Tag: Autism

Jan 12 2026

Book review: Neurotribes by Steve Silberman

Following on from my earlier reviews of books on autism this one is of Neurotribes: The Untold History of Autism and the Potential of Neurodiversity by Steve Silberman.

The book is chronological with a couple of lengthy forewords and an introduction by Silberman describing his original contact with the autistic community stemming from the Silicon Valley culture in 2000.

It is easy to see autism as a modern illness, before the eighties clinically defined autism was very rare. However, even under the strict original definitions there were people like 18th century scientist Henry Cavendish who we would identify as autistic. Cavendish did the same walk every day, changing it only once when he met some people on his usual route after which he always used his new route, he ate a leg of mutton every evening. He attended the Royal Society once a week, where his colleagues were touchingly neuroaffirmative – they valued his contributions but knew to talk in his presence to elicit his input rather than talk to him directly – which would cause him to flee. Cavendish flourished because he came from a wealthy family which could support both his scientific tendencies and his personal oddities.

The term “autism”, as we understand it now, was first used almost simultaneously by Leo Kanner in the US in the diagnosis of “early infantile autism,” and Hans Asperger in Austria with the diagnosis “autistic psychopathy” in papers published in 1943 and 1944. The term autism had been coined by Paul Bleuler in 1911 to describe certain symptoms of schizophrenia – a focus on an inner world or the self. Autism was seen as a childhood presentation of schizophrenia.

Asperger worked in the Children’s Clinic in Vienna, he saw his role as finding the special skills of his patients which could be developed so that they could go on to lead fulfilling and hopefully independent lives.

The Children’s Clinic was to become central to the Nazi euthanasia program which saw the murder of nearly 800 children. A survey from a similar institute in Saxony in 1920 had asked effectively “Would it be ok if your child died in our care, you know, a bit “accidentally”.” to which the answer in some cases the answer was “Why are you asking us? Get on with it”. It was here that the Nazi eugenics programs originated. Asperger was at least complicit in this and his work was consequently ignored until the late eighties.

Kanner was Jewish born in the Ukraine 1896 but had left his job as a doctor in Germany in 1923 largely for economic reasons. He had written a book called Child Psychiatry in 1935 and went on to be the head of child psychiatry at the Johns Hopkins Hospital in Baltimore. He later employed two of Asperger’s former colleagues in his clinic at Johns Hopkins, they were Jewish and had fled the Nazis.

Until the 1950s the standard “treatment” for autistic children and indeed anyone with mental illness was institutionalisation in organisations with names like “Home for Non-educable feebleminded children”. As an aside the original name for the UK’s autistic society was the “Society for Psychotic Children”! Over the years various scandals were unearthed regarding these institutions. It wasn’t until the seventies that the US and UK moved to a legal framework in which disabled people had a right to education rather than institutionalisation.

Both Asperger and Kanner had a very narrow view of what constituted autism seeing it has having a very strict set of criteria, restricted to children. Under their criteria incidence was something like 4 in 10000 children. It wasn’t until Lorna Wing’s work in the eighties that Asperger’s work was finally recognised and the Diagnostic and Statistical Manual of Mental Disorders (DSM) was updated with new, broader diagnostic criteria. It was from Wing that the term “autistic spectrum” came into being. Even in the early nineties there was debate as to whether autism existed in adults. Nowadays the incidence of a more broadly defined neurodiversity is somewhere in the region of 15-20% of the population.

Diagnosis is about providing support – Wing saw that a lot of children needed support – he daughter included – and were failed by diagnosis. At one point a researcher says that for their research work in autism they applied diagnostic criteria rigorously whilst in private practice they were more permissive so that their patients could get the support they needed. All through the period covered by the book some autistic people have made it through to independent adulthood but it has been dependent on the support they are given. As Kanner said “if one factor is significantly useful, it is a sympathetic and tolerant reception by the school”.

If the environment changes to make life easier then there is less need for diagnosis. We could think of the “diagnosis crisis” as an “environment crisis”, we are building environments – particularly schools which are increasingly challenging for neurodiverse people.

The film “Rain Man”, released in 1989, was an amalgam of several people in real life familiar to the screenwriter Barry Morrow. It produced a sea change in the way autistic people were viewed by wider society.

