Abstract Concepts - difficulty with abstract concepts such as time, math or money. Language problems; difficulty comprehending the meaning of language and accurately answering questions. May agree or confabulate - comply or fill in the blanks. Many talk excessively, yet are unable to engage in a meaningful exchange. The sheer volume of words creates the impression of competence. *SFSP

Alcohol - a colorless liquid, produced by the fermentation of sugar or starch, that is the intoxicating agent in fermented drinks

Alcohol-Related Birth Defects (ARBD) - specific organ damage resulting from confirmed prenatal alcohol exposure.

Alcohol-Related Neurodevelopmental Disorder (ARND) - children with this diagnosis do not have growth impairment or the characteristic facial features of prenatal alcohol exposure but do have severe learning and behaviour problems, as well as a confirmed history of alcohol exposure. Children with this diagnosis may be just as disabled as children with pFAS or FAS. In fact, some evidence suggests that they have worse outcomes, probably because it is more difficult to get people to believe that their problems are real. *CL

Biomarker - a specific physical trait or a measurable biologically produced change in the body connected with a disease or health condition. For example, body temperature is a well-known biomarker for fever.

Changing Modalities - this requires transferring information from one area of the brain to another area of the brain. It involves acting after listening. Generally you can help a person change modalities by demonstrating specific steps. Before working with parents practise writing out each step and illustrating each step with a pictogram. The degree of agreement between modalities will indicate the degree of understanding held by the parent. *SFSP

Chronological age - the number of years and days elapsed since birth. See also Developmental age

Clinical consultation - relevant professional consultation and guidance on issues relating to the effective and appropriate provision of services, such as: maintaining confidentiality; setting boundaries, and working with families with complex issues. In some cases, clinical consultation and job supervision may be provided by the same person, but this is not a requirement. (MCFD, 2009)

Conceptualizing - this requires developing a picture in your mind when the item or concept is not actually in sight. Help find the concept by using the person's preferred learning style; e.g. Use kinesthetic visual, auditory. If they are visual learners use pictures. A necessary requirement of conceptualizing is to link the concept to a meaningful time and place. For example, what does it look like for this family to stay together? Making a family album that dates back to the grandparent's time may create a visual concept of what "families together" represent. *SFSP

Communication Challenges - appear to understand instructions, nod and agree, but are not able to comprehend. Often repeat rules verbatim then fail to apply the rules - "talk the talk" but don't "walk the walk". *SFSP

Complex Developmental Behavioural Conditions (CDBC) - a term used in British Columbia to describe children seen by the Ministry of Health's CDBC network of developmental clinics. This term is intended to describe children who have difficulty in multiple areas of functioning, whether or not they have prenatal alcohol exposure. *CL

Complex Developmental Behavioural Conditions (CDBC) Network - the network of Regional and Provincial Health Authority teams which provide multidisciplinary assessments for children and youth with significant difficulties in multiple areas of function including: development and learning, mental health and adaptive and social skills. (MCFD, 2009)

Cultural safety framework - this approach involves examining and understanding the historical power inequities, individual and institutional discrimination and the dynamics between professionals and members of an ethnoculteral group. (MCFD, 2009)

Developmental age - an amalgam of a child or adolescent's physical development (assessed by skeletal maturity or bone age), together with the incorporation of mental, cognitive and emotional maturity. Developmental age is highly individualistic. See also Chronological age

Disorder - a medical condition involving a disturbance to the usual functioning of the mind or body; a morbid physical or mental state

Dysmaturity - refers to the gap between the chronological and developmental ages in different domains (eg expressive language, social maturity etc.) due to the effects of prenatal alcohol exposure (Malbin); the term “uneven maturation” is also sometimes used to describe this condition. See also Immaturity.

Epigenetic - affecting a cell, organ or individual without directly affecting its DNA; may indirectly influence the expression of the genome. (medterms.com)

Epigenetics -
 1. The study of heritable changes in gene function that occur without a change in the sequence of the DNA. For example: the process of DNA methylation and the process of chromatin remodeling
 2. The study of certain processes that occur in embryonic development (medterms.com)

Family - persons who play a significant role in an individual's life and act as his/her support network. Due to the diversity of family structures, it may include people who are not legally related to the individual.

