Autism, PDA presentations and Theory of Mind


The Relationship between Theory of Mind and Traits Associated with Autism Spectrum Condition and Pathological Demand Avoidance Presentations

UCL Doctorate Thesis in Clinical Psychology by Ellie Bishop

Extracts from the Impact Statement:

The overall aim of this thesis was to contribute to an understanding of the relationship between theory of mind (ToM), and traits and behaviour in children with and without autism spectrum condition (ASC)….

The literature review found that better ToM capacity relates to lower levels of aggressive behaviour in childhood, especially in children under the age of six

The empirical study found lower parent-reported ToM in children with ASC compared to controls, and that better ToM significantly predicted lower rates of social and communication impairments in ASC

The empirical paper also studied pathological demand avoidance (PDA) traits in ASC. PDA traits in ASC are not well understood, but have been associated with increased rates of behavioural difficulty, parental stress and educational exclusion. There was no relationship between these traits and ToM. This suggests the mechanisms underlying these behaviours may differ to those implicated with core traits in ASC and stresses the need for professionals to develop distinct behavioural management and support strategies to manage these. In addition, the paper reveals much-needed insight into the behavioural profile of PDA, emphasising the importance of individualised assessment and early identification of traits during the ASC diagnostic process.

In conclusion, this thesis provides insight into the relationship between ToM and behaviour in children with and without ASC, which could inform the development of well-researched and evidenced clinical interventions. It provides a valuable contribution to the relatively scarce literature on PDA traits in ASC, with important implications for the ASC assessment process. In addition, it highlights the need for individualised behavioural management strategies to help improve the quality of life for children and families.


Author: Ellie Bishop

Published: University College London, 2018