![]() 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. 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. 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. 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. Pathological (or extreme) demand avoidance is a term sometimes applied to complex behaviours in children within-or beyond-autism spectrum disorder. 6 Newcastle University, Newcastle upon Tyne, UK Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, 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.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.3 Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK.Electronic address: 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. 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.Relationships between pathological demand avoidance and other emotional and behavioural difficulties should be explored in future research, as should the perspectives of individuals with pathological demand avoidance themselves.Īnxiety autism pathological demand avoidance. Problems concerning definition and measurement in the reviewed studies currently limit any conclusions regarding the uniformity or stability of the behaviours described, or the characteristics of individuals displaying them. No studies explored the views of individuals with pathological demand avoidance themselves. Most studies relied exclusively on parental report for data, and there was a general failure to take account of alternative explanations for the behaviours under study. However, the methods used to develop these criteria were not clearly described. All the studies had based the identification of pathological demand avoidance, directly or indirectly, on descriptions from the original study by Newson and colleagues. ![]() After a comprehensive search, 13 relevant studies using a wide range of methods were identified and systematic quality assessments were undertaken. Further aims were to describe how pathological demand avoidance has been identified and to explore the relationships with autism and other developmental and psychiatric disorders. The current study was undertaken to summarise and review the methodological quality and findings from current research into pathological demand avoidance in children and adolescents. The concept of pathological demand avoidance has been criticised for undermining the self-advocacy of autistic people and neglecting the potential role of anxiety as a possible underlying or contributing cause. ![]() ![]() Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue.
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