All through the book parents and their children are central. Many times clinicians observed parents to be rather obsessive about their children’s condition and more often than not at least a bit autistic themselves. Even some of the clinicians involved were neurodivergent. Major figures in the book like Bernie Rimland started their journey as parents of autistic children determined to do their best for them. This is reflected today in the parents of autistic children, who in my experience have very deep knowledge of the bureaucratic systems to navigate in order to get support.

For a long time the focus of parents and the medical establishment has been finding a cure for autism, and there has always been a population of snake oil salesmen willing to sell that cure (or at least find a cause to blame). Autism was variously attributed to mothers, vaccines, vitamin deficiencies and ultimately genes depending on the mores of the time. Treatments were at times absolutely brutal – until quite recently electrocuting autistic children to change their behaviour was legal. This is where the anti-vaccine movement comes in rising to prominence as a result of the large increase in autism diagnosis due to the change in diagnostic criteria.

Nowadays more and more autistic people are saying they are not looking for a cure but rather a society that provides relevant accommodations. The cause of autism is generally seen as genetic, not a result of parents, the environment, vaccines or medicines.

The final chapters talk about autistic people being able to speak for themselves, starting in the late eighties with Temple Grandin. It is from this period that the terms neurodiverse and neurotypical come. The internet is core to this – social media often work well for autistic people since much of the social complexity is removed. One wonders how banishing children from social media will work for this group. The role that social media plays is not a new thing, in the early to mid-20th century ham radio and science fiction provided a community for many who would now be described as somewhat neurodivergent.

I loved this book, it is highly readable and it speaks to my concerns not only for my son but also for me.

Sep 22 2025

Book review: Untypical by Pete Wharmby

Untypical by Pete Wharmby is a book about the personal experience of autism, and ways you can help autistic people in your life*. I picked it up because my son is on the waiting list for an autism assessment (1 year in and counting), and I have suspicions about myself – my wife’s suspicions are stronger!

Wharmby worked as a teacher for some time before a diagnosis of autism after the birth of his daughter and a bout of depression, he stopped teaching as a result of the COVID pandemic and is now self-employed as an author and speaker on autism. The book is very personal, I found it compelling reading.

Untypical is divided into 8 chapters covering different aspects of autism and life. Each chapter includes some bullet points on how you can help an autistic person, which can be summarised as “show some empathy given the information in this book” but you’ll need to read the book to get the details.

The first couple of chapters are on socialising and friends. The problem with socialising is not knowing the rules of communication, which are unwritten. Many autistic people have a phobia of telephones as a device for talking to people because the number of cues as to how to respond are reduced still further. Online friendship often works very well for them though. I am the most sociable person in my household (this really isn’t saying much) and the most likely to use a telephone although, with the exception of talking to parents, it is a last resort. I remember not feeling extrovert and sociable for a very large part of my life, nowadays I find it useful in addressing anxiety but I feel like I’m simulating being sociable. For autistic people this type of simulation is called masking, and it can be exhausting to maintain. Later, talking about the transition to university, Wharmby says that he used alcohol, probably to excess, to cope with the social side of university – this too sounds familiar.

Wharmby talks about falling into university almost by accident, it was the easiest next step having obtained good A-level results. This is the subject of the next chapter, “Tying shoelaces and Other Daily Challenges” which talks about the issues autistic people can have with getting started on something (autistic inertia), executive function (working towards a goal) and PDA (Pathological Demand Avoidance). If you are interested in PDA then When the Naughty Step Doesn’t Work by Dr Naomi Fisher and Eliza Fricker is well worth a read. This isn’t to say autistic people can’t do goal-oriented tasks – they just need to be cast in the right way. I think here of Alfred Wainwright’s Pictorial Guide to the Lakeland Fells, completed with machine-like precision over a 10 year period. Wainwright may or may not have been autistic but nevertheless his Pictorial Guide looks exactly like the product of a “special interest”. I feel the same way about much of my career, a lot of it was down to following the easiest path boosted by my “special interest” driven abilities.

In the context of autism a “special interest” or monotropism is a strong focus on a single subject. They provide a way of regulating moods and managing stress. The autistic sensorium is very cluttered and finding a single point of focus is soothing. Wharmby talks about computer games, Minecraft, Pokémon Go, Lego and trains as examples of his “special interests”. His go-to task for immediate stress relief is to read a Wikipedia page about a steam train. As I write I am just entering my weekly gas, electric and solar panel meter readings into a spreadsheet, a dataset which stretches back to 2004. My dad kept a notebook in the glove box of his car where, usually my mum, wrote the mileage, volume of petrol bought and cost whenever they visited a garage. I was very confused when I discovered my wife’s car had no such book!

