yourself and your family, there will be no time for work, too. One of the most impressive changes in children with CD is when they go into a setting in which there is full time parenting (foster care, residential care, or hospital). There is often an almost instant improvement. Why is this? Children with CD need a huge amount of supervision and involvement from the person who is responsible for them. They frequently don't form close relationships easily, they don't do well without structure, and they need to be watched and watched and watched. While Baby sitters, groups, and relatives are great, they are not the same as the parent/principal care giver.

What if you can't afford to not work?
Between living with less, Government agencies, and family, nearly everyone can do this. I find that parents who say that they are going to stay home for their child with CD get a lot of support from families, agencies, and the community. Often money follows.

Someone to talk to
Whether it is your spouse, relative, friend, pastor, or a counselor, you need to be able to talk to someone with total frankness, especially if things go wrong. You can not do it yourself. Here are some of the common issues which come up.

Having your child arrested for committing a crime in your home.

Having people blame you for what the child has done.

Having large amounts of money disappear and suspecting your child with CD

Considering out of home placement

Arranging schooling for a child with CD who has been suspended for the year.

Having to tell the child he can not stay with you.

Grieving the loss of the child you hoped you would have.

Hearing about crimes and wondering if it was your child.

Seeing the system write your child off.

Sometimes admitting that you just can not cope with this child.

Putting it all together
Here are some recent suggestions which summarize the management of CD and ODD by John Werry, a psychiatrist in Auckland, NZ

Intervention should be as early as possible.

It should cover as much of the child's day as possible every day

It should include all caregivers

It should be consistent across all environments and across time

It should be maintained as long as needed (this may be years)

It should include many different types of interventions and not just focus on one aspect of the problem

It should address comorbidites such as depression, drug and alcohol abuse, and ADHD
ODD example
Jean is 8 years old. He has ODD, ADHD and a reading disability. The parents finally got help when Jean's mom was faced with a school suspension after only five days of school. After many battles, things are a little better. To start with, Jean's Dad and mom get a baby sitter three times a week. Sometimes they go out, and sometimes they take the child to the baby-sitter and just go back home. It is these every other day "dates" which see them through this. Jean's parents meet weekly with the school in person, along with a daily report card. Jean gets to use the computer at home only if he does well in school. Jean's Aunt helps twice a week with the reading, as Jean's parents just can not stand to do it. In exchange Jean's mom teaches her nephew piano. Jean takes medication for ADHD which helps, but it is no cure all. He is in Karate, and scouts. About once a week, there is a "problem" in the neighborhood or school which Jean is usually at the center of. Jean wants a dog badly. Through an elaborate Behavior plan, he is slowly "earning" this. Jean feels like everyone is on his case for nothing. It is half true; he is watched closely. Jean's father prays each night that his child will not develop conduct disorder. So far, so good.

CD Example
Tony is 13 and has conduct disorder and depression. He is living with his Uncle and Aunt who have basically raised him since birth. Occasionally his mom comes by, but not on a regular basis. The father is unknown. Tony's Uncle and Aunt adopted him. They are the head of a "team" which cares for Tony. This includes respite foster parent's two weekends a month, Tony's other uncle one weekend a month, and his grandparents or his adopted parents the other weekend. At the moment, Tony is doing well. After the last sentencing, they were able to get better cooperation from their probation officer and a more workable probation agreement. Tony is supervised more than his adopted parent’s four year old. Last year he was hospitalized after he cut his wrist when he was caught drinking. Tony is now part of a group at school who are putting together a house. For once he is doing real well, except when he tried to steal an electric saw. But Tony's parents had warned the school to watch for this, and they did, and they caught him. The punishment? No electric guitar for four days. Every week or so while Tony is at school, his parents go through all his stuff. They have told Tony they will do this. Tony thinks it is mean and unfair. On the other hand, there have been no knives in the house for a month now. His parents call it "room service".

In summary,
ODD is one bad problem. There is no one thing that will probably fix it. Make sure you are not prematurely ruling out any of the possible interventions above. If you are not careful, it can destroy you long before it ruins the kid. If nothing is done, the outcome can be dismal. It is absolutely key to keep working to do everything you can to keep this problem from devastating your life and your child's.

CD is the worst medical or psychiatric problem there is to bear as a parent or caregiver. If you don't approach this problem with this view, it will most likely devour you. Even when everything is done right, a bad outcome is still possible. On the other hand, turning around a child with CD is the most rewarding thing a parent or caregiver can do. Good luck!

Optic Nerve.
The nerve that carries impulses from the eye to the brain.

Optician.
A specialist trained to grind lenses according to a prescription.

Optometrist.
A vision professional who specializes in the evaluation and optical correction of refractive errors.

Oral Approach.
A philosophy and approach to educating deaf children that stresses learning to speak as the essential element for integration into the hearing world.

Oral Language.
Those verbal communication skills needed to understand (listen) and to use (speak) language.

Organic.
Factors usually associated with the central nervous system that cause a handicapping condition.

Organicity.
A disorder of the central nervous system; brain damage.

Organic Therapy.
A broad term referring to any treatment or therapeutic technique that involves the use of noxious stimuli (unpleasant physical sensation); i.e., electric shock, drugs, etc.

Orientation.
The ability to establish one’s position in relation to the environment.

Orientation and Mobility Services.
Related service; includes services to visually impaired students that enable students to move safely at home, school, and community.

Orthopedic impairment.
Disability category under IDEA; orthopedic impairment that adversely affects child’s educational performance

Orthopedic Impairment.
Any disability caused by disorders to the musculoskeletal system.

Orton Dyslexia Society.
Organization of professionals in the field of LD as well as scientists and parents.

Orton-Gillingham Approach.
An approach to teaching individuals with learning disabilities. The technique, devised by Dr. Samuel Orton, Anna Gillingham, and Bessie Stillman, stresses a multisensory, phonetic, structured, sequential approach to learning.

Ossicles.
Three small bones (hammer, anvil, and stirrup) that transmit sound energy from the middle ear to the inner ear.

Osteogenesis Imperfecta.
A hereditary condition in which the bones do not grow normally and break easily; also called Brittle Bone Disease.

Otitis Media.
An infection or inflammation of the middle ear that can cause a conductive hearing loss.

