Pathological Demand Avoidance: What and Who are being pathologized and in whose interests?

Research output: Contribution to journalArticle

Abstract

The term ‘Pathological Demand Avoidance’ (PDA) was first coined in 1983. In recent years, diagnostic tools have emerged to enable practitioners to identify, name and treat PDA and, at least in the UK, there is an increasing number of children who attract this label. In addition to what are defined as the core ‘deficits’ of autism, including assumed difficulties in social communication, difficulties in social interaction and restrictive interests, children with PDA are thought to have an extreme anxiety-driven need to control their environment and control the demands and expectations of others. This article will argue that we must exercise extreme caution in accepting the validity of PDA and will suggest that it can be seen as an attempt to psychiatarise autistic children’s resistance which, in so doing, restricts their agency. First, it will draw on the arguments put forward by some autistic scholars who have claimed that PDA is better understood as Rational Demand Avoidance (RDA); an understandable and rational response to the circumstances that one finds oneself in. Second, it will consider the intersection between autism and childhood. When one of the defining characteristics of PDA is an inability to recognise and, presumably, respect social hierarchy, children’s competencies as social actors and active meaning makers of their world can easily become pathologized as defiance. Finally, the paper will address the intersections of autism, childhood and gender. Girls are much less likely to be diagnosed as having an autism spectrum condition than boys are, with a ratio traditionally estimated at approximately 1:4. However, PDA diagnoses are fairly evenly spread between boys and girls. It will be argued that it is girls’ resistance to the ordinary and everyday demands of her as a girl and her subsequent rejection or transgression of those expecations, that is being pathologised.
Original languageEnglish
JournalGlobal Studies of Childhood
Publication statusAccepted/In press - 21 Oct 2019

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Autistic Disorder
demand
autism
Social Hierarchy
Interpersonal Relations
Names
Anxiety
childhood
Communication
Exercise
social actor
number of children
respect
diagnostic
deficit
transgression
anxiety
gender
communication
interaction

Keywords

  • Pathological Demand Avoidance
  • PDA

Cite this

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title = "Pathological Demand Avoidance: What and Who are being pathologized and in whose interests?",
abstract = "The term ‘Pathological Demand Avoidance’ (PDA) was first coined in 1983. In recent years, diagnostic tools have emerged to enable practitioners to identify, name and treat PDA and, at least in the UK, there is an increasing number of children who attract this label. In addition to what are defined as the core ‘deficits’ of autism, including assumed difficulties in social communication, difficulties in social interaction and restrictive interests, children with PDA are thought to have an extreme anxiety-driven need to control their environment and control the demands and expectations of others. This article will argue that we must exercise extreme caution in accepting the validity of PDA and will suggest that it can be seen as an attempt to psychiatarise autistic children’s resistance which, in so doing, restricts their agency. First, it will draw on the arguments put forward by some autistic scholars who have claimed that PDA is better understood as Rational Demand Avoidance (RDA); an understandable and rational response to the circumstances that one finds oneself in. Second, it will consider the intersection between autism and childhood. When one of the defining characteristics of PDA is an inability to recognise and, presumably, respect social hierarchy, children’s competencies as social actors and active meaning makers of their world can easily become pathologized as defiance. Finally, the paper will address the intersections of autism, childhood and gender. Girls are much less likely to be diagnosed as having an autism spectrum condition than boys are, with a ratio traditionally estimated at approximately 1:4. However, PDA diagnoses are fairly evenly spread between boys and girls. It will be argued that it is girls’ resistance to the ordinary and everyday demands of her as a girl and her subsequent rejection or transgression of those expecations, that is being pathologised.",
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