The chapter on school is close to my heart, it is the reason my son is on a waiting list for an autism assessment. For autistic children school is a nightmare, on top of the forced socialisation they are usually very overwhelming sensory environments. We found that the “need for justice” mentioned later in Untypical is also an issue, particularly around group “punishments”. Wharmby observes that much “bad behaviour” can be attributed to child reaching the point of autistic meltdown. He has some words on the nightmare of group work which will speak to many adults. This chapter is very timely since the Education Select Committee’s SEND Inquiry report is very keen on inclusion in mainstream schools as a solution to the SEND crisis – the committee have noted that the Department of Education has failed to define what this means. Wharmby notes that when he was at school in the 1990s refusal to go to school did not appear to be an option. Attendance in school dropped after the the COVID pandemic – I think it demonstrated that school was not the only place to learn for a very large number of children and their parents. In addition the restrictions of the COVID pandemic pushed some autistic people into meltdown – all the social interaction rules changed, and then changed back again as normal life resumed.

The issues with work are largely those of school, with uncontrolled environments and people all over the place. He calls out hot-desking specifically. Wharmby also mentions that autistic people can be very sensitive to criticism (hence my footnote to this post). The most stressful part of my working life has been annual assessments, this are critical by design – the company typically wants to see a distribution in “grades” and will tend to criticism rather than support. I can also say this is stressful for a manager. The same applies in redundancy processes, the company will seek to show you are not up to the job in order to smooth your exit from their point of view.

Chapter 7 talks a bit about the overlap of autism and ADHD with the resulting restless brain. This is where “stimming” comes in. Stimming is a variety of repetitive actions (every autistic person has their favourite) which provide some relief from stress – these can be disturbing to the neurotypical. This chapter also talks about the stresses of all forms of travel for autistic people usually through unpredictability and crowded and noisy environments. I was struck with his comments on struggling with mindfulness meditation as a way of providing relaxation, I too have struggled with mindfulness – finding it incredibly difficult to focus on just my breath, for example, or dispassionately observing my thoughts passing by.

The final chapter is on the autistic need for justice, mentioning Greta Thunberg’s campaigning on climate change (Thunberg is autistic), and also intersectionality – the overlap of the autistic community with the trans community in particular but also the neglected areas of being a woman and autistic and black and autistic. He highlights a couple of online resources which provide wider coverage of the autistic community – I’ve signed up to the Neuroclastic newsletter.

I have to say that overall it is a bit of a harrowing read, Wharmby has a nice writing style but the continual state of stress and anxiety he finds himself in is oppressive for the reader let alone the author!

Wharmby writes near the end of the book that he considers himself an imposter as an autistic person, something that he attributes to his late diagnosis. I must admit to feeling the same, I don’t think I’m as autistic as he is but so much in this book struck a chord with me. At the age of 55, and semi-retired, I don’t see the point in seeking a diagnosis, for my son I see it as useful but I must admit to some qualms about medicalising him for the sake of fairly limited support. I also worry that owning up to autism will not help secure a job.

The rising diagnosis of autism is a hot topic currently, to me it seems that there have always been a lot of autistic people but we never recognised it as a distinct thing, even in white men and boys, let alone women and girls or any other ethnicity. If we look back the signs were there: my dad’s petrol consumption recording, the male Hopkinson’s all stimming as they organised themselves for a family photo, the trainspotters, a whole load of scientists who recorded detailed data on all many of things…

Untypical is definitely worth reading: it either describes you, someone you know or someone you will interact with and more knowledge can only be a good thing. It’s important because life expectancy for autistic people is much lower than for others, and with some adaption their/our lives could be so much better.

*For the benefit of Pete – this is not a critical review, my reviews are descriptive much to the chagrin of professional historians!

Mar 27 2025

Book review: When the Naughty Step Makes Things Worse by Dr Naomi Fisher and Eliza Fricker

Another book in the parenting thread: When the Naughty Step Makes Things Worse by Dr Naomi Fisher and Eliza Fricker.

