Study questions whether PDA is a valid diagnosis

A meta-analysis by researchers in Australia casts doubt on whether pathological demand avoidance (PDA) is a legitimate diagnosis. Many of the symptoms of PDA, which was first described in the 1980s, are also symptoms of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder, and/or oppositional defiant disorder.

Features include passivity during infancy, a strong resistance to ordinary life demands, social impairments, volatile moods, language delays, an interest in role-playing, obsessive behaviors, clumsiness, and physical awkwardness.

Dylan Company and Joe Anthony Rotella note that PDA “remains a contentious diagnosis with several interpretations and no validated diagnostic criteria.” Currently, PDA is not formally recognized as a diagnosis by the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases. Some researchers argue that it is a subtype within the autism spectrum, while others believe it is a distinct condition.

To investigate the issue, the researchers analyzed data from 12 studies on PDA. Nine of the studies involved children, two involved adults, and one involved both age groups. Most of the studies relied on surveys or self-reported questionnaires, while several used diagnostic tools.

The researchers found that all of the studies appeared to be at high risk for methodological bias because of their design and the means by which they recruited participants. “There was considerable inconsistency in the way PDA was identified across studies,” they say, “with a large proportion of studies relying on subjective rather than objective measures.” Moreover, they say, the diagnostic tools used to identify PDA in some studies have not been validated for this purpose.

The researchers suggest that the studies they reviewed may suffer from circular logic, a logical fallacy in which the premise of an argument assumes the conclusion to be true—“in other words,” they say, “the diagnostic test identified PDA in this person because the person who underwent the diagnostic test has PDA.” They conclude that this “makes it difficult to support any of the diagnostic tools pertaining to PDA, let alone the condition itself.”

Citations

“A systematic review of pathological demand avoidance (PDA): a veritable diagnosis or a case of circular logic?”, Dylan Company and Joe Anthony Rotella, Journal of Autism and Developmental Disorders, July 2026 (free online). Address: Joe Anthony Rotella, [email protected].