I understand that Pathological Demand Avoidance or PDA is not a diagnosable condition listed in the DSMV but it is gaining notoriety in the field of special education and with ASD researchers. Many assume it is on the ASD spectrum and I have had some students with ASD avoid any tasks that are not free choice or are self directed. But I feel like this is more due to their other preoccupations and/or inability to do the tasks asked. But I have many 3 and 4 year old students entering my special education preschool who are being diagnosed or assumed to have ASD that really only have the characteristic of avoiding demands/withdrawing/refusing to perform even simple activities. I also don't see the other features of oppositional defiance in these children. They can otherwise be very pleasant children but just refuse to do anything with a demand. What is causing this sudden increase? Is it qualitatively different than ASD or ODD?
Here are some articles on this topic:
Gillberg C, Gillberg IC, Thompson L, Biskupsto R, Billstedt E. Extreme ("pathological") demand avoidance in autism: a general population study in the Faroe Islands. Eur Child Adolesc Psychiatry. 2015 Aug;24(8):979-84. doi: 10.1007/s00787-014-0647-3. Epub 2014 Nov 15. PMID: 25398390.
Egan V, Bull E, Trundle G. Individual differences, ADHD, adult pathological demand avoidance, and delinquency. Res Dev Disabil. 2020 Oct;105:103733. doi: 10.1016/j.ridd.2020.103733. Epub 2020 Jul 15. PMID: 32682221.
O'Nions E, Viding E, Floyd C, Quinlan E, Pidgeon C, Gould J, Happé F. Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/'pathological' demand avoidance. Child Adolesc Ment Health. 2018 Sep;23(3):220-227. doi: 10.1111/camh.12242. Epub 2017 Oct 12. PMID: 32677301.
O'Nions E, Gould J, Christie P, Gillberg C, Viding E, Happé F. Identifying features of 'pathological demand avoidance' using the Diagnostic Interview for Social and Communication Disorders (DISCO). Eur Child Adolesc Psychiatry. 2016 Apr;25(4):407-19. doi: 10.1007/s00787-015-0740-2. Epub 2015 Jul 30. PMID: 26224583; PMCID: PMC4820467.
O'Nions E, Christie P, Gould J, Viding E, Happé F. Development of the 'Extreme Demand Avoidance Questionnaire' (EDA-Q): preliminary observations on a trait measure for Pathological Demand Avoidance. J Child Psychol Psychiatry. 2014 Jul;55(7):758-68. doi: 10.1111/jcpp.12149. Epub 2013 Oct 7. PMID: 24117718.
For many of these children, school may be the first time they are asked to perform in a group setting. Children with both ADHD and ASD have similar social and behavioral symptomologies. I would even postulate that in a future DSM clinically, we may need to consider having ADHD and Autism both considered spectrum disorders in their own right. Furthermore, that may, in fact, cross like a giant X- with high-functioning autism and ADHD with Hyperactivity at the top of the X and lower-functioning autism and ADHD with Inattention at the bottom of the X. Where it meets in the middle may contain many people with schizoaffective diagnoses in addition to the Spectrum disorders. In many educational and clinical settings, we are witnessing this.
- Badges
- Science topic
- Similar topics
- Psychology