Pathological Demand Avoidance syndrome
What are the symptoms?
The following are the defining criteria for PDA (more detailed descriptions, with examples, are available from the Early Years Diagnostic Centre):
- Passive early history in first year: ignores toys, often delayed milestones, 'just watches.' This passivity becomes active resistance to the ordinary demands on small children; a few actively resist from the start.
- Continues to resist and avoid normal demands to a pathological extent; seems to feel under intolerable pressure from these, does everything on own terms. This is not a 'difficult phase' but continues into adulthood (so far as follow-up research has yet shown). As language develops, strategies of avoidance are essentially socially manipulative: this is an important diagnostic feature. If frustrated in avoidance, major outbursts occur, often violent, apparently panic attacks.
- Surface sociability, but apparent lack of social identity, pride or shame. Seems sociable, but doesn't identify with other children, and shocks them by complete lack of normal boundaries. No sense of responsibility, seems very naughty, but parents and others recognise as confused. Praise and punishment ineffective.
- Lability of mood, impulsive, led by need to control situations. Many seem constantly on the edge of violence or loud excitability. May apologise but re-offend at once, or totally deny the obvious. Rules and routine do not help; better with variety and novelty.
- Comfortable in role-play and pretending: some appear to lose touch with reality. May take over roles as coping strategy; parents often confused as to 'who s/he really is.' May behave as teacher to control other children, or as baby or disabled person to avoid demands; often more animated when pretending than in real life. Interest in fantasy persists in adulthood.
- Early language delay, perhaps result of passivity: good degree of catch-up, often sudden. Eye contact often over-strong, and facial expression over vivacious. Speech content usually odd or bizarre.
- Obsessive behaviour. Much of child's behaviour carried out in obsessive way, especially demand avoidance and role play. This results in underachievement. Some target other people obsessionally, either harassing or showing overpowering liking.
- Neurological involvement. Soft neurological signs: clumsiness, awkwardness; many never crawled. Some absences, fits or episodic dyscontrol. Most show barely controlled excitability and impulsivity. Research currently in progress on PDA combined with epilepsy.
Fifty per cent of children with PDA are girls; this compares with about twenty per cent girls in autism and less than ten per cent girls in Asperger syndrome, both clearly significantly different from PDA figures.
Background
| What are the causes? 
Tell us what you think of this information...
Print whole article
|
|
|
|
This site complies with the HONcode standard for trustworthy health information: 
Cash Counts
Donate Now
Subscribe to the