10TH OF MAY 2022 UPDATING THE PATHOLOGICAL DEMAND-AVOIDANCE-BELIEFS SCALE (PDA-BS).
Introduction.
This blog post sets out the latest version of the Pathological Demand-Avoidance-Beliefs Scale (PDA-BS). The rationale for the need of the PDA-BS is explained in a previous blog post linked below:
Since then, the potential bias of many participants in PDA studies has been acknowledged by a recent systematic review (Kildahl et al, 2021). This blog post is intending to set out where the individual items (questions) in the PDA-BS are sourced from. Before that, it must state there is an additional question in the latest version of the PDA-BS, which has been added to assess for a person’s views on dividing autism. Below is the current version of the PDA-BS.
Table 1: Pathological Demand Avoidance – Beliefs Scale (PDA-BS).
| Number | Item | Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly Agree |
| 1 | PDA’s other name is Extreme Demand Avoidance. | |||||
| 2 | We need to maintain the integrity of how the condition is understood. | |||||
| 3 | Autistic persons should be divided into subgroups/ subtypes. | |||||
| 4 | Autistic individuals often benefit from being in control of their lives. | |||||
| 5 | A prolonged debate about what PDA is distracts from focusing on the true purpose of a diagnosis. | |||||
| 6 | The demand avoidance strategies are socially manipulative in nature. | |||||
| 7 | The gender ratio for PDA is evenly split between males and females, it is 1:1. | |||||
| 8 | We need to maintain the integrity of the nature of support that is needed by individuals with PDA. | |||||
| 9 | PDA can be identified in non-autistic persons. | |||||
| 10 | PDA’s primary impairment is high anxiety driven demand-avoidance. | |||||
| 11 | PDA was a Pervasive Developmental Disorder | |||||
| 12 | Individuals can transition between proposed autism subgroups (e.g., a child diagnosed with more typical autism can grow into the PDA profile). | |||||
| 13 | PDA needs to be significantly different from more traditional autism subgroups (e.g., Asperger’s Syndrome and Kanner’s Syndrome). | |||||
| 14 | PDA has the same strategies and approaches as more typical autism. | |||||
| 15 | PDA is a profile of the Autism Spectrum. | |||||
| 16 | The PDA profile needs to be used all the time with individuals to inform their support strategies. | |||||
| 17 | For PDA, sometimes the demand avoidance is because a person does not want to do an activity. | |||||
| 18 | For PDA, demand avoidance must be present from early infancy, i.e., before 12 months old. | |||||
| Total out of seventy-two. |
Directions of scoring.
5 Anchor Point scale.
Questions: 1. 2, 3, 5, 7, 8, 10, 11, 13, 15, 16, 18.
(0) Strongly disagree; (1) Disagree; (2) Neither agree nor disagree; (3) Agree; (4) Strongly agree.
Question: 4, 6, 9, 12, 14, 17.
(4) Strongly disagree; (3) Disagree; (2) Neither agree nor disagree; (1) Agree; (0) Strongly agree.
Table 2: Rationale for individual PDA-BS items/ questions.
| Number. | Item/ Question. | Reversed Scored. | Source of item. |
| 1 | PDA’s other name is Extreme Demand Avoidance. | No. | There is substantial dislike with the “Pathological” descriptor in the name for PDA, hence there are many competing different names for PDA in print (Woods 2020). Extreme Demand Avoidance seems to be the most common alternative for PDA in print, for instance see Eaton & Weaver (2020); Gillberg (2014); Gillberg et al (2015) O’Nions et al (2014a); O’Nions & Eaton (2021); O’Nions et al (2021); Reilly et al (2014); Stuart et al (2020); Summerhill & Collett (2018); Truman et al (2021). |
| 2 | We need to maintain the integrity of how the condition is understood. | No. | Is adopted from: “To build on developments, insights and increasing recognition of PDA but maintain the integrity of how the condition is understood and the nature of the support that is needed by individuals” (Christie, 2016, s62). The quote is also seen in Christie (2018;2019). Considering the apparent efforts of “PDA Profile of ASD” advocates to ignore divergent opinions on PDA to try and protect their position on PDA, it seems apt to directly quote Christie on the topic. |
| 3 | Autistic persons should be divided into subgroups/ subtypes. | No. | Most autistic persons do not want autism to be divided into subtypes/ subgroups/ “Profiles” (Fletcher-Watson & Happé, 2019; Kapp & Ne’eman, 2019). Claiming PDA is a “Profile of ASD” is directly choosing to ignore most autistic persons preferences on how to conceptualise autism. |
