Abstract
The term ‘pathological demand avoidance’ (PDA) was coined by Elizabeth Newson to describe children within the autism spectrum who exhibit obsessive resistance to everyday demands and requests (Newson et al., Arch Dis Child 88:595–600, 2003). Clinical accounts describe avoidance strategies including apparently strategic use of distraction or socially shocking behaviour, and obsessive need for control, reflected in domineering behaviour to peers and adults. Educational and management approaches effective for PDA reportedly differ from those for ‘typical’ autism spectrum disorders (ASD), and include novelty, humour and flexibility. Identification of PDA in individuals with ASD may have important implications for management (Eaton and Banting, J Learn Disabil Offending Behav 3:150–157, 2012). Despite increasing interest, no clinician-rated instrument for PDA has been developed. Here, items relevant to PDA were identified from the Diagnostic Interview for Social and Communication Disorder (DISCO) (Wing et al., J Child Psychol Psychiatry 43:307–325, 2002). The most PDA-specific subset of relevant DISCO items was selected, based on low endorsement in general across a sample of 153 individuals assessed for possible ASD using the DISCO. Having selected 11 DISCO PDA items for the measure, a subset of individuals with a high number of these features was identified (N = 27). Consistent with Newson’s descriptions, this high scoring group was characterised by lack of co-operation, use of apparently manipulative behaviour, socially shocking behaviour, difficulties with other people, anxiety and sudden behavioural changes from loving to aggression. All but one case met criteria for an ASD. This study brings the field a step closer to a clinician-rated measure of PDA features and highlights the need for further elucidation of the PDA phenotype.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-015-0740-2) contains supplementary material, which is available to authorized users.
Highlights
Pathological demand avoidance (PDA) is a term coined by Elizabeth Newson in the 1980s to describe children putatively within the spectrum of pervasive developmental disorders who exhibited an unusual pattern of behaviour [1]
Endorsement of PDA-relevant DISCO items was examined across the 153 cases assessed using the DISCO, to identify which PDA-relevant items might be sufficiently unusual to be discriminating
The aim of the present study was to identify interview items from within the DISCO that would make it possible to distinguish cases with PDA features, avoiding items tapping behaviours that are relatively common across the autism spectrum
Summary
Pathological demand avoidance (PDA) is a term coined by Elizabeth Newson in the 1980s to describe children putatively within the spectrum of pervasive developmental disorders who exhibited an unusual pattern of behaviour [1]. Key characteristics included an obsessive resistance to everyday demands and a tendency to use a range of ‘socially manipulative’ strategies to subvert requests (e.g. Eur Child Adolesc Psychiatry (2016) 25:407–419 distraction, targeted shocking behaviour, threats). A second feature was ‘surface sociability’—a superficial ability to manage social interaction, but with little evidence of a normal sense of social identity (e.g. believing themselves to be on a par with or superior to adults), and a lack of pride or shame, evident in socially shocking behaviour viewed as infantile or irksome by peers. Additional features were language delay, which was considered the result of passivity, obsessive behaviour often targeted at particular people or their characteristics, a passive early history and neurological involvement (e.g. delayed milestones, clumsiness, seizures or absences in a minority) [1]
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