Pathological Demand Avoidance

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What to expect

Pathological Demand Avoidance

Pathological demand avoidance is commonly classed as one of the autistic spectrum disorders. Pathological demand avoidance is where a child will avoid the everyday demands which are placed on them by others; this is due to high levels of anxiety which the child cannot control.

Speech and language therapy is a beneficial treatment for children with pathological demand avoidance and also their parents / carers. The speech and language therapist will support the child and their family in managing any speech, language and communication difficulties. Children with pathological demand avoidance do not respond well to the traditional highly structured behavioural approaches used for children with autism. Due to the nature of the condition it is important that the therapist adopts an indirect approach to treatment trying to reduce the demands which are placed on the child.

What is pathological demand avoidance?

Pathological demand avoidance is a condition which is characterised by avoidance of demands which are placed on a child by others.

Pathological demand avoidance is a lifelong difficulty and will vary in the severity of its associated difficulties. Due to the variation of the difficulties associated with the condition and how they impact on the individuals life, each child will differ in the amount of treatment and support they require.

The main difficulty children with pathological demand avoidance have is avoiding demands which are placed on them by others.

Although pathological demand avoidance is increasingly being classed as part of the autistic spectrum, children with pathological demand avoidance will experience different difficulties than children with Autism. Children with pathological demand avoidance will often be more sociable with others and have better social communication skills than children with Autism. Children with pathological demand avoidance often have well developed skills in role paly and social mimicry.

The main characteristics of pathological demand avoidance are:

  • Resistance of every day demands made by others.
  • Often appearing sociable but experiencing difficulties in the depth of their understanding.
  • Mood swings with sudden switching of moods.
  • Extremely comfortable when pretending and role playing.
  • May experience delay in language due to passivity, but will often catch up with their same age peers.
  • Obsessive tendencies and behaviour towards people rather than objects or things.

Children with pathological demand avoidance will often appear controlling over situations, more so when the child is anxious that they are not in control or in charge of the situation. In comparison, children with pathological demand avoidance can also be charming when they feel they are in control of the situation. Parents of children with pathological demand avoidance often describe their childs behaviour as Jekyll and Hyde.

Although children with pathological demand avoidance may appear normal to others around them, it is important to note that they do have an underlying difficulty which is affecting their behaviour. Both the child and their parents / carers will need help and support in managing the behavioural difficulties experienced by children with pathological demand avoidance.

What causes pathological demand avoidance?

The exact cause of pathological demand avoidance is still unknown. However like Asperger Syndrome and Autism it is associated with neurological difficulties i.e. in the brain. It has been suggested that the cause of pathological demand avoidance is more than likely due to a combination of factors including environmental, genetic and brain development.

It is important to note that Pathological demand avoidance is not caused by how a child is brought up or to do with parenting skills.

What problems caused by pathological demand avoidance can speech and language therapy help with?

Speech and language therapy can help with some of the following difficulties which may be experienced by children with pathological demand avoidance:

How is pathological demand avoidance diagnosed?

Pathological demand avoidance is diagnosed by a team of medical professionals. A diagnosis will usually be confirmed by a paediatrician or consultant doctor. Due to the nature of the disorder and the childs use of social skills, a diagnosis may be missed in early childhood and made later in life.

A diagnosis of pathological demand avoidance is important and needs to be distinguished from autism due to the differences in response to treatment. Unlike Autism, which responds extremely well to structured educational programmes, pathological demand avoidance does not. A diagnosis of pathological demand avoidance will assist the therapist when planning treatment.

A diagnosis of pathological demand avoidance is also important in helping parents and the child to understand why they behave in certain ways and also in realising their behaviour is not just because they are naughty.

A number of health professionals may be involved in the assessment and treatment of pathological demand avoidance.

The speech and language therapist will carry out an initial assessment which will involve the following:

  • A general discussion with the parents / carers about the childs speech, language and communication abilities and any areas of concern.
  • A case history the childs development, medical and family history.
  • An observation of the childs speech, language and play skills.
  • A detailed assessment of the childs language, play and interaction skills.

How does speech and language therapy help children with pathological demand avoidance?

Speech and language therapy will aim to maximise the communication and social interaction skills of children with pathological demand avoidance. The highly structured behavioural approaches used for children with Autism will not work for children with pathological demand avoidance as they will often avoid the requests of the therapist.

There is increasing knowledge about how to treat individuals with pathological demand avoidance. It is important that the child receives an appropriate intervention to meet their specific needs and abilities.

Children with pathological demand avoidance respond well to indirect methods of treatment which use a negotiative style, they respond well to this type of treatment as it allows them to feel in charge of the situation.

Speech and language therapists will tailor the wording of their requests to make sure there are reduced demands placed on the child.

There are a set of guidelines which the speech and language therapist and other professionals can follow to ensure they gain the best outcome from therapy for the child with pathological demand avoidance.

The speech and language therapist will carry out a detailed initial assessment which will highlight any areas of speech, language and communication which need to be addressed in therapy. The therapist will then create a speech and language therapy programme tailored to the childs specific needs and abilities.

Placing demands and pushing a child with pathological demand avoidance will only worsen the childs behaviour and will often create high anxiety and panic attacks. The speech and language therapist will provide advice, support and education for parents, other professionals and educational staff on such difficulties in order for them to manage the child in a more appropriate way.

What would speech and language therapy treatment for pathological demand avoidance involve?

In the first instance the speech and language therapist will carry out an initial assessment of the childs speech, language and communication skills to highlight any areas of difficulty the child is having. The speech and language therapist will then devise an individualised treatment programme which will be tailored to the specific needs and abilities of the child.

After this point speech and language therapy may involve any of the following:

During the treatment phase the parents / carers and the child will also be given the opportunity to share any concerns they have and also any things they would like us to work on in therapy.

How do I arrange a speech and language therapy assessment for pathological demand avoidance?

To arrange an appointment with one of our highly experienced speech and language therapists please email office@slt.co.uk or call 0330 0885 643.

Summary

Pathological demand avoidance is a condition which is characterised by the avoidance of the everyday demands which are placed on a child. Unlike children with autism, children with pathological demand avoidance do not respond well to highly structured, behavioural and educational treatment plans. Speech and language therapy will focus on developing, improving and supporting a childs speech, language and communication difficulties through a more indirect and negotiative style treatment approach.

If you feel our speech and language therapy service would be beneficial and would like to book an appointment with one of our specialist speech and language therapists, please email office@slt.co.uk or call 0330 0885 643.


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