Parental experiences in the use of fluoxetine for management of ‘disruptive behaviours’ in children and youth with autism and pathological demand avoidance – a mixed methods exploratory study (Fluoxetine study)

Background Pathological demand avoidance (PDA) is a relatively new profile described in autism spectrum disorder (ASD), characterised by an extreme resistance to everyday demands and social interactions and may present as aggressive, destructive behaviours. This study aims to explore (through use of parental recall) the utility of fluoxetine in managing disruptive behaviours attributed to PDA. Methods Mixed-methods study incorporating surveys and semi-structured interviews with caregivers. Results Extreme Demand Avoidance 8-item measure (EDA-8) survey results showed a significant decrease in most behaviours attributed to PDA, including a decrease in frequency of the child obsessively resisting and avoiding ordinary demands and requests and having difficulties complying with demands unless they were carefully presented. The majority of participants in this study indicated that their child had either a co-occurring diagnosis of an anxiety disorder or that their child experienced anxiety. After initiating fluoxetine, parents noted improvement in their child’s behaviours and consequently improvement in their family’s quality of life. Conclusion Fluoxetine shows promise as an effective treatment in improving disruptive behaviours in children with PDA. Given the high prevalence of anxiety in children with PDA, we propose that the disruptive behaviours of PDA are secondary to an embodied experience of anxiety in children with autism.