CAMH Editorial: Volume 25, Issue 2, May 2020

Editorial: Demand avoidance — pathological, extreme or oppositional?

Ann Ozsivadjian

Abstract

Since its inception in 1980, the term PDA has generated much debate, indeed, arguably few subjects have generated such controversy in the neurodevelopmental literature. However research in the area is moving into more practical arenas, including trying to understand why some children present with problematic demand avoidant behaviour, in order to provide practical support to families. In this special edition of Child and Adolescent Mental Health, data from two studies are presented which begin to look for underlying factors contributing to an anxious need for control. Commentaries then follow, highlighting inherent nosological and methodological difficulties in investigating PDA. In this lively debate, while the controversy continues, some headway is made in terms of understanding why some young people might present with such a rigid and maladaptive response to everyday demands, including an aversion to intolerance of uncertainty leading to controlling behaviour. It will be crucial for both health and education to develop a robust evidence base to understand the driving mechanisms for demand avoidant behaviour, and develop specific strategies for managing what can be very challenging behaviours.

We hope that you enjoy the full editorial of this issue, which is free on the Online Wiley Library.

Ann Ozsivadjian

 

 

 

 

 

 

 

 


Principal Clinical Psychologist at Evelina London Children’s Hospital, Guy’s and Thomas’ NHS Foundation Trust

Dr. Ozsivadjian trained in clinical psychology at Oxford and is now an honorary principal clinical psychologist at the Evelina London Children’s Hospital, honorary researcher at King’s College London and is also an independent practitioner. Ann worked in the Complex Paediatric Neurodevelopmental Disability Service at the Children’s Neurosciences Centre, Evelina London Children’s Hospital (Guy’s and St Thomas’ NHS Foundation Trust) for 16 years. Her clinical and research interests include the assessment and treatment of mental health difficulties in ASD, cognitive pathways to anxiety in ASD, and also working with girls and women on the autism spectrum.

Discussion

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Can I politely suggest that this is compulsory reading for all your CAMHS colleagues with special attention being given to the following quote “research is moving into more practical arenas, including trying to understand why some children present with problematic demand avoidant behaviour, in order to provide practical support to families who have a child or children who present with demand avoidant behaviour, which can place a considerable burden on both parents and siblings, as well as limiting the child’s opportunities for social and emotional development.“ My family’s experience is many years of false promises and failure to reply to desperate parents pleading for help or keep them informed.

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