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An Updated Interest Based Account (Monotropism theory) & a Demand Avoidance Phenomenon discussion.

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Abstract

This talk explores recent literature on monotropism theory to explain Demand Avoidance Phenomenon (DAP). Previous DAP theory focuses on role of anxiety in producing a need for control that is suggested leads to demand avoidance. However, we provide an alternative view by situating in critical DAP scholarship, highlighting the uncertainty around the DAP construct. Utilising the work of Beardon (2017) to develop monotropism to elucidate how anxiety acts in autism & thus, DAP. Monotropism theory clarifies the nature DAP phenotype behaviour from a non-pathologising perspective, bringing DAP theory in line with common views of autistic persons. The theory adds to the epistemic integrity of DAP research & assist in closing the theory-to-research-to-practice gap. Consequently, generating accurate interpretations that can allow for use of suitable strategies. I have updated the slides and reduced the number of sides compared to the original talk. Additionally, I have added some more material to expand on some points. Disclaimer, Monotropism autism theory, is Dinah Murray's theory, not my own. I have logically progressed the theory.
Monotropism & DAP. 1
An Updated Interest Based Account
(Monotropism theory) & a Demand
Avoidance Phenomenon discussion.
Richard Woods.
12th April 2019.
Monotropism & DAP. 2
PERSPECTIVE.
Remembrance.
1) Deeply saddened by passing of Mike Oliver.
2) Likewise, by sudden death of Judy Eaton’s
son.
Monotropism & DAP. 3
PERSPECTIVE.
My Bias.
1) The speaker meets its proposed profile, but
that does not mean much.
2) Demand Avoidance Phenomenon (DAP)
Sceptical that DAP is an autism subtype or a
syndrome.
3) Significantly more compelling research, in
quantity and quality.
4) Speaker has never hated DAP.
5) Annoyed by its construct & it operation.
6) Good reasons to be antagonised by DAP.
Monotropism & DAP. 4
CHEAP PLUG.
Autism Policy & Practice.
1) Open Access autistic-led good practice
journal.
2) Access via link below:
https://www.openaccessautism.org/index.ph
p/app/about
3) Alternatively, contact Dr Mitzi Waltz.
mitziwaltz@yahoo.com
Monotropism & DAP. 5
IN THE BEGINNING.
Introduction.
1) Builds on previous talk on Monotropism and
anxiety. (Woods 2018c).
2) What DAP is.
3) Case “against” DAP.
4) What is Monotropism.
5) Further refinement.
6) DAP discussion topics, plus Questions &
Answers.
Monotropism & DAP. 6
WHAT IS IN A NAME?
A Suitable Name.
1) Demand to change its name (Eaton 2018;
Gillberg 2014; Milton 2017a; Newson et al
2003; PDA Society 2019; Reilly et al 2014;
Sanchez 2018; Woods forthcoming).
2) DAP, Demand Avoidance Phenomenon.
3) Will be clear later why this is appropriate.
Monotropism & DAP. 7
LET’S TALK.
Main DAP Discourse.
1) Called Pathological Demand Avoidance or
Extreme Demand Avoidance.
2) A distinct syndrome.
3) An autism subtype/ Pervasive Developmental
Disorder.
4) DAP is controversial (Falk 2019; Fidler and
Christie 2019; Green et al 2018b; Kaushik
2015; O’Nions et al 2014a; O’Nions et al
2014b).
5) Dichotomy “for” & “against” sides.
Monotropism & DAP. 8
DEPTH OF PERSPECTIVE.
DAP Controversy.
1) Substantial levels of disagreement with main
discourse (Brede et al 2017; Dore 2016; Evans-
Williams 2018; Fieldman 2018; Flackhill et al
2017; Garralda 2003; Green et al 2018a;
Haroon 2019; Kaushik 2015; McElroy 2015;
Malik & Baird 2018; Milton 2017a; Slaughter et
al 2019; Wing 2002; Woods 2017).
Monotropism & DAP. 9
DEPTH OF PERSPECTIVE.
DAP Controversy.
1) Highly contested, undermining credibility of
all DAP “experts” (Vassilev & Pilgrim 2009),
including the speaker.
2) Reciprocal claims to some: charlatans,
extremists, gaslighting, spreading nonsense &
unethical conduct.
Monotropism & DAP. 10
TIME TO PROFILE YOU.