| 4 | Autistic individuals often benefit from being in control of their lives. | Yes. | Most/ all human being benefits from being in charge, or having a sense of control (Woods, 2019). Yet, this tends to be ignored in “PDA Profile of ASD” literature, as PDA is often described as having a “need for control”, e.g., (Newson et al, 2003). One can only say PDA has a “need for control” if one conveniently ignores that most/ all persons have a need for control, including autistic persons. |
| 5 | A prolonged debate about what PDA is distracts from focusing on the true purpose of a diagnosis. | No. | “prolonged debate about whether PDA is a syndrome within the family of pervasive developmental disorders or a subgroup of what has become another umbrella term of ASD becomes rather distracting. Instead, we should be constantly focused on the true purpose of diagnosis: to better understand and make sense of individuals and to use that understanding to help us formulate more effective forms of intervention and provision.” (Christie, 2007, p6). Point is restated in Christie et al (2012) and Fidler and Christie (2019). Considering the general aversion “PDA Profile of ASD” supporters seem to have to accept other perspectives on PDA (see Woods, 2019), it seems suitable to include it. |
| 6 | The demand avoidance strategies are socially manipulative in nature. | Yes. | Originally PDA’s social-avoidance features were seen as being manipulative in nature (Newson et al, 2003), lately “PDA Profile of ASD” supporters are attempting to argue PDA’s social-avoidance features are strategic in nature, for instance (O’Nions & Eaton, 2021). In a forthcoming essay I explain that all PDA tools have some questions which view behaviours to be committed with intent, i.e., on purpose. Presently, I view manipulative vs strategic social-avoidance features debate to be a false-dichotomy, to me, PDA social avoidance features present as a continuum with manipulative on one end, and strategic on the other. The point is that if one is heavily invested in “PDA Profile of ASD” narrative, they should view PDA’s social-avoidance features to be strategic in nature as PDA having manipulative features makes it problematic fitting PDA in the autism spectrum (Christie et al, 2012; Gillberg et al, 2015; O’Nions et al, 2015; Trundle et al, 2017). |
| 7 | The gender ratio for PDA is evenly split between males and females, it is 1:1. | No. | Newson et al (2003) reported PDA’s gender ratio is 1:1. Although, some have questioned if this ratio was a result of sample biases created by demographics of Newson’s clinic (Bishop, 2018). This result has not always been replicated in clinical settings, for instance see O’Nions (2016). Despite this PDA is often argued to be a female form of autism (Christie, 2007). |
| 8 | We need to maintain the integrity of the nature of support that is needed by individuals with PDA. | No. | Is adopted from: “To build on developments, insights and increasing recognition of PDA but maintain the integrity of how the condition is understood and the nature of the support that is needed by individuals” (Christie, 2016, s62). The quote is also seen in Christie (2018;2019). Considering the apparent efforts of “PDA Profile of ASD” advocates to ignore all divergent opinions on PDA to try and protect their position on PDA, it seems apt to directly quote Christie on the topic. |
| 9 | PDA can be identified in non-autistic persons. | Yes. | Studies with PDA seen in non-autistic persons (Absoud, 2019; Eaton, 2018b; Egan et al, 2019; Flackhill et al, 2017; Newson et al, 2003; O’Nions et al, 2014a; O’Nions et al, 2014b; O’Nions et al, 2015; O’Nions et al, 2016; Reilly et al 2014). Studies PDA probably contain non-autistic persons (Stuart et al, 2020; Trundle et al, 2017). Experts stating PDA is seen outside of autism (Green et al, 2018b; Woods, 2020). |
| 10 | PDA’s primary impairment is high anxiety driven demand-avoidance. | No. | It is widely argued and assumed PDA’s central impairment is high anxiety (Christie, 2007; Christie et al, 2012; Eaton, 2018a; Eaton & Weaver, 2020). “PDA Profile of ASD” supporters ignore that it is widely accepted that anxiety is not a feature of autism, for instance see (APA, 2013; Woods, 2020). |
| 11 | PDA was a Pervasive Developmental Disorder | No. | Newson et al (2003) argued PDA was needed to be accepted as a Pervasive Developmental Disorder. Later Christie used this to argue PDA is an autism spectrum disorder due to how public conflated Pervasive Developmental Disorders with the autism spectrum (Christie 2007; 2016; 2018; 2019; Christie et al (2012). This ignores the many reasons why Christie’s logic is fallacious (Woods, 2021). |
