A quick thread on reasons why PDA is controversial.

I would appreciate feedback on this, and it is in no particular order.
•The “pathological” descriptor is demeaning and horrible.
•PDA lacks consensus on what it is.
•There is no standardised diagnostic profile or validated tools.
•PDA is not in either main diagnostic manuals.
•PDA risks undermining validity of clinical based language, as it involves an atypical approach to nosology.
•Ignoring non-autistic persons with PDA and how clinical justifications for PDA are applicable to them.
•Prematurely forming a community of practice around outlook “PDA is an ASD”; generally missing/ ignoring valid critique of PDA.
•PDA pathologises traits from accepted conditions and thus cannot be a Disorder. Personally, this should only matter to prevent PDA being accepted as something, it is more than e.g., A + B + C ≠ A.
•Some features of PDA are hard to reliably measure.
•Lack of cogent accounts and descriptions of PDA, e.g., missing/ ignoring non-autistic persons in research samples and still calling PDA an “autism profile”. Or deficits in “Pride/ Shame/ Social identity” causing panic attacks...
... These deficits are meant to allow a person to be highly motivated to avoid demands of “ordinary life” (non-autistic life), however now arguing demand avoidance is compulsive in nature (i.e, not by choice).
•PDA is viewed as an ASD and is trying to divide autism despite many autistic persons not wanting autism to be subdivided.
•PDA seems to pathologise a person’s self-agency and risks undermining a person’s human rights.
•Poor quality of much of PDA research, circular in nature, with generic features, or relying on snowball sampling or caregiver reports.
•Signs of many vulnerable persons are supporting “PDA is an ASD” narrative.
•Lack of disclosure of Conflict of Interests.
•PDA is a culturally based construct, to the UK
•Viewing PDA as an ASD and arguing some autistic persons should be protected from reinforcement-based approaches like ABA/ PBS, while leaving the rest of autistic population to potentially be exposed to ABA/ PBS.
•PDA is a culturally based construct, to the UK
•PDA is potentially highly stigmatising and is potentially problematic for autistic persons to escape stigma of autism, as PDA stereotypes are opposite of autism.
•PDA can adversely impact a person’s life chances, e.g. who would wish to employ someone who has a “pathological”/ “extreme” aversion to demands?
•PDA strategies replicate good practice and comparable strategies are widely practiced;
Table comparing autism vs PDA stereotypes.
@Allison66746425 @milton_damian @IgHawthorne @AutZebra @Neurodiversit19

Please can you see the above list of potential reasons why PDA is controversial. Is there anything you think should be taken out? Or anything that should be included?
@threadreaderapp Please could you unroll?

Thank you in advance.
@PDASociety @Autism

Representatives of your organisations/ or "clinicians" who consult on "PDA is an ASD" can respond privately to the above list of potential controversies of PDA. Please respond by Monday 31/05/2021.
@PDASociety @Autism I doubt that either organisation would publicly respond to this list, but I am willing to hear out a defense on particular point.

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More from @Richard_Autism

2 May
I am slightly upset by this. For those who think PDA is significantly different for autistic persons vs non-autistic persons. I give you 150 reasons that contradicts you (as it includes non-autistic persons):
There are other reasons to think, such as processes that develop & maintain PDA behaviours are not specific to PDA. Also need same strategies & protection from reinforcement-based approaches.

I will keep on saying this what matters the most
"criteria will be their clinical utility for the assessment of clinical course and treatment response of individuals grouped by a given set of diagnostic criteria."

I.e. not a clinicians view PDA is autism.
Read 4 tweets
1 May
Considering ethics of PDA research.

Does anyone else consider the potential impact of propagating a controversial construct, that is clinically unrequired and possibly heavily stigmatising?

Kind of expecting @milton_damian would pick up on this if I do not.
The point here it is a reasonable question, considering PDA strategies are good practice & widely practiced. Critique PDA represents features/ traits from accepted constructs also seems valid. Another point I have forgotten.
Then there is substantial dislike of "Pathological" descriptor & other "problematic" connotations around PDA, like like substantial non-compliance to societal/ cultural norms.
Read 5 tweets
21 Apr
So I have been looking at Soppitt's PDA and how it relates to other conditions diagram. This is my version of Soppitt's diagram (2021, p299). I fully spelled out ADHD's name.
This is my version of the diagram. I might change the "Rational Demand Avoidance" to "Pathological Demand Avoidance", as to me its the same thing. Nominally using RDA as it is a better name than PDA.
I have added anxiety in between autism and trauma circles. I have added trauma/ developmental trauma to recognise some view PDA to be developmental (even though that is optional for a PDA dx/ not needed).
Read 21 tweets
20 Apr
@Keirwales If you do have Sammi Timimi on the podcast, please could you ask him, what is their response is to the points around the validity of autism made here:
@Keirwales How co-occurring conditions often present differently inside & outside autism, due to simultaneously interacting with each other. Surely, there is something valid there causing co-occurring conditions to present slightly differently?
@Keirwales E.g. anxiety disorders often have different causes for their behaviour in autism.
Read 24 tweets
19 Apr
So I was flicking through these slides of Christie's in 2016
There are some comments towards the end which I think are insightful, not necessarily for good reasons.
These four before his final comment (which I critique elsewhere).
I will probably be critiquing these comments of Christie's over the next of couple of days, not necessarily in order.

This seems fair to me:
"Significantly improve awareness and understanding of PDA in adults"
Read 47 tweets
14 Apr
Has anyone argued autism is not a disorder, from the APA's definition of disorder?
"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental...
... Mental disorders are usually associated with significant
distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss,...
Read 21 tweets

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