. Individuals with PDDNOS who also have mental retardation may never develop more than a limited understanding of speech. Children who have less severe impairments may follow simple instructions if given in an immediate context or with the aid of gestures (e.g., telling the child to "put your glass on the counter," while pointing to the counter). When impairment is mild, only the comprehension of subtle or abstract meanings may be affected. Humor, sarcasm, and common sayings (e.g., "it's raining cats and dogs") can be confusing for individuals with the most mild PDDNOS.Impairment in Speech DevelopmentMany infants with PDDNOS do not babble, or may begin to babble in their first year but then stop. When the child develops speech, he or she often exhibits abnormalities. Echolalia (seemingly meaningless repetition of words or phrases) may be the only kind of speech some children acquire. Though echolalic speech might be produced quite accurately, the child may have limited comprehension of the meaning. In the past, it was thought that echolalia had no real function. More recent studies have found that echolalia can serve several functions, such as self-stimulation (when a child says words or phrases repeatedly without a communicative purpose--just because it feels good); as a step between a child being nonverbal and verbal; or as a way to communicate (Prizant & Rydell, 1993). Other children develop the appropriate use of phrases copied from others. This is often accompanied by pronoun reversal in the early stages of language development. For instance, when the child is asked "How are you?" he or she may answer "You are fine." The actual production of speech may be impaired. The child's speech may be like that of a robot, characterized by a monotonous, flat delivery with little change in pitch, change of emphasis, or emotional expression. Problems of pronunciation are common in young children with PDDNOS, but these often diminish as the chil...
