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How does the origin of pathological demand avoidance (PDA) affect its diagnosis? What breakthroughs did Elizabeth Newson's research make?
Pathological demand avoidance (PDA), also known as extreme demand avoidance (EDA), is a disorder proposed as a subtype of autism spectrum disorder characterized by extreme avoidance of everyday social demands . This behavior shows extreme resistance to the demands and expectations of others. Even common activities in daily life, such as brushing teeth or going to the amusement park and other expected activities, may trigger avoidance behavior.
When demands are unavoidable, patients may experience panic attacks or emotional breakdowns.
Elizabeth Newson’s research history
PDA was first studied as a separate disorder of autism in the 1970s by Elizabeth Newson at the Child Development Research Clinic in Nottingham. At the time, most of the children referred to the clinic were considered atypical. Many children exhibit behavioral patterns similar to autism, but their referring doctors are unsure about a diagnosis.
When Newson became Professor of Developmental Psychology at the University of Nottingham in 1994, she devoted her first lectures to pathological need-avoidance syndrome.
The PDA Society was founded in the UK in 1997 by parents of children with PDA traits and became a registered charity in January 2016. This movement influenced the global understanding of PDA in the following years, notably Newson's 2003 article in Archives of Pediatric Diseases, calling for recognition of PDA as a unique syndrome.
Characteristics and diagnostic status of PDA
The main indicator of PDA is atypical resistance to everyday social demands. These needs can be broadly understood as social interaction or any opportunity for collaboration. For PDAs, requests may include even simple commands such as "It's time to do homework" or other social behaviors such as shaking hands. Unlike the occasional uncooperative behavior of ordinary children, the resistant behavior of children with PDA is extreme and can seriously interfere with their daily life.
These children may use various means to avoid demands and even exhibit intentional shock behaviors, such as deliberately kicking people, often without feeling shame or remorse.
Controversy over the diagnosis of PDA
Despite its unique characteristics, PDA is not currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Therefore, all patients who display PDA behavior are often diagnosed based on autism criteria. As of 2014, there are still no officially recognized diagnostic criteria, leading to controversy among many medical professionals about their understanding of the disease.
Surveys show that patients with PDA generally exhibit difficulties with social interaction and communication, leading them to be more frequently diagnosed with oppositional challenge disorder (ODD).
The causes and background of PDA
Some experts believe that the core cause of PDA is the high anxiety levels that people with autism have about social demands. This anxiety causes them to feel a lack of control when faced with demands and therefore they must avoid these situations. It is reported that about 40% of people with autism also suffer from anxiety disorders.
Call for wider recognition
In 2011, the UK's National Institute for Health and Care Excellence (NICE) noted that PDAs had been proposed as part of the autism spectrum, but no further discussions were held. Pete Gilberg in 2014 denounced the existence of the disease and its therapeutic intervention as facing major challenges. Raising the world's awareness of PDAs will help many families and patients receive more appropriate support and resources.
As more and more cases are reported, the understanding of PDA is gradually deepening. However, there are still many questions and debates in the academic and medical circles.
The research conducted by Elizabeth Newson marked an important milestone in the diagnosis and development of PDA, and today, PDA is still discussed and explored as a potential independent diagnosis. Does this mean we may have a more comprehensive understanding of this disorder and more effective treatments in the future?
