Pathological Demand Avoidance is a term first used by child 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.
It’s now officially recognized by the National Autistic Society as a distinct type of ASD.
Pathological Demand Avoidance: Symptoms and Positive Parenting Strategies
It is not yet universally accepted as a diagnosis in the medical field. However, it’s increasingly receiving more recognition.
Signs of Pathological Demand Avoidance
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 caused by 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 symptoms of pathological demand avoidance include:
Children with pathological demand avoidance will use various avoidance techniques to avoid demands.
Oppositional Defiant Disorder or PDA?
There are a lot of overlapping symptoms between ODD and PDA,
Due to PDA only beginning to receive recognition, children may be susceptible to misdiagnosis.
The most likely misdiagnosis is ODD. However, they could also be misdiagnosed with Reactive Attachment Disorder (RAD), Conduct Disorder (CD), ADHD, or have their behavior blamed on poor parenting.
PDA and ODD are different.
Children with ODD aren’t as likely to avoid activities that they enjoy simply to avoid the demand, but children with PDA are.
Also, children with ODD will try not to draw in negative attention from their peers because they’re more social and want to fit in. They are also more likely to comply when you use rewards/consequences and positive reinforcement.
Differentiating between pathological demand avoidance and oppositional defiant disorder is important because, without the right diagnosis, their behavior could be misunderstood, which means the wrong strategies may be used to help them.
Parenting Strategies for Pathological Demand Avoidance
If your child has pathological demand avoidance, using the right positive parenting strategies can reduce the amount of avoidant behavior and also lessen anxiety, making your child feel better.
1. Reduce demands at early signs of stress
When you notice your child getting stressed, scale back on the number of demands you’re giving them. A little time and space without any demands can help them feel more at ease again.
Be aware of the subtle cues that indicate your child is stressed or anxious. This includes changes in body language, or tone of voice, fidgeting, reddening of the cheeks, etc.
As soon as you notice these cues, give your child some space and wait before making any more requests.
2. Pick Your Battles
If you know everything you ask your child to do is going to lead to a blowout fight, carefully consider the importance of a request before making it and pick your battles.
Some things are necessary and unavoidable, like going to school.
But some things can be put off, at least for a while. For example, do you really need to spend the entire evening trying to make your child clean their bedroom when you can just close the door?
These nonessential demands can be addressed another time when your child is feeling more cooperative.
Also, as you learn better ways to communicate with your child it will become easier to make these demands without a corresponding meltdown.
3. Disguise Demands
Try using indirect language so your demand doesn’t sound like a demand. Your child will be more likely to cooperate if they don’t feel like they’re being ordered to do something.
Instead of saying things like “You need to go clean your bedroom” try asking a question, such as “What’s your game plan for your bedroom this weekend?”
Or, try making it competitive by saying something like “I bet we can’t get all these toys off the floor in less than 5 minutes …let’s try to beat the clock”
4. Allow Time to Observe
Instead of telling your child that they must participate in a family activity, leave an open invitation and give them time to observe. When they see others enjoying themselves, they will be more likely to make the choice to join in.
For example, “Your brother and I are going to paint rocks. You can join in if you want.” If your child refuses, say “That’s okay, you can just watch”. And then go about your activity. Wait for them to approach the activity on their own, and then allow them to participate.
5. Use Their Interests
Chances are your child has their own special interests that they enjoy more than anything else. When there’s something you need your child to do, you should immediately be asking yourself “How can I make this task about X?”
One great way to incorporate their interests into their responsibilities is with Power Cards. You can see an example of what a Power Card is here.
Another way to incorporate their interests is by using them to create motivating rewards to entice your child to complete their responsibilities. It can be tricky to motivate children with pathological demand avoidance, but this guide will help you.
6. Avoid Confrontations and Arguments
This is pretty straightforward but sometimes as parents, we engage in arguments and confrontations with our kids because we feel that naturally, as the parent, our child should listen to us.
Unfortunately, that makes everything worse and leads to unnecessary power struggles. It can get to the point that your child will persistently resist doing something just because you brought it up.
To avoid confrontations and arguments, if you ask your child to do something and they refuse, simply say “okay”.
This doesn’t mean they get to do what they want, it means you’re avoiding a confrontation. You need to reconsider all of the other strategies for dealing with pathological demand avoidance, and then reapproach the demand in a different way.
7. Give Plenty of Choices
Since it’s believed that pathological demand avoidance is driven by anxiety and the need to be in control, it makes sense that giving your child more control, through choices, will help them.
Of course, you can’t have a free-for-all where they have full control over everything. But we can help kids feel like they have more control by giving them choices.
You can use the forced-choice method that gives them two options with the same outcome.
For example “Would you like to walk to school, or ride your bike to school today?” or “Would you like to shower tomorrow morning when you wake up, or tonight before bed?”.
Some kids respond well to this and some don’t. If they see that they aren’t really getting much of a choice at all it won’t be helpful.
You can also give them more open choices. Your child should have as much freedom to make their own choices as possible.
In other words, never make a decision for your child that they’re capable of making for themselves. For example, allow them to chose what to wear, what to pack on their lunch, what afterschool activities they want to join.
If having open choices is too much for them and leads to indecisiveness, offer several options to choose from.
For example set out 3 or 4 different types of juice, fruit, vegetables, snacks, etc and let your child pack their own lunch for school by picking one of each.
8. Reinforce Social Hierarchies With Social Stories
Children with pathological demand avoidance often seem to ignore social hierarchies or attempt to take on an authoritarian role with their peers by acting “bossy” with other children.
You can create your own social stories that explain things such as how acting bossy can make other children feel, what everyone’s responsibilities are at home and what their roles in the household are.
I don’t believe in teaching children to blindly obey adults without question because this can make them vulnerable. However, a social story can reinforce things like following the teacher’s directions.
For example, “This is Ms. Peters, she is the class teacher. Ms. Peters makes the classroom rules and directs the class to do activities. It is your job
9. Share Responsibilities
Share responsibilities with your child and give them the opportunity to delegate some of the work that needs to get done.
For example, write a list of all the chores that need to be completed in order to get their bedroom cleaned up.
This might include picking up toys, putting away laundry, putting away books, vacuuming and making the bed. T
hen tell your child “We need to get your room clean together. Can you be the leader and decide which jobs will be mine and which jobs will be yours?”
10. Create a Democratic Household
In a democracy, everyone has equal rights and the leaders involve the people in making important decisions that will affect them. In your household, the leaders are the parental figures and the people are the kids.
Children are more cooperative when they feel that they’ve been included in the decision making, that their voice matters, and when there’s been an open discussion and compromise when making decisions.
How do you create a democratic household?
If you’re looking for inspiration to create your family rules, you can download a copy of our family rules that I use in my home. Feel free to print these for your family or use them as an aid to create your own.
It may be a long hard road, with many bumps along the way, when building a cooperative relationship with your PDA child.
Be ready to wipe the slate clean over and over again, take a positive approach, stay calm and to show lots and lots of love, even on the hardest of days.