If you are reading this you may be searching for information about your child or a child you care about. Perhaps they have an ASD diagnosis and while it fits to a degree you feel like there is something you still do not understand about your child’s behaviours and needs. You might be following suggestions for how to support an autistic child but everything you do seems to make situations worse. This is how we felt a few years ago. I started searching even though I did not know what I was looking for. I researched Oppositional Defiance Disorder but it did not feel right. You can read more about our journey here.
Pathological Demand Avoidance (PDA) is an Autism Spectrum Disorder identified by Dr Elizabeth Newson in the UK in the 1980s. Dr Newson was working with a group of autistic children who did not fit the typical profile of ASD. While the children showed traits of autism as outlined in the DSM-V (below), she found that they all exhibited another set of common characteristics that stemmed from high anxiety due to a loss of control. The children used common behaviours to avoid demands in order to regain control over their world and reduce anxiety.
The following from the PDA Society Website outlines how PDA differs from typically presenting autism.
A PDA profile of autism means that individuals share autistic characteristics …
- “persistent difficulties with social communication and social interaction” and “restricted and repetitive patterns of behaviour, activities or interests” present since early childhood to the extent that these “limit and impair everyday functioning” (according to the Diagnostic and Statistical Manual Fifth Edition (DSM-5))
- often including a different sensory experience in relation to sight, smell, taste, touch, hearing, vestibular, proprioception and interoception.
… and also:
- have a need for control which is often anxiety related
- are driven to avoid everyday demands and expectations (including things that they want to do or enjoy) to an extreme extent
- tend to use approaches that are ‘social in nature’ in order to avoid demands
- present with many of the ‘key features’ of PDA rather than just one or two
- tend not to respond to conventional parenting, teaching or support approaches
Due to these differences it may be that you are not sure if the autism diagnosis you have is correct or perhaps you are not considering autism as a possible diagnosis. The list below from www.priorychildrensservices.co.uk was so helpful for me in seeing how our son is autistic with some other distinct characteristics. It was like someone turned on a light.
Young people with PDA are less likely to:
- have caused anxiety to their parents before 18 months of age
- show stereotypical motor mannerisms
- show echolalia or pronoun reversal
- show speech abnormalities in terms of pragmatics
- show tiptoe walking
- show compulsive adherence to routines
Young people with PDA are more likely to:
- resist demands obsessively (100%)
- be socially manipulative (100% by age of 5)
- show normal eye contact
- show excessive lability of mood and impulsivity
- show social mimicry (including gesture)
- show role play (more extended and complete than mimicry)
- show other types of symbolic play
- be female (50%)