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PDA

Pathological Demand Avoidance Syndrome (PDA)

This is an anxiety disorder closely related to autism first described by Professor Elizabeth Newson in the 1980's. PDA is also known as Newson's Syndrome. There is still considerable debate over whether PDA is a separate condition from autism or a sub-type within the umbrella term of Autistic Spectrum Disorder (ASD). However, the diagnostic criteria for PDA does identify a group of children who appear to have distinct characteristics from ASD and this can be very useful for parents and professional staff supporting the child.

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Status of PDA

There is no officially agreed diagnosis of PDA. It does not appear in either the Diagnostic and Statistical Manual of Mental Disorder (DSM-V) or International Classification of Diseases (ICD 10). This makes it difficult for professionals involved in diagnosing behavioural disorders to give a PDA diagnosis. As a sub-type of autism it is sometimes diagnosed as ASD with a demand-avoidant profile.

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Presentation of PDA

PDA children are very adept at avoiding demands made of them. They will do this for all demands including trivial everyday demands and often for things that they like and enjoy. They achieve this using a variety of demand avoidance strategies:

Distraction

PDA children are the masters of deflection and effortlessly manipulate others into forgetting their demands through changing subject, asking a question, or drawing their attention to something else. Often they achieve this with charm and guile and it is this socially manipulative skill that distinguishes them from ASD children.

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Excuses

PDA children are quick to provide an excuse as to why they can't do something asked of them. The child may often appear absorbed in their excuse activity and avoid eye-contact at this point.

'I just need to do..." or "...finish this.'
'My pencil's broken.'
'My hand's not working.'

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Withdrawing into fantasy

PDA children often enjoy imaginative play and will retreat into their own fantasy worlds when threatened by a demand. They will then 'invent' excuses based around their fantasy:

'Robots don't eat lunch.'
'I need to brush my unicorn's hair.'

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May use toys to resist demand

This is related to the withdrawing into fantasy where the child personifies toys and sometimes other object to enlist their support is resisting the demand.

'My teddy doesn't want me to do this.'
'Dolly wants me to stay and play with her.'

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Arguing

Older children will continually provide counter arguments as to why they can't follow the request given to them. Being very socially manipulative they try to turn the argument away from them by for example pointing out someone else not doing the request.

'You only want me to do this because you don't want to do it yourself.'
'It's so unfair, why aren't they doing it.'

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Meltdowns

When avoidance strategies fail the child can become instantly angry and this can lead to aggressive outbursts. A PDA child is capable of 'trashing' a room when angry and often has little compassion about what they damage or break. It is extremely difficult to debrief such incidents with a PDA child and so restorative approaches tend not to work.

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Social Control

PDA children are very controlling as a way of minimising demands made on them. This can lead to conflict with peers as they try to dominate the play interactions. This can be seen in the way they tend to always take on dominant roles in play and games with other children:

'I'm the queen and you are my servants.'
'I'm the captain.'
'I'll be the teacher and you are in my class.'

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Little interest in children own age

PDA children are more likely to play with children either younger or older than them. Younger children are happy to be lead by them

Play with older children who allow themselves to be directed by the younger child

Complaints from other children of unfairness over game choices and roles
Anger and aggression towards other children during play negotiations

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Other features of PDA children

PDA children are usually outwardly sociable and want to engage with others. Their social language skills are age approriate though there is frequently a history of late speech development and delayed language.

PDA children are often described by parents as having been placid and passive babies

Children with PDA are subject to rapid mood swings moving from calm to rage and back to calm in an instant

Children may display some obsessive behaviours as they try to control their world

It is also quite common for children with PDA to have co-morbid neurological diagnoses such as dyslexia or dyspraxia.

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Diagnosing PDA

As discussed above, PDA does not have a national or internationally agreed criteria for diagnosis and professionals maybe unwilling or unable to give PDA as a formal diagnosis. Children presented at clinic are most likely to be given a diagnosis of ASD and possibly Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). Less frequently the child may get a diagnosis of Reactive Attachment Disorder (RAD). Sometimes 'Demand Avoidance' is listed as a co-morbid problem alongside what ever diagnosis is given.

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Resources

PDA Presentation 1 - What is PDA?

What is PDA?

Presentation 1 focusses on the history of the condition and information about diagnosis.

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PDA Presentation 2 - PDA Avoidance Behaviours

PDA Avoidance Behaviours

Presentation 2 focusses on behaviours that PDA children use to avoid demands made of them.

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PDA Presentation 3 - PDA and School

PDA and School

Presentation 3 examines how PDA children struggle in school and how school's struggle with PDA children.

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PDA Presentation 4 - PDA Management Strategies

PDA Management Strategies

Presentation 4 explores ten strategies for managing PDA children.

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You may also be interested in the following pages:

ASD

Five Minute Guide to PDA

Managing PDA