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Lancet Child Adolesc Health. 2018 Jun;2(6):455-464. doi: 10.1016/S2352-4642(18)30044-0. Epub 2018 Mar 23.

Pathological Demand Avoidance: symptoms but not a syndrome.

Author information

1
Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, and Manchester Academic Health Sciences Centre, Manchester, UK. Electronic address: jonathan.green@manchester.ac.uk.
2
Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
3
Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK.
4
Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK.
5
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
6
Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK.

Abstract

Pathological (or extreme) demand avoidance is a term sometimes applied to complex behaviours in children within-or beyond-autism spectrum disorder. The use of pathological demand avoidance as a diagnosis has, at times, led to altered referral practice and misunderstandings between professionals and the families of patients. In our Viewpoint, we reviewed the current literature and conclude that the evidence does not support the validity of pathological demand avoidance as an independent syndrome. Nevertheless, the use of the term highlights an important known range of co-occurring difficulties for many children with autism spectrum disorder that can substantially affect families. We explore how these difficulties can best be understood through understanding of social, sensory, and cognitive sensitivities in autism spectrum disorder, identification of frequently occurring comorbid conditions, and assessment of how these problems interact within the child's social environment. Such understanding should then inform individualised management strategies for children and families, and in social settings, such as education. It is crucial that a shared understanding is achieved between professionals and families in this area.

Comment in

PMID:
30169286
DOI:
10.1016/S2352-4642(18)30044-0
[Indexed for MEDLINE]

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