Pervasive Development Disorders

The pervasive developmental disorders include individuals with varying levels of developmental delay across multiple systems of growth and maturity.  Problems are most often seen in several of the following areas: social and emotional development; receptive and expressive language development; sensory reactivity and processing; motor tone; and motor planning.  These individuals have some level of difficulty in relating to other people, in responding appropriately in social settings, and in their overall ability to adapt and make transitions into unfamiliar situations.  They typically have a poor sense of behavior and its consequences or of the internal emotional life of other people, limiting their ability to relate appropriate to others.  Rarely if ever are these skills missing entirely.  Rather, they are sufficiently behind the level of same-age peers that these individuals stand out, particularly in social situations. 

Some individuals diagnosed with pervasive developmental disorders have below average intelligence; others have an unusually well developed ability to memorize information, but have greater difficulty making connections among what they have learned and greater difficulty thinking abstractly.  Many individuals with PDD show behavior patterns that feel “stuck,” that is, actions that may be mechanical, perseverative, stereotyped, or repetitive. 
The following are the indicators of a pervasive developmental disorder:

1. Impaired reciprocal social interactions:  This involves significant difficulty in developing relationships and responsiveness to other people that may be out-of-step or inappropriate.  There is often a limited ability to develop cooperative play, imaginative play, and friendships.  Some individuals show little interest in developing friendships; some prefer adults to same-aged peers because these relationships tend to help them focus and relate and are less challenging and variable than relationships with other individuals. 
2. Restricted repertoire of activities and interests:  These individuals often prefer routines and may resist even minor changes in the environment.  A task or activity may need to be repeated over and over, and tantrums may result if this is not possible.  They may be fascinated with movement, for example, watching traffic or creating their own visual patterns to observe.  Long-term memory is often excellent, but may appear to be ''stuck,'so that it is repeated over and over again regardless of appropriateness to the current social context.
3. Impaired communication and imaginative activity:  Individuals with significant delays in language skills may have immature grammatical structure, may echo what is said to them, or may speak with an atypical cadence or inflection (e.g., sing-song, high pitch, or a question-like rise of inflection at the end of sentences).  They often have difficulty using abstract terms or applying abstract concepts appropriately, leading to difficulties when these are needed in school.  Nonverbal communication is often impaired, with limited use of gestures and/or minimal facial expressions.  Imaginative activity such as "pretend" play is often absent or slow to develop and of little interest. 

Individuals with this difficulty vary significantly in their level of functioning, depending largely on their intelligence and the development of social and language skills.  Progress is often excellent, leading to in involvement in all the typical activities of adolescence and adulthood.  Treatment generally focuses on social and emotional skills.  At home, this would include: minimizing time in isolation or in solitary activities and maximizing conversational give-and-take; helping with understanding and use of social verbal and non-verbal cues; and expanding comfort with a variety of social settings through coaching and practice.   At school, this would include: expanding the application of information through analogies and comparisons; increasing comfort with transitions and variable routines; encouraging social participation through clubs and groups.  Additional school-based or private services are added depending upon an individual's particular profile.  These are aimed at helping the person appreciate and capitalize upon their strengths as well as improving areas of deficit so that wider options are available to them academically, behaviorally, socially, and emotionally.  Progress is typically greatest if multiple areas needing improvement are addressed simultaneously, and if remedial services are adjusted to reflect current needs.