The title describes the central theme of the book; some children simply don’t respond to the widespread, traditional punishment / reward method of parenting. If you try to put them on the Naughty Step they will refuse to go, and get ever angrier about it. As the authors highlight a motivated child has a higher stamina for opposing your parenting strategies than you have for executing them! You will typically have other things to worry about; a child can fully commit their energies to opposition.

They describe these children as “pressure sensitive” – they are made anxious when they feel under pressure to do something and their behaviour arises from this – finding ways to avoid the thing, elsewhere this is given a diagnosis of “pathological demand avoidance” (PDA). Their answer to pressure sensitive children is “low demand” parenting with the aim of widening the child’s “window of tolerance” for demands over a long period.

Fisher talks about how parenting was “invented” in the 1950s with the work of Baumrind and their demandingness/responsiveness model. It extends behaviourism, which sees animals trained by a combination of reinforcement (reward) and punishment, to the training (raising) of children with the addition of responsiveness which is trying to meet the needs of the child and being emotionally warm with them.

I sometimes wonder what fraction of animals refuse to be trained under the behaviourism model. When I reviewed Other Minds (all about octopuses) I read about efforts to measure the intelligence of three octopuses:

… two octopuses in their study put in some effort to carry out the tests presented whilst Charles insisted on squirting water at the experimenters and being otherwise uncooperative. It does make you wonder whether measures of animal intelligence are more a combination of willingness and intelligence. 

The authors refer to behaviourism models of parenting, somewhat tongue in cheek, as Good Parenting(TM). It is relevant to highlight the contrast because much of the internal battle for a low demand parent is the opinions of others, and whether they are right: are we here because we are poor parents? what does my parenting look like to other people? What are people thinking? Largely the author’s prescription is to ignore these outsiders except where necessary (other family members and professionals with important roles).

Thinking about pressure sensitive children it is easy to see how they struggle at school where systems of punishment and reward are becoming ever harsher. Furthermore in a classroom environment there is little scope for responsiveness. Therefore schools end up being strictly authoritarian environments which absolutely don’t work for a fraction of children, and greatly stress a further proportion. My experience of schools is that they have little appreciation or understanding of the existence of pressure sensitive children. Many of the children mentioned in the book have been pushed out of the mainstream school system, some are in special schools or home education.

After the preamble chapters talking about the group of children in question, and earlier models of parenting, The authors spend several chapters talking about different aspects of low demand parenting in practice, communication, behaviours, emotions, and screens. They are pretty positive about screens – highlighting that games like Minecraft offer pressure sensitive children a complex world which they control completely and often it is the only thing they will engage in. Most of the practices of low demand parenting are captured in acronyms – REACH, FLASH, JOIN UP. The core is to throw away your previous concepts of Good Parenting(TM) and seek a more equal relationship with your child (rather than trying to force them into conformance), join them with what they are interested in (for a while my wife and I played Fornite with our son), and focus on the necessary (sitting at the table eating healthy homecooked meals without your elbows on the table may be an ideal but sitting in front of the TV eating beige food is actually fine).

It is a bit difficult to judge the age group this book targets, much of the start feels like a discussion of younger children – at primary school and earlier but there are frequent mentions of children going into adolescence. One of the stories in the final chapter tracks that of my now 13 year old son almost exactly – apparently fine and doing very well in school until the demands of secondary school were overwhelming with an exit into online school.

There is a chapter on self-care for parents, a subject touched on earlier in the book in coping with the disapproving looks of other parents. This chapter uses techniques like radical acceptance, visualisation and mantras which I’m familiar with from counselling.

Despite being over 400 pages long When the Naughty Step… is an easy read. The text is broken up with Fricker’s cartoons, personal stories and various tables and exercises. Each chapter ends with a dialogue between Fisher and Fricker (which I found really useful), a bullet point summary and some suggestions for further reading.

I sometimes worry I have joined the cult of Fisher / Fricker, in common with many parents whose children have not been entirely straightforward to raise, I will enthusiastically recommend their books (and webinars). I think the core of their success is that they identify very clearly how our children are, when few others do, and reassure us that it is not the end of the world, when most are trying to convince us it is.

Jan 26 2025

Book review: The Teenager’s Guide to Burnout by Dr Naomi Fisher and Eliza Fricker

I recently reviewed Understanding Pathological Demand Avoidance Syndrome in Children, this book follows that theme – I’m reviewing The Teenager’s Guide to Burnout by Dr Naomi Fisher and Eliza Fricker. The Teenager’s Guide is a far easier read, directed at teenagers rather than adults although it includes a section at the end for adults.

