Pathological Demand Avoidance

Definition of Pathological Demand Avoidance

There is no recognised diagnostic definition of Pathological Demand Avoidance (PDA), although it is widely thought of as falling within the Autism Spectrum Disorder umbrella.

Clinicians can currently only use PDA as a descriptive diagnosis alongside an Autism Spectrum Disorder Diagnosis. It is not recognised by either internationally recognised standardised diagnostic tools; the DSM-V or the ICD-11.

Despite the lack of clinically defined diagnostic criteria, it is felt that PDA encompasses those children who are demand and expectations avoidant 'to an extreme extent'. This means the individual becomes highly reactive when demands and expectations are placed upon them by others.

Types of PDA

It is generally agreed that those who fit the profile of PDA are required to first meet the criteria for an Autism Spectrum Disorder diagnosis, alongside the proposed differentiating symptoms of PDA.

Much like with an Autism Spectrum Disorder diagnosis, those who fit the PDA profile present with individualised symptoms which can present differently from person to person.

Causes of PDA

The main causal factor underlying PDA is thought to be high levels of anxiety and that the behavioural symptoms indicative of PDA are driven by this anxiety.

Symptoms of PDA

The proposed diagnostic criterion for PDA is widely debated, however the following symptoms are thought to be demonstrative of a PDA profile:

• Passive early history before the age of 1, avoidant of everyday demands.
• Consistent avoidance of demand and associated panic attacks with this.
• Appear sociable but lack social identity.
• Mood swings and impulsivity.
• Enjoys role play and imaginative play.
• Language delay.
• Obsessive behaviour.

Examples of Demand and Expectation Avoidance Behaviours

The child may use one or more of the following behaviours to resist demands and expectations:

• Becoming argumentative
• Blame others for outcomes
• Bombarding the communication partner with speech or noises to drown out their speech
• Bossy behaviour by constantly telling others what to do
• Changing the topic of conversation
• Complaining of physical ailments
• Constantly negotiating
• Delaying or postponing something
• Distracting the communication partner
• Excuse-making
• Insisting on having the last word
• Interrupting others often
• Mimicking the other’s gestures and/or speech purposefully
• Panic-driven verbal and/or physical aggression
• Physically incapacitating self (e.g., hiding under table, flopping)
• Quick to anger, get upset or worried when under pressure
• Refusing to speak
• Repetitive questioning or talking about the same topic repetitively to avoid doing a task
• Straight-out refusal
• Withdrawing into fantasy world

Behaviour Help

If you are supporting an individual with PDA , please refer to our services and resources. They aim to help children, adolescents and adults achieve better communication, social, emotional, behavioural and learning outcomes. So, whether you are wanting guidance on parenting, teaching, supporting or providing therapy, Behaviour Help is at hand.

Note: This is not an exhaustive list of all the possible causes, symptoms and types but some general information that can be further explored. Based on what you have read, if you have any concerns about an individual, please raise them with the individual/s caregivers. The caregiver can then raise these concerns with their local doctor who can provide a referral to the relevant professional (e.g. paediatrician, psychologist, psychiatrist, allied health professional and learning specialists) for diagnosis and treatment if appropriate.

References

Fidler, Ruth; Christie, Phil (2019). Collaborative Approaches to Learning for Pupils with PDA: Strategies for Education Professionals. Jessica Kingsley Publishers.

Moore, A., 2020. Pathological demand avoidance: What and who are being pathologised and in whose interests?. Global Studies of Childhood, 10(1), pp.39-52.

Newson, E. (2000). Defining criteria for diagnosis of pathological demand avoidance syndrome (2nd revision). Nottingham: The Elizabeth Newson Centre.