| 12 | Individuals can transition between proposed autism subgroups (e.g., a child diagnosed with more typical autism can grow into the PDA profile). | Yes. | PDA literature contains examples of persons transitioning into PDA (Newson, 1989; Newson 1999; Newson et al, 2003; Wing, 2002; Wing et al, 2011). However, if one is invested in “PDA Profile of ASD” narrative, one tends to assume PDA starts from early infancy, for example see Eaton & Weaver (2020). |
| 13 | PDA needs to be significantly different from more traditional autism subgroups (e.g., Asperger’s Syndrome and Kanner’s Syndrome). | No. | “Clearly, “hanging together as an entity” is not enough if that entity is not significantly different from both autism and Asperger’s syndrome, either separately or apart, and this is evidenced by the very high significance levels yielded by discriminant functions analysis on a wide range of variables (see website).” (Newson et al, 2003, p599). Recently “PDA Profile of ASD” supporters are arguing PDA is needed to push back boundaries of autism. |
| 14 | PDA has the same strategies and approaches as more typical autism. | Yes. | Green et al (2018b) point out similar strategies to PDA have been utilised with autism for years independently of a PDA construct. PDA’s clinical literature frequently argues it has different approaches to that often used with autistic persons, such as (Christie, 2007; Christie 2012; Newson et al, 2003). If one supports “PDA Profile of ASD”, it is likely one would often ignore this aspect of Green et al (2018b), as it undermines the clinical need for PDA. |
| 15 | PDA is a profile of the Autism Spectrum. | No. | I have written and spoken extensively on the myriad reasons which are legion in number on why it is silly to view PDA as a “Profile of ASD”, like in Woods (2020; 2021). Nonetheless, thousands of persons would attest to that PDA is a part of the autism spectrum. For examples on the eagerness of some to support “PDA Profile of ASD”, see Russell (2018). |
| 16 | The PDA profile needs to be used all the time with individuals to inform their support strategies. | No. | “we should be constantly focused on the true purpose of diagnosis: to better understand and make sense of individuals and to use that understanding to help us formulate more effective forms of intervention and provision.” (Christie, 2007, p6). The above quote is also mirrored in Newson et al (2003) rationale for PDA is needed to better explain a person’s actions and to provide different support packages from autism. This argument is still at the forefront of justifying PDA’s clinical need. Despite this, PDA strategies replicate good practice and benefit many persons (Woods, 2019). |
| 17 | For PDA, sometimes the demand avoidance is because a person does not want to do an activity. | Yes. | Recently “PDA Profile of ASD” supporters are arguing PDA’s demand-avoidance is compulsive in nature, and the demand-avoidance is not by choice, i.e., not because a person wishes to avoid doing an activity (O’Nions & Eaton, 2021). However, this is contradicted by how all PDA tools have some questions which view behaviours to be committed with intent, i.e., on purpose. Or that they contain items due to person expressing PDA features due to wanting something. |
| 18 | For PDA, demand avoidance must be present from early infancy, i.e., before 12 months old. | No. | PDA literature contains examples of persons transitioning into PDA (Newson, 1989; Newson 1999; Newson et al, 2003; Wing, 2002; Wing et al, 2011). Theoretically, under transactional accounts, a person should be able to transition into PDA via stress &/ or trauma (Kildahl et al 2021). Developmental traits are generic. Developmental traits were removed from profile (Fidler 2019; Fidler & Christie 2019; Green et al 2018a; Russell 2018), for being too common in autistic population to identify PDA (O’Nions et al 2016). DSM-5 Disorder definition does not require it to be “Developmental” (APA 2013). Passive Early History seems not to cluster with of PDA traits (O’Nions 2013). EDA-Q & Revised PDA DISCO questions do not require it to be from early infancy (O’Nions et al 2014a; O’Nions et al 2016). Extreme Demand Avoidance-Questionnaire has been used to diagnose PDA (Lyle & Leatherland 2018; Reilly et al 2014; Summerhill & Collett 2018). However, if one is invested in “PDA Profile of ASD” narrative, one tends to assume PDA starts from early infancy, for example see Eaton & Weaver (2020). |
References.
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Rational Demand Avoidance 