Otolaryngologist.
A medical doctor specializing in diseases of the ear and throat.

Otologist.
A physician who specializes in the diagnosis and treatment of diseases of the ear.

Otoselerosis.
A bony growth in the middle ear that develops around the base of the stapes, impeding its movement and causing hearing loss.

Overcorrection.
A procedure in which the learner must make restitution for, or repair, the effects of his/her undesirable behavior and then put the environment in even better shape than it was prior to the misbehavior; used to decrease the rate of undesirable behaviors.

Overexcitabilities.
A term originated by Kazimierz Dabrowski to describe excessive response to stimuli in five psychic domains (psychomotor, sensual, intellectual, imaginational, and emotional) which may occur singly or in combination. Overexcitabilities are often used to describe certain characteristics of the gifted. “It is often recognized that gifted and talented people are energetic, enthusiastic, intensely absorbed in their pursuits, endowed with vivid imagination, sensuality, moral sensitivity and emotional vulnerability. . . .
[They are] experiencing in a higher key.” - Michael Piechowski. Extreme overexcitabilities or a strong imbalance between them may reduce the individual's ability to function in society.

Pacing.
The speed at which content is presented and instruction delivered. Pacing which matches the student's rate of learning is optimal. Because gifted students are usually able to learn faster, they often prefer accelerated pacing.

Paired-associate Learning.
A form of learning in which two items are presented together to the student, one item being the stimulus and the other being the desired response.

Panic Attack.
A serious episode of anxiety in which the individual experiences a variety of symptoms including palpitations, dizziness, nausea, chest pains, trembling, fear of dying, and fear of losing control; these symptoms are not the result of any medical cause.

Paralysis.
An impairment to or a loss of voluntary movement or sensation.

Paranoia.
A personality disorder in which the individual exhibits extreme suspiciousness of the motives of others.

Paraplegia.
Paralysis of the lower part of the body, including both legs; usually results from injury to, or disease of, the spinal cord.

Paraprofessional.
Trained classroom aide who assists a teacher; may include parents.

Parasuicide.
Actual suicide attempts that are unsuccessful.

Parent.
Parent, guardian, or surrogate parent; may include grandparent or stepparent with whom a child lives, and foster parent.

Parietal Lobe.
The portion of each hemisphere of the cerebrum that controls tactile sensations from various parts of the body; located in the top rear of the head, between the frontal and occipital lobes.

Parkinson's Disease.
In Parkinson's disease, for reasons that are not fully understood, nerve cells in the part of the brain that produces dopamine, the substantia- nigra, begin to decrease in number. This causes a decrease in the amount of the available dopamine. Also, the chemical in the synapse that breaks down the dopamine (MAO-B) continues to deplete what little dopamine is left. The overall effect is a large loss of dopamine in the brain. This throws off the normal dopamine/acetylcholine balance, since the level of acetylcholine remains normal.

There is an imbalance of dopamine and acetylcholine in Parkinson's disease. In Parkinson's disease, there is not enough dopamine to keep balance with the acetylcholine. The result of this imbalance is a lack of coordination of your movement that often appears as tremor, stiff muscles and joints, and/or difficulty moving. Currently, there is no way to stop the loss of nerve cells that produce dopamine or to restore those that have already been lost. However, there are several methods, including drug therapy, that can help you manage the slow decline in function that occurs with Parkinson's disease.

Partial Participation.
Teaching approach that acknowledges that even though an individual with severe disabilities may not be able to independently perform all the steps of a given task or activity, he/she can often be taught to do selected components or an adapted version of the task.

Pediatrician.
Provides medical services to infants, children, and adolescents; trained in overall growth and development of these individuals and their motor, sensory, and behavioral development.

Peer Nomination.
A strategy of rating social competence that depends on the ratings of peers.

Peer Tutoring.
A structured instructional system in which peers instruct each other in academic skills.

Perceptual Abilities.
The abilities to process, organize, and interpret the information obtained by the five senses; a function of the brain.

Perceptual Handicap.
Difficulty in ability to process and organize as well as interpret information through the senses.

Perceptual Impairment.
A term formerly used to describe some conditions now included under the term "specific learning disabilities"; refers to a difficulty in the ability to process and organize as well as interpret information through the senses.

Perceptual-Motor.
Muscle activity resulting from information received through the senses.

Perceptual Speed.
Specific meaning of this term varies, depending upon the manner in which a given test measures this ability. May refer to motor speed, how fast something is copied or manipulated, or to visual discrimination, e.g., how quickly identical items in a given series are identified, etc.

Performance-Based Assessment.
An assessment model that involves demonstration of knowledge and skills, requiring students to think through and construct responses; these assessments are used to examine a student’s ability to apply knowledge to a given situation.

Performance Criteria.
A description of the characteristics to be assessed for a given task. Performance criteria may be general, specific, analytical trait, or holistic. They may be expressed as a scoring rubric or scoring guide. (See rubrics and scoring guide.)

Performance Task.
An assessment exercise that is goal directed. The exercise is developed to elicit students' application of a wide range of skills and knowledge to solve a complex problem.

Perinatal.
Occurring at or immediately after birth.

Peripheral Vision.
Monitoring and interpreting what is happening in the surrounding field of vision.

Personality Disorder.
A group of behavior disorders, including social withdrawal, anxiety, depression, feelings of inferiority, guilt, shyness, and unhappiness.

Pervasive Developmental Disorder (PDD).
Pervasive Developmental Disorders are characterized by severe and pervasive impairment in several areas of development: reciprocal social
interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities. The qualitative impairments that define these conditions are distinctly deviant relative to the individual’s developmental level or mental age. The term PDD encompasses Autistic disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified. These disorders are usually evident in the first years of life and are often associated with some degree of mental retardation. PDD are sometimes observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system).

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).
A severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when
stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. This category includes atypical autism: presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or subthreshold symptomatology.

PET Scan (Positron Emission Tomography Scan).The use of radioactive isotopes injected into the brain through the bloodstream while the flow of isotopes is recorded to investigate brain function.

Petit Mal Seizure.
See Absence Seizure.

Phenylketonuria PKU.
(PKU) is an inherited error of metabolism caused by a deficiency in the enzyme phenylalanine hydroxylase. Loss of this enzyme results in mental retardation, organ damage, unusual posture and can, in cases of maternal PKU, severely compromise pregnancy.

