Wednesday, 15 June 2011

Pathological Demand Avoidance

This is a bit of a different post in that it's more descriptive than opinion. I would however say that the subject matter is important, particularly given the upcoming changes to the DSM criteria for 'autism spectrum disorders' that have been the subject of so much discussion and speculation.

Pathological Demand Avoidance (PDA). I first heard about PDA quite a few years ago at a small conference held in North-East England. Prof. Elizabeth Newson and colleagues from Nottingham presented some data on the definition of PDA and the varied ways in which PDA was distinguished from, and related to, other autism spectrum conditions. The main features of PDA (as taken from Newson et al*) are:

  • A passive early history (watching not interacting) which merges into becoming actively passive (objecting to normal demands).
  • Demand avoidance characterised by resisting the ordinary demands of life via social manipulation.
  • Apparent lack of sense of social identity, shame or pride (no sense of responsibility).
  • Mood lability and a need for control.
  • No problem with role playing or pretend play.
  • Language delay as a result of passivity.
  • Obsessive behaviour.
  • Neurological impairment (clumsiness, physical awkwardness).

There are quite a few summaries of this information (one of which can be viewed here). The main differences I take from these description compared with autism seems to focus on the child's intentions, and in particular, the active use of 'social manipulation' in PDA to action those intentions, coupled with no evidence of role and/or pretend play problems. I don't see any plans to formally include PDA in DSM or any other diagnostic text and am a little uncertain why, given that conditions such as Oppositional Defiant Disorder (ODD) have found a place in the diagnostic texts (and will continue to do so).

That's it. And because this was such a short post I leave you with probably the best music video ever - 'Buddy Holly' by Weezer for all you fans of the Fonz.

* Newson E, Le Marechal K, David C. Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood. 2003; 88: 595-600.