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Autism

Answer

Pathological demand avoidance (PDA) is not recognised within either the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). As a result, there are no specific recommendations for the diagnosis or treatment of PDA.

In the course of the development of the National Institute for Health and Care Excellence (NICE) clinical guideline on the treatment of autism in children and young people (CG128), the developers looked at differential diagnoses for autism. In this, they did consider PDA, identifying it as a particular subgroup of autism that could also be described as oppositional defiant disorder (ODD). The guidance recommends that consideration should be given to differential diagnoses for autism (including ODD) and whether specific assessments are needed to help interpret the autism history and observations. However, due to the lack of evidence and the fact that the syndrome is not recognised within the DSM or ICD classifications, NICE was unable to develop specific recommendations on the assessment and treatment of PDA.

The Department therefore has no current plans to issue specific guidance on PDA.

However, we would expect the diagnosis, appropriate treatment and well-being of people with autism spectrum disorders to be addressed in plans outlined in both the adult autism strategy, “Fulfilling and Rewarding Lives”, and the recently published update of the adult autism strategy, “Think Autism”.

The strategy and the recent update both clearly recognise the importance of diagnosis as a vital step to ensuring appropriate support and treatment. Since the publication of the strategy in 2010, we have taken a number of steps to support local areas develop a clear pathway to diagnosis. Health services should have a pathway to diagnosis just as local authorities should have a clear framework for assessing the care and support needs of children and adults with autism. The Department for Education has worked closely with the Department of Health over a number of years to encourage early identification of potential autism and to link this with relevant support in school.

The NICE Clinical Guidelines, “Recognition, referral and diagnosis of children and young people on the autism spectrum and Recognition, referral, diagnosis and management of adults on the autism spectrum” recommend the creation of diagnostic leads in every area together with a multi-disciplinary autism group to support the development and delivery of clear, local autism pathways. Our recent self-assessment exercise to map progress locally and nationally with delivery of the adult autism strategy showed that these structures are in place in many areas which should avoid unacceptable regional variations.

Improving well-being of children and adults with autism is a core component of “Think Autism” which focuses on three key areas: enabling people to be included in their local community; promoting innovative, local ideas, services or projects which can help people in their communities through new models of care; providing comprehensive, joined up advice and information for people.

Secondary information

Type

Written question

Reference

195315; 579 cc450-1W

Session

2013-14

Subjects

Autism Health services

Link

View this Written question on www.publications.parliament.uk