Effects of declarative language and an indirect reward system on participation in adult-selected activities in an autistic child with features of pathological demand avoidance

Abstract

Pathological Demand Avoidance (PDA) is a behavioral profile that is often associated with autism spectrum disorder and has received increased attention in the field of child psychiatry, child neurology, and pediatrics. Despite its prevalence, autistic children with a PDA profile often do not respond to many evidence-based interventions recommended for individuals on the autism spectrum. Scarce but available research, coupled by practical guidelines from the PDA Society and PDA North America, suggests the use of low or indirect demands and prioritizing the individual’s autonomy. Using an experimental, single-case, concurrent multiple baseline across activities design, we examined the effects of declarative language and an indirect reward system on participation in adult-selected activities in an autistic child with PDA. Results showed a robust functional relation between the intervention package and the child’s participation in adult-selected activities. Interventionists and the participant’s caregiver positively reported the social importance, appropriateness, and effectiveness of the intervention package. Contributions, limitations, and implications for research and practice are discussed.