Thread by @Richard_Autism

So, this is a thread on draft text of slides for a video on "Examples how “Pathological Demand Avoidance (PDA) Profile of ASD” seems to be a constructed category."

https://twitter.com/Richard_Autism/status/1700290528602964116

Usual caveats, not providing text from slides which are common to talks. I will provide images of the reference slides, but not text from references slides.

I will tweet text from one slide at a time & then post an of each slide.

Introduction.

1)An introduction to topic showing a few examples.
2)PDA features continua diagram.
3)How “PDA Profile of ASD” is being socially constructed.

4)Socially “manipulative”-”strategic” avoidance trait change.
5)Autism/ social communication categories history.
6)Autism, anxiety, & PDA.
7)Reflective questions.

Below is image of text from slide 4.

Below is image of PDA features as a series of continua from slide 5.

Autism criteria bias towards males is constructed.

1)Methodological bias, resulting from the inclusion of predominantly male samples, as well as the use of clinical tools designed to fit the male autism presentations.
2)Stereotype autism is a “boy’s disorder”

3)Males are many times more likely to referred than females.
4)When autism features are comparable levels, females are less likely to be attributed with autism than males.

5)Autistic females are often being missed, diagnosed later than males or misdiagnosed (Lockwood-Estrin et al 2021).

Below is image of text from slide 6.

“PDA Profile of ASD” is constructed via similar processes.

1)“It should be noted that, so far, we have approached this profile from the starting point of our expertise in ASD.” (O’Nions et al 2016b, p2).

2)“As a result of this broadening of the way that autism and the autism spectrum are seen, the contributors’ view is that PDA is currently best understood as a ‘profile’ (or cluster of traits) on the autism spectrum.” (PDA Society 2022, p3).

3)Investigating population prevalence in autistic persons (Gillberg et al 2015).
4)Exploring PDA’s behaviour profile in suspected autistic person’s (Eaton & Weaver 2020).

Below is image of text from slide 7.

“PDA Profile of ASD” is constructed via similar processes.

1)EDA-Q, EDA-8, & 11 Revised PDA DISCO items are validated in supposedly entirely autistic samples (O’Nions et al 2014a; O’Nions et al 2016b; O’Nions et al 2021).

2)Assumed PDA is a meaningful autism subgroup & arbitrarily seen in less than 30% of autistics (O’Nions et al 2016a).

3)“within their autism diagnosis, there is a range of terminology that is used in formulations, including ASD with:
• a PDA profile/a Pathological Demand Avoidance profile
• a demand avoidant profile/a profile of demand avoidance
• extreme/pervasive demand avoidance” (PDA Society 2022, p20).

Below is image of text from slide 8.

“Manipulative” vs “strategic” avoidance behaviours example.

1)PDA descriptions changed away from indicating not autism, to become autism-like features.
2)E.g., “manipulative” behaviours are not indicative of autism (Woods 2022).

3)E.g., “strategies of avoidance are essentially socially manipulative” (Newson et al 2003, p597) to “strategies of avoidance that are essentially ‘socially manipulative’” (O’Nions et al 2016a, p415), then to “Uses social strategies as part of avoidance, eg, distracting, giving excuses” (Green et al 2018a, p457).

Below is image of text from slide 9.

“Manipulative” vs “strategic” avoidance behaviours example.

1)“This was combined with sufficient social understanding and sociability enable the child to be “socially manipulative” in their avoidance”. (Fidler & Christie 2019, p10).

2)“They are also able to use social strategies in attempts to avoid demands in a way that Elizabeth Newson described as “socially manipulative” but others tend to describe as socially “strategic” (Fidler & Christie 2019, p11).

Below is image of text from slide 10.

Newson’s views on “manipulative” avoidance behaviours.

1)“At first sight normally sociable with enough empathy to manipulate adults as shown above; but ambiguous and without depth.”

2)“No sense of responsibility, not concerned with what is “fitting to her age” (might pick fight with toddler). Despite social awareness, behaviour is uninhibited…”
3)“…because motivation to avoid demands is so sustained, and because the child knows no boundaries to avoidance.” (Newson et al 2003, p597).