Autism + DAP Traits criteria.
1) Comfortable in role play and pretend.
2) Continues to resist and avoid ordinary
demands of life.
3) Demand avoidance can use social strategies.
4) Lability of mood & impulsive.
5) Obsessive behaviour, often focused on other
people.
6) Surface sociability, but apparent lack of sense
of social identity, pride, or shame (Fidler
2019; Green et al 2018a; Newson et al 2003).
Monotropism & DAP. 11
TIME TO PROFILE YOU.
Non-essential criteria.
1) Delayed Speech Development.
2) Neurological Involvement.
3) Passive early history (Newson et al 2003).
4) Sensory differences (Eaton et al 2018).
Monotropism & DAP. 12
TWO FACES.
Citation Survey Results.
1) Main discourse is being challenged.
2) Key literature is being accessed thousands of
times.
3) Key literature rarely references critical
literature, except to support its case or
disagree with critique.
4) Lack of autistic perspectives referenced.
5) Forming a community of practice.
Monotropism & DAP. 13
A STATE OF MATTER.
Why this matters.
1) Overstating “for” case.
2) Reification (Rutter & Pickles 2016).
3) Potentially negligent assumptions (Dore 2016;
Milton 2017a).
4) Nonsense, “atypical autism”.
5) Metaphors can be dangerous (Dinishak &
Akhtar 2013; Goodley et al 2019; Hacking
2010; Walsh 2018).
Monotropism & DAP. 14
A STATE OF MATTER.
Why this matters.
1) Ethically, a balanced perspective should be
presented (Brooks et al 2014; Dawson 2004;
Rutter & Pickles 2016; Waltz 2007).
2) Ramifications of community of practice can
lead to sources of confirmation bias (Milton
2017a).
3) Undermines literature’s epistemic integrity
(Milton et al 2018).
Monotropism & DAP. 15
TIME TO PROFILE YOU.
Profile limitations.
1) DAP criteria is unstable (Eaton 2018a).
2) No agreement over diagnostic criteria & are
not consistently applied.
3) No agreement on how to do diagnose DAP.
4) DAP profile overlaps autism behaviour profile
(O’Nions et al 2018).
Monotropism & DAP. 16
TIME TO PROFILE YOU.
Profile limitations.
1) Autism dx from age 3+, as when behaviours
consistently manifests (Green et al 2018).
2) “Passive Early History” & Avoidant behaviours
are generic, with anecdotal evidence open to
confirmation bias.
3) Assumptions on ontology, nosology & aetiology
of DAP should avoid anecdotal evidence.
Monotropism & DAP. 17
THE OTHER SIDE.
Non-Specific Nature.
1) DAP has no specificity (Attwood 2018; Christie
et al 2012; Christie & Fidler 2015; Garralda
2003; Malik and Baird 2018; PDA Society 2019;
Wing 2002).
2) Signs of DAP seen in Asperger’s case studies
(Falk 2019; Philip & Contejean 2018; Sanchez
2018).
3) At least 15 medical ontologies, including many
common autism comorbidities (Woods 2018c).
4) Large overlap between many of these (Rutter
& Pickles 2016).
Monotropism & DAP. 18
THE OTHER SIDE.
Non-Specific Nature.
1) Such co-morbidities are being seen in recent
samples (Brede et al 2017; Eaton 2018b; Egan
et al 2018; Kaushik 2015; Lyle & Leatherland
2018; Trundle et al 2017).
2) Interaction with comorbidities affects autism
development (Brede et al 2017; Flackhill et al
2017; Green et al 2018a; Verhoeff 2012).
Monotropism & DAP. 19
THE WRONG SPECTRUM.
Part of the Spectrum?
1) DAP is autism subtype due to high anxiety
levels & Theory of Mind issues (Christie &
Fidler 2015).
2) Anxiety is not part of the autism diagnostic
criteria (Woods 2018a).
3) Theory of Mind issues are found outside of
autism, including attention deficits, LD &
Schizophrenia (Lawson 2011).
Monotropism & DAP. 20
THE OTHER SIDE.
The “Against” Case.
1) Atypical nosology (Green et al 2018b).
2) Autism subtypes lack validity, including
Asperger’s and DAP (Green et al 2018a; Happe
2011).
