Jump to comment:

• Pathological demand avoidance syndrome or psychiatric disorder?
  M Elena Garralda
  Published on: 22 March 2016

• Published on: 22 March 2016

  Pathological demand avoidance syndrome or psychiatric disorder?

  • M Elena Garralda, Professor of Child and Adolescent Psychiatry

  Dear Editor

  In the recent issue of the Archives, Newson et al.[1] make the case for a distinctive "pathological demand avoidance syndrome". This arose out of the work by the authors in a clinic for children with problems in communication.

  These children are described as having a tendency to avoid or resist ordinary demands, to have surface sociability but a lack of sense of identity, pride and sham...

  Show More

  Dear Editor

  In the recent issue of the Archives, Newson et al.[1] make the case for a distinctive "pathological demand avoidance syndrome". This arose out of the work by the authors in a clinic for children with problems in communication.

  These children are described as having a tendency to avoid or resist ordinary demands, to have surface sociability but a lack of sense of identity, pride and shame, labile mood, impulsivity led by need to control, language delay, obsessional behaviour and some sort of - usually "soft" - neurological involvement. The syndrome is not a recognised psychiatric disorder in either ICD-10 or DSM-IV classification systems.

  How well do the authors make the case for this new syndrome? Some of the features outlined (for example sense of identity, price and shame) would be specially difficult to identify reliably. Others are suggestible of a number of different child and adolescent psychiatric disorders as described in ICD-10 and DSM-IV (WHO, 1991; APA, 1994).[2,3] From the authors' descriptions, the impression is that these children are likely to have had co-morbid developmental and psychiatric problems, varyingly including oppositional defiant and/or hyperkinetic disorder or social anxiety disorder of childhood. In some cases the features described may have been precursors of a schizotypal disorder.[4] The paper does not however make a case for the validity or specificity of the syndrome in relation to these disorders.

  The paper helpfully draws attention to the clinical variability amongst children with communication disorders. However, it would seem regrettable if new syndromes were to be used in clinical practice without consideration of whether an established psychiatric diagnosis would have been appropriate, as this will create confusion for parents and others involved. Better integration of paediatric and child psychiatric services working with children with developmental communication disorders should help reduce the likelihood of this happening.

  References

  (1) Newson E, Le Marechal K, David C. Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders. Arch Dis Child 2003; 88:595-600.

  (2) APA. Diagnostic and statistical manual of mental disorders, 4th Edition. DSM-IV. Washington: APA, 1994.

  (3) WHO. ICD-10 classification of mental and behavioural disorders. London: Churchill Livingstone, 1991.

  (4) Roberts S, Garralda E, Renfrew D. Schizotypal disorder among child and adolescent mental health users. Journal of the American Academy of Child and Adolescent Psychiatry 2001;40:1366.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top