Pathological Demand Avoidance: symptoms but not a syndrome

Jonathan Green, Michael Absoud, Victoria Grahame, Osman Malik, Emily Simonoff, Ann Le Couteur, Gillian Baird

Research output: Contribution to journalComment/debatepeer-review


Pathological (or extreme) demand avoidance is a term sometimes applied to complex behaviours in children within—or beyond—autism spectrum disorder. The use of pathological demand avoidance as a diagnosis has, at times, led to altered referral practice and misunderstandings between professionals and the families of patients. In our Viewpoint, we reviewed the current literature and conclude that the evidence does not support the validity of pathological demand avoidance as an independent syndrome. Nevertheless, the use of the term highlights an important known range of co-occurring difficulties for many children with autism spectrum disorder that can substantially affect families. We explore how these difficulties can best be understood through understanding of social, sensory, and cognitive sensitivities in autism spectrum disorder, identification of frequently occurring comorbid conditions, and assessment of how these problems interact within the child's social environment. Such understanding should then inform individualised management strategies for children and families, and in social settings, such as education. It is crucial that a shared understanding is achieved between professionals and families in this area.

Original languageEnglish
Pages (from-to)455-464
Number of pages10
JournalThe Lancet Child and Adolescent Health
Issue number6
Early online date23 Mar 2018
Publication statusPublished - 1 Jun 2018


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