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Pathological Demand Avoidance

Pathological Demand Avoidance syndrome (PDA) was originally described by Elizabeth Newson as being characterized by “extreme” behavioural avoidance of demands and social expectations, based on an anxiety-driven need to be in control. Newson proposed that these behaviours could be differentiated from children with typical presentations of Autism.

As further research has been completed, and the diagnostic criteria for Autism has broadened, understanding of PDA has developed considerably since this early work. The use of the term PDA is controversial, with many clinicians disputing the validity of the behavioural syndrome (Green et al, 2018). However, there is an emerging consensus that these difficulties with avoidance and a need for control can be viewed as a set of coping strategies that a small group of children with Autism may use to cope with a social world that they experience as overwhelming. These strategies may be used for a range of reasons, including difficulties understanding the thoughts and feelings of other people (i.e. theory of mind), difficulties with planning, sequencing and social imagination, as well as adverse childhood experiences.  

At the ENC we aim to complete a comprehensive psychological assessment of young people who are referred, taking into account a range of factors including family history, mental health, experiences of education, level of functioning, as well as possible social communication difficulties. We are particularly experienced in conducting assessments for children who experience difficulties associated with demands and social expectations, and we recognise the impact that this has on young people and their families. We aim to support young people and their families by offering a detailed and robust formulation of their presentation to assist them in accessing appropriate support throughout their lives.