Pathological Demand Avoidance – aktueller Forschungsstand und kritische Diskussion
Abstract
Zusammenfassung: Bei der „Pathological Demand Avoidance“ (PDA) handelt es sich um ein kontrovers diskutiertes Konzept zur Beschreibung von Kindern, die durch ein zwanghaftes Vermeiden jeglicher Anforderungen klinisch auffällig werden. PDA wird als extremes und angstgetriebenes Bedürfnis nach Kontrolle der Umwelt, der Verweigerung von alltäglichen Anforderungen und Erwartungen beschrieben. Die Symptomatik wird mit der Autismus-Spektrum-Störung in Zusammenhang gebracht. Unter Berücksichtigung des aktuellen Forschungsstandes diskutiert die vorliegende Arbeit die Frage, ob PDA als eigenständige diagnostische Entität einzuordnen ist, stellt den Zusammenhang zu Autismus sowie anderen psychischen Störungen und die Relevanz dieses Verhaltensprofils für Verlauf und Behandlung dar. Es wird geschlussfolgert, dass PDA weder eine eigenständige diagnostische Entität noch einen Subtyp des Autismus darstellt, sondern als ein Verhaltensprofil zu begreifen ist, das sich ungünstig auf den Verlauf bei verschiedenen Störungsbildern auswirken kann. Es wird deutlich gemacht, dass PDA eine Facette in einem komplexen Störungsmodell darstellen kann, in dem nicht nur Charakteristika der betroffenen Person selbst, sondern auch Erziehungspersonen sowie deren eigene Psychopathologie eine zentrale Rolle einnehmen. Entscheidend sind die Reaktionen der Interaktionspartner_innen auf das Verhaltensprofil sowie die individuellen Behandlungsentscheidungen. Substanzielle Forschung hinsichtlich des Verlaufs verschiedener Störungen bei Vorliegen des Verhaltensprofils PDA sowie im Hinblick auf das Ansprechen auf therapeutische Interventionen ist erforderlich.
Abstract: Pathological demand avoidance (PDA) describes children who obsessively avoid any demand to a clinically relevant extent and is presently the subject of controversial discussion. Their behavior may be interpreted as an attempt to reduce anxiety by establishing security and predictability through rigid control of the environment as well as the demands and expectations of others. The symptoms are described in the context of autism spectrum disorder. This article reviews the current state of research and discusses the questionable validity of pathological demand avoidance as an independent diagnostic entity. It also addresses the impact of the behavior profile on development and treatment. This paper concludes that PDA is not a diagnostic entity nor a subtype of autism; rather, it is a behavior profile that can be associated with adverse illness progression and unfavorable outcomes. PDA is one feature in a complex model. We must consider not only the patient’s characteristics but also those of the caregiver and their psychopathology. The reactions of the interaction partners as well as the treatment decisions play a key role play for the affected individuals. Substantial research is needed concerning the occurrence of the behavior profile PDA in diverse disorders, treatment options, and treatment responses.
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