PDA sociopathic condition related to aspergers syndrome

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19 Oct 2009, 1:45 am

nirrti_rachelle wrote:
That's no disorder. That sounds like spoiled kids who grew up with parents that let them do whatever they want. They never had boundaries or demands put on them so they never learned to take responsibility for themselves. Do we have to pathologize everything? :?


That's really cute. Are all the undiagnosed mods here this judgmental of others' ASDs? For your information:

Quote:
PDA syndrome: 'We thought she was naughty - it turned out she was ill'

The symptoms of Pathological Demand Avoidance syndrome, a little-known relative of autism, include compulsive disobedience. Catriona Wrottesley meets parents of children who can't do what they're told

Sunday, 28 July 2002

At four years old, Hayley frequently squared up to her nursery school teacher. Knee-high to the adult who towered above her, her tone was deep and authoritative. She demanded respect. At the end of her first week at nursery, her parents were informed she talked down to her teacher and behaved dictatorially with other children.

Over the years, this compulsion to dominate, coupled with an obsessive avoidance of doing what is asked of her, has got Hayley, now 14, into endless trouble. Intelligent, vivacious, articulate and charming, she struggles to grasp the usual boundaries of human behaviours, interactions and relationships.

Consultations with child psychologists and other mental health professionals failed to come up with an explanation. Until last Easter. At a group for parents of children with behavioural difficulties, Hayley's father Jim, 46, a teacher from Richmond, Surrey, met a parent who suggested it sounded like Pathological Demand Avoidance syndrome (PDA). "When I read the PDA diagnostic criteria, I felt this could have been specially written about Hayley," he says.

PDA is a condition first identified by Professor Elizabeth Newson, former head of the Child Development Research Unit at the University of Nottingham, now consultant in developmental psychology to the Early Years Diagnostic Centre in Ravenshead, Nottinghamshire. "During the Eighties, we tended to get very puzzling children at the research unit," she says. "We specialised in non-communicating children. People would say this child's behaviour reminds me of autism but can't be because these aspects don't fit. To begin with I'd describe these children as 'non-typical autistic'. As time went on, however, I began to realise that although they were not typical of autism, they were typical of each other.

"By the time I had eight children who fitted this pattern, I began to think I might have another syndrome. I now have 150 PDA children on my database."

More than 20 years since Professor Newson identified PDA, word is spreading about the syndrome and Professor Newson is publishing a paper on it this autumn. As yet, however, it does not appear in the diagnostic manual used by paediatricians and child psychiatrists. Why the delay?

"The diagnostic manual is a working document," explains Professor Newson. "Diagnosis is movable. Many of my colleagues are taking PDA on board, before it reaches the manual." Obviously the problem with PDA and similar conditions is that they may be difficult for parents and professionals to recognise. It is natural to hope that your child is having a few behavioural problems rather than suffering from something more serious.

Jill Curtis, a child psychotherapist, is about to publish Does Your Child Have a Hidden Disability?, which looks at PDA, ADHD, autism, Asperger syndrome, giftedness, dyspraxia, dyslexia and a number of other "hidden disabilities". "Often parents know in their bones that this isn't just a naughty or hard-to-settle child," she says. "One mum told me she'd realised something was wrong when her child was four days old, because he didn't seek her face or eyes, like other babies."

Curtis's recommendation is to seek professional help when you are sufficiently worried to want an outside opinion. But even then there are many hurdles. "One mum read her child's medical file and was horrified to read a note in it saying 'this mother has Munchausen syndrome by proxy'. Some parents find themselves referred for marital counselling. The assumption is that the child's behaviour is caused by conflicts in the marriage and over-parenting."

PDA is a pervasive developmental disorder. This means it affects every aspect of a child's life and development, and, unlike an illness, there is no cure. PDA is in the same family of disorders, but different from, autism and Asperger syndrome. A key difference is that those with PDA are superficially socially skilled and even manipulative, unlike those with autism and Asperger syndrome. "Children with PDA often maintain steady eye contact as a means of getting others to do what they want," says Professor Newson. "They are often governed by obsessions. The predominant obsession is avoidance of demands placed on them. Even the most ordinary requests like getting into a car may throw them into panic."

Fran Mitchell, 31, a student from near York, and her husband John Green, 44, a lift engineer, have two daughters, Sophie, nine, and Vicky, seven. Vicky was diagnosed with PDA when she was four. "It's very difficult if I need to go somewhere and Vicky has to come," says Fran. "Getting her into the car can be a major problem. She'll say, 'I can't at the moment. I've got to do something or other' or 'I'm poorly. I've got tummy ache. I need to go to the toilet.' Sometimes she'll flatly refuse. If I can introduce the idea of going out early enough, we can get that refusing over with earlier. When it suits her she'll say, 'Come on, let's go.' That way it has become her decision and that's fine. Everything has to be on Vicky's terms."