3) ASD+PDA traits dual diagnosis has not always
been used, e.g. Elizabeth Newson Centre
started using it 2015.
4) DAPers originally being diagnosed with
Atypical Autism or PDD-NOS (Christie et al
2012; Newson et al 2003), were already being
diagnosed as autistic.
Monotropism & DAP. 21
THE OTHER SIDE.
Remission rates.
1) O’Nions et al (2016a) suggests a 40% remission
rate.
2) Gillberg et al (2015) 1 out of 9 persons
meeting profile into adulthood; 90% remission
rate.
Monotropism & DAP. 22
THE OTHER SIDE.
Result of trauma?
1) The behaviours can be caused by other
conditions, resulting from trauma (Brede et al
2017).
2) Egan et al (2018) suggests behaviours are
caused by personality, not autism.
3) Some DAPers showing signs of emerging
Personality Disorders (PDA Society 2019).
4) Personality Disorders are caused by trauma
(Fieldman 2018).
Monotropism & DAP. 23
AUTISM MANIFOLD?
Measuring problems.
1) Difficult/ impossible to measure boundaries
between subtypes.
2) Autistic persons frequently transition between
subtypes (Leatherland 2018; Wing 2002; Wing
et al 2011), including in different situations
(Verhoeff 2012; Walsh 2018; Watts 2017;
Woods 2018b).
3) Lack sense of identity/ pride/ shame are hard
to measure (Garralda 2003).
4) Using questionnaires & lacking specific items
from using caregiver reports (Lord et al 2018).
Monotropism & DAP. 24
AUTISM MANIFOLD?
Possible sources of bias.
1) DAPers are prone to internalising (Woods
2018b), & showing signs of such.
2) Plausible confirmation bias from DEP &
divergent stakeholder perspectives (Woods
2018a).
3) High risk of confirmation bias via looping
effects (Heasman & Gillespie 2018; Loomes
2019).
4) Risk of confirmation bias due to vague
questions, behaviours that are not unique &
reliance on caregiver reports.
Monotropism & DAP. 25
THE OTHER SIDE.
Alternative results explanations.
1) DAP will lead to confusion (Garralda 2003;
Green et al 2018b).
2) Plausible conditioning into DAP profile (Woods
2018b).
3) High anxiety levels can be partly explained by
masking (Goffman 1963).
Monotropism & DAP. 26
DOWNING TOOLS.
Screening & diagnostic tools.
1) Extreme Demand Avoidance Questionnaire is a
screening tool; EDA-Q.
2) EDA-Q flaws: has a rater bias (Green et al
2018a) and divergent scores across
stakeholders (Brede et al 2017).
3) EDA-Q flaws: has not been standardised
(Summerhill & Collett 2018).
4) EDA-Q flaws: Detects demand avoidance
behaviours in other conditions & false
positives (Eaton 2018b; Green et al 2018;
Kaushik 2015).
Monotropism & DAP. 27
DOWNING TOOLS.
Screening & diagnostic tools.
1) Diagnostic Interview for Social and
Communication Disorders; DISCO.
2) DISCO flaws: Does not take into account
fantasy and roleplay traits (Philip and
Contejean 2018).
3) Questioned if objective measures can be
developed (PDA Society 2019).
Monotropism & DAP. 28
TOP CONDITION?
Behaviourism in DAP.
1) Use of functional analysis in clinical practice
& theoretically (Lyle & Leatherland 2018;
O’Nions & Neons 2018; PDA Society 2019;
Summerhill & Collett 2018).
2) Has low success rates with Positive Behaviour
Support & Applied Behavioural Analysis
(Dawson 2004; Hassiotis et al 2018; Murray
2016).
3) Changes in behaviour can be from many
factors, including those not considered in
practice (Milton 2017b).
Monotropism & DAP. 29
A VALID QUESTION.
Research approach.
1) Started from their understanding of autism &
then to investigate if behaviours are found
elsewhere (O’Nions et al 2016b; PDA Society
2019).
2) Research needed to support clinical based
understandings as an autism subtype (Christie
et al 2012).
3) DAP needs to be autism subtype to fall under
Autism specific legislation & guidelines
(Christie & Fidler 2015).
Monotropism & DAP. 30
A VALID QUESTION.
Research approach.
1) DAP needs reliability over validity (Christie
2018), ignoring present validity based autism
nosology (Green et al 2018b; Happe 2011).
