Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders.

A proposal is made to recognise pathological demand avoidance syndrome (PDA) as a separate entity within the pervasive developmental disorders, instead of being classed under "pervasive developmental disorder not otherwise specified" (PDDnos, DSM-IV). Discriminant functions analysis shows PDA to be significantly different on many counts from classic autism and Asperger's syndrome, both separately and together, including an equal sex ratio (150 cases). Demand avoidance using social manipulation is seen in all children, which strongly contrasts with the features of autistic spectrum disorders. A criterial structure is described, supported by statistical data from a random sample of 50 children diagnosed with PDA, together with a follow up sample of 18 young adults.