Lack of a sense of self means these children will imitate the behaviour of others. Often they find it difficult to understand that they are not an adult. In class, a child with PDA will frequently try to take the role of teacher. "Vicky's come a long way," says Fran. "If you met her you'd think what a lovely child – depending on what she's like at that moment. The hardest thing is that I can't describe her. One minute she can be very loving but within a minute she can be totally upsetting. It's always extremes. There's no middle ground. I don't know who Vicky is."

Handling guidelines for schools are available from the Diagnostic Centre, or the PDA support group website. "The guidelines are quite expensive to put into place and difficult to follow," says Professor Newson. "Whereas autistic children like and respect rules, PDA children like variety. What works today may not work tomorrow, but might work again next week. It is important to remember they do not choose to behave the way they do. These are defensive manoeuvres, stemming from anxiety."

Jim has experienced the benefits of diagnosis and guidelines. In July, last year, Hayley's PDA was diagnosed. By September, an educational statement had been drawn up to meet her needs. She now attends school less than half the time, studying her four favourite subjects, with her favourite teachers. The result is a much happier, more settled child.

The long-term prospects for those with PDA are not positive. The original eight children diagnosed by Professor Newson have not fared well. "The eldest is now 33. They cause tremendous problems because nobody knows what to do with them. They are very manipulative and resist the ordinary demands of life. I only know one in a job. They live with their parents and a few live in communities of one sort or another. One of the earliest girls was placed in an adult community of autistic people but she was excluded in the end and is now in a secure unit. These people appear very robust but they are not. Their panic attacks can be violent. The ray of hope is we now have handling guidelines, so children with PDA should be managed better."

Jim is optimistic. Since Hayley's diagnosis, he says she is easier to be with. He focuses on her positive sides, which far outweigh the negatives. "Having seen what we can achieve, I hope Hayley will go on to study the subjects she has a real flair for. She has a very scientific mind and wants to be a marine biologist."

'Does Your Child Have a Hidden Disability?' by Jill Curtis (Hodder and Stoughton, out 19 September, £7.99). The Early Years Diagnostic Centre (01623 490879).


And we're not psychopaths, mushroom. :? Would be very grateful for a link to where you have read that, for as long as it's not this dude: Digby Tantam, Malice and Asperger Syndrome, who's actually talking about AS and not PDA, and about people with AS being baby killers:
Quote:
Several features of Alice's actions often recur in malicious actions by other people with AS. Younger children may be targets, quite
often siblings. There is often an experimental explanation given and, afterwards, there is a lack of remorse or fear. The 'real'
explanation is elusive. Wing (personal communication) has suggested that the person with AS may harm others in the
furtherance of a special interest.


Can't link because I don't have five posts yet (and from what I've seen so far in available attitudes against people with PDA on this forum I don't think I'll ever make more), but it should pop up on Google.

Neanthhumain, thank you for being the only one who doesn't feel like needing to marginalize people with PDA even more.



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19 Oct 2009, 2:43 am

Does it tend to occur in families with autism/aspergers? Only ask because it sounds like my former brother that I disowned.



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19 Oct 2009, 2:55 am

I can't really figure out the difference between PDA and a combination of classical autism/Asperger's and oppositional defiant disorder. Can anybody who knows a difference point it out and explain it?

Some sort of information to how it differs from already recognised disorders that also include parts of the symptoms of PDA such as common PDDs, AD(H)D, ODD, CD, anxiety and mood disorders as well as some of the personality disorders would be very helpful to define PDA as a differential diagnosis to show if it's a valid syndrome that cannot be explained away by established diagnoses.


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19 Oct 2009, 10:02 am

Isn't PDA supposed to be the "childhood version" of BPD?



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19 Oct 2009, 10:39 am

I have seen people who are like this. They are extremely manipulative and can often get away with doing nothing because they are so good at it. These are the types that cause me the most puzzlement because I think how do they get people to put up with them doing nearly nothing at all, having no respect, badmouthing them and still do nice things for them, want to be friends or partners with them? The examples I can think of are usually good looking, attractive types who are friendly but want to be taken care of and want someone else to do everything for them. They can get others to do this too, as if by magic. This disorder might be more common than people realize. It is different from autism because most autistics aren't as good at successful manipulation. They might try to manipulate, but they don't get the same results. People are less likely to do what they want or put up with it like they will the PDA person.



