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Unusual Patterns of Behavior

The unusual responses of children with PDDNOS to the environment take several forms.

• Resistance to change. Many children are upset by changes in the familiar environment. Even a minor change of everyday routine may lead to tantrums. Some children line up toys or objects and become very distressed if these are disturbed. Efforts to teach new activities may be resisted.
• Ritualistic or compulsive behaviors. Ritualistic or compulsive behaviors usually involve rigid routines (e.g., insistence on eating particular foods) or repetitive acts, such as hand flapping or finger mannerisms (e.g., twisting, flicking movements of hands and fingers carried out near the face). Some children develop preoccupations; they may spend a great deal of time memorizing weather information, state capitals, or birth dates of family members.
• Abnormal attachments and behaviors. Some children develop intense attachments to odd objects, such as pipe cleaners, batteries, or film canisters. Some children may have a preoccupation with certain features of favored objects, such as their texture, taste, smell, or shape.
• Unusual responses to sensory experiences. Many children may seem under responsive or over responsive to sensory stimuli. Thus, they may be suspected of being deaf or visually impaired. It is common for such young children to be referred for hearing and vision tests. Some children avoid gentle physical contact, yet react with pleasure to rough-and-tumble games. Some children carry food preferences to extremes, with favored foods eaten to excess. Some children limit their diet to a small selection, while others are hearty eaters who do not seem to know when they are full.

The typical motor milestones (e.g., throwing, catching, kicking) may be delayed but are often within the normal range. Young children with PDDNOS usually have difficulty with imitation skills, such as clapping hands. Many such children are very overactive, yet tend to become less overactive in adolescence. Children with PDDNOS may exhibit characteristics such as grimacing, hand flapping or twisting, toe walking, lunging, jumping, darting or pacing, body rocking and swaying, or head rolling or banging. In some cases the behaviors appear only from time to time; in other cases they are present continuously.

Intelligence and Cognitive Deficits

Generally, children with PDDNOS do very well on tests requiring manipulative or visual skills or immediate memory, while they do poorly on tasks demanding symbolic or abstract thought and sequential logic. The process of learning and thinking in these children is impaired, most particularly in the capacity for imitation, comprehension of spoken words and gestures, flexibility, inventiveness, learning and applying rules, and using acquired information. Yet, a small number of children with PDDNOS show excellent rote memories and special skills in music, mechanics, mathematics, and reading.

Because many children with PDDNOS are either without functional speech or otherwise untestable, some people question the validity of testing their intelligence. Moreover, it has been observed that a number of these children show major improvements in other developmental areas during the follow-up period without a change in their tested IQ. Follow-up studies have also shown that retardation present at the time of initial diagnosis tends to persist. Those children with a low IQ show more severely impaired social development. They are more likely to display unusual social responses, such as touching or smelling people, ritualistic behavior, or self-injury.

Associated Features

The emotional expression of some children with PDDNOS may be flattened, excessive, or inappropriate to the situation. For no obvious reason, they may scream or sob inconsolably one time, yet giggle and laugh hysterically another time. Real dangers, such as moving vehicles or heights, may be ignored, yet the same child might seem frightened of a harmless object, such as a particular stuffed animal.

Conclusion

Children with PDDNOS happen to have a unique disorder that will make certain parts of life more challenging.

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