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Pathological Demand Avoidance syndrome


Pathological demand avoidance syndrome (PDA) was originally described as a pervasive developmental disorder related to, but different from, Autism and Asperger syndrome (see entry Autism Spectrum disorders, including Asperger syndrome). PDA was first described by Professor Elizabeth Newson, who drew attention to a group of children that often reminded people of children with autism but seemed to be different in other ways. The profile these children displayed didn't easily fall into diagnostic categories. Subsequent clinical accounts and research has led to PDA being increasingly considered as a condition within the autism spectrum.


Last updated April 2016 by Phil Christie, Consultant Child Psychologist, The Elizabeth Newson Centre, Nottingham, UK.

What are the symptoms?

  • Avoidance of everyday demands to an extreme extent
  • Apparently sociable on the surface but lacking real depth in social and emotional understanding
  • Excessive and often sudden mood swings
  • Language delay, but often with good degree of catch up
  • Comfortable in role play and pretend
  • 'Obsessive' behaviour, frequently linked to particular people

The central, characteristic feature of PDA is the extent of avoidance of ordinary demands, driven by high anxiety when children feel that they are not in control. This is combined with sufficient social understanding to enable the child to use this to their advantage and, as Newson put it, to be 'socially manipulative' in their avoidance.

What are the causes?

As with other conditions within the autism spectrum it is unlikely that there is a single cause, and it seems that the condition is part of a complex interplay between genetic, biological and environmental factors that account for changes in brain development.

How is it diagnosed?

Diagnosis is based on taking a careful developmental history (both past and present), direct observation of the child and information taken from other sources. This information is considered alongside the criteria and any other potential explanations. Work is taking place to extend questionnaires and schedules developed for research purposes into clinical tools.

How is it treated?

Management can involve elements of medical, educational and social support. There are specific guidelines that have been published outlining an approach that is less directive and more flexible than methods usually suggested for children with a more typical autism spectrum disorder presentation.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
It seems likely that genetic factors are similar to those in autism, but refer to inheritance of an autism spectrum disorder rather than PDA specifically. Thus perhaps six per cent of children with PDA are known to have a sibling with either PDA or autism/Asperger. Preliminary research is currently underway.

Prenatal diagnosis
None at present.

Is there support?

PDA Society


Formerly known as the PDA Contact Group, the PDA Society aims to offer support, advice and information to anyone involved with an individual with Pathological Demand Avoidance Syndrome, whether suspected or diagnosed. 

Group details last updated October 2015.

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