Phobia.
An intense irrational fear, usually acquired through conditioning to an unpleasant object or event.

Phonemes.
The smallest individual sounds that carry meaning; typically represented by individual letters, digraphs, diphthongs, etc.

Phonics Approach.
Method for teaching reading and spelling in which emphasis is placed on learning the sounds which individual and various combinations of letters make in a word. In decoding a word, the child sounds out individual letters or letter combinations and then blends them to form a word.

Perseveration.
Continuous repetition of an activity or behavior. For example, an individual may repeat the same word or draw the same symbol over and over to an excess. Usually considered inappropriate behavior.

Photophobia.
Extreme sensitivity of the eyes to light; occurs most notably in albino children.

Physical Therapist (PT).
A professional trained to help people with disabilities develop and maintain muscular and orthopedic capability and make correct and useful movement.

Pidgin Sign English (PSE).
A visual-gestural language with its own rules of syntax, semantics and pragmatics; the standard form of sign language used in the United Kingdom.

Play Audiometry.
A method of assessing a child’s hearing ability by teaching the child to perform simple but distinct activities.

Portfolio Assessment.
A method of assessment involving a collection of student work (artifacts) that demonstrates mastery of a set of skills and/or applied knowledge.

Positive Reinforcement.
The implementation of a favorable consequence contingent on a specified behavior that tends to increase the likelihood of future occurrences of that
behavior.

Postlingual.
Occurring after the development of language; usually used to classify hearing losses that begin after a person has learned to speak.

Postnatal.
Occurring after birth.

Prader-Willi Syndrome.
A condition linked to chromosomal abnormality that is characterized by delays in motor development, mild to moderate mental retardation,
hypogenital development, an insatiable appetite that often results in obesity, and small features and stature.

Pragmatics.
Study of the rules that govern how language is used in a communication context.

Precision Teaching.
An instructional approach that involves: specifying the skills to be learned, measuring the initial fluency with which the student can perform those skills, establishing a goal for the child’s improvement, using daily measurement to monitor progress made under an instructional program, charting the results of those measurements, and changing the program if progress is not adequate.

Precocity.
Development significantly earlier than normal. Most gifted children show precocious intelligence, but not all who develop skills early are gifted: they may reach a plateau, allowing those of average ability to catch up.

Prior Written Notice.
Required written notice to parents when school proposes to initiate or change, or refuses to initiate or change, the identification, evaluation, or
educational placement of the child.

Prelingual.
Describes a hearing impairment acquired before the development of speech and language.

Prenatal.
Occurring before birth.

Prenatal asphyxia.
A lack of oxygen during the birth process usually caused by interruption of respiration; can cause unconsciousness and/or brain damage.

Prereferral Process.
A procedure in which special and regular teachers develop trial strategies to help a student showing difficulty in learning remain in the regular classroom.

Present Level of Educational Performance (PLEP).
A statement summarizing a student’s accomplishments, knowledge and skills within an academic area; must be included in the IEP as mandated by P.L. 94-142.

Prevalence.
The number of people who have a certain condition at any given time.

Problem Solving.
A method of learning in which students evaluate their thinking and progress while solving problems. The process includes strategy discussion--determining solution strategies to similar problems and pinpointing additional problems within the context of their investigation.

Procedural Safeguards Notice.
Requirement that schools provide full easily understood explanation of procedural safeguards that describe parent’s right to an independent
educational evaluation, to examine records, to request mediation and due process.

Prodigy.
A child (usually under age 10) who is able to perform at an adult level in a specific skill. Unlike savants, prodigies often have high intelligence and are aware of their thinking strategies.

Professional Improvement Plan (PIP).
A detailed plan listing professional activities that will be undertaken to improve oneself as a professional teacher.

Program Specialist.
Specialist with expertise in at least one of the disabling conditions who provides services of consultation, staff development, and program evaluation and innovation.

Project 2061.
A reform initiative, developed by the American Association for the Advancement of Science, which seeks to improve the quality, increase the
relevance, and broaden the availability of science, math, and technology education.

Projective Test.
A personality test in which an individual is asked to respond to unstructured materials or stimulus items such as ink blots and pictures. The structure that the individual imposes on the item is regarded as a projection of his own personality.

Prosthesis.
Any device used to replace a missing or impaired body part.

Protocol.
The orgiginal records of the results of testing. Also used to refer to the client responses on a given test, i.e. WJR III.

Psychiatrist.
An individual who treats behavioral or emotional problems. Is a licensed medical doctor (M.D.), so is permitted to use medications in treating a
problem.

Psychological Examination.
An evaluation by a certified school or clinical psychologist of the intellectual and behavioral characteristics of a person.

Psychological Services.
Related service; includes administering psychological and educational tests, interpreting test results, interpreting child behavior related to learning.

Psychomotor.
Pertaining to the motor effects of psychological processes. Psychomotor tests are tests of motor skill which depend upon sensory or perceptual motor coordination.

Psychosis.
A serious mental disorder in which the individual has difficulty differentiating between fantasy and reality.

Psychosocial Disadvantage.
Category of causation for mental retardation that requires evidence of subaverage intellectual functioning in at least one parent and, when
applicable, one or more siblings; often used synonymously with Cultural-Familial Retardation.

Public Law (P.L.) 94-142.
The federal Education for All Handicapped Children Act that became law in 1975. P.L. 94-142 requires each state to provide free and appropriate public education to all handicapped children from birth through age 21. The law also requires that an Individualized Education Plan be prepared for each handicapped child, that parents must have access to their child's school records, and are entitled to a due process hearing if they are dissatisfied with the educational plan.

Pull-out.
A part-time special educational program that takes exceptional learners out of the regular classroom for a limited time. Many elementary gifted programs are once a week, pull-out, enrichment activities. Since gifted students are gifted all day, every day, pull-out programs alone seldom meet their needs.

Punishment.
Causing psychological or physical pain to another usually with the goal of changing the other's future behavior. Punishment may quickly produce submission or obedience, with longer term side effects such as rebellion, revenge, or withdrawal.

Pupil.
The circular hole in the center of the iris of the eye, which contracts and expands to let light pass through.