Below is image of text from slide 11.

Below is Newson et al (2003, p599). Pervasive Developmental Disorders diagram, which is on slide 12.

PDA tool question or sub-question denoting intent/ manipulative (Woods 2022, p70).

1) Good at getting round others and making them do as s/he wants.
2) I blame or target a particular person/persons.

3) Does A harass other people? (e.g.writing threatening letters, making verbal threats, stalking, untrue accusations of sexual abuse).
4) Does A frequently tease, bully, refuse to take turns, make trouble.

5) Socially shocking behaviour with deliberate intent
6) Lies, cheats, steals, fantasises, causing distress to others.
7) Would you describe A as good at getting round others and making them do as s/he wants, or playing people off against each other?

8) What strategies does A use to get out of things? Are these strategies targeted at a particular person?
o Distracting (e.g. asking questions)
o Apologising and making excuses
o Withdrawing into role play or toy play
o Charm
o Passively (e.g. selective mutism)
o Other

9) Does A ever threaten to hurt him/herself, or do things to hurt him/herself?
10) Is this behaviour impulsive, or does A do it on purpose to show s/he is in control, cause distress or get attention?

Below is image of text from slide 13.

Biasing PDA research & descriptions.

1)Socially “strategic” denotes with intent as done part of a plan.
2)PDA not related to ToM issues (Bishop 2018).
3)“Socially manipulative” = socially “strategic”.
4)Where does socially “strategic” behaviours originate from?

Below is image of text from slide 14.

Below is image of text from slide 14.“Strategic” avoidance behaviours are result of methodology.

1)Socially “strategic” avoidance features are from O’Nions et al (2018).
2)O’Nions et al (2018) is a replication study of O’Nions et al (2015).

3)“…examples suggest social insight sufficient to use targeted social manipulation…” (O’Nions et al 2015, p1).

4)O’Nions et al (2018) coded interview data with 11 Revised PDA DISCO items; e.g., “Apparently manipulative behaviour”,\ cannot be “manipulative” due to “apparently” descriptor!

Below is image of text from slide 15.

Has autism expanded to include PDA example.

1)“As a result of this broadening of the way that autism and the autism spectrum are seen, the contributors’ view is that PDA is currently best understood as a ‘profile’ (or cluster of traits) on the autism spectrum.” (PDA Society 2022, p3).

Below is image of text from slide 16.

Below is table on slide 17. Table compares Newson et al (2003) Pervasive Developmental Disorders category grouping with accepted PDD category grouping in DSM-4.

Newson's PDD category is NOT the same as DSM-4 one.

Has autism expanded to include PDA example.

1)Supposedly as PDDs were replaced DSM-5 ASD (Christie 2007; Christie et al 2012; Fidler & Christie 2019).

2)DSM-5, PDDs replaced by ASD & SCD within Neurodevelopmental categories (APA 2013).
3)Rett’s Syndrome excluded for having biomarker (Thomas & Boellstorff 2017).

Below is image of text from slide 18.

Brief social communication issues & RRBIs categories history.

1)Kanner viewed autism as a form of CS (Silberman 2015).
2)Historically many other categories with social communication issues & RRBIs were proposed, either as subtypes of CS, or as standalone categories (Wing 1991).

3)Paradigm shift, CS died out in 1980s, similar time as autism started to be viewed as a PDD & entered DSM-3.
4)First PDA case in 1975, & in 1986 Newson proposed PDA as a Pervasive Developmental Coding Disorder (Newson 1989).

5)Late 1980s “autism spectrum”, as part of PDDs.
6)1999 Newson revised PDA as a PDD (Newson 1999).

Below is image of text from slide 19.

DSM-5 era autism history.

1)DSM-5 autism criteria not designed to create autism subtypes (Kapp 2023).
2)Seems little interest in SCD (Kapp & Ne’eman 2019).
3)Atypical time of social communication & RRBIs categories with one undivided category in common use.

