Whilst autistic children can be reluctant to comply, this is often in a non-social way; they lack the empathy to make excuses or develop strategies for avoidance.
In contrast, children with PDA develop multiple strategies of avoidance, which they are able to adapt to the adult involved and can appear socially manipulative. As I began to review the small, but growing, research literature on PDA I was struck by the similarities between the proposed characteristics of PDA and those shown by children with attachment difficulties.
Future studies will examine if PDA occurs in other clinical populations.
Pathological demand avoidance (PDA) is a behavioural profile associated with apparently obsessive non-compliance, distress, and florid challenging and socially inappropriate behaviour in children, adolescents and adults (Newson et al. PDA is associated with a passive early history over the first year of development; avoidance of demands, with extreme outbursts if demands are escalated; surface sociability but apparent lack of sense of social identity; lability of mood and impulsivity; comfort in role play and pretending; language delay, possibly attributable to passivity; obsessive behaviour; and soft neurological signs (awkwardness, clumsiness, dyspraxia and similar) (Newson et al. Some propose a terminological move from ‘pathological’ to ‘extreme’ demand avoidance.
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.
Irrespective of underlying drivers, there is little doubt individuals with PDA sometimes present with very problematic behavior, including aggression, socially maladaptive behaviours, and, commonly, educational placement breakdown (O’Nions et al. Anecdotal reports suggest parents and teachers of persons with PDA-like behaviour struggle to manage unpredictable and volatile behaviour.
While one study found that PDA in the context of ASD reduces from child to adulthood (Gillberg et al. Research on PDA has not yet considered adult populations, partly because no reliable tool has been available for use in systematic studies of these features in adults.
Only a short while ago, PDA (pathological demand avoidance) was a term little known to the public; however, due to an increased presence in social media, PDA is becoming a household term.
It is not surprising, therefore, that services are under increasing pressure to consider PDA as a diagnosis.