Dr Naomi Fisher is a clinical psychologist well-known for her work on the mental health of children, parenting and schooling. She experienced many different schools in different countries as a result of her parents’ life-style. Eliza Fricker is an illustrator and author and has experience of the issues covered in the book and drew the illustrations.

The book starts with some generally comments about stress and burnout which could apply to anyone, it’s useful in setting the scene although I did worry whether I’d got the right book. Perhaps surprisingly the book doesn’t mention “autistic burnout” except in the final section for adults where Fisher says that burnout is burnout, some children are neurodivergent but that’s not the key feature.

The action quickly moves on to school which in general is what will cause burnout in teenagers. The process of burnout is divided into four sections:

  1. Breakdown – burnout often seems to come out of the blue, a child is “fine at school” and then suddenly can no longer go in. It is traumatic for parents as well as children. Fisher (rightly) attributes this largely to the school environment and emphasises that a return to school should not be the short term gaol. This stage is about re-connecting with the child, it turns out our family sessions of Fortnite were actually a pretty good thing to do!;
  2. Repair – this is when we start to find the new normal with a child at home not at school, and a family rearranged to accommodate. There is often sadness here at the life apparently lost. This stage is about the teenager trying to find some enjoyment in life;
  3. Learning from the journey – this is about learning about what went wrong; why was it that school became unbearable? Sometimes as parents we will discover that our well meaning efforts were just pressuring our child and worsening the problem. I think of our efforts to get our son to see a counsellor here;
  4. The Road Ahead – this is about finding another path to education, outside of mainstream school. Part of the current process is, typically, to pressure children by telling them that mainstream school is the only option and they will be a failure if they don’t attend. Fisher describes it as a myth, really it is an outright lie;

Fisher believes that a key mistake most people make is to see a return to mainstream school as the goal throughout this process. If an adult had a burnout as a result of a high stress job we probably wouldn’t see going back to that job as the goal. She sees the school environment as being the problem which reflects the WHO recognition of burnout as an “occupational phenomena”. She cites increasingly high pressure methods used in schools to control behaviour (see SLANT), enforce attendance (“your parents will be fined and may go to prison if you don’t go to school”) and recover the academic progress lost during the pandemic. I have to say I agree with all of this.

Fisher is scathing about schools, pointing out her experience of so many different school systems highlights which school rules are in fact unnecessary she mentions UK uniform rules and the UK tradition of calling teachers “Sir and Miss” as examples of this. The world doesn’t end if you don’t wear a school uniform and address your teachers by their first name.

Fisher says a little about why burnout is an increasing problem, some of it is changes in the world – particularly the pandemic. She mentions world events like climate change meaning there is little to hope for in the future, as a child of the seventies and eighties I can say there is no change there – we feared nuclear annihilation! She says that in the past those suffering from burnout might have been diagnosed as having glandular fever or simply truants. It strikes me that in the past twenty years or so we have been become (on the face of it) much more understanding of mental health issues in adults but we don’t extend that sympathy to children.

I found her comments on friends and social development interesting, one of the key worries of those educating at home is the lack of social interactions. However, Fisher points out that frequently younger children have a quite limited social circle covering only family and relatives. Friendship at secondary schools has the air of protection, being in with a group so you are not alone at lunch time or the school gate, not the target of bullying. That said she provides a long list of venues outside school where teenagers might find new friends.

I suspect this book will be mainly read by parents; teenagers in the process of burnout are likely only receptive to it at stage 4 (The Road Ahead). The best time for an adult to get this book would be prior to stage 1, perhaps when the first signs of issues at school appear but it is useful at any time in the process. I heartily wish no one needed this book.

The Teenager’s Guide is great: for affirming we are not alone, for providing reassurance and also for providing some strategies to try for a better future. Although it is purportedly written for teenagers it is fine for adults, making for an easy read with short recaps at the end of each chapter. There are some handy tables / exercises which also act as summaries.

Jan 20 2025

Book review: Understanding Pathological Demand Avoidance Syndrome in Children by Phil Christie, Margaret Duncan, Ruth Fidler and Zara Healey

Today I open up a new strand of reviews with Understanding Pathological Demand Avoidance Syndrome in Children by Phil Christie, Margaret Duncan, Ruth Fidler and Zara Healey. This is for reasons I alluded to in my review of 2024.

