in being with or playing with other children. They may even actively avoid other children.In middle childhood, such children may develop a greater awareness or attachment to parents and other familiar adults. However, social difficulties continue. They still have problems with group games and forming peer relationships. Some of the children with less severe PDDNOS may become involved in other children's games. As these children grow older, they may become affectionate and friendly with their parents and siblings. However, they still have difficulty understanding the complexity of social relationships. Some individuals with less severe impairments may have a desire for friendships. But a lack of response to other people's interests and emotions, as well as a lack of understanding of humor, often results in these youngsters saying or doing things that can slow the development of friendships.Impairment in Nonverbal CommunicationIn early childhood, children with PDDNOS may develop the concrete gesture of pulling adults by the hand to the object that is wanted. They often do this without the typical accompanying facial expression. They seldom nod or shake their heads to substitute for or to accompany speech. Children with PDDNOS generally do not participate in games that involve imitation. They are less likely than typical children to copy their parents' activity.In middle and late childhood, such children may not frequently use gestures, even when they understand other people's gestures fairly well. Some children do develop imitative play, but this tends to be repetitive.Generally, children with PDDNOS are able to show joy, fear, or anger, but they may only show the extreme of emotions. They often do not use facial expressions that ordinarily show subtle emotion. Impairment in Understanding SpeechComprehension of speech in children with PDDNOS is impaired to varying degrees, depending on where the child is within the wide spectrum of PDDNOS...
