Cognition Clinical Psychology are often asked by parents, carers and professionals if we can assess and diagnose Pathological Demand Avoidance (PDA).
We thought long and hard about this, given the clear rise in the attention PDA is receiving and thought we should explain what it is and how, or if, it can be assessed and diagnosed.
What is PDA?
Originally conceptualised by Dr Elizabeth Newson, a developmental psychologist, PDA can be thought of as a behavioural profile that is sometimes identified with individuals who are being assessed for Autism. PDA is best understood as an anxiety driven need to be in control and avoid other people’s demands and expectations.
Although not everyone will display the same traits, the distinctive features of PDA in children show them to:
Resist and avoid the ordinary demands of life
Use social strategies as part of avoidance, eg distracting, giving excuses
Appear sociable, but lack understanding
Experience excessive mood swings and impulsivity
Appear comfortable in role play and pretence
Display obsessive behaviour that is often focused on other people.
Individuals with this profile can appear controlling and dominating, especially when they feel anxious. However, when in control they can be charming, relaxed and engage positively with others around them.
Assessment for PDA
PDA is not officially acknowledged in either of the current internationally recognised diagnostic manuals: the “Diagnostic and Statistical Manual, version 5” (DSM-V) and the “International Classification of Diseases, version 11” (ICD-11). Therefore, it is unlikely to be diagnosed as a mental health condition, illness, or any other ‘stand -alone’ disorder.
The National Autistic Society has recently made clear their thoughts on PDA becoming a recognised behavioural profile under the Autism Spectrum.
However, it should be noted, there is no specific recognised PDA assessment process and it is unlikely at present that even the NHS in the UK will develop such a specific pathway, instead, opting to refer individuals for an Autism Diagnostic Assessment.
Cognition Clinical Psychology and PDA
Cognition Clinical Psychology like most other organisations, local authorities and NHS Trusts, follows the diagnostic classifications laid out in DSM – V and ICD – 11 in which PDA is not a recognised diagnosis.
Cognition Clinical Psychology does however recognise that PDA is a behavioural profile which falls under the umbrella term of Autism.
As part of our assessment process all children and adults with Autism who are assessed will come away with an individual behavioural profile.
If an individual fits the criteria, a diagnosis of Autism will be made with a description of individual needs, one of which may be marked demand avoidance. A profile such as this may include significant emotional difficulties in relation to managing transitions; inability to accept routine expectations and demands to engage in activities or learning; or coping with social environments.
Please see links below for more information.