Pathological Demand Avoidance (PDA)

Pathological Demand Avoidance (PDA) is a term used to describe a profile within the autism spectrum characterized by an extreme and pervasive avoidance of everyday demands. It is different from Oppositional Defiant Disorder which is defined by consistent patterns of anger towards and arguing with authority figures. A child with a PDA profile is not distinguishing between those who are in authority and those who aren’t, their motivation is to avoid the demand placed upon them no matter who this demand is from.  

Understanding Pathological Demand Avoidance (PDA) 

Pathological Demand Avoidance is recognized as a complex and distinct presentation within the autism spectrum. Individuals with PDA experience an overwhelming need to be in control, leading them to resist and actively avoid demands placed upon them. Individuals with PDA may display an ability to socialize superficially, but they struggle with authority, inflexibility, and intense anxiety when confronted with expectations. Often demands placed upon them can send a child with PDA into a fight or flight response.  

Six Strategies to support Pathological Demands Avoidance

Identifying the signs of PDA is crucial for understanding the unique needs of individuals with this profile. Common indicators may include extreme avoidance of everyday demands, an apparent need to be in control of situations, high anxiety levels and a strong desire for sameness and routines. 

Strategies for Supporting Individuals with PDA: 

• Adopt a collaborative and flexible approach: Focus on collaborating and negotiating with them, involving them in decision-making processes, and offering choices and alternatives within demands to empower them and foster a sense of control. 
• Use indirect language and strategies also known as declarative language: Individuals with PDA may respond better to indirect language and strategies when it comes to tasks or requests. Frame demands in a more subtle, non-confrontational manner to reduce anxiety and resistance. For example, using humor, distractions, or storytelling can make requests more palatable. 
• Build trust and establish positive relationships: Create a safe and supportive environment, listen to their concerns, and validate their emotions. Building trust helps reduce anxiety and increases their willingness to engage and co-operate.
• Provide structure and predictability: Visual schedules, clear expectations, and consistent routines can provide a sense of security and reduce anxiety. 
• Recognize and manage anxiety: Help individuals develop coping mechanisms to manage anxiety, such as deep breathing exercises, mindfulness techniques, or engaging in preferred activities that promote relaxation. Encourage open communication about fears and worries and provide reassurance and support. 
• Collaborate with professionals and support networks: Seek guidance from professionals experienced in PDA to develop individualized strategies and interventions. Occupational therapists, psychologists, and PDA-specific support groups can offer valuable insights and support to navigate the challenges associated with PDA. 

Pathological Demand Avoidance presents unique challenges for individuals within the autism spectrum. By understanding the distinctive features of PDA and adopting tailored strategies, we can support individuals with PDA to lead meaningful and fulfilling lives. By focusing on collaboration, flexibility, and recognizing the need for control, we can help reduce anxiety, build trust, and empower individuals with PDA to navigate demands more effectively.