Pathological Demand Avoidance: does it exist, and if so what is it?

In recent years in the UK there’s been an increasing amount of talk about something called pathological demand avoidance, or PDA. It’s described as a subtype of autism that children (and some adults) are increasingly being diagnosed with. The National Autistic Society has been promoting acceptance of it, there’s a PDA Society, training courses and parent support groups are being set up. Paediatric and CAMHS services are seeing increasing numbersĀ of referrals requesting assessment for PDA.

This is perhaps surprising because (and you wouldn’t know this from scanning the NAS or PDA Society websites) it’s not a recognised condition. Neither the DSM-5 nor the ICD-10 (the two main classification systems for mental disorder) have anything to say about pathological demand avoidance. The NICE guidelines (which set out best practice for UK clinicians) don’t mention PDA in their guidelines for diagnosing autism either forĀ children or adults. It’s virtually unkown outside the UK (and a few parts of Scandinavia and Australia), and the research evidence base for it is wafer-thin.

So, I decided to look into PDA. What is it, does it really exist, and if it does exist, is it really a form of autism?

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