2) To maintain integrity of how DAP is
understood & nature of support (Christie
2018).
3) Mainly using deductive/ circular methods.
4) Using (& suspected) entire autistic samples
(Egan et al 2018; Gillberg et al 2015; O’Nions
et al 2016a; Reilly et al 2014).
Monotropism & DAP. 31
THE OUTLOOK.
Pertinent Issues.
1) Extremely difficult for anyone to credibly
claim to know what DAP is with lack of
evidence & DAP’s systemic flaws.
2) Pluripotential nature of its’ behavioural
profile and subjective symptoms means any
condition can be identified as DAP if one is
looking for it (Woods, submitted).
3) Significant sized minority of DAPers are likely
to be non-autistic (PDA Society 2019).
4) Most current DAP research can be viewed as
self-validating pseudoscience.
Monotropism & DAP. 32
THE OUTLOOK.
Pertinent Issues.
1) DAP seems to not lower formal exclusions,
yet, raises informal exclusions (PDA Society
2019).
2) DAP is not a recognised research priority of
autistic persons (Woods 2017).
3) DAP is the only certainty some vulnerable
persons have, e.g. as a shield from parent
blame.
4) “Lightbulb moment” is used as justification
for utilising DAP.
Monotropism & DAP. 33
TIME TO STRATEGISE.
Overlapping Strategies & Pedagogies.
1) Autism Catatonia (Eaton 2018a).
2) Autistic preferred approaches (Laurent 2019;
Milton 2018b).
3) Capabilities Approach (Woods, forthcoming).
4) Dielectric Therapy (Eaton 2018a; Fieldman
2018).
5) Evidence based practices (Green et al 2018b).
6) Inquiries based learning.
7) SPELL Framework (Milton 2017a).
8) Universal Design for Learning (Woods,
forthcoming).
Monotropism & DAP. 34
ANOTHER STATE OF MATTER.
Contextual Issues.
1) Autism traditionally has poor quality ethics
and research (Waltz 2007). This is still
ongoing, e.g. Applied Behavioural Analysis/
Positive Behaviour Support and Autism
Innovative Medicine Studies.
2) DAP viewed as a threat to (hard won) validity
of clinical language (Green et al 2018b).
3) American Psychiatric Association/ World
Health Organisation/ Autistic persons place to
decide what is and is not autism.
4) Similarly, for DAP.
Monotropism & DAP. 35
ANOTHER STATE OF MATTER.
Contextual Issues.
1) Ethically, DAP needs good quality evidence to
be used (PDA Society 2019).
2) Following DAP logic to nosology (DAP has
specific strategies); it could be viewed as
form of Catatonia & Personality Disorder, due
overlap in respective strategies.
3) Some argue autism is only a cultural construct
(Runswick-Cole et al 2016).
4) Likewise, autism is an artefact of diagnostic
practice (Walsh 2018).
Monotropism & DAP. 36
THE TWILIGHT ZONE.
The Null Hypothesis.
1) Prioritise integrity & validity of autism, over
diagnosing DAP.
2) Scientific knowledge is driven by disproving
null hypothesis.
3) “Until proven otherwise, is that there is no
characteristic natural entity that can be
elicited and reliably measured/identified
that corresponds with Demand Avoidance
Phenomenon”.
4) Adapted from Timimi (2018).
Monotropism & DAP. 37
THE QUICKENING.
Summary.
1) Covered core issues against DAP.
2) Contextualised DAP relevant discourses.
3) Arguing for scientific approach to DAP to
maintain integrity & validity of autism.
4) Switching to Monotropism.
Monotropism & DAP. 38
AN INTEREST BASED ACOUNT.
Monotropism 101.
1) Attention is a scarce resource, there is
competition for its use by myriad interests.
2) An interest is anything that gains your
attention; from sensory stimuli, thoughts to
emotions.
3) Each person can only process a certain amount
of attention resource at any moment.
4) Continuum of perceiving attention; One end is
Monotropism and the other Polytropism.
5) Autistic persons tend to be monotropic.
6) Non-autistic persons tend to be polytropic.
Monotropism & DAP. 39
AN INTEREST BASED ACOUNT.
Monotropism 101.
1) Attention tunnels are made from attention
resource.
2) Monotropism is with a single attention tunnel
when entire attention resource is used.
