Pathological demand avoidance

Pathological demand avoidance (PDA), or Newson's syndrome, is a proposed subtype of autism characterized by an avoidance of demand-framed requests by an individual. It was proposed in 1980 by the UK child psychologist Elizabeth Newson. The Elizabeth Newson Centre in Nottingham, England carries out assessments for the NHS, local authorities and private patients around Autism Spectrum Disorder, which include, but not exclusively PDA.

PDA behaviours are consistent with autism, but have differences from other autism subtypes diagnoses. It is not yet recognised by either the DSM-5. nor the ICD-10.

Some clinicians are increasingly prepared to diagnose children (and some adults) with PDA when this subtype of autism fits the patient profile more accurately than another subtype. In the United Kingdom there are suggested interventions that can be followed in order to help integrate PDA children into the school system such as 'The Distinctive Clinical and Educational Needs of Children with Pathological Demand Avoidance Syndrome: Guidelines for good practice' by Phil Christie. Despite its lack of formal recognition, the National Autistic Society (a UK autism charity) have produced a leaflet entitled 'What is PDA?' in 2008.

The defining criteria developed by Newson include:

The Diagnostic Interview for Social and Communication Disorders (DISCO) was developed for use at The Centre for Social and Communication Disorders, by Lorna Wing and Judith Gould, as both a clinical and a research instrument for use with children and adults of any age. The questionnaire has 17 recognized markers for PDA within it.

Newson and her colleagues at the Elizabeth Newson Centre have been diagnosing PDA since the 1980s. This centre is part of Sutherland House Children's Services a subsidiary of Nottingham Regional Society for Children and Adults with Autism NORSACA. Phil Christie and his team of psychologists, speech therapists, teachers and play therapists complete assessments on children referred there.

Newson first began to look at PDA as a specific syndrome in the 1980s when certain children referred to the Child Development Clinic at Nottingham University appeared to display and share many of the same characteristics. These children had often been referred because they seemed to show many autistic traits but were not typical in their presentation like those with classical autism or Asperger's syndrome. They had often been labelled as 'atypical autism' or PDD-NOS. Both of these terms were felt by parents to be unhelpful. She wrote up her findings in several papers based on increasingly larger groups of children. In 2003 this culminated in a proposal published in Archives of Diseases in Childhood for PDA to be recognised as a separate syndrome within the pervasive developmental disorders.

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