Thread by @Richard_Autism

@DrJudes03 @DrJoelSchwartz @PDASociety It is perfectly reasonable when
1) Help4Psychology produce an algorithm that is not representative of broader literature. E.g. see:

https://twitter.com/Richard_Autism/status/1421472735369256962

@DrJudes03 @DrJoelSchwartz @PDASociety 2) Goes against Christie's views to reduce number of PDA traits.

"refine our understanding of the essential criteria and the core difficulty with social identity" Christie, 2016, s60.

@DrJudes03 @DrJoelSchwartz @PDASociety From O'Nions and Eaton, 2021, p413. There are more traits there, than in most PDA behaviour profiles.

@DrJudes03 @DrJoelSchwartz @PDASociety 3) "clinicians were not particularly ‘on the lookout’
for PDA features in their cases" O'Nions et al, 2016, p418.

Clinicians can be on the lookout for PDA. We are talking about a private clinic that specialises in PDA, & also views PDA to be an ASD.

@DrJudes03 @DrJoelSchwartz @PDASociety Sorry image for point two.

@DrJudes03 @DrJoelSchwartz @PDASociety 4) The potential bias of participants is actively discussed in PDA literature, including SR. We know that a clinicians bias can impact a person receiving an autism dx, such as in females.

@DrJudes03 @DrJoelSchwartz @PDASociety It is logical to assume clinicians bias to PDA being an ASD, may impact how they diagnose a person who they believe has PDA. Unless you are arguing you, or other clinicians are also exempt from such biases?

@DrJudes03 @DrJoelSchwartz @PDASociety 5) Your response also over reifies the knowledge base of clinicians and supposes that non-clinicians do not understand the diagnostic process. Although, I can point to other tweets of mine that would indicate that I do understand that process.

@DrJudes03 @DrJoelSchwartz @PDASociety 6) "In addition, there is no scoring scheme to identify the requisite severity or pervasiveness of these behaviours" O'Nions, 2013, p84.

Which begs the question on what literature/ opinion Help4Psychology decided that PDA needs to be pervasive?

@DrJudes03 @DrJoelSchwartz @PDASociety DSM-5 definition for Disorder is broad & its threshold for features being "pathological" is:

"the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." APA 2013, p21.

@DrJudes03 @DrJoelSchwartz @PDASociety Which is actually quite low, it does not require a feature to be an issue in multiple settings or even be pervasive.

@DrJudes03 @DrJoelSchwartz @PDASociety 7) “Professionals and teams working with children need to become aware of the ways in which girls can mask their difficulties, and need to move away from using the DSM as a ‘bible’...

@DrJudes03 @DrJoelSchwartz @PDASociety ... Stating that someone does not fulfil criteria, when these criteria are based on upon a ‘male’ presentation of a disorder, is short sighted in the extreme.” (Eaton, 2017, page 176).

@DrJudes03 @DrJoelSchwartz @PDASociety I generally accept the point that DSM-5 criteria are biased towards males & those not conforming to autism stereotypes. I do not really have any issue with Help4Pyschology using different criteria for autistic females.

@DrJudes03 @DrJoelSchwartz @PDASociety Thread where I discuss that DSM-5 often struggles to diagnose persons who do not conform to autism stereotypes.
…emandavoidancecom.files.wordpress.com/2020/08/01-aug…

@DrJudes03 @DrJoelSchwartz @PDASociety PDA stereotypes often are opposite of autism stereotypes.

@DrJudes03 @DrJoelSchwartz @PDASociety

@DrJudes03 @DrJoelSchwartz @PDASociety The issue is that based on your own acknowledgement Help4Psychology make an autism diagnosis before it diagnoses PDA (which is a practice that intrinsically discriminates against non-autistic persons with PDA).

@DrJudes03 @DrJoelSchwartz @PDASociety When one views PDA to be an ASD, one tends to locate features/ issues within the individual, & not transactional in nature. Some view PDA to be a female form of autism.

@DrJudes03 @DrJoelSchwartz @PDASociety I suspect why Comfortable & Pretend trait did not cluster with other demand-avoidance traits in O'Nions (2013) is probably because the EDA-Q views PDA to be an ASD.

@DrJudes03 @DrJoelSchwartz @PDASociety So Comfortable Roleplay & Pretend features were seen as fixed aspects of a person, not a coping mechanisms as Newson suggested. Presumably those features should cluster with demand-avoidance traits if one takes a transactional approach to PDA.

@DrJudes03 @DrJoelSchwartz @PDASociety The point I am trying to make here, is that we cannot be sure that Help4Psychology views PDA is an ASD, has not impacted how it makes an autism diagnosis in those it believes have PDA, as it is likely PDA features are conflated with DSM-5 autism ones.

@DrJudes03 @DrJoelSchwartz @PDASociety Help4Psychology seems to have no issue not strictly following DSM-5 autism criteria when it thinks it is appropriate. The clinic diagnoses PDA when it is not in the DSM-5.

@DrJudes03 @DrJoelSchwartz @PDASociety As Help4Psychology diagnoses autism, before it diagnoses PDA, is going to contain autistic females who do not conform to the DSM-5 criteria. Presumably these individuals are in both autism & autism with PDA groups.

@DrJudes03 @DrJoelSchwartz @PDASociety Likewise, if PDA features are being conflated with DSM-5 autism criteria, it is likely to impact how Help4Psychology diagnoses autism, across the entire gender range, as PDA features are seen across the entire autistic population.

@DrJudes03 @DrJoelSchwartz @PDASociety Bottom line is we cannot be sure how many those diagnosed with PDA by Help4Psychology actually meet the DSM-5 criteria. One could probably argue for any autism diagnosis from Help4Psychology.

@DrJudes03 @DrJoelSchwartz @PDASociety There is probably an issue of over reporting autistic persons with PDA across the PDA literature since 2011, due to this fallacy that PDA is an ASD.

@DrJudes03 @DrJoelSchwartz @PDASociety @threadreaderapp Please could you unroll?

Thank you in advance.