3) Polytropism is with many attention tunnels
that have similarly distributed attention
resources.
Monotropism & DAP. 40
AN INTEREST BASED ACOUNT.
Single attention tunnel leads to:
1) Interests are processed sequentially in order
of importance.
2) Experiencing intense sensations.
3) Binaric black and white thinking.
4) External information being occluded from
awareness.
5) Intensity of our thoughts leave stronger
impression on subconscious.
6) More difficult to restart attention tunnels.
Monotropism & DAP. 41
CONFLICTING INTERESTS.
An Interest Based Account Reading.
1) For further reading see (Murray et al 2005):
https://www.researchgate.net/publication/78
79954_Attention_monotropism_and_the_diagn
ostic_criteria_for_autism
2) The Passionate Mind (Lawson 2011).
3) Monotropism An Interest Based Account of
Autism (Murray 2018).
4) Me and Monotropism: A unified theory of
autism (Murray 2019):
https://thepsychologist.bps.org.uk/me-and-
monotropism-unified-theory-autism
Monotropism & DAP. 42
GOING WITH THE FLOW.
Flow States.
1) An optimal experience that is beneficial to our
wellbeing and happiness.
2) Experienced when a person is deeply involved
in an activity and nothing else seems to
matter.
3) Flow states can happen in social interaction.
4) Provide stability, e.g. an escape from anxiety.
5) Such activities that engage with flow states
can become a compulsion and addictive.
6) Aversive to chaotic life outside of the person.
7) (McDonnell & Milton 2014).
Monotropism & DAP. 43
CLUMPING TOGETHER.
Clumping Attention Resource.
1) Where the flow of attention resource is halted
due to sticking together.
2) Can form blockages to prevent attention
resource bringing certain information into
person’s awareness.
3) (McDonnell & Milton 2014).
Monotropism & DAP. 44
IN THE LOOP.
Biolooping.
1) How a person’s mental state affects their
physical state.
2) Vice versa.
3) A person thinking they are ill, can make
themselves ill.
4) Again, vice versa.
5) Yoga.
6) (Hacking 1999).
Monotropism & DAP. 45
DEVELOPMENTAL TRAJECTORY.
Developing Monotropism.
1) N = Attention Resource (Murray 2018).
2) A = Anxiety.
3) F = Flow states. Duration and intensity of a
flow state.
4) R = Stored N. Depleted by persons using N
Monotropism & DAP. 46
DEVELOPMENTAL TRAJECTORY.
Developing Monotropism.
1) C = Capacity: N that is available for use after
automatic cognitive processing; forming the
perception based on sensory inputs and any
intrusive thoughts that consume R before it
can be used for day-to-day tasks (Murray et al
2005).
2) Higher F = Higher N and Lower A.
3) Higher F Higher C.
4) Higher F Higher R.
Monotropism & DAP. 47
AN ANXIOUS MOMENT.
Monotropism and anxiety.
1) All humans (and animals) need stability.
2) Points of interest can be stability points.
3) Black/ white thinking style. Either have
certainty/ uncertainty on a subject.
4) Obscure other thoughts that are linked to the
subject of interest; obscure & reduce anxiety.
5) Therefore these flow states form fixed points
of stability for autistic persons.
Monotropism & DAP. 48
AN ANXIOUS MOMENT.
Monotropism and anxiety.
1) Autistic persons engage with subjects that
interest them.
2) Requires significant N to engage with
uninteresting matters.
3) Explains autistic social communication issues.
4) When a person has no N and an attention
tunnel is violently disrupted, an autistic
person can lose control; go into meltdown/
shutdown/ panic attacks.
5) Autistic persons will tend to have higher
anxiety levels due to black and white
thinking.
Monotropism & DAP. 49
REMEMBER, JUST BREATHE.
Monotropism and anxiety.
1) Autistic persons being 1-2% of population and
not interested in non-autistic social norms;
they have different sources of stability.
2) Polytropism easily engages in social
interactions; thus forming flow states from it.
3) Non-autistic benefiting from lower anxiety
and increased R.
4) Non-autistic stability also comes from
understanding non-autistic social interaction
and being able to rely on this consistently.
Monotropism & DAP. 50
AN ANXIOUS MOMENT.
Flow state Example & Implications.
1) Autistic person’s breakfast routine, allows
person to function for rest of the day.
