Adult diagnosis of pathological demand avoidance – subsequent care planning

Many patients in residential and secure settings have no formal diagnosis of Autism but may in fact be on the spectrum. This paper seeks to outline the diagnosis and subsequent treatment and intervention planning for a young woman in a low secure hospital.

This paper summarises the literature in relation to the diagnosis of Pathological Demand Avoidance (an atypical presentation of Autism Spectrum Disorder) in children and describes how this diagnosis may present in adults. This search revealed that whilst there was a growing literature around PDA in Children, there was very little literature available about either the clinical presentation or management guidance in adults. A case study design was adopted.

The paper concludes that the lack of an appropriate diagnosis and inappropriate formulation of the underlying causes of challenging behaviour can lead to patients becoming impossible to manage. Many may benefit from diagnosis and Autism‐specific intervention.

This paper highlights the challenges of adult diagnosis of Autism in highly complex individuals and outlines novel approaches to treatment.