Pupils with Handicapping Conditions (PHC).
Children classified as disabled by the Committee (SST or SRT) on Special Education.

Pupils with Special Educational Needs (PSEN).
Children defined as having math and reading achievement lower than the twenty-third percentile and requiring remediation; these students are generally not considered disabled but are entitled to assistance to elevate their academic levels.

Quadriplegia.
Paralysis of all four extremities.

Quartile.
A score in a frequency distribution below which either 25 percent (first quartile), 50 percent (second quartile), 75 percent (third quartile), 100
percent (fourth quartile) of the total number of scores fall.

Random Activity.
Refers to an individua'ls behavior that appears to be haphazard and having no specific goal.

Random Sample.
A sample of observations drawn from a population in such a manner that each member of the population has an equal chance of being selected.

Range.
Indicates the spread of a group of scores. The lowest score is subtracted from the highest score.

Rate of Behavior.
A measure of how often a particular action is performed; usually reported as the number of responses per minute. Also referred to as Frequency of Behavior.

Rationalization.
The interpretation of one’s own behavior so as to conceal the motive it expresses by assigning the behavior to another motive.

Raw Score.
An individuals' unconverted score on a given test; i.e., the number of items answered correctly on a specific test.

Reaction Formation.
A complete disguise of a motive that it is expressed in a form that is directly opposite to its original intent.

Readiness.
Acquisition of skills considered prerequisite for academic learning.

Reading disability.
A marked discrepancy between one's expected and actual reading achievement levels according to chronological age.

Reading Pacers.
A variety of assistive technology designed to allow the reader to read at a faster rate.

Reasonable Accommodation.
Adoption of a facility or program that can be accomplished without undue administrative or financial burden.

Reasoning Ability.
Specific meaning of this term varies, depending upon the manner in which a given test measures this ability; generally refers to nonverbal, deductive, inductive, analytical thinking.

Reauditorization.
A type of language disability in which an individual is able to understand and recognize words but is unable to remember them in order to use them in spontaneous language.

Rebus.
Pictorial symbols. Picture words that stand for words.

Receptive Aphasia (sensory aphasia) (auditory aphasia)
Inability to understand the meaning of written, spoken, or tactile speech symbols, due to disorder of the auditory and visual word centers.

Receptive Language.
The process of receiving and understanding language which is spoken or written by others.

Receptive Language Disabilities.
Difficulties that result from an individual's inability to understand spoken
language.

Recidivism.
Going back; return to. Frequently used in the mental health context to refer to individuals who 'return to' residential treatment centers, institutions, etc., after having been placed in the community.

Reciprocal Teaching.
A metacognitive instructional method that requires students to complete four steps during a lesson, including predicting, questioning, summarizing and clarifying.

Refraction.
The bending or deflection of light rays from a straight path as they pass from one medium (air) into another (the eye); used by eye specialists in assessing and correcting vision.

Regression-Based Discrepancy.
Calculation of an ability-achievement discrepancy based on standard score comparisons that take into account the mathematical phenomenon of regression to the mean.

Regrouping.
In arithmetic, the processes traditionally known as carrying in addition or borrowing in subtraction.

Regular Education.
All education not included under special education; also called General Education.

Regular Education Initiative (REI).
A position advocated by some special educators that students with disabilities can and should be educated in regular classrooms under the
primary responsibility of the general education teacher.

Rehabilitation Act of 1973.
The Civil Rights Act for the Handicapped. The act prohibits discrimination on the basis of physical or mental handicap in all federally-assisted programs. Section 504 of the act stipulates that handicapped people are entitled to:

the same rights and benefits as nonhandicapped applicants and employees
all medical services and medically-related instruction available to the public
participate in vocational rehabilitation, senior citizen activities, day care (for
disabled children), or any other social service program receiving federal
assistance on an equal basis with nonhandicapped persons
an appropriate elementary and secondary education for physically or
mentally handicapped children.

Reinforcement.
The strength of a particular response.

Related Services.
Developmental, corrective, and other supportive services required for a child with disabilities to benefit from special education including: special transportation services, speech and language pathology, audiology, psychological services, physical and occupational therapy, school health services, counseling and medical services for diagnostic and evaluation purposes, rehabilitation counseling, social work services, and parent counseling and training.

Reliability.
An indicator of score consistency over time or across multiple evaluators. Reliable assessment is one in which the same answers receive the same score regardless of who performs the scoring or how or where the scoring takes place. The same person is likely to get approximately the same score across multiple test administrations.

Remediation.
Process in which an individual is provided instruction and practice in skills which are weak or nonexistent in an effort to develop/strengthen these skills.

Repression.
The psychological process involved in not permitting memories and motives to enter consciousness though they are operating at an unconscious level.

Residual Hearing.
The remaining hearing, however slight, of a person who is deaf.

Resource Room.
An instructional setting to which a special education student goes for specified periods of time on a regularly scheduled basis.

Resource Program.
A program model in which a student with LD is in a regular classroom for most of each day, but also receives regularly scheduled individual services in a specialized LD resource classroom.

Resource Teacher.
A specialist who works with handicapped students; may also act as a consultant to other teachers.

Respite Care.
The temporary care of a person with a disability.

Response Cards.
Cards, signs, or items that are simultaneously held up by all students to display their response to a question or problem presented by the teacher; response cards enable every student in the class to respond to each question or item.

Response Cost.
A procedure for reducing the frequency of inappropriate behavior by withdrawing a specific amount of reinforcement contingent upon occurrence of the behavior.

Retina.
A sheet of nerve tissue at the back of the eye on which an image is focused.

Retinitis Pigmentosa (RP).
An eye disease in which the retina gradually degenerates and atrophies, causing the field of vision to become progressively more narrow.

Retinopathy of Prematurity (ROP).
A condition characterized by an abnormally dense growth of blood vessels and scar tissue in the eye, often causing visual field loss and retinal detachment. Usually caused by high levels of oxygen administered to premature infants in incubators. Also called Retrolental Fibroplasia (RLF).

Retrieval.
The ability to retrieve information that has been stored in long-term memory.

Retrolental Fibroplasia (RLF).
See Retinopathy of Prematurity.

Reversals.
Difficulty in reading or reproducing letters alone, letters in words, or words in sentences in their proper position in space or in proper order. May also refer to reversal of mathematical concepts (add/subtract. multiply/divide) and symbols (>; x+). See also Transposition.