Fetal - relating to or characteristic of a fetus

Fetal Alcohol Spectrum Disorder (FASD) - a term for all three of the diagnoses related to prenatal alcohol exposure: Fetal Alcohol Syndrome, Partial Fetal Alcohol Syndrome, and Alcohol Related Neurodevelopmental Disorder. *CL
See seperately Fetal Alcohol Spectrum Disorder

Fetal Alcohol Syndrome (FAS) - children with this diagnosis have all three of the features associated with prenatal alcohol exposure - (1) growth impairment, (2) characteristic facial features, and (3) severe learning and behaviour problems. This is the only fetal alcohol spectrum diagnosis that can be made without a confirmed history of alcohol exposure, because it is unlikely that all three would occur together for any other reason. *CL
See seperately Fetal Alcohol Syndrome

Fetus - unborn offspring; an unborn vertebrate at a stage when all the structural features of the adult are recognizable, especially an unborn human offspring after eight weeks of development

Functional Assessment - the measurement of purposeful behaviour in interaction with the environment which is interpreted according to the assessment's intended use. It is the process of appraisal which can be used to measure ability, competence, or performance.

Generalizing Information - inability to generalize information; difficulty forming links and associations, unable to apply a learned rule in a new setting; learns to not take Johnny's bike, but then takes Mary's bike: It's not Johnny's. The lesson hasn't been generalized and applied to Mary's bike. *SFSP

Incidence - the rate of occurrence of new cases of a disease or condition. Incidence is calculated as the number of new cases of a disease or condition in a specified time period (usually a year) divided by the size of the population under consideration who are initially disease free. See also Prevalence.

Immaturity -
 1. not fully grown or developed
 2. a person does not respond to the circumstances or environment in an appropriate manner
 See also Dysmaturity

Impulsivity - impaired judgment, often unable to make decisions. Difficulty understanding safety and danger, friend and stranger or differentiating fantasy from reality. Impulsivity coupled with inability to abstract and predict outcomes; acts first and then is able to see the problem after the fact. *SFSP

Learning Style - the preferred way by which people learn. Common learning styles include: visual (learn by seeing), auditory (learn by hearing) and kinesthetic (learn by doing). *SFSP

Learning Theory - a theory based on the belief that most brains function in a similar way.

Level of Stamina - how does fatigue affect this person? *SFSP

Memory - difficulty with memory; information input, integration, forming associations, retrieval and output. Difficulty learning from past experiences. Often repeat the same mistake over and over again in spite of increasingly severe punishment. This is being able to find information when the information is needed. Explore what does work for the person. Fridge magnets, talking clocks, talking with friends are some options. Give lots of time without interrupting their thought process. Encourage others to provide information that can fill in the blanks. Accept that memory may not be available at times. If this happens, go on to a new activity or topic. For example, when doing long division 2 into 444; each time 4 is divided by 2 will have to be refigured. *SFSP

Metacognition -
 1. awareness or analysis of one's own learning or thinking processes
 2. a person's "ability to initiate activities, as well as to monitor behaviour and to remember important tasks related to social interactions" (Schonfeld et al, 2009)

Morbid - In Medicine: relating to disease; relating to or resulting in illness.

Neurobehavioural - linking behaviours to the brain dysfunction.

Neurobehavioural Assessment - one component of the assessment process for FASD implemented by a multidisciplinary assessment team. A diagnosis of FASD requires a comprehensive history and physical and neurobehavioural assessment. The neurobehavioural assessment includes the following domains: Hard and soft neurological signs (including sensory-motor signs), Brain structure (occipitofrontal circumference, magnetic resonance imaging, etc), Cognition (IQ), Communication: expressive and receptive, Academic achievement, Memory, Executive functioning and abstract reasoning, Attention deficit / hyperactivity, Adaptive behaviour and social skills and social communication. (CMAJ;Mar1,2005;172)

Neurobehavioural Disorder - this is a descriptive diagnosis and not an etiological (causal) diagnosis. It is used to describe individuals who have learning and behaviour problems that are less severe and/or less varied than those described as having Static Encephalopathy. In this case the experts would say that these problems are possibly related to a problem in how the brain works. Keep in mind that many children will get this description just because they are too young for formal testing of all aspects of learning and behaviour (we can do this testing with more confidence when they reach the age of 8 to 12). Young children with this description should still be considered at high risk for a diagnosis of fetal alcohol spectrum disorder when they are older. *CL

Neurogenesis - the process whereby precursor cells, or stem cells  reproduce, migrate to other brain areas and mature into neurons (Society for Neuroscience)

Neuroplasticity -
 1. The brain's ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment. (medterms.com)
 2. the responsiveness of the human brain to changing conditions (Mate)

Organizing - compromised executive functioning; may have difficulty planning, predicting, organizing, prioritizing, sequencing, initiating and following through. Difficulty setting goals, complying with contractual expectations, being on time or adhering to a schedule. This involves knowing what steps to take, what categories things in the person's world fit into. If a person has a "pasta pot" and another pot appears to be interchangeable, explore what makes the "pasta pot" work for the pasta and nothing else. Explore your values. For example, if you believe that clean clothes need to be in drawers, check to see what is useful to the person. It may be to keep clean clothes in a laundry basket until worn. *SFSP

