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A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance:
Noelle E Carlozzi1, Wendy L Lombard1, Jonathan P Troost2
1Department of Physical Medicine and Rehabilitation University of Michigan Ann Arbor Michigan USA.
Pediatric Investigation
|June 26, 2026
Summary
The Paradigm Shift Program is a feasible and acceptable 12-week intervention for parents of children with pathological demand avoidance (PDA). This program demonstrated improvements in parental health-related quality of life and child behavior, addressing a gap in evidence-based support for PDA.
Area of Science:
- Child Psychology
- Developmental Disorders
- Behavioral Interventions
Background:
- Pathological Demand Avoidance (PDA) is a distinct behavioral profile within Autism Spectrum Disorder, first described in 1980.
- Limited scientific evidence currently supports interventions for children with PDA and their families.
- There is a need for evidence-based programs to support parents and guardians of children with PDA.
Purpose of the Study:
- To evaluate the feasibility and acceptability of the Paradigm Shift Program®, a 12-week educational and training intervention for parents/guardians of children with PDA.
- To assess the program's impact on parental health-related quality of life (HRQOL) and child behavior.
Main Methods:
- Seventy-six parents/guardians of children with PDA were enrolled.
- Participants completed baseline and end-of-program assessments, including patient-reported outcomes (PROs), proxy measures, and feasibility/acceptability questionnaires.
- Data analysis focused on program completion rates, satisfaction, and changes in PROs and proxy measures.
Main Results:
- High program acceptability and satisfaction were reported by parents/guardians (agreement >70%).
- Significant improvements were observed in 10 out of 13 PROs related to parental HRQOL (P < 0.05).
- Parent/guardian proxy reports indicated significant improvements in demand characteristics (P < 0.05) and a trend towards improvement in conduct problems, total difficulties, and externalizing behaviors in their children with PDA.
Conclusions:
- The Paradigm Shift Program® is a feasible and acceptable intervention for parents/guardians of children with PDA.
- The program shows evidence of improving parental HRQOL and positively impacting the behavior of children with PDA.
- This study provides valuable preliminary evidence for an effective support program for families affected by PDA.
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