Reye’s Syndrome.
A relatively rare disease that appears to be related to a variety of viral infections; most common in children over the age of six. About 30% of
children who contract it die; survivors sometimes show signs of neurological damage and mental retardation. The cause is unknown, although some studies have found an increased risk after the use of aspirin during a viral illness.

Rh Incompatibility.
A blood condition in which the fetus has Rh positive blood and the mother has Rh negative blood leading to a buildup of antibodies that attack the fetus. If untreated, can result in birth defects.

Rheumatic Fever.
A disease characterized by acute inflammation of the joints, fever, skin rash, nosebleeds, and abdominal pain. This disease often damages the heart by scarring its tissues and valves.

Rigidity.
A type of cerebral palsy characterized by increased muscle tone, minimal muscle elasticity, and little or no stretch reflex.

Ritalin.
Trade name for one of several stimulant drugs often given to modify hyperactivity in children.

Rorschach Test.
An unstructured psychological test in which the individual is asked to project responses to a series of ten inkblots.

Rubella.
German measles; when contracted by a woman during the first trimester of pregnancy, may cause visual impairments, hearing impairments, mental retardation, and/or other congenital impairments in the child.

Rubric.
An assessment tool that lists the criteria for a specific piece of work.

Savant.
A person with exceptional ability in a specific skill, often artistic, mathematical or musical, who seems intuitively to "know" but is unaware of thinking strategies. Savants often display flattened emotions and little creativity.

Scaffolding.
An instructional technique in which the teacher breaks a complex task into smaller tasks, models the desired learning strategy or task, provides support as students learn to do the task, and then gradually shifts responsibility to the students. In this manner, a teacher enables students to accomplish as much of a task as possible without adult assistance.

Scale.
The range of scores possible for the student to achieve on a test or an assessment. Performance assessments typically use a 4- to 6-point scale, compared to a scale of 100 or more with traditional multiple-choice tests.

Scatter.
Variability in an individual's test scores.

Schizophrenia.
A severe behavior disorder characterized by loss of contact with one’s surroundings and inappropriate affect and actions.

School Phobia.
A form of separation anxiety in which the child’s concerns and anxieties are centered on school issues and as a result he/she has an extreme fear about coming to school.

School Psychologist.
A person who specializes in problems manifested in and associated with educational systems and who uses psychological concepts and methods in programs which attempt to improve learning conditions for students.

School Social Worker.
Professional who provides individual and group counseling, consultation to teachers, and other services which help students cope with their disabilities; in addition, these professionals also collaborate with community agencies and provide case management for students and families requiring multiple services.

Scientific knowledge.
Knowledge that provides people with the conceptual and technological tools to explain and describe how the world works.

Sclera.
The tough white outer layer of the eyeball that protects as well as holds the eye’s contents in place.

Scoliosis.
A weakness of the muscles that results in a serious abnormal curvature of the spine. This condition may be corrected with surgery or a brace.

Scoring Guide.
A set of guidelines for rating student work. A scoring guide describes what is being assessed, provides a scoring scale, and helps the teacher or rater correctly place work on the scale.

Scotopic Sensitivity Syndrome.
An oversensitivity to certain frequencies and wavelengths of white light that affect the way printed materials are perceived visually.

Screening.
A procedure in which groups of children are examined and/or tested in an effort to identify children who are most likely to have a disability; identified children are then referred for more intensive examination and assessment.

SEA.
State Education Agency (the state Department of Education).

Section 504.
Section of the Rehabilitation Act of 1973 that guarantees the civil rights of disabled children and adults. It also applies to the provision of services for children whose disability is not severe enough to warrant classification, but could benefit from supportive services and classroom modifications.

Selective Attention.
The ability to selectively attend, through conscious effort, to a particular aspect of a stimulus under discussion.

Selective Mutism.

Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak in select social settings, such as school. These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed.

Over 90% of children with Selective Mutism also have social phobia or social anxiety, and some experts view Selective Mutism as a symptom of social anxiety. Others view it as a separate, but related, disorder. It is not yet understood why some individuals develop typical symptoms of social anxiety, like reluctance to speak in front of a group of people or feeling embarrassed easily, while others experience the inability to speak that characterizes Selective Mutism. What is clear is that children and adolescents with SM have an actual fear of speaking and of social interactions where there is an expectation to talk. They may also be unable to communicate nonverbally, may be unable to make eye contact and may stand motionless with fear as they are confronted with specific social settings. This can be quite heart wrenching to watch, and is often very debilitating for the child as well as frustrating for parents and teachers.

Self-Advocacy.
The development of specific skills and understandings that enable children and adults to explain their specific learning disabilities to others and cope positively with the attitudes of peers, parents, teachers, and employers.

Self- Concept.
How a person feels and thinks about himself or herself. Sometimes called self-image.

Self-Contained Class.
A class wherein disabled children receive their entire instructional program.

Self-Monitoring.
A metacognitive instructional technique that requires children to repeatedly ask themselves whether they were acting appropriately in order to increase the frequency of the behavior; this method can be used to improve attention span, hyperactivity, etc.

Self-Stimulatory Behavior.
The repetitive movement of one’s body or of objects; typically observed in students with developmental disabilities. Also called Stereotypy.

Self-Stimulation.
In reference to mental illness and mental retardation, any repetitive, stereotyped activity which appears only to provide some sensory feedback. For example: hand flapping, rocking, etc.

Semantics.
The meaning or understanding given to oral or written language.

Semantic Aphasia.
A condition characterized by the pronouncing or repeating of words accurately but without comprehension.

Semantic Aphasia.
A condition characterized by the pronouncing or repeating of words accurately but without comprehension of meaning. Frequently observed in individuals who appear able to decode words correctly but who have little or no idea of what they have just read.

Semicircular Canals.
The three canals within the middle ear that are responsible for maintaining balance.

Sensorimotor.
Relationship between sensation and movement.

Sensorineural Hearing Loss.
A hearing loss caused by damage to the auditory nerve or the inner ear.

Sensory Acuity.
The ability to respond to sensation at normal levels of intensity.

Sensory Deprivation.
A condition in which one or more of the major senses (vision or hearing) are sufficiently impaired as to restrict significantly the individual's use of that sense.

