The term Pathological Demand Avoidance was first used by child developmental psychologist Elizabeth Newson in the 1980s. She proposed that pathological demand avoidance, or PDA for short, was a “personality profile” of some children on the autism spectrum.
Her team initially observed PDA in autistic children who resisted ordinary demands, not just those they disliked. This behavior differs from what is typically seen in other forms of autism.
It’s now officially recognized by the National Autistic Society as a distinct type of ASD and gaining more recognition by medical professionals.
This article offers an in-depth explanation of pathological demand avoidance (PDA) for parents so you can better understand the characteristics of PDA, how it manifests in children, and what steps to take if you suspect your child has pathological demand avoidance.
What Is Pathological Demand Avoidance (PDA)?
Pathological Demand Avoidance (PDA) is a behavior profile believed to be part of the autism spectrum. People with PDA display extreme avoidance of everyday demands and requests. This avoidance includes activities that are routine or even enjoyable for them.
People with PDA use a variety of avoidance strategies and behaviors. They often go to great lengths to avoid these demands, sometimes leading to intense stress or outbursts. This is described in more detail below.
Current Understanding of PDA
Professionals in psychology and pediatrics view PDA as a complex behavior profile that can vary significantly from one person to another.
It’s important to note that PDA is still a subject of ongoing research and debate. Some experts see it as a distinct condition within the autism spectrum, while others view it as part of broader autism-related behaviors.
Currently, professionals’ primary focus is to better understand the unique challenges people with PDA face and how to support them better. Experts believe anxiety plays a role in pathological demand avoidance and that developing tailored approaches to help children (and adults) with PDA can improve their daily lives.
Characteristics and Symptoms of PDA
Children with pathological demand avoidance have the same challenges as others with ASD.
This includes social communication difficulties, restrictive and repetitive behaviors, and sensory processing challenges.
However, they also have what is described as “An anxiety-driven need to be in control and avoid the demands and expectations of others.”
Most likely, this is due to extreme rigidity and intolerance for the unexpected. Rigidity is a hallmark symptom of autism, and PDA is thought to be one of the ways that behavior can manifest.
The characteristics of pathological demand avoidance include:
Resists ordinary day-to-day demands and routines:
This includes day-to-day activities such as getting dressed, eating meals, family activities, etc. Children with PDA will resist these demands even if it’s something they want to do.
For example, if your family was going to the playground and you told your child, “Put on your shoes, we’re going to the playground,” despite wanting to go, your child would resist or refuse to put on their shoes.
Appears to be more social than children with classic ASD:
A child with pathological demand avoidance may appear to be far more social than what you would typically see in kids with a classic autism diagnosis.
However, children with PDA often copy the social behaviors of others without really understanding the meaning of them. You’ll notice they don’t fully grasp implicit social rules (the unwritten social norms most people follow).
Excessive mood swings and impulsivity:
Kids with PDA may have sudden, intense changes in mood, or they may use impulsive behavior as an avoidance technique.
These behaviors, which on the surface level may seem like a tantrum or intentional, are most likely a stress response to feelings of extreme anxiety.
If you ask your child about the impulsive behavior afterward, they may say things like “their brain told them to do it” or that they knew it wasn’t a good choice but couldn’t stop themselves. This may be very upsetting to them as well.
Engages in pretend play:
Children with autism often don’t meet the developmental milestones of play skills and seem to lack imagination or the ability to engage in pretend play scenarios.
When autistic children do participate in pretend play, you may notice they’re recreating scenes from TV shows or the same scenario over and over again.
However, children with PDA engage in more spontaneous pretend play and may often take on the role of an authority figure—for example, pretending to be a police officer, teacher, etc.
Kids with pathological demand avoidance may also use their pretend play as a way to avoid demands.
It may seem like children with pathological demand avoidance are manipulative or always know just want to do or say to upset somebody.
They may use various forms of social manipulation, like lying, blame-shifting, affection, or opposition, to escape demands.
These behaviors are often a coping mechanism to deal with the anxiety or stress caused by the demands or expectations they face.
Understanding this behavior as a part of PDA is crucial for parents and educators to provide appropriate support and intervention.
Early language delay:
Although kids with PDA may have an early language delay, similar to other autistic children, typically they “catch up” suddenly to their peers, as opposed to children with classic autism whose language may plateau or catch up gradually.
How PDA Characteristics Manifest in Different Settings
Pathological demand avoidance affects all areas of a person’s life.
In home settings, PDA might manifest as resistance to family routines or refusal to perform household tasks and chores.
In school settings, kids may struggle with the structured nature of the day. This often leads to avoidance of classroom activities, social expectations, and homework.
In social settings, they may have challenges with group dynamics and following social norms. Organized sports and group activities are often very challenging. They’ll struggle to form and maintain friendships and will find it hard to build positive relationships with authority figures.
