In the July issue of The Lancet Child & Adolescent Health Journal a commentary entitled “Demand avoidance is not necessarily defiance“, written by O’Nions, Happe, Viding, Gould and Noens was published.

This was a response to the article “Pathological Demand Avoidance: symptoms but not a syndrome” written by Green and colleagues in the same publication in March.

The authors state that they “are concerned that conceptualising pathological (or extreme) demand avoidance as a set of co-morbidities, including oppositional defiant disorder, could encourage the automatic use of reinforcement based approaches to alter the child’s response to demands” and that “over time, inappropriate management would probably promote rapid escalation of extreme behaviour in response to demands, which might generalise to other triggers”.

They welcome “Green and colleagues’ proposal that behaviours described in extreme demand avoidance be systematically assessed and included within diagnostic formulations” but importantly “argue against the application of terms such as oppositional defiant disorder, on the basis that the term defiant suggests that the difficulties result from the child’s wilfulness.”

They “argue for much-needed research to establish what interventions are most effective for problematic demand avoidance in autism spectrum disorder” and for “establishing evidence based
interventions to help such children”.

The PDA Society feels that this is a timely and helpful contribution to the debate.