2) Autistic person is in a flow state from that
routine.
3) Benefiting from reduced anxiety and
increased N. If it is a flow state present from
the routine, it would be a fixed point as
explained by Monotropism.
4) Regular low levels of R and C over extended
time periods can lead to trauma and anxiety.
Monotropism & DAP. 51
REMEMBER, JUST BREATHE.
Polytropism & Anxiety.
1) Non-autistic persons can experience
inconsistent social interaction.
2) Some staff also find it anxiety provoking to
spend extended periods of time with another
person who is anxious and has mood swings.
This group of pupils can be very intense to
work with, which is tiring” (Fidler and
Christie 2019, p. 140).
3) Anxiety here can also be explained by masking
(Goffman 1963).
Monotropism & DAP. 52
REMEMBER, JUST BREATHE.
Polytropism & Anxiety.
1) DAP parents often have higher anxiety levels
than either autism parents & CD parents
(Durà-Vilà & Levi 2019).
2) Correlation between parents with high anxiety
& children with high anxiety (Howard 2017).
Monotropism & DAP. 53
BACK TO MODELS.
SOR Developmental Model (Howard 2017).
Monotropism & DAP. 54
SINGLE FOCUS.
Monotropism DAP Model.
1) Howard Model can be adapted for Sensory
Under Responsivity & Monotropism.
2) Monotropism uses an embodied mind/
environment feedback (Murray 2019).
3) Crucially, this from birth.
4) Mechanisms for biolooping & looping effects
(Hacking 1999; Heasman & Gillespie 2018;
Loomes 2019).
Monotropism & DAP. 55
A SNUG FIT.
Monotropism DAP Model.
1) Autism + Environment = Outcome (Beardon
2017, p11).
2) Environment component uses DEP &
“Goodness of fit” (Green 2016; Milton 2018).
3) Thus, is transactional.
4) Matching environment to individuals needs
(Green 2016).
5) Preschool Autism Communication Trial; PACT
intervention.
6) Sustained reduction in “severity” of autism
“symptoms” (Pickles et al 2016).
Monotropism & DAP. 56
PEAK INTEREST.
Monotropic developmental peaks.
(Murray 2019).
Monotropism & DAP. 57
PEAK DISTRICT.
Polytropic developmental peaks.
(Murray 2019).
Monotropism & DAP. 58
PEAK INTEREST.
Monotropic developmental peaks.
(Murray 2019).
Monotropism & DAP. 59
MATCHING SALIENCES.
Environmental Impact on development.
1) More synchronised environment to autistic’s
interests, the more opportunities to enter
flow states.
2) Thus, autistic person will have more fixed
points.
3) Likewise, higher Global Stability levels.
4) Activities that are fixed points are over time
internalise to be part of autistic’s identity.
5) E.g. Harry Thompson responding to dares
(2019).
6) Or my bad jokes.
Monotropism & DAP. 60
MIS/ MATCHING SALIENCES.
Environmental Impact on development.
1) More an autistic’s external environment is
matched to their interests.
2) The more densely connected their peaks.
3) Likewise, more external connections between
their peaks.
4) Autistic persons can loose sense of self from
trauma (Milton 2017c).
5) Due to connections between peaks severing &
possibly the shattering of peaks.
Monotropism & DAP. 61
MISMATCHING SALIENCES.
Impact of trauma on development.
1) Process can be exacerbated by experiencing
distressing situations.
2) Can internalise distressing response.
3) Creating a destructive feedback loop.
4) Traumatic experiences can shatter autistic
persons fixed points.
5) This forces individuals to search for different
activities they can enter flow states with.
Monotropism & DAP. 62
MISMATCHING SALIENCES.
Impact of trauma on development.
1) If an autistic person is repeatedly
traumatised, they can gradually shift from
automatically responding to dares to
controlling their food intake. E.g. Thompson
(2019).
2) Or retreat to other “extreme” activities as
sources of fixed points, increasingly entering
fantasy worlds.
Monotropism & DAP. 63
MISMATCHING SALIENCES.
Impact of trauma on development.
1) This matters, as over time from repeatedly
entering a flow state by rituals controlling
food intake, these become fixed points.
2) Then internalised to become part of the
person in a form of an eating disorder.
3) Applicable to other “extreme” fixed points.
4) Autistic persons need environments we can
easily enter flow states with many different
sources.
