Impulsivity and immediate mood changes were also reported more in individuals with PDA, whereas individuals with ASD were noted to lack impulsivity and adhered to routine.Recent work in individuals with ASD and problem behavior suggests a robust correlation between non-compliance with routine requests and irritability (Chowdhury et al. Also differentiating ASD and PDA, there is some evidence to show individuals with PDA show good imagination and role-playing [although reports of observed behaviour suggest this often involves mimicking characters and stories rather than introducing novelty (O’Nions et al. PDA is informally recognised by some practitioners and some service-user groups in the UK and beyond, but has remains controversial.Future studies will examine if PDA occurs in other clinical populations.
Whilst PDA currently falls under the umbrella diagnosis of autism spectrum disorders (ASD) (DSM-5), individual services/clinicians can choose to use PDA as a descriptive diagnosis alongside a clinical diagnosis of ASD.
It was for this reason that I was asked to review the existing research literature on PDA to help the service decide whether to use PDA as a descriptive diagnosis, a regular request from families in the wake of a TV series on childhood behavioural difficulties aired earlier this year.
The observer-rated EDA Questionnaire (EDA-Q) for children was adapted as an adult self-report (EDA-QA), and tested in relation to personality and the short-form Autism Screening Questionnaire (ASQ).
Study 1 (n = 347) found the EDA-QA reliable, univariate, and correlated with negative affect, antagonism, disinhibition, psychoticism, and ASQ scores.
Professor Elizabeth Newson (founder of the term PDA) and her colleagues suggest that PDA accurately describes a group of children who, similarly to children on the autistic spectrum, present with difficulties in social communication, relationships and use of language, as well as displaying rigidity and obsessive behaviour.
However, they highlight a few key, but important differences between PDA and ASD.Broadening diagnostic criteria over the last 30 years means many of the 12 children Newson originally described would now likely meet diagnostic cut-offs for ASD.Indeed, one study found similar levels of autistic traits in children identified as having PDA compared to a sample with ASD not selected for PDA (O’Nions et al. Behavioural non-compliance and emotional dysregulation is not exclusive to ASD, but have plausible drivers in the context of ASD [e.g.In addition, demand avoidance in individuals with PDA was reportedly unselective; enjoyable activities were as likely to be rejected as stressful ones.This suggests that demands in themselves were aversive for these individuals.Furthermore, research has shown that children with a diagnosed attachment disorder may be as impaired as autistic children in their social relatedness and language skills (Sadiq, et al., 2012), and one study found that the symptoms of ASD and attachment disorder can be comorbid (Giltaij, et al., 2015). Journal of Intellectual Disability Research, 59(2), 138–149. Therefore, given that PDA is currently considered a form of ASD, it is fair to assume that a similar overlap in symptoms may exist between PDA and attachment disorders. Pathological (“extreme”) demand avoidance (PDA) involves obsessively avoiding routine demands and extreme emotional variability.It is clinically linked to autism spectrum disorder (ASD).Autistic children invariably have marked difficulties in social communication with disordered pragmatics, eye contact and facial expression; on the contrary, whilst children with PDA often experience early language delay there is often a good degree of catch up; their language is not as disordered and their expressions and eye contact can be fair; however, speech content can seem odd or bizarre and, importantly, communication can be significantly effected by demand avoidance. Social use of language in children with reactive attachment disorder and autism spectrum disorders.The predominant characteristic of children with PDA is their continued resistance and avoidance of the ordinary demands of life. European Child and Adolescent Psychiatry, 21, 267–276.