Diagnostische validiteit van het concept Pathological Demand Avoidance: een systematische literatuurreview

Title: Diagnostic validity of the concept Pathological Demand Avoidance: a systematic review Background: Much is to be discussed about the evidence, positioning and usefulness of the concept Pathological Demand Avoidance (PDA). The concept of PDA envelopes a behavioural pattern of resistance to meet ordinary demands of life and the usage of manipulative strategies in order to achieve this; a superficial sociability, lability of mood, obsessive behaviour and fallback into role play as a coping strategy. Until now, the validity of this concept has not been systematically reviewed. Method: This review researches the different aspects of validity based on the five phases by Robins and Guze and a supplementary section about treatment guidelines. A systematic search has been conducted to find relevant studies concerning the validity of PDA using the following databases: Pubmed, Embase, Medline, Cochrane Library, Web of Science and Google Scholar. Full articles with a study design or case reports, published in a peer-reviewed journal were included. Results: 12 relevant study designs and 6 case reports were found. Regarding the two common symptomatic descriptions of PDA no operationalization nor cluster analytic studies were found. Two PDA-related measurement instruments are described. They demonstrated a good internal consistency, but are not validated by research in an independent clinical population. The PDA-dimension correlates with other dimensions of psychopathology (ASD, personality factors and ADHD). However, the positioning of PDA (within the Autism spectrum, as a combination of comorbid factors or as a unique diagnosis) remains unclear. Regarding other domains of validity, as regarding treatment response, insufficient conclusive research has been conducted. Conclusion: Insufficient arguments have been found in the current literature to perceive PDA as a valid concept. At first, cluster analytic studies about the symptoms need to be conducted. A valid definition and delineation regarding PDA is critical to conduct further research to other domains of validity.