Need for distinguishing PDA


Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders

The aim of this paper was to gain recognition for pathological demand avoidance (PDA) as a separate entity within the Pervasive Developmental Disorders (PDDs) (now termed Autism Spectrum Disorders, ASD). Elizabeth Newson and colleagues had recognised a group of children experiencing significant behavioural difficulties but who did not align with the diagnostic criteria for a more classic presentation of autism or Asperger’s syndrome. Many of these children had been given the diagnosis of ‘PDD not otherwise specified’ which was confusing to parents and often resulted in the wrong management strategies being implemented.

This paper explains the work undertaken by Newson to identify how the features displayed by children with PDA differ from others diagnosed with PDDs. The sample cohort used were children seen in her clinics and diagnosed with PDA between 1975 and 2000. An analysis of the features displayed by these children supported Newson’s argument for a separate diagnosis to be recognised.

A follow-up study was carried out with a small group of children from the original group when aged 16-32. A parental questionnaire was used to examine the robustness of Newson’s descriptive criteria and measure outcomes in early adult life. Apart from some changes in terminology it was found that Newson’s original descriptions of PDA were extremely robust and relevant from childhood into adult life.

Since the publication of this paper in 2003 there have been significant advancements in the recognition of PDA as part of the autism spectrum. This is still a relevant read for parents and professionals as it highlights the importance of obtaining the correct diagnosis in order for the individual to achieve the best possible outcomes.


Authors: Newson E, Le Maréchal K, David C

First published: Archives of Disease in Childhood 2003; 88:595-600.