5) Give us control of our routines; Structure part
of SPELL Framework (Milton 2014).
Monotropism & DAP. 64
MISMATCHING SALIENCES.
Easier said than done.
1) Autistic infants can be startled by “trivial”
interactions with carers.
2) With monotropic processing, infant may not
recognise they are in a safe situation when
being hugged; thus is shocked.
3) Can occur repeatedly.
4) Often not carers fault.
Monotropism & DAP. 65
A STARTLING REVELATION.
Easier said than done.
1) Startled infants could become hyper aware
and sensitive to their sensory environment.
2) Rises intolerance uncertainty & thus anxiety.
3) Carers told to follow standard parenting
advise raises mismatch between environment
& infant.
4) Generates cycle that deteriorate infants &
carers wellbeing.
5) Often not carers fault.
6) Can explain DAP behaviour in infants.
7) Needs strategies that works with the child.
Monotropism & DAP. 66
AVOIDANCE OF DOUBT.
Modelling DAP.
1) DAP fixed points tend to be fantasy, role play
& “challenging” behaviour. E.g. automatically
responding to dares (Thompson 2019).
2) Can be problematic leading by creating
substantial mismatch between autistic &
environment, leading to possible trauma.
3) Essentially views DAPers as traumatised
autistics.
Monotropism & DAP. 67
ROUND TABLE.
Summarising.
1) Strong scientific case against main DAP
discourse.
2) Scientific approach is needed to maintain
integrity & validity of autism.
3) Monotropism can explain anxiety in autism.
4) Developmental model places importance on
matching environment to child.
5) Autistic trauma is often not the carers fault.
Monotropism & DAP. 68
POSITIVE FEEDBACK.
Acknowledgements.
1) I thank the following for commentary on
development of this talk:
2) Carl Cameron, Judy Eaton, Jonathan Green,
Damian Milton, Dinah Murray & Harry
Thompson.
3) Andy McDonnell, Fergus Murray & Catriona
Stewart for having faith in my theorising.
4) Luke Beardon for his Global Instability Theory
that inspired the previous talk.
Monotropism & DAP. 69
ANY QUESTIONS?
The End Game.
1) Contact Details:
richardwoodsautism@gmail.com
2) Twitter handle:
@Richard_Autism
3) My researchgate:
https://www.researchgate.net/profile/Richar
d_Woods10
4) Any questions?
Monotropism & DAP. 70
SPANNISH INQUISITION.
Options for discussion.
1) DAP criteria.
2) Steph’s Two Girls quote.
3) Judy Eaton observation.
4) Fidler and Christie matching the dials
concept.
5) Milton’s Syndrome thought experiment.
6) Monotropism; specificity, uniqueness &
universality.
Monotropism & DAP. 71
READY PLAYER ONE?
Autism + DAP Traits criteria.
1) Comfortable in role play and pretend.
2) Continues to resist and avoid ordinary
demands of life.
3) Demand avoidance can use social strategies.
4) Lability of mood & impulsive.
5) Obsessive behaviour, often focused on other
people.
6) Surface sociability, but apparent lack of sense
of social identity, pride, or shame (Fidler
2019; Green et al 2018a; Newson et al 2003).
Monotropism & DAP. 72
TAKES TWO TO TANGO.
Steph’s Two Girls Example.
1) For years now, Sasha has controlled the
music in the car, and we have one CD on
repeat for weeks or months at a time. From
any one CD, there is usually only a handful of
songs at most which can be selected; I think
I've become immune to the repetition but am
sure others would find it unbearable if they
joined us regularly on our journey. It's become
apparent in the last few days that Sasha now
needs to listen to certain songs at a certain
time in the journey(Curtis 2018).
Monotropism & DAP. 73
THREE’S A CROWD.
Judy Eaton’s Controlling Food Intake.
1) Often go into meltdowns etc. when pushed to
follow anothers direction.
2) These persons are externalisers.
3) Punished for displaying clear emotions/
making mistakes.
4) Internalise their anger & frustration.
5) Thus to prevent further social isolation,
person control their food intake (behaviour)
instead of other persons to manage their
anxiety.
6) (Eaton 2018, pp. 146-147).
Monotropism & DAP. 74
THE FOUR CASE.
Fidler & Christie, Matching The Dials.
