<\/p>\n
Some children persistently avoid demands made from them, such as expectations or instructions. Such behaviour is generally considered to be part and parcel of autism spectrum disorder (ASD)[i]<\/a>,[ii]<\/a><\/sup>; however, an extreme version of demand avoidance has been described as Pathological or Extreme Demand Avoidance Syndrome (PDA\/EDA). Although PDA’s validity as a diagnosis has not yet been established, still, it provides a useful framework for understanding the nature and spectrum of such behaviours.<\/span><\/p>\n The key features of a PDA profile are:<\/span><\/p>\n (1) Demand avoidance has been present since early infancy and presented across contexts and time, often beginning with the child demonstrating reluctance to comply with daily tasks, and there is often extreme resistance to requests for activities such as walking with parents when outdoors or to tidy up or take a bath;<\/span><\/p>\n (2) Features of demand avoidance are noted in the child during the assessment process;<\/span><\/p>\n (3) Avoidance is pervasive and often seems illogical or perverse (e.g. the child may be unable to eat when hungry if requested to do so) and causes significant disruption to daily activities, which leads to parents\/caregivers needing to go to great lengths to manage any demand;<\/span><\/p>\n (4) Avoidance is not limited to a specific activity (or activities) in a specific context (e.g., reluctance to attend a school or complete homework, for example).<\/span><\/p>\n There are many reasons for challenging behaviour in children with or without ASD. Difficulties with executive functions, working memory, and processing speed can all present challenges in learning, creating behavioural challenges in the classroom. Hypersensitivity to various stimuli and uncertainty about the outcome of a change of plan can also cause resistance, anxiety, and challenging behaviour. However, there is often no clear reason for the distress resulting from apparently innocuous requests in children with PDA, and the usual management approaches, such as \u2018consequences\u2019, for managing behaviour difficulties appear not to be effective.[iv]<\/a><\/span><\/p>\n Interlinked dimensions of anxiety, fear, and intolerance of uncertainty[v]<\/a>, commonly seen in children with ASD, and the resulting need to be in control have been proposed to be the drivers of avoidant behaviours in P\/EDA.[vi]<\/a>,[vii]<\/a> \u00a0<\/sup>Other factors that may contribute to avoidant behaviour in ASD are reduced learning of social norms, difficulty reading intentions, difficulty in making sense of emotions and poor emotional regulation.<\/span><\/p>\n To understand an individual\u2019s behavioural response, one must explore the context of such behaviour and the factors that influence or change that behaviour. It has been argued that naming anxiety-driven avoidant behaviours as a discrete entity may not be helpful. Making a demand and responding to that demand is a social process in which two parties are involved. It is possible that some children, including those with ASD, either do not perceive or comprehend the demand or perceive them as unreasonable or irrelevant (Milton 2013)[viii]<\/a>. Naming the refusal of demands as a disorder and situating it within a child may obscure the influence of the context in which such demands are made.<\/span><\/p>\n [i]<\/a> Newson, E., Le Mar\u00e9chal, K., David, C. (2003).\u00a0Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7),\u00a0595\u2013600.\u00a0https:\/\/doi.org\/10.1136\/adc.88.7.595<\/a><\/p>\n [ii]<\/a> Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., Le Couteur, A., and Baird, G. (2018). Pathological Demand Avoidance: symptoms but not a syndrome. The Lancet Child & Adolescent Health 2, 455\u2013464.<\/p>\n [iii]<\/a> https:\/\/www.pdasociety.org.uk\/wp-content\/uploads\/2021\/05\/What-is-PDA-info-sheet.pdf<\/a><\/p>\n [iv]<\/a> O’Nions, E. and Eaton, J., 2020. Extreme \/ \u2018pathological\u2019 demand avoidance: an overview.\u00a0Paediatrics and Child Health<\/em>,\u00a030<\/em>(12), pp.411-415.<\/p>\n [v]<\/a> Boulter, C., Freeston, M., South, M., & Rodgers, J. (2014). Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(6), 1391-1402<\/p>\n [vi]<\/a> Stuart, L., Grahame, V., Honey, E., Freeston, M. (2020).\u00a0Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents. Child and Adolescent Mental Health, 25(2),\u00a059\u201367.\u00a0https:\/\/doi.org\/10.1111\/camh.12336<\/a><\/p>\n [vii]<\/a> O\u2019Nions, E., Viding, E., Floyd, C., Quinlan, E., Pidgeon, C., Gould, J., Happ\u00e9, F. (2018).\u00a0Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme\/ \u2018pathological\u2019 demand avoidance. Child and Adolescent Mental Health, 23(3),\u00a0220\u2013227.\u00a0https:\/\/doi.org\/10.1111\/camh.12242<\/a><\/p>\n [viii]<\/a> Milton, D. E. (2013).\u00a0\u2018Natures answer to over-conformity\u2019: Deconstructing pathological demand avoidance. Autism Experts.\u00a0https:\/\/kar.kent.ac.uk\/62694\/<\/a><\/p>\n [ix]<\/a> https:\/\/www.pdasociety.org.uk\/wp-content\/uploads\/2021\/09\/Helpful-approaches-for-parents-and-carers.pdf<\/a><\/p>\n [x]<\/a> https:\/\/lizonions.files.wordpress.com\/2019\/09\/1909childbehaviourparentingstrategiessummary.pdf<\/a><\/p>","protected":false},"excerpt":{"rendered":"What are the behaviours in the PDA syndrome<\/strong>[iii]<\/a><\/sup><\/span>?<\/strong><\/h2>\n
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Criteria proposed to identify a PDA profile in children with ASDiv<\/sup><\/h3>\n
PDA and anxiety<\/h3>\n
Helpful approaches for managing avoidant behaviour[ix]<\/a>,[x]<\/a><\/sup><\/span><\/h2>\n
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References<\/h3>\n