Sensory Motor.
Pertaining to the combined functioning of the sensory modalities and motor mechanisms.

Sequence
The detail of information in its accustomed order (for example, days of the week, the alphabet, etc.).

Sequential Memory.
The ability to recall a series of information in proper order.

Sequelae.
The permanent consequences of a disease or injury.

Serial Learning.
A form of rote memorization. A list of items is learned in a prescribed sequence so that each item is a cue to the one that immediately follows it.

Shaping (behavior shaping).
A principle of behaviorism. Teaching a new behavior by reinforcing small, progressively closer approximations of or attempts toward a specific goal.

Sheltered Workshops.
A transitional or long-term work environment for disabled individuals who cannot, or who are preparing for, work in a regular setting; within this setting, the individual can learn to perform meaningful, productive tasks and receive payment.

Short-Term Memory.
The ability to hold a stimulus in brief memory capacity; generally measured in less than ten seconds.

Shunt.
Tube that diverts fluid from one part of the body to another; often implanted in people with hydrocephalus to remove extra cerebrospinal fluid from the head and send it directly into the heart or intestines.

Sight Words.
Words a child can recognize on sight without aid of phonics or other word-attack skills.

Sight Word Approach.
Also known as whole word approach; method for teaching reading which relies heavily upon a child's visual memory skills, with minimal emphasis on sounding out a word; child memorizes the word based on its overall configuration.

Slingerland Method.
A highly structured, multisensory teaching method designed for group instruction of persons with specific learning disabilities. Named for its
developer, Beth Slingerland.

Snellen Chart.
A commonly used visual screening device for testing distant field visual acuity.

Social Competence.
The interaction, in an individual, between self-concept, positive relationships with others, the absence of maladaptive behaviors, and effective social skills that indicate one’s overall social aptitude.

Social Isolation.
The level of active peer rejection or dislike.

Social Perceptions.
The ability to interpret stimuli in the social environment and appropriately relate such interpretations to social situations.

Social Rejection.
The active social rejection of students, generally based on some offensive behavior or extremely unpleasant style of social interaction.

Social Skills.
Skills such as listening, conversation, and interpretation of nonverbal cues that facilitate social interactions.

Social Validity.
A desirable characteristic of the objectives, procedures, and results of intervention, indicating their appropriateness for the learner.

Socialized Aggression.
A group of behavior disorders, including truancy, gang membership, theft, and delinquency.

Socio-Cultural.
Combined social and cultural factors as they affect the development of a child in all areas of life.

Soft Neurological Signs.
Neurological abnormalities that are mild or slight and difficult to detect, as contrasted with the gross or obvious neurological abnormalities.

Sound Blending.
The ability to combine smoothly all the sounds or parts of a word into the whole.

Spastic Cerebral Palsy.
Spastic cerebral palsy is the most common type of cerebral palsy, accounting for nearly 80 percent of all cerebral palsy cases. Children with this type of cerebral palsy have one or more tight muscle groups which limit movement. Children with spastic cerebral palsy have stiff and jerky movements. They often have a hard time moving from one position to another. They may also have a hard time holding and letting go of objects.

Spatial Orientation.
Awareness of space around the person in terms of distance, form, direction, and position.

Spatial Relationships.
The ability to perceive the relationships between self and two or more objects and the relationships of the objects to each other.

Special Education.
Instruction specifically designed for handicapped children.

Specific Language Disability (SLD).
A severe difficulty in some aspect of listening, speaking, reading, writing, or spelling, while skills in the other areas are age-appropriate. Also called Specific Language Learning Disability (SLLD).

Specific Learning Disability (SLD).
The official term used in federal legislation to refer to difficulty in certain areas of learning, rather than in all areas of learning. Synonymous with learning disabilities.

Speech and Language Specialist.
Identifies and provides services for children with articulation problems, as well as expressive and/or reception language problems.

Speech Audiometry.
Tests a person’s detection and understanding of speech by presenting a list of two-syllable words at different decibel (sound volume) levels.

Speech Reception Threshold (SRT).
The decibel (sound volume) level at which an individual can understand half of the words during a speech audiometry test; the SRT is measured and recorded for each ear.

Speechreading.
Process of understanding a spoken message by observing the speaker’s lips in combination with information gained from facial expressions, gestures, and the context or situation.

Spina Bifida.
Spina Bifida is the name given to a series of birth defects that affect the neural tube, the structure in the developing fetus that develops into the spinal cord and brain. Meaning, literally, "split spine", this neural tube defect (NTD) occurs within the first four weeks of pregnancy. The vertebrae, spinal cord, or both fail to develop properly in the fetus, resulting in varying degrees of damage to the spinal cord and nervous system. The damage is permanent.

There is no single known cause of Spina Bifida. Research continues into the effects of factors such as heredity, nutrition, environment, pollution and physical damage to the embryo.

Spina Bifida Occulta.
A type of spina bifida that usually does not cause serious disability. Although the vertebrae do not close, there is no protrusion of the spinal cord and membranes.

Splinter Skills.
The tendency of students with learning disabilities to have specific skills that are dramatically more advanced than their delayed skills.

Standard Celeration Chart.
Chart for graphically displaying a student’s learning progress from day to day in terms of changes in the frequency of correct and incorrect responses per minute.

Standard Deviation.
A descriptive statistic that shows the average amount of variability among a set of scores.

Standard-Score Discrepancy.
The calculation of an ability-achievement discrepancy based on intelligence tests and achievement tests that have a common calculation for obtaining the standard scores; this is typically used to diagnose a learning disability.

Standardized Test.
A test that compares a child's performance with the performance of a large group of similar children (usually children of the same age). Also called a norm-referenced test. IQ tests and most achievement tests are standardized.

Stanine.
A standard score between 1 to 9, with a mean of 5 and a standard deviation of 2. The first stanine is the lowest scoring group and the 9th stanine is the highest scoring group.

State Anxiety.
Anxiety that is experienced as a result of exposure to a particular environment.

Stay-put.
If the parent and school disagree on a child's program, the child "stays put" in the last program agreed upon while the parties litigate. The purpose of this is to protect the child from being moved around during litigation.

Stereotype.
An overgeneralized or inaccurate attitude held toward all members of a particular group, on the basis of a common characteristic such as age, sex, race, or disability.

