Pathological Demand Avoidance (PDA) is characterised by an extreme aversion of demands that goes beyond mere defiance or bad behaviour. First coined by Elizabeth Newsome in 1980, it is said to be a subtype of Autism Spectrum Condition (ASC) but has also been recognised in Attention Deficit Hyperactivity Disorder (ADHD). Individuals with PDA often exhibit an extreme need to be in control and an overwhelming anxiety when faced with demands or expectations. This can lead to a cycle of avoidance, resistance, and high levels of stress for both the individual and those around them.
At its core, PDA is characterised by an avoidance of everyday demands and requests. This can manifest as:
- a refusal to comply with instructions
- a need to be in charge of situations
- a tendency to use social manipulation to avoid tasks
Unlike typical oppositional behaviour, which can occur in children as a developmental phase, PDA is more pervasive and resistant to traditional parenting or teaching strategies.
It’s important to understand that individuals with PDA are not being defiant or disobedient out of choice or a desire to be difficult. Their behaviour stems from an intense anxiety and a need to maintain control over their environment to feel safe. This anxiety can be triggered by seemingly simple requests or expectations, leading to a threat response that manifests as avoidance or resistance.
How is PDA diagnosed?
Diagnosing PDA can be challenging due to its overlap with other conditions, such as autism or ADHD. There is currently no specific diagnostic criteria for PDA in major diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11).Â
Therefore in practice, PDA is often diagnosed based on a combination of behavioural observations, developmental history, and input from parents, caregivers, and professionals. A diagnosis of PDA may involve a multidisciplinary team, including psychologists, psychiatrists, speech and language therapists, and occupational therapists.
Using standardised assessments, interviews, and observations in different settings, professionals typically look for specific behavioural characteristics, such as:
- Extreme demand avoidance even to ordinary daily demands
- Surface-level social skills but no social identity
- Swift changes in mood
- Good role-playing abilities to the point where the child may lose their sense of reality
- Social manipulation using distraction, delaying and excuses
How is PDA treated?
Traditional approaches used to address challenging behaviour is not very effective for individuals with PDA. Punishments, reward systems, or strict routines can often exacerbate the situation, causing increased anxiety and distress. Instead, interventions should focus on reducing stress, being more flexible, and building positive relationships to support PDA effectively. Here are some common strategies used for PDA:
- Educating acceptance: Educating family members, teachers, and caregivers about PDA and its underlying causes can help create a supportive environment that fosters understanding and acceptance of the individual’s challenges. The PDA Society provides useful information about the condition along with training for parents and professionals.
- Adapted Educational Strategies: Individuals with PDA may benefit from a flexible and individualised approach to education. This may include personalised learning plans, reduced demands, alternative communication methods, and sensory accommodations.
- Collaborative Problem-Solving: Encouraging collaboration and negotiation rather than confrontation can help reduce resistance and foster a sense of control for the individual. Offering choices and involving them in decision-making can increase engagement and cooperation.
- Sensory Support: Addressing sensory sensitivities and creating a sensory-friendly environment can help reduce anxiety and improve overall well-being. This may involve providing sensory tools, offering sensory breaks, and minimising sensory triggers. An occupational therapist can help identify these triggers and provide sensory diets to help with sensory avoidant or sensory seeking behaviour.Â
- Therapeutic Interventions: Cognitive-Behavioural Therapy (CBT), occupational therapy, speech and language therapy, and social skills training can all be beneficial for individuals with PDA. These therapies can help address anxiety, improve communication skills, and enhance social interactions.
- Medication: In some cases, medication may be prescribed to manage co-occurring conditions such as anxiety, ADHD, or mood disorders.Â
- Structure and Routine: Establishing predictable routines and clear expectations can help reduce anxiety and provide a sense of security for individuals with PDA. Consistency and structure can help mitigate challenging behaviours.
Generally, one key aspect of supporting individuals with PDA is recognising and respecting their need for control. It’s also important to involve the individual in the decision-making processes and to use strategies that focus on building motivation and engagement rather than coercion. By offering choices and using the strategies specified above, it’s possible to reduce anxiety and help individuals with PDA thrive at school or work.
Do you relate to PDA? If so, it may be helpful to discuss this with a professional. Take a look on the directory to see if someone can help.
Author: Illin Johnson
Illin is a content creator for NeuroDirect and a neurodevelopmental support coach for her business Neurostar Wellbeing. Being a late-diagnosed autistic herself, she is dedicated to raising awareness about neurodiversity and empowering neurodiverse individuals through her social media content and work as a coach. With a background in neuropsychology and behavioural therapy she approaches her work with curiosity and compassion and strives to create a genuine and supportive connection with her readers.