Richard Woods highlights the occurrence of PDA in non-autistic children.
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.
Mr. Richard Woods.
PhD Student at London South Bank University.
Autimedes Training and Consultancy.