Thread by @Richard_Autism

What do you think about this?
"Those with severe IDD were excluded from some of the analyses regarding the rate of PDA in subgroups, given that it is difficult to envisage the whole PDA phenotype developing in an individual with severe or profound general cognitive dysfunction."

Quote is from p981 in Gillberg et al 2015.

Link below to the article
link.springer.com/article/10.100…

I will make time to give my thoughts on this quote when I have time, it will take me about an hour to organise thoughts into something cohesive for Twitter. A lot can be said about that quote. Quote has implications for PDA prevalence rate suggested in Gillberg et al (2015).

Before adding my notes. I should give context the quote at the start. Quote is from Gillberg et al (2015), which seems to have a slightly different portrayal of PDA to how some do in the UK.

"However, the apparently socially manipulative behaviour is not characteristic of ASD, and is, in fact, by some, considered to be an exclusionary criterion for a diagnosis of ASD...

... Wing et al. [18] suggested that PDA might be a “double hit”, that PDA is an additional problem in ASD but not due to ASD." Gillberg et al 2015, p980.

"“Classic PDA” was defined as Total PDA score of 5 or more and including the presence of socially manipulative or shocking behaviour to avoid demands." Gillberg et al 2015, p981

Previous quote is important in how socially manipulative behaviour is often considered compulsory to a PDA identification, so having it either or is quite low...

... score of 5 or more, is a score of 5 or more on 15 original PDA DISCO items. Due to nature of proportion of PDA traits are assessed by separate items, it is possible for person to score 5 ore more by expressing traits which are not considered essential by others.

I.e., Gillberg et al (2015) has a low diagnostic threshold for PDA. Which is something I discuss in detail here:
rationaldemandavoidance.com/2021/04/25/pda…

Before discussing my own thinking on Gillberg et al (2015) quote I should point out that it is not necessarily reflective of others thinking on PDA. For instance PDA Society states that PDA can be present in those with ID.

"Those with severe IDD were excluded from some of the analyses regarding the rate of PDA in subgroups, given that it is difficult to envisage the whole PDA phenotype developing in an individual with severe or profound general cognitive dysfunction." Gillberg et al 2015, p981.

That if those with ID issues have been excluded from analyses, it suggests the prevalence rate of 18% for PDA in autistic persons is an under estimate. If so, the suggested prevalence rate in autistic persons would be offset by low diagnostic threshold used for PDA in study.

https://twitter.com/Richard_Autism/status/1601340532323942400

Quote suggests what kind of behaviours people use to express their self-agency are valued by society. This has already been commented in detail by others, including @KatyBenson20 & @Jodiewilde_

Gillberg et al (2015) views PDA's social avoidance behaviours as being manipulative, it seems that author's assumed those with LD could not do manipulative social avoidance behaviours....

... Despite this, it seems unclear how else those with LD could not express PDA features. It is possible for someone to non-verbally express demand-avoidance behaviours...

... It is possible to:
use distractions.
incapacitate oneself.
be violent.
give control/ take control.
threaten others oneself
leave area etc.
& other demand-avoidance features without uttering an word, while conveying information entirely through body language &/ or actions....

.., This takes me back to point of how Gillberg et al (2015) quote can be used to interrogate which behaviours society & culture values, when people are asserting their self-agency.

Quote also assumes a predefined notion of what PDA is. I also suggest it supports the notion PDA is being used to mark "support needs" in persons, perpendicular to the linear autism spectrum, which tends to run based on IQ...

... An example below. Image below compares a linear spectrum of autistic features compared to functioning ability. Diagram is flawed, as it shows notion that those who are low functioning automatically have higher support needs than those who are high functioning...

... So PDA is modelled as being a perpindicular to that linear autism spectrum, with PDA being used to mark support needs that is independent of IQ. The shading in autism & PDA boxes is meant to show levels of support needs. Again it is using a false assumption on support needs..

... The diagram is there to explain how PDA is being used in practice. I think this makes sense when one compares how PDA is being justified compared to "Profound Autism"...

... Below diagram shows three clusterings of traits, representing Aggregated PDA, DSM-5 autism & "Profound Autism" groups.

I am getting close to end of my views on Gillberg et al (2015) quote. Just going to clarify point about that "strategic" behaviours are done with intent, & thus equivalent to "manipulative" behaviours....

... My present thinking is that "strategic" behaviours are equivalent to "manipulative" behaviours, as they both require intent to do the action. If something is strategic, it is part of a strategy, and thus part of a plan, so i.e., someone has chosen to do it...

... I am referring to "automatic" social avoidance features, done when highly stressed/ distressed as compulsive, especially those which have generalised....

https://twitter.com/Richard_Autism/status/1601346975810846720

Above 3D model for demand-avoidance behaviours is applicable to those with LD, irrespective if a person is expressing "strategic"/ "manipulative"/ compulsive avoidance behaviours.

On that note, I do not have anything else to add on my critique of Gillberg et al 2015 quote, at least off the top of my head, late on a Friday. haha.

I hope people have found critiquing the Gillberg et al (2015) useful & interesting.

@threadreaderapp please can you unroll?

Thank you in advance.