Pathological Demand Avoidance (PDA) is a proposed mental
disorder, which frequently invokes strong passions advocating
for and against its use.
PDA is described as possessing obsessive resistance to
demands of “ordinary” life, involving manipulative strategies
to avoid demands. Other features include rapid changes in
mood, being comfortable in roleplay and pretending. Finally,
much, or most behaviour is obsessive in nature.
Developmental features of PDA are not essential for a diagnosis,
its most prominent screening tool for children and young
persons (CYP) does not require a person’s demand avoidance
to be from early infancy. At least four studies suggest PDA’s
features reduce as CYP mature, hence, is not pervasive in
nature. Nonetheless, many view PDA to be a form of autism.
Almost a decade ago, it was argued that PDA is a common
phenomenon, perhaps even a new childhood disorder. Lately,
it is recognised that the original research investigating PDA
contains non-autistic persons with PDA. This is supported by
several studies finding PDA in non-autistic persons. While
validating an adult screening tool, it has been found that PDA
is present in the general population.
There has been a consistent view that PDA is seen in non-
autistics, initially with its discoverer stating PDA is not autism.
Recently, many experts have expressed the opinion that PDA
is seen in non-autistic persons.
It is argued that PDA has different strategies compared to
autism, which involves offering choice, and negotiating with
persons with PDA. This is partly because reinforcement-based
approaches concerning praise, reward and punishments do not
work with persons with PDA (including non-autistic persons
with PDA). Such approaches can cause escalation of distress
behaviours associated with PDA. At worst, this approach can
extinguish CYP’s only effective coping behaviours to aversive
demands, and in time develop learned helplessness. Therefore,
a PDA diagnosis is required to protect CYP with PDA from
reinforcement-based approaches commonly seen in caregiving
interventions for disruptive behaviour disorders.
A multi-agency assessment pathway for PDA, regularly suggests
the use of PDA strategies for CYP without a PDA diagnosis.
This pathway was established to prevent deterioration of well-
being, and PDA is diagnosed under the universal rights CYP
have under the Convention on the Rights of the Child. The
United Kingdom Special educational needs and disabilities
(SEND) system is needs based, not diagnosis based. By
demonstrating the clinical need for PDA in autistic persons,
its advocates have also established the need for PDA in non-
autistic persons. Non-autistic persons with PDA, have the
same rights to PDA diagnosis, research, and support as autistic
persons with PDA. There is an urgent need for a more equitable
debate on PDA.
Point of view: student
Rights of non-autistic children
and young persons with PDA
Richard Woods highlights the occurrence of PDA in non-autistic children.
About the author
Richard Woods is a PhD Student at London South Bank
University. Autimedes Training and Consultancy.
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