Exploring pathological Demand Avoidance
Pathological demand avoidance (PDA) is a term first coined by Professor Elizabeth Newson and refers to what her research indicates as a distinct subset of children within the umbrella of pervasive developmental differences.
These children present with an extreme obsessional avoidance of the ordinary demands of life. They are therefore deeply threatened by educational demands and organisational rules. However challenging the behaviour and extreme the noncompliance, the child is not wilfully being naughty and cannot easily behave differently (Newson et al, 2003).
Children with PDA may demonstrate comparable levels of autistic traits and peer relationship problems with those children with an ASC diagnosis, and a similar level of anti-social traits like those seen in children with conduct problems, but higher levels of emotional symptoms than in both of these groups (O’Nions et al, 2014).
The defining criteria for a diagnosis of PDA syndrome according to Newson and colleagues are:
- Passive early history.
- Long term avoidance and resistance of ordinary demands (and socially manipulative avoidance).
- Surface sociability, but lack of sense of identity, pride or shame.
- Lability of mood, impulsivity and the child is led by a high need to control (generally due to underlying anxiety).
- Comfortable in role play and pretending.
- Language delay (seems to be as a result of passivity).
- Obsessional behaviour.
Despite these criteria being available, there are relatively few services nationally commissioned to assess and diagnose PDA, so many may have an ASC diagnosis but have a PDA profile. What is important to note is that the techniques and strategies need major adaptations for children with a PDA-profile.
Rememberavoidance of demands can happen whenyoung people on the spectrum experience high anxiety levels and feel out of control. It doesn’t necessarily mean they have PDA.
Sometimes demand avoidance is due to how the child interprets the question or instruction.
This can lead the young person to avoid or refuse tasks and activities that they would otherwise enjoy. This can be upsetting for the young person.