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A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance: The Paradigm Shift Program® Pilot Study
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A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance: The Paradigm Shift Program® Pilot Study
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Journal Article
A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance: The Paradigm Shift Program® Pilot Study
2026
Overview
Importance Although pathological demand avoidance (PDA; also known as “extreme” or “persistent” demand avoidance and persistent drive for autonomy) was first described in 1980 as a distinct behavioral profile among a subgroup of children with autism spectrum disorder, there is limited scientific evidence to support children with PDA or their parents/guardians. Objective To establish the feasibility and acceptability of the Paradigm Shift Program®, a 12‐week educational and training program for parents and guardians of children with PDA. Methods Seventy‐six parents/guardians of children with PDA were enrolled in the study. Prior to the start of the program, the parents/guardians completed a baseline assessment (demographic questions, program expectations, and several patient‐reported outcomes [PROs] and proxy measures). At the end of the program, parents/guardians repeated the PROs and proxy measures, and completed a feasibility and acceptability questionnaire and anchor items. Results A total of 71 parents/guardians completed the pre‐program assessment, and 60 (85%) completed the end‐of‐program assessment. Among those with both assessments, program acceptability was high, and parents/guardians were generally satisfied with the different program elements (level of agreement >70% for agreed or strongly agreed). Parents/guardians reported significant improvement in health‐related quality of life (HRQOL) in 10 of the 13 PROs (all P < 0.05). Parent/guardian proxy reports also indicated significant improvements in demand characteristics (P < 0.05), as well as a trend for significant improvement in conduct problems (P = 0.08), total difficulties (P = 0.05), and externalizing behavior (P = 0.05), in their child with PDA. Interpretation The paradigm shift program was both feasible and acceptable. Furthermore, there was evidence that this program improved the HRQOL of parents/guardians as well as the behavior of children with PDA. The Paradigm Shift Program, a comprehensive training program for parents of neurodivergent children with pathological demand avoidance (PDA), was feasible and acceptable, and there were significant improvements in parents’ well‐being following program completion. As the first examination of a parent‐focused intervention for PDA, results suggest a promising alternative to traditional programs.
Publisher
John Wiley & Sons, Inc,Wiley
Subject
