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How is Pathological Demand Avoidance diagnosed?

Pathological Demand Avoidance can be provisionally diagnosedin the preschool years, however, it is more difficult to diagnose than Autism as the child normally shows more social interest, increased imaginative play and more age appropriate language than that of Autistic children. This can lead to many children not being diagnosed until they are older.

A diagnosis of Pathological Demand Avoidance is normally made by a health professional such as a paediatrician or child psychologist. By providing an individual with a correct diagnosis of Pathological Demand Avoidance, it will enable them and their families to have an understanding of why they experience certain difficulties, and can also begin the process of obtaining professional help. This will then allow individuals to access appropriate support and services that can provide them with advice about management strategies.

Below is a list of common criteria used to assist health professionals when diagnosing Pathological demand avoidance:

  • Early history of passive behaviour in the first year of life - the child will often have delayed developmental milestones. When more demands are place on the child they tend to become actively passive, with strong objections to normal demands.
  • As the child ages, they will continue to resist and avoid the everyday demands of life - they appear to feel under intolerable pressure from the normal, everyday expectations of young children. Socially manipulative strategies of avoidance will emerge as the child develops in their language skills. Individuals with Pathological Demand Avoidance will become focussed on avoiding any demands which are placed on them.
  • The child may appear sociable on the surface, but may lack social identity, pride and/or shame. Individuals will often not identify with other children and will have a complete lack of boundaries. Rewards, praise or punishment will often be ineffective.
  • Inconsistency and change of mood, with an impulsive drive and need to be in control. This may include sudden mood changes e.g. being affectionate to suddenly lashing out at someone for no apparent reason.
  • Often appears comfortable in pretend situations and during role play.Some children may appear to lose touch with reality. Often, puppets or roles may be used to get children to perform demands.
  • Language delay. Pragmatics are not normally disordered, and the child is able to make good eye-contact (sometimes too much) with normal expression used. However, speech content is often bizarre.
  • Obsessive behaviours - the main obsession will be that of demand avoidance.
  • Children may appear clumsy and have an awkward gait. They may also experience seizures

A diagnosis of Pathological Demand Avoidance can be made following the input from a number of professionals. Following a diagnosis an appropriate treatment plan will be made which will be tailored to the specific needs and abilities of the individual.

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