Why Pathological Demand Avoidance Syndrome (PDA) is not the same as, or another way of, describing Oppositional Defiant Disorder (ODD)
PDA is not currently thought of, by the experts in this field in the UK, to be another name for ODD or to be another name to give to an individual who may actually have ASC and co morbid ODD. A child with PDA will have a unique profile that may not be accurately described or indeed helped by the mix and match of these two labels.
The PDA Society explain the differences between these two conditions on p.g. 14 of their Clinician’s Booklet.
Quote by Phil Christie 2015
“It is inevitably the case that when conditions are defined by what are essentially lists of behavioural features there will be interconnections and overlaps. Aspects of both of these conditions can present in a similar way to those features that make up the profile of PDA. There is also the possibility of the co-existence or ‘co-morbidity’ of different conditions and where this is the case the presentation is especially complex.
ODD, Oppositional Defiant Disorder, itself often exists alongside ADHD, and is characterised by persistent ‘negative, hostile and defiant behaviour’ towards authority. There are obvious similarities here with the demand avoidant behaviour of children with PDA. PDA, though, is made up of more than this, the avoidance and need to control is rooted in anxiety and alongside genuine difficulties in social understanding, which is why it is seen as part of the autism spectrum. This isn’t the case with descriptions of ODD. A small project, supervised by Elizabeth Newson, compared a group of children with ODD and those with a diagnosis of PDA and found that the children with PDA used a much wider range of avoidance strategies, including a degree of social manipulation. The children described as having ODD tended to refuse and be oppositional but not use the range of other strategies. Many children with ODD and their families are said to be helped by positive parenting courses, which is less often the case with children with PDA.” (P. Christie 2015 ‘My Daughter is Not Naughty’ p.g 310 – 311)
Recent research has concluded that there are indeed behavioural overlaps between individuals with PDA, typical ASD and ODD but that the PDA group had unique features that were not shared by either of the other two groups and that the PDA group were also atypical of the behavioural profile typically seen in individuals with ASD or conduct problems.
‘While these findings could indicate that the PDA group has an ASD with co-morbid conduct problems, plus additional extreme emotional symptoms, this does not fully accommodate the main difficulties in PDA as outlined in the ‘Introduction’ (of that research paper). Specifically, poor social cognition associated with autism appears inconsistent with instrumental use of social manipulation. Impoverished imagination in autism is inconsistent with role play and excessive fantasy engagement in PDA (e.g. taking on the role of a teacher when interacting with peers and telling tall tales). While children with conduct problems may resist complying in order to pursue their own interests – for example, to avoid a task they dislike – obsessive avoidance of even simple requests, regardless of the personal consequences, goes beyond this. PDA may represent a subset of those who tick boxes for ASD, conduct problems and emotional symptoms, with these additional very characteristic problematic features. However, current educational or therapeutic provision for ASD children with conduct problems does not seem to suit those described as having PDA. The term may well reflect disturbances in more circumscribed socio-cognitive pathways associated with social reciprocity or processing of incoming social cues. These hypotheses must be explored using cognitive-level paradigms. Elucidating the neurocognitive basis of this profile, and possible interventions, remain key issues for future research.’ O’Nions E, Viding E, Greven CU, Ronald A & Happé F (2013) Pathological Demand Avoidance (PDA): exploring the behavioural profile; Autism: The International Journal of Research and Practice.
I hope that the information shared in this post may help some of you who are currently trying to persuade professionals that your child’s profile most closely fits PDA and that this is not just another term for ODD.