Pathological demand avoidance in children and adolescents: A systematic review

Area of Science:

• Child and Adolescent Psychiatry
• Developmental Psychology
• Clinical Psychology

Background:

• Pathological demand avoidance (PDA) is a controversial concept with increasing diagnostic requests.
• Criticisms include undermining autistic self-advocacy and neglecting anxiety's role.
• Existing research lacks clarity on PDA identification and its relationship with other disorders.

Purpose of the Study:

• To systematically review the methodological quality and findings of current PDA research in children and adolescents.
• To describe how PDA has been identified in existing literature.
• To explore PDA's relationship with autism and other developmental/psychiatric disorders.

Main Methods:

• A comprehensive literature search identified 13 relevant studies.
• Systematic quality assessments were conducted on the selected studies.
• Methods relied on descriptions from the original Newson et al. study, often using parental reports.

Main Results:

• Methodological quality varied, with unclear criteria development for PDA identification.
• Most studies exclusively used parental reports, neglecting alternative explanations.
• No studies incorporated the perspectives of individuals diagnosed with PDA.
• Limitations in definition and measurement hinder conclusions about PDA's uniformity and characteristics.

Conclusions:

• Current research on pathological demand avoidance is limited by methodological weaknesses.
• Further research needs to explore PDA's relationship with other conditions and include individual perspectives.
• Future studies should address definition and measurement issues for clearer understanding of PDA.