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Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders.

ABSTRACT: A proposal is made to recognise pathological demand avoidance syndrome (PDA) as a separate entity within the pervasive developmental disorders, instead of being classed under "pervasive developmental disorder not otherwise specified" (PDDnos, DSM-IV). Discriminant functions analysis shows PDA to be significantly different on many counts from classic autism and Asperger's syndrome, both separately and together, including an equal sex ratio (150 cases). Demand avoidance using social manipulation is seen in all children, which strongly contrasts with the features of autistic spectrum disorders. A criterial structure is described, supported by statistical data from a random sample of 50 children diagnosed with PDA, together with a follow up sample of 18 young adults.

SUBMITTER: Newson E

PROVIDER: S-EPMC1763174 | biostudies-literature | 2003 Jul

REPOSITORIES: biostudies-literature

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Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders.

Newson E E Le Maréchal K K David C C

Archives of disease in childhood 20030701 7

A proposal is made to recognise pathological demand avoidance syndrome (PDA) as a separate entity within the pervasive developmental disorders, instead of being classed under "pervasive developmental disorder not otherwise specified" (PDDnos, DSM-IV). Discriminant functions analysis shows PDA to be significantly different on many counts from classic autism and Asperger's syndrome, both separately and together, including an equal sex ratio (150 cases). Demand avoidance using social manipulation i ...[more]

PMID: 12818906

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Project description:ObjectiveChildren with Pervasive Developmental Disorders (PDDs) have social interaction deficits, delayed communication, and repetitive behaviors as well as impairments in adaptive functioning. Many children actually show a decline in adaptive skills compared with age mates over time.MethodThis 24-week, three-site, controlled clinical trial randomized 124 children (4 through 13 years of age) with PDDs and serious behavioral problems to medication alone (MED; n = 49; risperidone 0.5 to 3.5 mg/day; if ineffective, switch to aripiprazole was permitted) or a combination of medication plus parent training (PT) (COMB; n = 75). Parents of children in COMB received an average of 11.4 PT sessions. Standard scores and Age-Equivalent scores on Vineland Adaptive Behavior Scales were the outcome measures of primary interest.ResultsSeventeen subjects did not have a post-randomization Vineland assessment. Thus, we used a mixed model with outcome conditioned on the baseline Vineland scores. Both groups showed improvement over the 24-week trial on all Vineland domains. Compared with MED, Vineland Socialization and Adaptive Composite Standard scores showed greater improvement in the COMB group (p = .01 and .05, and effect sizes = 0.35 and 0.22, respectively). On Age Equivalent scores, Socialization and Communication domains showed greater improvement in COMB versus MED (p = .03 and 0.05, and effect sizes = 0.33 and 0.14, respectively). Using logistic regression, children in the COMB group were twice as likely to make at least 6 months' gain (equal to the passage of time) in the Vineland Communication Age Equivalent score compared with MED (p = .02). After controlling for IQ, this difference was no longer significant.ConclusionReduction of serious maladaptive behavior promotes improvement in adaptive behavior. Medication plus PT shows modest additional benefit over medication alone. Clinical trial registration information-RUPP PI PDD: Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://www.clinicaltrials.gov; NCT00080145.

Dataset Information

Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders.

Publications

Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders.

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