Extreme/‘pathological’ demand avoidance: an overview


Extreme/‘pathological’ demand avoidance: an overview

In this article, Elizabeth O'Nions and Judy Eaton provide an overview of PDA, discuss the clinical presentation of individuals with a PDA profile, and differences compared to children with documented attachment difficulties. They then discuss empirical work describing how anxiety-driven avoidance of routine demands can emerge in autistic children and provide recommendations for strategies that aim to avoid strengthening habitual avoidance behaviours, and instead, allow new mutually rewarding routines to develop, which may provide opportunities to gradually increase the child's tolerance of demands.

The authors argue that using the PDA profile, or describing relevant behaviours, as part of a clinical formulation can be helpful in alerting caregivers and educational professionals to particular challenges surrounding some autistic children’s ability to comply with everyday requests.


Authors: Elizabeth O'Nions & Judith Eaton

Published: Paediatrics and Child Health, October 2020

Also freely available via Liz O'Nions's research website

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