I am going to discuss the trending topic in the trade and social media on Pathological Demand Avoidance, a condition identified in the 1980s or earlier thought to occur in children on the Autism Spectrum. Vigorous debate continues as whether this is a separate disorder comorbid with ASD, a subtype of ASD, or just an expected condition when we understand that nearly half of ASD individuals have high anxiety coupled with a preference for sameness and routine and a fear of new or unexpected activities. The latter things conspire to make many ASD people likely to try to avoid even routine demands. Lately, the concept of PDA has left the ASD discussion to be said to occur on its own, that it is a separate neurodevelopmental condition, and that it is distinct from other disorders like ODD. Here I examine these issues as well as the idea that parents are self diagnosing PDA in their children or asking clinicians to do so to avoid parenting responsibilities involved in managing child misbehavior and holding children accountable for such misbehavior. I end with a discussion of the origins of defiant behavior in children and the numerous studies that show that disrupted parenting is, in fact, a major contributor to child refusal, defiance, and demand avoidance.
Website References and Research Discussed in the Video
The ADHD Guys Podcast (Episode 15): https://www.youtube.com/watch?v=E_8CUqq9BOg
Pathological Demand Avoidance, Wikipedia: https://en.wikipedia.org/wiki/Pathological_demand_avoidance
Kildahl, A. N. et al. (2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism, 25 (8).
https://doi.org/10.1177/13623613211034382
Onions, E. & Eoton, J. (2020). Extreme/‘pathological’ demand avoidance: an overview. Pediatrics and Child Health, 30 (2), 411-415.
https://doi.org/10.1016/j.paed.2020.09.002
Moore, A. et al. (2020). Pathological demand avoidance: What and who are being pathologised and in whose interests? Global Studies of Childhood, 10(1).
https://doi.org/10.1177/2043610619890070
Green, J. et al. (2018). The Lancet: Child & Adolescent Health.
DOI: 10.1016/S2352-4642(18)30044-0
The DSM5 Criteria for Oppositional Defiant Disorder. National Library of Medicine.
https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t14/
Diagram on the Origins of Defiant and Oppositional Behavior. Barkley, R. A. (2013). Defiant Children: A Clinicians Manual for Parent Training. New York: Guilford Publications. See also my YouTube channel videos on ODD. The fulll length lecture is here:
https://www.youtube.com/watch?v=wtZY1HXa30ghttps://www.youtube.com/watch?v=wtZY1HXa30g
OR the brief overview of ODD is here:
https://www.youtube.com/watch?v=yZ2oiQJbCnw