The concept of Pathological Demand Avoidance (PDA), was first proposed by Elizabeth Newson some twenty years ago. Since this time, researchers and clinicians have continued to work on how it should be defined. There is still considerable debate regarding this. However, The National Autistic Society, and others currently view PDA as a behaviour profile seen in some autistic children.
Autistic children with the PDA profile have an inability to tolerate demands imposed upon them and an overwhelming need to control their environment.
This need for control is often driven by high levels of anxiety, which can lead the child to engage in sometimes challenging behaviour, in order to avoid demands. Some children do not display behaviour that challenges, but instead ‘shut down’ or attempt to escape a situation they find intolerable.
There is little available research evidence about what kind of long-term outcome is likely for children with PDA profile or whether, and how, it changes over the years. It is known that many children with this profile spend a period of time out of school or are home educated. Having an assessment of a child’s strengths and difficulties can help to plan for the child’s future and support them in the most appropriate way possible.
We have extensive experience in the recognition, assessment and diagnosis of the PDA profile. If the child does not already have a diagnosis, the assessment process starts with an assessment for Autism. We follow the NICE guidelines and involve a variety of professionals in our assessment. We can also offer follow-up support to both school and families, as although the PDA profile is considered as part of the broader Autistic Spectrum, the management strategies which tend to be more effective with children with the PDA profile are very different.
These children may exhibit superficial sociability but tend to lack responsibility and awareness of acceptable boundaries (social or otherwise). They also can be impulsive and demonstrate lability of mood with frequent temper tantrums and ‘meltdowns’. These difficulties often become more apparent when the child begins to attend school, when demands on them tend to become greater. However, our experience of this profile indicates that the demand avoidant behaviour will have been present to some extent from a very young age. Behaviour can deteriorate quickly and the child may resort to manipulation, or even violence to avoid demands. More often the child will resort to this type of behaviour across all settings, sometimes becoming very upset and being unwilling, or refusing to attend school. Some cause significant disruption within the classroom. However, it is not uncommon for children to ‘hold it together’ and remain compliant whilst they are at school, and then display challenging and distressed behaviour when out of school. Avoidance tactics can include repetitive questioning, ignoring, changing the subject, talking over people. Some children can resort to more extreme behaviour, with others ‘shutting down’ and becoming reluctant to leave the family home. They can find it difficult to negotiate with peers, and can become bossy and domineering during play.
Please click here for full details of our Assessment and Diagnosis process PDF.