Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, and Manchester Academic Health Sciences Centre, Manchester, UK.
Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Lancet Child Adolesc Health. 2018 Jun;2(6):455-464. doi: 10.1016/S2352-4642(18)30044-0. Epub 2018 Mar 23.
Pathological (or extreme) demand avoidance is a term sometimes applied to complex behaviours in children within-or beyond-autism spectrum disorder. The use of pathological demand avoidance as a diagnosis has, at times, led to altered referral practice and misunderstandings between professionals and the families of patients. In our Viewpoint, we reviewed the current literature and conclude that the evidence does not support the validity of pathological demand avoidance as an independent syndrome. Nevertheless, the use of the term highlights an important known range of co-occurring difficulties for many children with autism spectrum disorder that can substantially affect families. We explore how these difficulties can best be understood through understanding of social, sensory, and cognitive sensitivities in autism spectrum disorder, identification of frequently occurring comorbid conditions, and assessment of how these problems interact within the child's social environment. Such understanding should then inform individualised management strategies for children and families, and in social settings, such as education. It is crucial that a shared understanding is achieved between professionals and families in this area.
病理性（或极端）需求回避是有时用于描述自闭症谱系障碍儿童或超出自闭症谱系障碍儿童的复杂行为的术语。将病理性需求回避作为一种诊断方法的使用，有时会导致转诊实践的改变和专业人员与患者家属之间的误解。在我们的观点中，我们回顾了当前的文献，并得出结论，没有证据支持病理性需求回避作为一个独立综合征的有效性。然而，该术语的使用突出了许多自闭症谱系障碍儿童中常见的一系列已知的共同困难，这些困难会对家庭产生重大影响。我们探讨了如何通过了解自闭症谱系障碍中的社会、感官和认知敏感性、识别经常出现的共病情况，以及评估这些问题在儿童的社会环境中如何相互作用，来最好地理解这些困难。这种理解应该为儿童和家庭的个体化管理策略提供信息，并在教育等社会环境中提供信息。在这方面，专业人员和家庭之间达成共识至关重要。