Insights from Professionals:
Child psychologists emphasize the importance of understanding the underlying anxiety that drives PDA behaviors.
Identifying PDA involves looking beyond the surface behaviors to understand the child’s need for control and comfort in response to anxiety.
Observing the child in various settings and consulting with professionals who can offer a comprehensive assessment and guidance for support and intervention strategies is recommended.
Avoidance Techniques Used by Kids with Pathological Demand Avoidance (PDA)
Children with pathological demand avoidance will use various avoidance techniques to avoid demands. Understanding what these techniques look like can help parents and educators develop more effective strategies to support children with PDA.
- Distraction: Asking questions, changing the subject, or engaging in behaviors that divert attention away from the demand.
- Delaying or Procrastination: Delaying the response to a demand definitely or indefinitely. For example, they may say, “I’ll do it in 10 minutes?” or “I’ll get to it soon.”
- Negotiation and Bargaining: Trying to alter the terms of the demand to make it more acceptable. For example, “Can I put away half of my laundry now and the other half after my favorite show?”
- Withdrawing: This includes covering their face, acting like they don’t see or hear you, or physical withdrawal, like leaving the situation or hiding.
- Drowning out requests with noise: For example, singing loudly, yelling, screaming, and even swearing over you when you speak.
- Imaginative play to avoid demands. For example, they may say, “I can’t put my shoes on, I’m a cat, and cats don’t wear shoes,” then begin crawling on the floor and meowing.
- Direct Refusal: Simply saying ‘no’ or not responding to requests.
- Making Excuses: Providing reasons, which could be genuine or fabricated, to avoid complying with a demand.
- Humor or Charm: Using humor or being overly charming to deflect from the demand.
- Play Acting: Pretending not to understand or role-playing as someone else.
- Denial: Claiming you never asked them to do something to begin with or suggesting the demand isn’t relevant to them.
- Meltdowns: When other avoidance techniques are unsuccessful, your child’s behavior may escalate to a complete meltdown. This overwhelming emotional response isn’t a choice, but it does make it impossible for them to comply with a demand.
Challenges of Pathological Demand Avoidance in School
School-age children with PDA face unique challenges in educational environments, such as:
- Difficulty with Routine and Structure: The structured nature of school can be overwhelming.
- Resistance to Classroom Demands: Tasks like completing assignments or participating in group activities can trigger avoidance behaviors.
- Social Interaction Difficulties: Despite often having better social skills, children with PDA may struggle with the complex social dynamics of school.
Teachers and educators can support children with PDA by:
- Understanding PDA: Educating themselves about PDA and how it impacts learning and behavior in the classroom.
- Collaborative Approach: Working closely with parents and specialists to develop effective strategies.
- Positive Reinforcement: Using encouragement and positive feedback with kids.
- Emotional Support: Recognizing and addressing the child’s emotional needs, helping them feel safe and understood in the school environment.
- Modified Language to Reduce Perceived Demands: Changing the way tasks and demands are given, allowing the child to feel more in control and have more choices.
- Differentiation in the Classroom: Adapting teaching methods to accommodate the child’s need for control and comfort.
- Individualized Learning Plans: Tailoring educational plans to the child’s specific strengths and challenges.
Parenting Strategies for PDA Children
When parenting a child with PDA, understanding their behavior as a result of anxiety and not a conscious decision to be oppositional and difficult is crucial.
All children with PDA are unique, so tailoring parenting strategies to your child’s individual needs and challenges is essential.
At its core, parenting strategies for kids with PDA involve building a collaborative relationship with your child. It’s better to focus on long-term coping abilities rather than short-term compliance.
You’ll want to reduce the perception of demands while supporting your child’s social-emotional development and sensory needs.
For more in-depth information, read this list of 15 effective parenting strategies for children with pathological demand avoidance.
Seeking Support and Professional Help
If you’re noticing consistent patterns of demand avoidance in your child and it’s impacting their daily lives, you should consider seeking professional support.
How to Seek Help for Pathological Demand Avoidance:
- Consult a Pediatrician: Start with your child’s primary healthcare provider to discuss concerns and get referrals.
- Specialist Evaluation: Seek assessment from a child psychologist or a psychiatrist, especially those with experience in autism and pathological demand avoidance.
- Educational Assessment: Involving school psychologists or educational specialists can provide insights into how PDA affects learning and help the school develop an individual education plan.
- Comprehensive Approach: Often, adopting a multi-disciplinary approach involving different professionals is the best way to support your child.
Remember, understanding and managing Pathological Demand Avoidance (PDA) involves recognizing its characteristics and implementing tailored strategies to support your child.
As a parent, you should build a collaborative relationship with your child, seek professional guidance, and focus on long-term coping abilities rather than short-term compliance.
It’s important to remember that each child with PDA is unique, requiring personalized approaches that cater to their individual needs.
By embracing this individuality and working collaboratively with professionals, parents can effectively support their children in navigating the challenges of PDA.