Abstract
Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue. The concept of pathological demand avoidance has been criticised for undermining the self-advocacy of autistic people and neglecting the potential role of anxiety as a possible underlying or contributing cause. The current study was undertaken to summarise and review the methodological quality and findings from current research into pathological demand avoidance in children and adolescents. Further aims were to describe how pathological demand avoidance has been identified and to explore the relationships with autism and other developmental and psychiatric disorders. After a comprehensive search, 13 relevant studies using a wide range of methods were identified and systematic quality assessments were undertaken. All the studies had based the identification of pathological demand avoidance, directly or indirectly, on descriptions from the original study by Newson and colleagues. However, the methods used to develop these criteria were not clearly described. Most studies relied exclusively on parental report for data, and there was a general failure to take account of alternative explanations for the behaviours under study. No studies explored the views of individuals with pathological demand avoidance themselves. Problems concerning definition and measurement in the reviewed studies currently limit any conclusions regarding the uniformity or stability of the behaviours described, or the characteristics of individuals displaying them. Relationships between pathological demand avoidance and other emotional and behavioural difficulties should be explored in future research, as should the perspectives of individuals with pathological demand avoidance themselves.
Highlights
Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue
pathological demand avoidance syndrome (PDA) has been mainly described in autistic individuals, a group that is vulnerable to disorders related to stress and anxiety (Hollocks et al, 2019; Kerns et al, 2020; Rosen et al, 2018)
Two changes were made to the protocol during the review: (1) the scope was extended from focusing on autistic individuals only, due to the authors becoming aware of suggestions that PDA may occur in other neurodevelopmental conditions (Gillberg, 2014); (2) the decision was taken to focus the review on PDA in children and adolescents as the literature on PDA in adults was extremely limited
Summary
Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue. Research, conducted largely in the United Kingdom, suggests that requests for diagnoses of pathological demand avoidance syndrome (PDA) by parents or caregivers have increased markedly over recent years (Green et al, 2018; Stuart et al, 2020). In their original paper, Newson et al (2003) describe children with PDA as using ‘social. These issues are relevant to the understanding of PDA as they suggest anxiety and other mental health problems could be underlying or contributing causes, even if their presence or influence is not observable to others
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