4)Examples of PDA attributed as standalone category, such as, Crane et al (2016), Newson et al (2003), & Trundle et al (2017).

5)If PDA is an ASD, PDA is also a Neurodevelopmental category.
6)Arbitrary to view PDA as a “Profile of ASD” when it can be attributed as a standalone Neurodevelopmental category!

Below is image of text from slide 20.

A reflection exercise.

1)Simple thought experiment which highlights “PDA Profile of ASD” is constructed.

2)How would one conceptualise & clinically attribute PDA in different historical periods, e.g.,1940s, or 2000s?
3)Hint: Kanner folded autism within CS.
4)Hint: Newson evolved PDCD grouping into variation of PDDs.

Below is image of text from slide 21.

Final example indicating “PDA Profile of ASD” is constructed.

1)“PDA Profile of ASD” central impairment is meant to be anxiety, causes most-all demand-avoidance (PDA Society 2022).
2)DSM-5 autism criteria views anxiety is a co-occurring difficulty.

3)PDA features predicted by hyperactivity, conduct problems & anxiety (Green et al 2018).
4)Maybe “triple-hit” of autism, conduct problems & anxiety (O’Nions 2014b).

5)“Both autistic traits and anxiety were unique and equally important predictors of demand avoidance.” (White et al 2023, p2680).
6)A + B + C ≠ A, PDA cannot be something it is more than.

Below is image of text from slide 22.

Using co-occurring difficulties to create autism severity levels.

1)“In Waizbard-Bartov et al. (2023) we argue that due to the high prevalence of co-occurring challenges among autistic individuals, and the significant impact these challenges have on individuals’ everyday lives,...

"...it is appropriate to consider including them as part of a formal classification system for autism severity. It is the nature of diagnostic classifications to evolve over time as more information is collected and a better sense of the condition is reached..."

"When more autistic individuals are diagnosed with co-occurring anxiety than not (Kerns et al., 2020), should anxiety be considered a co-occurring condition or a fundamental part of having autism contributing to its severity level?” (Waizbard-Bartov et al 2023, p1)."

Below is image of text from slide 23.

Problems with co-occurring difficulties to create subtypes.

1) “Diagnostic categories as described within the American Psychiatric Diagnostic Manual (DSM-5), are not designed to map large sections of a person’s spiky profile,..."

"...with residual categories commonly diagnosed. Often pertinent parts of a person’s spiky profile are missed during assessments, consequently, DSM-5 contains a section for cross-categorical tools,..."

"...and it is common to have multiple diagnoses (American Psychiatric Association, 2013)...."

"...Frequently the differences between diagnostic categories are arbitrary, with clinicians’ bias affecting what a person is diagnosed with, such as through diagnostic substitution.” (Woods et al 2023, p1)."

Below is image of text from slide 24.

Concluding reflective questions.

Are there other examples indicating “PDA Profile of ASD” is constructed?
Why?

Is “PDA Profile of ASD” a rare autism subtype, before or after, O’Nions et al (2016a) arbitrarily decided PDA is seen in less than 30% of autistics?
Why?
Has autism expanded to include PDA features, in part, or in entirety?
Why?

Below is image of text from slide 25.

Concluding reflective questions.

Can one assume a person is autistic due to being attributed with PDA?
Why?

If one accepts most assumptions underpinning of “PDA Profile of ASD”, can PDA be attributed as a standalone Neurodevelopmental category?
Why?
How should one conceptualise & clinically attribute PDA during 2010s?
Why?

Below is image of text from slide 26.

This all the text I will be quoting.

There are 5 reference slides, which I will start in this tweet.

Below is the first reference slide.

Below image is the second reference slide.

Below image is the third reference slide.

Below image is the fourth reference slide.

Below the fifth & last reference slide.

That is the text & references shared of the slides for the video titled "Examples how “Pathological Demand Avoidance (PDA) Profile of ASD” seems to be a constructed category."

@threadreaderapp please can you unroll?

Thank you in advance.