Thread by @Richard_Autism

So something that has been nagging me this morning due to a couple of recent articles.

Can autism be viewed as a disorder without adopting a medical model of disability approach to it, i.e., conceptualising autistic features as deficits?

This is one of the articles in question, be @liz_pellicano .
acamh.onlinelibrary.wiley.com/doi/full/10.11…

I am specifically referring to the DSM-5 definition of Disorder from page 20 (APA 2013).

I think that how I model PDA, intrinsically conforms to this definition of Disorder, without locating the issues often associated with PDA as deficits located within the person.

Yet, I think this is rather fortunate, as features associated with PDA seem to rather conveniently adhere to this definitions components.

For example, behaviours/ responses need to contradict cultural norms, this something @Allison66746425 describes very well on her work on PDA, how asserting ones self-agency, especially as a CYP contravenes many cultural norms.

Other components.
"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 functioning."

Next component features of a disorder impact functioning in certain areas, &/ or associated with substantial distress.

"Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities."

These components of a Disorder, PDA seems to inherently meet. It is literally about avoidance of demands, often "ordinary demands of life" (non-autistic societal demands).

Specifically referring to impact on functioning in certain areas. Even if one adopts my wording for that trait "Avoidance of everyday demands" (so should be more routed to each person's "everyday demands). It still would be viewed as disabling.

Even at lower diagnostic thresholds, such as:
“…start to display avoidant behaviour and challenging behaviour in response to a particular stressor…” (Eaton 2018, p20).
Would tend to be avoidance of going to school, which is transgressing "ordinary" demands

Next aspect of this component:
"Mental disorders are usually associated with significant distress"
I think there is a good case to view PDA as a being related to distress & trauma.
…emandavoidancecom.files.wordpress.com/2020/08/06-aug…

"Switching of mood may be response to perceived pressure; goes “over the top” in protest or in fear reaction"
"(As last resort): outbursts, screaming, hitting, kicking; best construed as panic attack." (Newson et al 2003, p597).

"Repetitive questions used for distraction, but may signal panic." (Newson et al 2003, p597)
"60% have extreme outbursts or panic attacks." (Newson et al 2003, 596).

I also discuss here, how I view PDA to be about stress management using a transactional perspective.

The point I am trying to make is that significant distress is meant to be an intrinsic feature of PDA. which conforms to one aspect of being a disorder.

I am not going to describe exactly how PDA conforms to a definition of a disorder, but will give one more example of how it conforms to it.

"clinically significant disturbance in an individual’s cognition, emotion regulation"

Specifically, the emotional regulation issues, this would be represented by the rapid mood changes/ lability of mood trait.

"Sixty eight per cent of the sample in studies A and B showed extreme lability of mood, and among these 30% included a switching from “love” to “hate” in their behaviour. At an apparently trivial level,..." (Newson et al 2003, p597).

I am unsure if autism itself can so easily conform to DSM-5 Disorder definition, but it is something I will need to reflect upon, & probably logically breakdown. I suspect that autism will not so easily meet this definition as PDA does.

If it is the case that autism does not intrinsically easily conform to DSM-5 Disorder definition while PDA does, it would support notion PDA is not "Profile of ASD". That PDA represents it's own distinct clustering of features.

Just to remind everyone, PDA has always meant to represent a different clustering of features from autism. Eg. O'Nions PhD thesis p93.

Newson's PDA diagram in 2003.

Previous diagram is on page 599.

Newson's original PDA diagnostic grouping diagram. The clustering of features for autism, includes Asperger's Syndrome.

Available from here (Newson 1996, p6):
autismeastmidlands.org.uk/wp-content/upl…

A more recent image of mine based on current published research results, showing PDA with its "spiky profile" of features (Woods 2021m p12).

I getting the impression, it would probably be best if I create a table of aspects of the DSM-5 Disorder Definition & seeing how PDA & Autism conform to it, or not.

I will do this, it might take me some time, there are a few deadlines I need to meet this month, which are taking priority (e.g. I am currently drafting slides for my talk on the 18th). This is an exercise I think is worth doing.

*Yes*. I have started work on the blog post of this. I am awaiting advise I have accurately represented DSM-5 Disorder definition's separate components. This blog post will be done to a similar standard as this:
rationaldemandavoidance.com/2021/04/25/pda…

Contrary to what some people think, I do doubt myself, I do try to get advise from other persons, & I do try to act upon it.

*Yes* I have started the slides for the talk on the 18th of November:

"Demand-Avoidance Phenomena (“Pathological”/ “Extreme” Demand Avoidance): It’s four schools of thought, and how you may conceptualise it?"

I will create a Youtube video of this talk.