What is Pathological Demand Avoidance?

What is Pathological Demand Avoidance?

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: 

• Explicit or Implicit: Direct demands from others but also insinuated or polite requests
• External or Internal: Demands imposed from others and from setting their expectations before avoiding or ignoring them

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. 

Pathological Demand Avoidance in Adults

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. 

Pathological Demand Avoidance in Children

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. 

Relationship to Autism and Other Forms of Neurodiversity

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: 

• An anxiety-driven need for control 
• Avoiding everyday demands including things they would like to do 
• Lack of response to conventional engagement approaches from parents and teachers
• It may show many of the key features of PDA as opposed to one or two

Pathological Demand Avoidance Checklist

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:  

1. Obsessive avoidance of or resistance to demands: May be obsessive and show consistent resistance to carrying out day-to-day requests. Could also experience intense anxiety in the face of meeting expectations. 
2. A need for control or to be in charge: May find it hard to allow others to be in control or try to manipulate others to help them avoid meeting demands.  
3. Social problems: May dictate how others should behave but not do so themselves. May not reciprocate when interacting with others like asking questions. 
4. Difficulties with uncertainty: May show heightened anxiety or distress when feeling uncertain or unclear. Could have difficulties managing changes in routine. 
5. Extreme emotions: May show intense emotional reactions or mood swings in the face of demands. May try to distract or negotiate with others to get out of meeting demands
   
6. Rigid thinking: May be too fixed on specific routines or obsessive over a certain viewpoint. 
7. Problems communicating: May struggle to express their needs or show a limited use of language in certain social contexts.  

Demand Avoidance vs Pathological Demand Avoidance

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. 

What Causes Pathological Demand Avoidance?

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.  

How to Treat Pathological Demand Avoidance

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: 

• Deepen your understanding of PDA: Discover as much as you can about which other things trigger PDA beyond a typical demand. For instance, compliments or comments on work performance can trigger anxieties based on expectations. 
• Focus on accepting the disorder: Some people with PDA can push through their disorder too much and end up feeling overwhelmed or burnt out. This can impact their professional and personal lives.   
• Be discerning: The anxiety that arises from PDA can put excess pressure on meeting needs straight away. Instead, questioning these assumptions can be useful.  
• Modify the demand: Reframing language to be less direct and more conversational can help lessen the resistance people with PDA face. For an employee with PDA who finds direct demands stressful, offering alternate methods – like voice-to-text communication for requests or updates – can reduce pressure and give them more control over the interaction.
• Schedule downtime: Scheduling downtime after you meet a request or demand can help you regain energy and better manage your nervous system.  

To understand more about how to treat Pathological Demand Avoidance, the PDA Society offers a comprehensive and helpful booklet that’s worth reviewing.