PATHOLOGICAL DEMAND AVOIDANCE SYNDROME
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What is PDA?
Pathological Demand Avoidance syndrome (PDA) is a pervasive developmental disorder. PDA is related to, but separate from, what is currently termed the autistic spectrum, namely autism and Asperger syndrome. Individuals with PDA are typically socially manipulative with people, and are thus superficially socially skilled, which sets them apart from autism and Asperger syndrome.
People with PDA usually have good eye contact, and use this to good effect when socially manipulating others. They lack self identity, and children find it difficult to recognise that they are not adult, and seldom identify with other children. While people with PDA usually know how others should behave, they are unable to include themselves within these expectations. They are often imitative of inappropriate behaviour, and it is for this reason that, wherever feasible, support should be given in mainstream school to provide them with as normal a peer group as possible. They show an obsessive need to dominate in social interactions, and to ensure that everything is done on their own terms, and often come across as overbearing. It is helpful to view this behaviour as a defensive strategy that is borne out of deep anxiety about the demands that they fear will be made of them, and a need to control their environment to prevent this.
People with PDA seem to feel an urgent need to avoid the ordinary everyday demands placed on them, to a pathological degree which is not normal laziness or timidity. Their social skills allow them to use excuses; distraction attempts (such as 'Wow, look over there!' just as you are asking for their cooperation), or controlling the interaction by refusing to speak or trying to drown out your voice with speech or singing (according to the child's personality) are all very common. For more descriptive details of ways in which different children try to resist demands, please refer to the Diagnostic Criteria section.
People with PDA may remind others of autism/Asperger syndrome. However, because they do not fulfil those criteria precisely, or have other features that are unusual in autism and Asperger syndrome, they may have been described as having 'atypical' or 'non-typical' Asperger or autism, or 'Pervasive Developmental Disorder n.o.s' (not otherwise specified).
Children with PDA usually under-achieve in school compared with what is perceived as their 'true' potential, only producing the barest minimum of work. This is reflected by frustrated teachers in comments such as 'I know he could do better if only he tried' or 'She must be more intelligent than she seems because she's so devious!' Some children try to keep a very low profile, trying to blend in to avoid any attention being drawn to them, and this has been described by some as the 'Camouflage Effect'; however, when they receive unwanted attention they may become actively disruptive. Some hit out or swear as another way of stopping imminent demands. These two types of PDA behaviour both seem anxiety-induced and might be described as 'actively passive' to 'actively disruptive'; they could be seen as possible sub-groups, but some children move from one type of behaviour to another at different ages. It is important to remember that these children do not choose to behave in these ways. It is their inability to cope with what they perceive as the stress of everyday demands that manifests itself differently according to their individual personalities, and possibly underlying cognitive deficits and neurological pathologies.
PDA was first identified as a pervasive developmental disorder that needed to be distinguished from autism and Asperger syndrome as a separate diagnostic entity by Professor Elizabeth Newson OBE, Hon FRCPCH, over twenty years ago. Her research was carried out at the Child Development Research Unit, University of Nottingham, England, and more recently at the Early Years Diagnostic Centre, Nottingham.