Pathological Demand Avoidance (PDA) is a condition first identified in children being evaluated for autism by Elizabeth Newson in the late 1970s.

The core of the PDA diagnosis is the idea that demands of a child causes them anxiety which results in a range of responses around refusing those demands, and developing strategies to avoid demand. This is a problem because often the child will refuse “demands” that would lead to things they wanted to do for example “Please put your shoes on so that we can go to the zoo” – “No!”. It also makes education and everyday life challenging.

The term did not enter the literature until around 2000, and its use has grown substantially since 2012 (see Google Ngram). This book was written around 2012. The current professional opinion on PDA appears to be that is a recordable trait for neurodivergence assessments but it is not a standalone diagnosis.

Understanding PDA is divided into 6 chapters:

  1. What is PDA?
  2. Positive Everyday Strategies – this is about managing PDA in the classroom;
  3. Living with PDA – this is about managing PDA at home;
  4. Providing the Best education for a child with PDA;
  5. Developing emotional well-being and self-awareness in children with PDA;
  6. Summing up and questions for the future;

The chapter “What is PDA?” is about diagnosis, it lists a set of diagnostic criteria and provides some examples of what these criteria look life in action. The criteria proposed for PDA are:

  1. Passive early history in the first year;
  2. Resists and avoids the ordinary demands of life;
  3. Surface sociability – sociability is used as a tool to avoid demands;
  4. Liability of mood;
  5. Comfortable in role playing and pretending;
  6. Language delay;
  7. Obsessive behaviour;
  8. Neurological involvement;

It places PDA alongside autism spectrum conditions broadly divided into “able autism” and “autism with additional learning disabilities”. Reading this I realised my son had some elements of the diagnosis but not many, I also noted that typically the children considered in this book were of primary school age – 5-10 years old. It was also a salutary reminder that our son’s behaviour is fairly mild, one parent reported being threatened by their 8 year old son with a knife! This was not the only example of violent behaviour in children.

Many parents reading this will be asking themselves whether their child fits this diagnosis, and many will be looking at the criteria and realising that they have at least some elements themselves. This presents issues in management of the condition but also provides valuable insights.

As someone with a background in physical sciences my predisposition is to see a diagnosis such as PDA as a concrete undisputable thing. However, it is better to see such diagnoses as a conversation opening to help discuss strategies for living with a child with PDA. The following chapters cover strategies for dealing with a child with PDA at home and in school. The strategies they come up with are as follows:

  1. Reducing demands;
  2. Disguising demands;
  3. Distraction;
  4. Offering choices;
  5. Ignoring undesirable behaviour;
  6. Flexibility and adaptability – learning to be willing to change plans;
  7. Depersonalising demands – a routine depersonalises demands;
  8. Staying calm and neutral – shouting can raise the “excitement” for a child, and so is something that might be sought;
  9. Dealing with bedtime difficulties – fortunately we don’t have these – they’re clearly a common problem;

This seems like an important section to read – it recognises that parents are not perfect and need to develop their own coping strategies. Parents also find themselves wondering where they went wrong to end in this position (they didn’t go wrong), and also feeling guilty for losing their tempers (which is common and natural). It also highlights that the impact of handling a child with PDA on other children including both siblings and class mates. Another lesson is that just because something on one day doesn’t mean it will work on another, the context and the child’s mood is important.

I found the chapter on handling PDA in school environments interesting, not for its relevance directly to me, but because government are keen on the idea of “inclusion” – teaching children on the autistic spectrum in mainstream schools. Reading the accommodations suggested for PDA pupils this seems unworkable, fundamentally because accommodations make a child stand out in a school and for children on the autistic spectrum that is something they definitely don’t want. Secondly, it is difficult to see how such approaches can be accommodated in class sizes of 30 or so typically found in mainstream schools. The authors comment that in the end success comes to the personal relationship between the child and the adult rather than any particular system.

I don’t think I would recommend this book, it is quite academic in style in a field that is not my own. It has to be seen a bit as a campaigning book for the PDA diagnosis written in 2012, so somewhat out of date. I found the National Autistic Society page on demand avoidance a useful alternative to this book. It provides a short summary of some of the key points in Understanding PDA with better context for the diagnosis’s wider, current relevance.