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example – and, second, most of the children diagnosed as having semantic-pragmatic disorder also have some mild autistic features. For example, they usually have difficulty understanding social situations and expectations; they like to stick fairly rigidly to routines; and they lack imaginative play.

      Research has shown that there is probably a single underlying cognitive impairment that produces both the autistic features and the semantic-pragmatic disorder. The fact that children with semantic-pragmatic disorder have problems understanding the meaning and significance of events, as well as the meaning and significance of speech seems to bear this out.

      The idea of an autistic continuum has been used to explain the situation. All the children on the continuum have semantic-pragmatic difficulties, but the degree of their other autistic impairments can be severe or moderate or mild. This parallels the autistic continuum relating to Asperger Syndrome, where all the children have a marked social impairment but those with Asperger Syndrome have only a relatively mild and subtle language impairment.

      Pathological demand-avoidance syndrome (PDA) is a pervasive developmental disorder which, it is believed, is related to, but not the same as, autism or Asperger Syndrome. Individuals with PDA are typically socially manipulative with people, and, therefore, superficially socially skilled, and this sets them apart from those with autism and Asperger Syndrome.

      The most central characteristic of people who have PDA is their obvious and obsessional avoidance of the ordinary demands of everyday life. This impacts in a very detrimental way in adult life when it comes to, say, meeting the demands of work. People with PDA lack a clear and defined sense of self, and, as a result, do not view themselves as being responsible for their actions. This latter characteristic is particularly significant in terms of social conformity.

      For this reason, a person with PDA is highly motivated to avoid demands and is so able in this domain that they may even appear manipulative as a variety of strategies are used with such determination towards the desired outcome of escaping demands.

      Characteristics are believed to include a continual resistance and avoidance of ordinary demands of life; sufferers may demonstrate surface sociability, but have an apparent lack of sense of social identity, pride or shame; there can be a tendency for rapid mood changes; they might be impulsive or led by a need to control; or they may be comfortable in role play and pretending.

      A person with PDA may present a language delay or obsessive behaviour. They may develop ‘illnesses’ to avoid doing something or deliver an endless stream of excuses. Some ‘normal’ people may admit to doing this occasionally in order to get out of doing something they don’t really want to do, but someone with PDA will do this almost all the time.