Stereotypy (Stereotypic Behavior).
See Self-Stimulatory Behavior

Stimulus Control.
Occurs when a behavior is emitted more often in the presence of a particular stimulus than it is in the absence of that stimulus.

Strabismus.
A condition in which one eye cannot attain binocular vision with the other eye because of imbalanced muscles.

Structure
Consistent use of rules, limits, and routines. The use of structure reassures a child with learning disabilities that the environment is somewhat predictable and stable.

Structural Analysis.
Using syllabication, prefix, suffix, and root word clues, etc. to read or spell a word.

Student Assistance Program.
A school-based program, modeled on employee assistance programs, that focuses on addressing students' behavior and performance at school and includes a referral process to help students address identified problems.

Stuttering.
A complex fluency disorder of speech, affecting the smooth flow of words; may involve repetition of sounds or words, prolonged sounds, facial grimaces, muscle tension, and other physical behaviors.

Substitution.
in reading, spelling,or math, interchanging a given letter, number, or word for another, e.g., sereal for cereal.

Subtest.
A group of test items that measure a specific area (i.e., math calculation and reading comprehension). Several subtests make up a test.

Subtype Research.
A recently developed research method that seeks to identify characteristics that are common to specific groups within the larger population of individuals identified as having learning disabilities.

Supported Employment.
Providing ongoing, individualized supports to persons with disabilities to help them find, learn, and maintain paid employment at regular work sites in the community.

Suppression.
The act of consciously inhibiting an impulse, affect, or idea.

Surrogate Parent.
A person other than the child’s natural parent who has legal responsibility for the child’s care and welfare.

Survival Skills.
Minimal skills needed for a student to cope with everyday society.

Symptom.
Any sign, physical or mental, that identifies something an underlying condition.

Syntax.
The system of rules governing the meaningful arrangement of words in a language. Grammar, sentence structure, and word order in oral or written language.

Syndrome.
A set of symptoms that indicates a specific disorder.

Systematic Replication.
A strategy for extending and determining the generality of research findings by changing one or more variables from a previous study to see if similar results can be obtained.

T-Score.
A standard score with a mean of 50 and a standard deviation of 10. A T-score of 60 represents a score that is 1 standard deviation above the mean.

Tactile.
Having to do with the sense of touch.

Task Analysis.
The breaking down of a component or activity into small sequential steps.

Tay-Sachs Disease.
A progressive nervous system disorder causing profound mental retardation, deafness, blindness, paralysis, and seizures; it is usually fatal by age five

Teaching For Understanding.
A teaching method that focuses on the process of understanding as the goal of learning rather than simply the development of specific skills. It focuses on forming connections and seeing relationships among facts, procedures, concepts, and principles, and between prior and new knowledge

Team Based Contingencies.
Reinforcement provided to team members based on the performance of their team; teams can compete against each other or against a preset criterion level.

Technology.
In education, a branch of knowledge based on the development and implementation of computers, software, and other technical tools, and the
assessment and evaluation of students' educational outcomes resulting from their use of technology tools.

Temporal Lobe.
The portion of each hemisphere of the cerebrum that controls hearing and auditory memory; located in the front of the head, below the frontal lobe.

Test bias.
The difference in test scores that is attributable to demographic variables (e.g., gender, ethnicity, and age).

Thematic Apperception Test.
A structured psychological test in which the individual is asked to project his/her feelings onto a series of drawings or photos.

Thematic Maturity.
Ability to write in a logical, organized manner that easily and efficiently conveys meaning.

Thematic Unit.
A method of organizing the curriculum by themes; also called instructional unit when those themes address important life skills.

Thinking Skills.
Refers to the manner in which humans acquire, interpret, organize, store, retrieve, and employ knowledge.

Tic.
An involuntary twitching and contraction of a small muscle group, generally in the facial area.

Time-on-Task.
The percentage of time in which a student is on-task or attempting to complete an educational task.

Time Out.
A behavior management technique that involves removing the opportunity for reinforcement for a specific period of time following an inappropriate behavior; results in a reduction of the inappropriate behavior.

Time Sampling.
A procedure used to quantify observational data. The observer records the occurrence or non-occurrence of a specific behavior or behaviors of a child within specified time frames; i.e. 30 seconds out of every 10 minute period.

Time Trials.
A fluency-building procedure in which a student performs a new skill as many times as he/she can during a short period of time; one-minute time trials are effective for most academic skills.

Tinnitus.
Refers to a ringing in the ears, and other head noises. No external stimulus is present. Frequently follows an individual's exposure to a loud sound.

Token Reward.
Any object that usually has no intrinsic reward value itself but whose value depends upon its being exchanged for something that is intrinsically rewarding (a primary reinforcer). For example: a token chip can be rewarding if the child learns that he or she can exchange it for a piece of candy.

Tone Deafness.
A condition characterized by a person's inability or severely impaired ability to discriminate or distinguish differences in pitch.

Topography of Behavior.
The physical shape or form of a response.

Total Communication.
A method of communication combining oral techniques (speech and speechreading) and manual techniques (fingerspelling and sign language).

Tracking.
The ability of the eyes to move smoothly across a printed page or while following a moving object.

Transduce.
To transmit information or stimuli from one sensory modality to another (visual to auditory).

Transition - Commonly used to refer to the change from secondary school to postsecondary programs, work, and independent living typical of young adults. Also used to describe other periods of major change such as from early childhood to school or from more specialized to mainstreamed settings.

Transposition.
In reading, spelling, or math, confusion of the order of letters in a word or numbers in a numeral, e.g., sliver for silver, 432 for 423, etc.

Traumatic Brain Injury.
A disability caused by injury or accident involving damage to the brain.

Tremor.
A type of cerebral palsy characterized by regular, strong, uncontrolled movements; may cause less overall difficulty in movement than other types of cerebral palsy.

Triplegia.
Paralysis of any three limbs.