Partial Fetal Alcohol Syndrome (pFAS) - children with this diagnosis have characteristic facial features AND severe learning and behaviour problems as well as a confirmed history of alcohol exposure. *CL

Perseveration - may be rigid, get stuck, have difficulty switching gears, stopping an activity, or transitioning to a new activity. Often react strongly to changes in setting, program or personnel. *SFSP

Predicting Outcomes - impulsivity coupled with inability to abstract and predict outcomes; acts first and then is able to see the problem after the fact. This is to experience what "it" means before "it" has happened. A person affected with FASD may not recognize that they didn't know what the outcome would be after "it" has happened. They may feel very guilty as if they did "it" on purpose. Again, using the person's strengths and preferred learning style, work through possible outcomes. For example, if I stop at the (friends, bingo, bar etc.) when I get paid, the kids will be hungry. If I go straight (home, bank, support person etc.) we will have money for food. *SFSP

Prevalence - how commonly a disease or condition occurs in a population. Prevalence measures how much of some disease or condition there is in a population at a particular point in time. The prevalence is calculated by dividing the number of persons with the disease or condition at a particular time point by the number of individuals examined. See also Incidence.

Probable FASD - children and youth whose challenges are likely related to prenatal alcohol exposure, including children who are too young for diagnosis, and children who do not meet the criteria for referral to the CDBC Network. (MCFD, 2009)

Primary Disability - a behaviour that most clearly reflects differences in brain structure and function.

Secondary Disabilities -
 1. “begin with discrepancies between expectations and a person’s ability to perform” (S. Clarren, 2004) (see Resources for complete reference)
 2. “develop over time when there is a chronic ‘poor fit’ between the person and his or her environment”  (D. Malbin, 2002) (see Resources for complete reference)
 3. “those that arise after birth and presumably could be ameliorated through better understanding and appropriate interventions” (The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities)
 4. “emotional and societal problems related to their difficulty managing typical expetations” (Streissguth and Kanter, 1997) (see Resources for complete reference)
 5. may include:
fatigue, frustration, anxiety, anger, non-compliance, shut down, avoidant, blaming, poor self-esteem, isolation, depression, disruption, tantrums, annoying behaviours, irritability
extreme school problems, trouble with the law, employment problems, drug and alcohol issues, mental health issues, victimization, difficulties with parenting, difficulties with independent living, exploitation, and inappropriate sexual behaviours

Sensory Differences - sensory systems dysfunctions; may be over-reactive to stimuli; e.g. tactile defensiveness, may be easily overwhelmed by sensory input, may be unable to filter out extraneous stimuli, symptoms of which appear as increased agitation, irritability, aggression or others. May be under-reactive to pain, may not complain of earaches, broken bones and be unable to experience painful stimuli. *SFSP

Sequencing - this is to experience the beginning, middle and end of an event in the correct order. For example, help the person "walk through" an event they are trying to explain or recall. *SFSP

Similar neurodevelopmental conditions - children assessed by the CDBC Network as having a neurodevelopmental profile similar to those found among children with FASD, but for whom there is no clear documentation of prenatal alcohol exposure. Neurodevelopmental conditions are most similar to FASD when they are diffuse (affecting multiple areas of brain function) and when problems with self-control, and executive functioning (decision-making and planning) are prominent. (MCFD, 2009)

Slow Auditory Pace - central auditory delays means language is processed more slowly, requiring more time to comprehend. May only grasp every third word of normally paced speech. *SFSP

Slow Cognitive Pace - may think more slowly, say "I don't know", shut down or require minutes to generate and answer rather than seconds. Those with FASD are "ten-second people in a one-second world". *SFSP

Spectrum - a range of values or ideas

Static Encephalopathy - this is a descriptive diagnosis and not an etiological (causal) diagnosis.  In plain English, it means a brain disorder that is not getting worse and not getting better.  In this context, it is used to describe individuals who have a pattern of learning and behaviour problems that are severe enough and varied enough that experts agree they are probably related to a problem in how the brain works.
Children with all three of the FASD diagnoses are described as having Static Encephalopathy.  However, the term is also used when a child or youth has the kind of learning and behaviour problems associated with FASD, but there is no confirmed prenatal alcohol exposure.  In this case, they would be described as having Static Encephalopathy, Alcohol Exposure Unknown. *CL

Strengths-based approach - an approach that promotes the child and family's strengths and resources in order to improve the functioning of the child, youth and family and minimize secondary risks associated with FASD. (MCFD, 2009)

Syndrome - a set of symptoms occurring together; the sum of signs of any morbid state.

Teratogen - any agent or factor which causes abnormalities of development in an embryo or fetus.

*CL
Christine Lilley, PHD
Registered Psychologist
Sunny Hill Health Centre for Children
May 2008

*SFSP
Structured for Success Project
South Fort George Family Resource Centre
Prince George, BC
May 2008