1) Person has a threshold capacity to demands,
determined by their anxiety levels.
2) There are 2 dials.
3) First for a person’s tolerances to demands.
4) Second for person’s levels of experienced
demands.
5) If first dial is high, demand and expectations
can be raised.
6) If first dial is low, demand and expectations
should be lowered.
7) Synchronise dials as much as possible.
8) (Fidler and Christie 2019, pp. 26-27).
Monotropism & DAP. 75
THE FIFTH COLUMN.
Milton’s Syndrome Thought Experiment.
1) What if the autistic population proposed an
autism subtype, called Milton’s Syndrome”?
2) This scenario Milton’s Syndrome has same
issues DAP has.
3) What would be the response to Milton’s
Syndrome?
Monotropism & DAP. 76
THE SIXTH SENSE.
Specificity, Uniqueness & Universality.
1) Specificity = “does autism arise from a
domain-specific factor or are multiple factors
involved?”.
2) Uniqueness = “Is the factor unique to the
disorder or is it also involved in other
developmental disorders?”.
3) Universality = Is the factor (or factors) found
in every individual with autism or just in the
majority?” (Rajendran & Mitchell 2007, p224).
Monotropism & DAP. 77
NOT THE ONE BIBLE.
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1) Woods, R. (Submitted). Commentary: The integrity and validity of Demand
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Conference (2018). Under peer review.
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Studies: a more inclusive interpretation. Disability & Society, 33(6), 974-979.
... Under the equation, anxiety is the outcome as it is caused by the environment. Monotropism theory views autistic anxiety as primarily caused by autistic persons being a minority group in an environment not readily adapted to our needs (Woods, 2019a). Pervasive anxiety experienced by autistic persons is either directly from a comorbid difficulty, or the result of comorbid difficulties interacting alongside autism; similarly, autistic persons with co-occurring attention deficit hyperactivity disorder (ADHD) showed higher anxiety, less working memory and less empathy (Harmsen, 2019). ...
... With around 40% of autistic population experiences co-occurring anxiety-based disorders, the extreme anxiety levels reported in the DAP literature are plausibly the result of the interaction between autism and a different comorbidity. DAP can be explained by trauma (Woods, 2019a(Woods, , 2019b. ...
... Stuart et al. (2019) provide a general overview of the DAP literature. There are gaps and difficulties with the extant research and challenges objectively measuring DAP (Woods, 2019a(Woods, , 2019b. The authors observe that the Extreme Demand Avoidance-Questionnaire (EDA-Q) used in their trial had a ceiling effect and suggest that the anchor points are not very sensitive in capturing variations in behaviour at the more extreme end. ...
Article
Full-text available
Demand Avoidance Phenomena (DAP) is a neutral term for Pathological Demand Avoidance, which is sometimes conceptualised as an autism subtype. There is much ongoing controversy around the construct. In this commentary, I attempt to contextualise the recent article, Intolerance of Uncertainty and anxiety (Stuart et al., 2019) within wider discourses. This discussion provides tentative support for monotropism autism theory and the growing body of research indicating that DAP may not be developmentally persistent (a high rate of persons not meeting clinical threshold into adulthood). Going forward I would suggest that Stuart and colleagues' research should be replicated, in order to add to the DAP literature. Read the full article at doi: 10.1111/camh.12336
... Richard Woods attempts to provide support for his Monotropism autism theory (Woods, 2019). Pathological Demand Avoidance (PDA) behaviour is increasingly, although not universally, becoming recognised as a behavioural profile within the United Kingdom, with increasing numbers of referrals to CAMHS teams nationally for assessment and diagnosis. ...
Article
This paper is in response to the commentary written by Richard Woods in which he attempts to provide support for his Monotropism autism theory and the research indicating that Demand Avoidance Phenomena may not be developmentally persistent (Woods, 2019). We acknowledge the continuing controversy around the proposed construct of PDA and the clinical dilemma faced by professionals, within the United Kingdom, following increased demand from families seeking assessment and support. We appreciate that research on this topic is scarce and understanding of PDA behaviours remains limited and that methodological improvements are required. However, it is important to remember that anxiety, which often has an onset in middle childhood and adolescence, is a major risk factor for mental health difficulties. Therefore, treatments targeting underlying and potentially modifiable mechanisms rather than anxiety symptoms may be more likely to be effective.
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