Turner Syndrome.
Turner's Syndrome is a rare chromosomal disorder of females (1:2500) characterized by short stature and the lack of sexual development at puberty. This syndrome was first described by H.H. Turner in 1938. Other physical features may include a webbed neck, heart defects, kidney abnormalities, and/or various other malformations. Normally, females have two X chromosomes. In some cases of Turner's Syndrome, however, one X chromosome is missing from the cells (45,X); research studies suggest that approximately 40 percent of these individuals may have some Y chromosomal material in addition to the one X chromosome. In other affected females, both X chromosomes may be present, but one may have genetic defects. In still other cases, some cells may have the normal pair of X chromosomes while other cells do not (45,X/46,XX mosaicism). Although the exact cause of Turner's Syndrome is not known, it is believed that the disorder may result from an error during the division (meiosis) of a parent's sex cells.

Tymphonic Membrane.
Located in the middle ear, the eardrum moves in and out to variations in sound pressure, changing acoustical energy to sound energy; also called the eardrum.

Underachiever.
An individual who is not achieving at a level expected for his or her age and ability level.

Ungrouped Scores.
Scores or values that have not been tabulated or assigned to classes.

Unilateral.
Refers to conditions on only one side of the body. The use of one side of the body to the exclusion of the other.

Unlearning.
A systematic effort to overcome the effect of some previous learning. For example, it may be desirable to assist a disabled child to unlearn some past behavior (bad habit) that is interfering with his or her adjustment.

Unit Approach.
A method of organizing the curriculum by important life themes.

Unsocialized Aggression.
Aggressive behavior characterized by hostility, impulsivity, and alienation from others.

Usher’s Syndrome.
An inherited combination of visual and hearing impairments.

VAK.
Acronym for visual-auditory-kinesthetic-tactile; multisensory teaching approach which emphasizes using all of the senses to teach skills and
concepts.

Validity.
The degree or extent to which a specific test actually measures what it is purported to measure by its authors and users. It is concerned with the appropriateness of the inferences that can be made on the basis of given test results.

Variable.
Any characteristic of an object, event, person, or whatever, that can take two or more values.

Verbal Ability.
Refers to oral or spoken language abilities.

Verbal Intelligence.
A type of intelligence that involves skill in the use of spoken or written language.

Vicarious Learning.
Learning by observation of the behavior of others. Acquisition of responses without practice. Learning by identification or modeling.

Vision Perception.
Understanding what is seen.

Visual Acuity.
Refers to the clarity or sharpness with which a person sees. Usually measured by such instruments as the Snellen Wall Chart. On such an
instrument, a person is described as having 20/20 vision if he/she is able to distinguish letters that an average person can distinguish at 20 feet. A 20/200 rating means that the person can distinguish letters at 20 feet that the average person can distinguish at 200 feet.

Visual Agnosia.
The inability to perceive overall configurations. Only isolated symbols are seen instead of syllables, whole word or number units

Visual Aphasia.
Refers to the inability to recognize printed words as representing the individual's listening/speaking vocabulary. The individual is not able to
understand that the printed word is talk in a written form.

Visual Association.
The process involved in the ability to relate visual symbols in a meaningful way. The ability to relate concepts presented through the visual process.

Visual Closure.
The ability to perceive visually and identify wholes when only parts are shown or presented. For example: recognizing a particular word after seeing only a part of the word.

Visual Discrimination.
The ability to distinguish the similarities and differences between objects.

Visual Efficiency.
The ability to use eyesight effectively. The use of visual acuity to the maximum extent possible.

Visual Figure-Ground.
Ability to focus on the foreground of material presented visually, rather than background. Those who have difficulty with this may find it hard to keep their place while copying or reading, may find a crowded page of print or illustrations confusing, etc.

Visual Memory.
The ability to recall material presented visually after a period of time.

Visual Motor.
Ability to translate information received visually into a motor response. Difficulties are often characterized by poor handwriting, etc.

Visual Perception.
Ability to correctly interpret what is seen. For example, a child sees a triangle and identifies it as a triangle.

Visual Sequential Memory.
The ability to recall or reproduce sequences of visual items (letters, numbers, words) from memory.

Visualization.
Accurately picturing images in the mind's eye, retaining and storing them for future recall.

Vitreous Humor.
The jellylike fluid that fills most of the interior of the eyeball.

Vocational Rehabilitation.
A program designed to help adults with disabilities obtain and hold employment.

Wechsler Scales of Intelligence.
A series of individual intelligence tests measuring global intelligence through a variety of subtests.

Whole Language Approach.
A philosophy of teaching reading that emphasizes meaning. This method involves students in reading literature, writing their own stories, and
employing critical thinking strategies.

Whole Word Method.
Before students read a story, unfamiliar words that will be encountered are introduced, often on flash cards, word lists, and in the context of sentences.

Williams Syndrome.
Williams syndrome is a rare genetic condition (estimated to occur in 1/20,000 births) which causes medical and developmental problems.

Williams syndrome was first recognized as a distinct entity in 1961. It is present at birth, and affects males and females equally. It can occur in all ethnic groups and has been identified in countries throughout the world.

What are the common features of Williams syndrome?
Characteristic facial appearance
Heart and blood vessel problems
Hypercalcemia (elevated blood calcium levels)
Low birth-weight / low weight gain
Feeding problems
Irritability (colic during infancy)
Dental abnormalities
Kidney abnormalities
Hernias
Hyperacusis (sensitive hearing)
Musculoskeletal problems
Overly friendly (excessively social) personality
Developmental delay, learning disabilities and attention deficit

Word-attack skills.
The ability to analyze unfamiliar words by syllables and phonic elements and so arrive at their pronunciation and possibly recognize their meaning.

Word Recognition.
Ability to read or pronounce a word; usually implies that the word is recognized immediately by sight and that the child does not need to apply word analysis skills. Does not imply understanding of the word.

Work Activity Center.
A sheltered work and activity program for adults with severe disabilities; teaches concentration and persistence, along with basic life skills, for little or no pay.

Written Language.
Encompasses all facets of written expression, e.g., handwriting, capitalization, punctuation, spelling, format, ability to express one's thoughts
in sentences and paragraphs, etc.

Xenophobia.
An abnormal, irrational fear of meeting new people.

Z.
A standard score.

Zeigarnick Effect.
Refers to a finding in psychology of learning research that individuals who are highly motivated and personally interested in certain tasks will remember them better, even though they have been interrupted, than they will remember completed tasks, in which the same level of ego involvement is not present.

Zone of Proximal Development.
A level or range in which a student can perform a task with help.