Part of this misperception is due to the application of a deficit model of autism that considers autistic people as incapable of displaying social agency. By pathogising such behaviour, one could unduly be blunting attempts at autistic self-advocacy. The label of PDA represents the medicalising and pathologising of behaviours that from an outsider perspective seem to be differentiated from what is deemed capable by autistic people, but could be seen as the behaviours of an autistic person who has gained a modicum of normative social skills and is simply asserting their agency. The avoidance of demands is interactional in nature, and much like a lack of social reciprocity cannot be located solely in the mind of any one individual (Milton, 2012a). Such behaviours arise from any number of transactions between the individual and environment. It will no doubt lead to treatments that try and stop such behaviours (which couldīe read as a form of self-advocacy and the gaining of skills). In essence, such protests are perceived as the fault of pathology inherent in the individual mind rather than a conflicting interaction (much like ‘theory of mind’). The PDA narrative suggests that those who gain some social interaction skills and assert their needs through avoidance of imposed demands are pathological. ![]() It is deemed pathological due the distaste of those doing the perceiving and their idealisation of cultural and psychological norms. The PDA narrative presents what is perfectly rational behaviour from the viewpoint of the autistic person displaying it when faced with highly stressful situations, as not as a consequence of ‘choice’ (whatever that may be) but as a pathological response. The labelling of the expressions of autistic agency as pathological is in itself disempowering. By pathologising such behaviour, one could unduly be blunting attempts at autistic self-advocacy. This paper concludes by arguing that the label of PDA represents the medicalising and pathologising of behaviours that from an outsider perspective seem to be differentiated from what is deemed capable by autistic people, but could be seen as the behaviours of an autistic person who has gained a modicum of normative social skills and is simply asserting their agency. PDA (Pathological Demand Avoidance) or Persistent Drive for Autonomy When faced with a demand (even a really minor one), PDAers can have extreme reactions. PDA causes someone to avoid demands and expectations for the sole purpose of remaining in control. The core of PDA is an anxiety-driven need for autonomy. ![]() PDA is not a formal diagnosis in the DSM-5 or ICD-10, and it is not well known in the U.S., though it is widely acknowledged in the U.K. I prefer this name because it is less judgmental, but also because it focuses less on demand avoidance (which can be caused by an endless number of things) and more on the core issue: the drive for autonomy. So let’s talk about the concept of Pathological Demand Avoidance (PDA), though I prefer Tomlin Wilding’s interpretation: Pervasive Drive for Autonomy. (PDF) Rational (Pathological) Demand Avoidance: what it is not, what it could be & what it does. Other RDA traits can viewed as a different way of being, therefore they are not necessarily a defect.The high anxiety levels and demand avoidance behaviours can be seen as an interactive process, with being labelled “demand avoidance behaviour” as disablism due to the RDAer vulnerability to internalising (Eaton 2018b Trundle et al 2017).The demand avoidance behaviour is how a RDAer attempts to regulate and adapt to the high anxiety.(2020) – Woods – 2020 – Child and Adolescent Mental Health – Wiley Online Library Commentary: Demand Avoidance Phenomena, a manifold issue? Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents – a commentary on Stuart et al. This discussion provides tentative support for monotropism autism theory and the growing body of research indicating that DAP may not be developmentally persistent (a high rate of persons not meeting clinical threshold into adulthood). In this commentary, I attempt to contextualise the recent article, Intolerance of Uncertainty and anxiety (Stuart et al., 2019) within wider discourses. There is much ongoing controversy around the construct. Demand Avoidance Phenomena (DAP) is a neutral term for Pathological Demand Avoidance, which is sometimes conceptualised as an autism subtype.
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