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19 Oct 2009, 12:15 pm

I don't understand why this condition is linked in with autism when there are so few symptoms in common.



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19 Oct 2009, 12:55 pm

nirrti_rachelle wrote:
Do we have to pathologize everything? :?


Yes! Of course we do! I just thought of one this morning. Since the women seem to get left out of or not considered for many disorders/syndromes, I thought of one for them. I had to make up a few more just to describe this phenomenon.

Footwear Obsession Syndrome (FOS)

FOS is more prevalent in females. There are approximately 50 females with FOS for each male with FOS. Metrosexual Clothing Syndrome (MSC) must be ruled out in males before a diagnosis of FOS can be made.

Diagnostic Criteria: Patients must have at least two of the symptoms below to be officially diagnosed with FOS.

1. Person has more pairs of footwear than can be worn in a single week (month/months in extreme cases).

2. Person often keeps several pairs of footwear in there vehicle.

3. Person experiences a loss of executive function upon entering a shoe store. (Patient may not know where to start, when to not buy a pair of shoes she/he will never wear, or know when to ask for assistance.)

4. Person may seek out fragrances that resemble "new shoe smell".

If you or a loved one exhibits symptoms of FOS you should seek the help of a professional. Unfortunately most footwear sales persons, medical doctors, and mental health providers have no experience with FOS. They may flat out deny your obvious case of FOS because they haven't kept current with footwear and mental conditions that have been recognized and studied in the past two decades. This lack of knowledge makes them angry and question their own credentials and ability to server the population they went to school to help. Such professionals may be suffering from DHAFCSYMNHIS (Don't have a farking clue so you must not have it syndrome).



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19 Oct 2009, 3:07 pm

I too wonder how this is related to autism. According to the article, the symptoms are caused by a defensive reaction to stress, which can be similar to autism, but thats about it. And one could make the argument that if you change the environment to remove stress from the autistic person, any similarities would vanish. I mean, just looking at the criteria:

Difficulty with nonverbal communication:
autism: yes
PDA: no

Disinterest or difficulty in forming relationships:
autism: yes
PDA: no

Oversensitive senses:
autism: yes
PDA: no

Difficulty communicating:
autism: yes
PDA: no

Physical clumsiness:
autism: yes
PDA: no

I am afraid I just dont see any similarities other then both having anxiety as a common co-morbid condition.



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19 Oct 2009, 3:25 pm

Tracker wrote:
I am afraid I just dont see any similarities other then both having anxiety as a common co-morbid condition.

I think they're lumped together simply because they both can have difficult behaviors, e.g. frequent tantrums, refusals, and meltdowns. Some autistic kids are fairly easy going though and are merely withdrawn. There doesn't seem to be any universal overlap.

One article I read mentions a genetic connection (according to one study children with PDA are more likely to have autistic siblings). Who knows?



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19 Oct 2009, 3:26 pm

nirrti_rachelle wrote:
Do we have to pathologize everything? :?


Perhaps, in order to recognise things we must pathologise. A behaviour is witnessed, it occurs in several people with things in common, there seems to be the same explanation for all of these and the medical community starts labelling. I am, controversially, a fan of labels. I understand that people shouldn't be defined by them but if you don't call it a snake I'm gonna be pretty surprised when it bites me. (that is in no way supposed to suggest that aspies bite and it's not even a pun cos I only just thought of that now.)

This disorder is interesting. It does sound a little like BPD, but then all personality disorders have a certain sort of thing in common. When I was younger I probably would have decided I had it. And I wasn't spoilt and certainly never got everything I wanted. But finding everyday tasks difficult and manipulating people to perform them for me, I was a bit like that when I was younger. Not anymore though, I still feel that way but I handle things alone.



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19 Oct 2009, 3:34 pm

in my opinion they put it with autism simply because it'd look more serious-- a new condition related to autism. I still do not see how PDA relates in anyway to autism besides "language delay" and "obsessive behavior". There's too many contradictions.

This is the comparison to AS/autism from a PDA website:

Quote:
PDA children are LESS likely:

* to have caused anxiety to parents before 18 months of age
* to show stereotypical motor mannerisms
* to show (or have shown) echolalia or pronoun reversal
* to show speech anomalies in terms of pragmatics
* to show (or have shown) tiptoe walking
* to show compulsive adherence to routines

PDA children are MORE likely:

* to resist demands obsessively (100%)
* to be socially manipulative (100% by age five)
* to show normal eye contact
* to show excessive lability of mood and impulsivity
* to show social mimicry (includes gestures and personal style)
* to show role play (more extended and complete than mimicry)
* to show other types of symbolic play
* to be female (50%)

People with PDA can become obsessive about particular individuals or relationships. They tend to show a high level of impulsivity, excitability and sometimes violent behaviour, often associated with these obsessive interests, and occasionally involving harassment of another child or adult. Their obsessive interests are qualitatively different from those seen in autism/Asperger.

