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Pathological Demand Avoidance – Symptoms & Parenting Tips

What’s inside this article: An overview of Pathological Demand Avoidance, including what it is, the signs of PDA, and how it differs from ODD. Plus, effective behavior management strategies for individuals with pathological demand avoidance.

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.

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:

  • Resists ordinary demands of life.
    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 the family was going to the playground and the child was told “put on your shoes, we’re going to the playground”, despite wanting to go, the child would resist because of the way the demand was placed.
  • Appears to be social.
    A child with pathological demand avoidance may appear to be far more social than what you would typically see in classic autism symptoms.

    However, they often copy the social behaviors of others without really understanding the meaning of them.
  • Excessive mood swings & impulsivity.
    Sudden changes in mood and impulsive behavior may be used as an avoidance technique or as a stress response to anxiety.
  • Engages in pretend play.
    Children with autism often do not meet the developmental milestones of play skills and seem to lack imagination.

    However, children with PDA do engage in pretend play and may often take on the role of an authority figure. For example, a police officer, teacher, etc.
  • Manipulative behavior.
    It may seem like children with pathological demand avoidance are manipulative or always know just want to do to upset somebody.

    In reality, they don’t want to hurt or upset others, it’s a reaction to anxiety.
  • Denies or blames.
    Even when caught in the act, they may outright deny behavior or blame their actions on someone else.
  • Early language delay.
    Although they may have an early language delay, typically they “catch up” suddenly to their peers. As opposed to children with classic autism whose language may plateau or catch up gradually.

Avoidance Techniques

Children with pathological demand avoidance will use various avoidance techniques to avoid demands.

  • Distraction, for example, asking questions, changing the subject.
  • Delaying, for example, “I will do it in 10 minutes”.
  • Withdrawing, for example hiding their face, acting as if they don’t hear you, or running away.
  • Drowning out requests with noise. For example, singing loudly, yelling or screaming and even swearing.
  • Imaginative play to avoid demands. For example, they may say ” I can’t get dressed because I’m a dog and dogs don’t wear clothes!”
  • Full meltdown. When other avoidance techniques are unsuccessful, your child’s behavior may escalate to a full meltdown in order to resist or avoid demands.

Oppositional Defiant Disorder or PDA?

There are a lot of overlapping symptoms between ODD and PDA, however, the two are very different. How can you distinguish between oppositional defiant disorder and pathological demand avoidance?

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 to complete the work given to you by Ms. Peters. When work is complete, you earn a reward.”

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?

  • Host a family meeting once a week. Go over upcoming events, meal plans, appointments, etc with the whole family.
  • Gather everyone’s input at these meetings. Allow everyone the opportunity to discuss any concerns or things that bothered them in the past week and work together for solutions.
  • Give your child decision making power over certain family events. For example, when meal planning, allow your child to choose the Monday night dinner every week. When you go over the meal plan at the meeting they can fill in what Monday’s meal will be.
  • When kids ask “why?” stop saying “because I said so” and start explaining why.

    For example, your child asks why they can’t jump on the couch, explain “It’s loud and distracting for others and it damages the furniture”. Explain that if someone else was doing something that was loud and distracting for them, you would also ask them to stop.
  • Decide on 4 or 5 “Family Rules”, hang them up and reference them regularly when addressing behavior expectations.

    For example, “The rules of the family state that everyone must respect one another. When we can’t do that, we need to go have some alone time in our rooms until we feel ready to be respectful again”.

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.

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Wednesday 30th of October 2019

Wow, I have never read anything that more accurately describes my son. He is almost 3 and we are just starting the process with a psychologist. I've always known he was a little different, but it's nice to have some specific strategies to help him. I already use a lot of these, but seeing it here really helps to reinforce that I'm doing things right!!

Alicia Murphy

Monday 16th of September 2019

My son has Autism and ADHD and this explains SO much about interacting with him lately! I had never heard of PDA until this post but I'll definitely be researching more about it. Thanks so much, navigating parenting on the spectrum can be tough but struggling with behaviors for which you cant determine the basis is even worse!

Nicole Day

Monday 16th of September 2019

You are so right. My son is in a special program right now to learn social skills & self-regulation skills and one thing they keep saying to ask yourself about your child's behavior is "deficit or defiance?" And how you respond depends on the answer to that question. It's hard though because sometimes those lines are blurred. For example with these PDA behaviors, they very much look like defiance - but what is beneath the surface of that defiance?

shelley torrez

Sunday 19th of May 2019

So much excellent content. I spent hours reading it and getting so much valuable and useful information to help me with my son. He has ADHD but some of the Autism advice was useful for him too.

Thank you so much!! I will be a fan for life!

Nicole Day

Sunday 19th of May 2019

Thank you so much, that makes me so happy to hear! My son has both autism and ADHD, a lot of the strategies are definitely helpfull with both. I'm glad I was able to help.