1
Department of Psychology, Faculty of Psychology and Educational Sciences, Shahid Beheshti University, Tehran, Iran
2
Altogether Autism, New Zealand
Abstract
Objective:To describe reformulation in an autistic child whose response to direct intervention was poorer than his demonstrated cognitive abilities predicted, and whether this discrepancy could signal a pathological demand avoidance (PDA) profile. Method: This retrospective case report integrated caregiver history, assessment records, school observations, teacher documentation, intervention records and questionnaires for an Iranian boy who entered a micro-school at 4 years 10 months. Analysis examined whether demonstrated skills varied with interpersonal demand and changed when pressure was reduced. Results: The child demonstrated preschool skills spontaneously and through play, yet often failed to access comparable abilities when requests became direct, repeated, monitored, praised, or linked to rewards. Pressure was associated with escalating avoidance and distress. This demand-sensitive discrepancy in cognitive performance across direct and lower-pressure conditions prompted PDA-focused reassessment. After the school reduced nonessential direct demands and used shared control, indirect requests, and role-mediated participation, teachers observed less freezing and crying within two to three weeks, followed by gains in engagement, communication, physical participation, and eating. Discussions: An established autism diagnosis may not provide a complete clinical formulation when intervention progress is inconsistent with demonstrated cognitive abilities. Poor performance under direct interpersonal demands, particularly when comparable abilities become more accessible under indirect, lower-pressure conditions, may warrant reconsideration and PDA-focused screening before pressure is intensified. Concurrent medication and service changes preclude causal attribution to the school reformulation alone.
Mozifian, N., Farshchi, F., & Bagherian Khosroshahi, S. (2026). Pathological Demand Avoidance–Informed Reformulation After Poor Response to Direct Autism Intervention: A Case Report. (e107494). Journal of Neurodevelopmental Cognition, (), e107494 https://doi.org/10.48308/jncog.2026.246014.1049
MLA
Mozifian, N., Farshchi, F., & Bagherian Khosroshahi, S. "Pathological Demand Avoidance–Informed Reformulation After Poor Response to Direct Autism Intervention: A Case Report" .e107494 , Journal of Neurodevelopmental Cognition, , 2026, e107494. doi: 10.48308/jncog.2026.246014.1049
HARVARD
Mozifian N., Farshchi F., Bagherian Khosroshahi S. (2026). 'Pathological Demand Avoidance–Informed Reformulation After Poor Response to Direct Autism Intervention: A Case Report', Journal of Neurodevelopmental Cognition, (), e107494. doi: 10.48308/jncog.2026.246014.1049
CHICAGO
N. Mozifian, F. Farshchi & S. Bagherian Khosroshahi, "Pathological Demand Avoidance–Informed Reformulation After Poor Response to Direct Autism Intervention: A Case Report," Journal of Neurodevelopmental Cognition, (2026): e107494, doi: 10.48308/jncog.2026.246014.1049
VANCOUVER
Mozifian N., Farshchi F., Bagherian Khosroshahi S. Pathological Demand Avoidance–Informed Reformulation After Poor Response to Direct Autism Intervention: A Case Report. JNCOG. 2026;():e107494. doi: 10.48308/jncog.2026.246014.1049
