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Pathological Demand Avoidance in a population-based cohort of children with epilepsy: four case studies

Colin Reilly1, Patricia Atkinson2, Leanne Menlove3

  • 1Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, Gothenburg, Sweden.

Research in Developmental Disabilities
|September 3, 2014
PubMed

Insights

Pathological Demand Avoidance (PDA) symptoms were found in 5% of children with epilepsy, significantly impacting their quality of life. These children also exhibited ADHD and other neurodevelopmental disorders, highlighting the need for PDA consideration in epilepsy care.

Area of Science:

  • Neuroscience
  • Child Psychology
  • Pediatric Neurology

Background:

  • Childhood epilepsy presents with diverse neurobehavioral comorbidities like ADHD and ASD.
  • These comorbidities often impact quality of life more than seizures.
  • Pathological Demand Avoidance (PDA) describes extreme resistance to demands and need for control.

Purpose of the Study:

  • To investigate the prevalence and characteristics of Pathological Demand Avoidance (PDA) in children with epilepsy.
  • To describe the neurobehavioral profile of children with epilepsy and PDA symptoms.

Main Methods:

  • Population-based study of 85 children with epilepsy.
  • Identification of children with significant PDA symptoms.
  • Assessment using the Extreme Demand Avoidance Questionnaire (EDA-Q).
  • Detailed case descriptions and diagnostic criteria (DSM-IV-TR) for comorbidities.

Main Results:

  • Four children (5%) with epilepsy displayed significant PDA symptoms.
  • All four children had cognitive impairment (IQ<85) and ADHD.
  • Three met criteria for ASD and Developmental Coordination Disorder (DCD); two for Oppositional Defiant Disorder (ODD).
  • Onset of seizures occurred before age 5 in all cases.
  • Significant functional impairment and management challenges were reported.

Conclusions:

  • PDA symptoms are present in a subset of children with epilepsy.
  • PDA frequently co-occurs with other neurodevelopmental disorders in epilepsy.
  • Consideration of PDA is crucial when assessing neurobehavioral comorbidities in childhood epilepsy.

Keywords:
Autism Spectrum DisorderEpilepsyPathological demand avoidance

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