This guideline document has been endorsed by the National Health and Medical Research Council (NHMRC) so represents optimal clinical care in Australia. However, the Autism CRC (Cooperative Research Centre for Living with Autism) released a national guideline in 2018 acknowledging the PDA profile as part of the autism spectrum. Looking to present day 2021, the DSM-5 now recognises autism as a spectrum, although neither the DSM-5 nor the ICD-2 make reference to PDA. Professor Newson died in 2014, but her work has been continued by former students and colleagues at the Elizabeth Newson Centre, who advocate for ongoing research in the area of Pathological Demand Avoidance. These children would most likely meet criteria for what was once known as Pervasive Developmental Delay Not Otherwise Specified (PDD-NOS) considered part of the autism spectrum. Whilst it was clear these children met many markers for autism such as communication difficulties, social challenges and emotional and sensory dysregulation, they were unusual in that there was often capacity for superficial social interaction, imaginative or fantasy play and a persistent lack of positive responses to the usual early childhood behavioural interventions. She was supported in this by the many parents who continued to bring their ‘autistic but not quite autistic’ children to her. Twenty-three years later she published an article in the Archives of Disease in Childhood journal arguing for the presentation of PDA to be recognised as a unique profile within the autism spectrum. In 1980, child psychologist Elizabeth Newson came to note a cluster of children attending with an atypical autism presentation at the Child Development Clinic within Nottingham University. Despite this the concept of PDA isn’t new. There is however a growing understanding of PDA across educational sectors, as well as within psychology, paediatrics and psychiatry, and thankfully slowly but surely families are starting to have a better chance of finding supportive professionals. These are the kids who inhabit the ‘too hard basket’ in schools and many families resort to homeschooling as the education system is unable to manage the unique features and challenges of the PDA child. Children with PDA do not respond to typical behavioural interventions and strategies, in fact any attempts to correct behaviours are usually met with escalation or even outright aggression. There is an emerging awareness of a distinct profile of autism currently termed Pathological Demand Avoidance (PDA). Introducing Pathological Demand Avoidance
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