Like all children with a pervasive developmental disorder, people with PDA will have certain communication problems, although these may be masked by their superficially high social skills of distraction and avoidance, thus the underlying deficits can be quite easily overlooked. Semantic pragmatic language (the social use of language, including body language) may also be affected, but not to the degree found in autism and Asperger syndrome. Bizarre content of language is more common than in autism, sometimes due to interest in fantasy.

Individuals with PDA tend to have over-active imagination as opposed to under-active, and this clearly sets them apart from Wing's description of the autistic Triad of Impairments. Individuals with PDA quite often become confused as to the boundaries of reality and imagination (as they also do with other boundaries). They may submerge themselves into characters that they have modelled themselves on, either from TV or from real life, and sometimes they can seem to have lost touch with their 'real' selves. Many children with PDA take on the role of their teacher in great detail, and will tell other children what to do (much to their annoyance!) Keeping the tolerance and sympathy of other children in the classroom can be a difficult task for teachers who are trying to meet the needs of a child with PDA.

Most of the characteristics mentioned tend to persist in various forms into adult life, but research in this area is not extensive at present. The prevalence of PDA compared with autism is not known.


They should stop grouping it with autism.



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19 Oct 2009, 3:39 pm

Yeah, I agree; it doesn't seem to have much to do with autism. At first I thought it might be related to the problem of autistic inertia (the "I want to keep doing what I'm doing whether or not I have to do anything else, whether or not I'm having fun, because it's easier than switching gears"), but this seems more like some kind of mashup of oppositional-defiant and adult borderline personality. I don't even know whether it's a legitimate diagnosis (it's not in the DSM or ICD), and it could even be entirely the result of shoddy parenting plus neutral predisposing personality traits.


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19 Oct 2009, 3:45 pm

TouchVanDerBoom wrote:
This disorder is interesting. It does sound a little like BPD, but then all personality disorders have a certain sort of thing in common. When I was younger I probably would have decided I had it. And I wasn't spoilt and certainly never got everything I wanted. But finding everyday tasks difficult and manipulating people to perform them for me, I was a bit like that when I was younger. Not anymore though, I still feel that way but I handle things alone.


I was called manipulative when I was younger as well but I really just wanted to have solid reasons for why I had to do something. I never "got it" that negotiation with adults is disrespectful or wrong. I kind of saw myself on an equal level with everyone, including adults and I always resented hearing "because I said so". I preferred following rules that I deemed reasonable for all parties rather than being blindly subjected to authority. I've seen this pattern with other kids on the spectrum as well and can see how it can easily be confused with demand avoidance.



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19 Oct 2009, 3:49 pm

Surely for a condition to belong on the Autistic spectrum it would have to share some Autistic traits. :?
Not to mention the fact that most Autistic people are about as far away from being sociopathic as humans are far away from 100% pure world peace, with no problems ever to arise in the future.


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19 Oct 2009, 7:32 pm

Then again, having superficially "good" social skills is just as bad as having marginal social skills.

The tendency of PDA children to be bossy and overbearing might work for a little while. But when these children get a bit older, and actual expectations are placed on them, they fall apart. You get nothing but empty bragging and narcissism.

They could be flunking out of school, and brag about being the most intelligent person in the classroom. They could denounce the rest of society as "losers" despite never working a day in their life. Anyone above the age of ten can see right through them.

That is what is meant by "superficial social skills". They seem adept at first, but they fail to realize that everyone who knows the truth about them is laughing behind their back. They are good at "talking the talk", but it isn't backed up by anything. As a result, people don't remain friends with them for long. But still, they keep on doing the same thing over and over again.

The point is, they DO have problems with communications and interactions with people. The difference between PDA and typical autism is assertiveness in communication and individual ego.



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19 Oct 2009, 9:24 pm

nirrti_rachelle wrote:
That's no disorder. That sounds like spoiled kids who grew up with parents that let them do whatever they want. They never had boundaries or demands put on them so they never learned to take responsibility for themselves.


Hmm, sure i've heard that somewhere before with regards to another condition, it's on the tip of my tongue...


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