This commentary by Malik and Baird discusses the challenges of defining and diagnosing Pathological Demand Avoidance (PDA). It responds to O’Nions et al.’s 2017 paper, Dimensions of Difficulty in Children with Autism and Extreme Demand Avoidance, by emphasising the need to look beyond demand avoidance itself and consider its underlying causes.
The authors argue that using PDA as a distinct label may be unhelpful, as it could overlook the complex factors driving these behaviours. They suggest that identifying and addressing the child’s specific difficulties-such as anxiety, sensory sensitivities, or difficulties with flexibility-may be more beneficial than applying a PDA diagnosis. The paper raises concerns that the PDA label could lead to misunderstandings and potentially limit effective interventions. Instead, they advocate for a broader, needs-based approach to assessment and support for children displaying extreme demand avoidance.