Pathological Demand Avoidance is a profile of autism that can stop people from participating in activities, events, or daily responsibilities. The condition was first recognised in children with autism but affects both adults and children. In this article, let’s explore these specific behaviours and how they impact people with autism.
Pathological Demand Avoidance (PDA) describes a pattern of behaviours that can cause individuals with autism to experience obsessive avoidance, resistance, ignorance, or intolerance to any “demands”. The disorder manifests as a fight, flight, or freeze response in reaction to others who threaten their sense of autonomy.
Pathological Demand Avoidance is also known as a Pervasive Drive for Autonomy–also abbreviated to PDA–which describes an anxiety-driven need for autonomy. In essence, Pathological Demand Avoidance refers to people who feel an obsessive compulsion to avoid, resist, or defy demands from others to maintain control. Sources of these demands may include:
British psychologist Professor Elizabeth Newson first coined the term after she identified patterns of behaviour in children. It’s mostly found in adults and children with autism, but is also associated with Intolerance of Uncertainty (IU), which is a cognitive bias found in people both with and without autism.
PDA in adults can manifest as problems with procrastination, difficulties completing projects, and work-based issues such as inappropriate responses to colleagues or customers. Adults with Pathological Demand Avoidance can feel trapped in a job or be intolerant to routine work.
As noted in his book “Avoiding Anxiety in Autistic Adults: A Guide for Autistic Wellbeing”, Dr Luke Beardon highlights the need to acknowledge the risks of heightened anxiety in people with autism and to establish strategies to reduce anxiety.
PDA is a response to the anxiety that people can feel when they worry about becoming overwhelmed or out of control of their usual responses. In many ways, this stands to reason since certain activities can provoke feelings of sensory or emotional overwhelm and may lead to long-term problems like autistic burnout, which affects up to 80% of people with autism.
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In children, people with features of PDA do not respond well to conventional parenting and Pathological Demand Avoidance can manifest as a lack of “self-directed behaviour”. This is where the parent can tell them or show them as much as they want but the child will still resist instructions or requests that someone else asks of them.
Many parents can feel frustration with their child knowing that they’re capable of certain tasks or even academic skills which the child may not show they’re capable of doing because of the resistance they experience.
In their 2023 survey report, the PDA society revealed how almost half of all surveyed children with PDA experienced depression in the last year. This shows the difficulties PDA reveals in children with autism who don’t have the skills to overcome their disorder.
Pathological Demand Avoidance describes a profile of autism so there will be similarities in characteristics when describing the two conditions.
Autism is a developmental condition affecting the way people behave and communicate. Individuals with autism can have specific interests and show repetitive behaviours that may manifest as anxiety. But there are also specific types of autism including PDD-NOS/Pervasive Developmental Disorder/Atypical autism. This is where PDA fits in since it’s a type of Pervasive Developmental Disorder due to obsessional and pervasive traits.
According to the PDA Society, those who have an autism and PDA profile also show the following attributes:
To assist with identifying whether someone may have Pathological Demand Avoidance, we’ve created a PDA checklist to consider using. It’s an interpretation and a helpful guide, not a diagnostic.
For the latest research and comprehensive checklist, the PDA Society has a section on its website dedicated to identifying and assessing PDA. For a snapshot of areas to review, here’s a compiled list:
Demand avoidance is a normal human trait that affects everyone from time to time, to varying degrees. We may all ‘put things off’ sometimes or resist doing difficult tasks. But there are extremes in demand avoidance which we will get into in this section.
Before then, to clarify, demand avoidance is a catch-all term. And many different disorders fall under this bracket including PDA, cognitive overload, sensory problems, limited energy, and executive functioning difficulties.
Heightened periods of stress and anxiety can also provoke a demand avoidance response. In many individuals, this can manifest as a more intense fight-or-flight response.
Studies also suggest that rates of demand avoidance are higher in people with ADHD and autism. And since up to 70% of people with autism also experience comorbid ADHD, the chances of experiencing a PDA profile rise too. Of course, every person with autism is unique and will experience a different set of symptoms that may or may not include PDA.
While the exact cause of PDA isn’t yet clear, researchers do have some evidence that it’s linked to the development of the brain and a complex interplay between different factors. These factors include genetic, neurological, environmental, early developmental, and other co-occurring conditions.
The existence of PDA isn’t reflective of someone’s upbringing or their treatment in childhood. And it’s not related to the social circumstances they found themselves in. So since it’s rooted in the brain’s development, the most helpful thing we can do is to avoid judging people with PDA or the people who raised them.
PDA can risk coming across to others that someone is being stubborn, lazy, defiant, or obstinate. Of course, people with PDA have no control over their reactions or the responses from their nervous system. So these assumptions are never fair or accurate.
Plus, it’s important to recognise that it’s inappropriate to treat or manage PDA in the same way as autism. They are separate disorders and, in some cases, attempts to treat them the same can worsen the situation.
There is no single approach to treating PDA. But knowing how to deal with Pathological Demand Avoidance boils down to a single focus on some key strategies:
To understand more about how to treat Pathological Demand Avoidance, the PDA Society offers a comprehensive and helpful booklet that’s worth reviewing.
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