Commentary: PDA – public display of affection or pathological demand avoidance? – reflections on O'Nions et al. (2014)

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A group of children presents with a rather peculiar type of oppositional behaviours, sometimes now subsumed under the label of ‘pathological demand avoidance’ syndrome, also increasingly referred to as PDA. Boys and girls with ‘this kind of PDA’ will do anything to avoid meeting demands of adults and children alike. The behaviours ‘used’ in maintaining avoidance range from openly oppositional or manipulative to ‘extreme shyness’, passivity and muteness. These behaviours in terms of expression of affection are rather the opposite of those associated with the commonly used meaning of PDA. However, the avoidant behaviour is quite often ‘publicly displayed’ and with no feeling for the inappropriateness of the, sometimes even, exhibitionist style of extreme demand avoidance (EDA). The ‘disorder’ was first heard of in 1980, when Elisabeth Newson presented the first 12 cases of what she believed to be a ‘new’ and separate syndrome and that she referred to as PDA. Even though PDA has attracted quite a bit of clinical attention in the United Kingdom and other parts of Europe (including Scandinavia), virtually no research has been published in the field so far (Newson, Le Maréchal, & David, 2003). Experienced clinicians throughout child psychiatry, child neurology and paediatrics testify to its existence and the very major problems encountered when it comes to intervention and treatment. It is therefore a major step forward that O′Nions and co-workers (this issue) have developed a new ‘trait measure’ for PDA (‘the EDA-Q’), a measure that appears to hold considerable promise for research, and eventually for clinical practice.

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