All children and teens (even us as adults) try to get out of doing something from time to time. That is normal. But what if they do it almost all the time with behavior that is extreme? Even when it’s something they say they want to do? This may be pathological demand avoidance, and it’s part of the autism spectrum.
What is Pathological Demand Avoidance?
The National Autistic Society in the United Kingdom describes pathological demand avoidance, or PDA, as “a profile that describes those whose main characteristic is to avoid everyday demands and expectations to an extreme extent.”
PDA was first named by Professor Elizabeth Newsom, a British psychologist, in the 1980s. She noted patients who had a need to avoid other people’s demands and be in control that came from anxiety. These demands are not just activities that someone wants to avoid but those that are associated with everyday living.
Children with PDA will go to extremes to avoid the expectations and requests from other people. Some examples include:
- Resist requests to do ordinary, life activities such as waking up, getting dressed and participating in a family outing. If the child does not want to do the activity, they may shout, hit, withdraw or even run away.
- Use social manipulation such as distractions, delays or drown out the request with noise to avoid the request.
- Doesn’t understand the difference between themselves and an authority figure.
- Exhibits significant mood swings and impulsivity.
- Enjoys role playing so much that reality and fantasy become blurred.
- Becomes obsessed with a person – real or fictional – in a love or hate relationship, which then affects their relationships with others.
Currently, PDA is not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). More research is being conducted to learn more about PDA, and some professionals via PDA as controversial. According to the PDA Society, many times PDA is misdiagnosed as oppositional defiant disorder, conduct disorder or even ADHD.
PDA is not discussed much in the United States. In fact, before I began this blog, I had never heard of it, and I’ve been on this journey of autism and ADHD for more than a decade. As I’ve learned more about PDA, I’ve wondered if our son J has shown signs of this. However, I believe his demand avoidance is more in line with the amount most autistics show and sometimes developmentally normal for many teenagers. He usually ends up complying with requests.
How do you know if your child exhibits PDA?
PDA reactions occur when your child exhibits the above to the extreme when asked to do ordinary activities that are part of life. These include even activities that the child may want to do. It’s natural to avoid some demands, and people with autism will often avoid those that increase their anxiety, cause sensory overload, disrupt their routines or transition to another activity.
However, people with PDA go beyond those more normal avoidances in that the avoidance is all-encompassing. It includes everyday requests, and their reactions seem irrational in relation to the type of request.
Many times, social situations or a change in routine will trigger these reactions in children with PDA. It usually starts with the child distracting the other person from the request, making excuses for not wanting to do the activity, and even drowning out the request with constant interruptions. They may even start to role play by taking on the persona of someone in authority to avoid the request. If none of those reactions work, then they may begin the more extreme behaviors such as shouting, using aggressive behavior or running away.
When someone has PDA, it is a part of them. Parents will notice it in them as infants, and it remains throughout their lives.
What are “demands”?
So what are “demands” to someone who has PDA? Demands include so many types, from a direct demand to internal expectations. These can include:
- Someone’s request directly to do something (e.g., put on your shoes)
- Decisions
- Choices
- Plans for an activity
- Questions
- Uncertainty
- Things that “ought” to be done
- Internal thoughts
- Other people’s presence
- Expectations (other people’s and their own)
- Praise
- Transitions
- Sensory overload
- Internal bodily demands (e.g., hunger, needing to use the bathroom)
Why is PDA on the autism spectrum?
PDA is a pervasive development disorder. PDA is part of the autism spectrum because people with PDA have difficulty communicating and socially interacting with others.
What approaches work for PDA?
As noted above, DSM-5 does not currently include PDA. In addition, many professionals misunderstand the condition. However, there many things parents and caregivers can do to help with PDA behavior. This includes:
- Keeping a predictable routine when possible
- Giving the right amount of notice to changes in routines (e.g., not too little but not too much)
- Using words carefully to conceal a request
- Encouraging role play to disguise requests
- Helping their child avoid sensory overload and seeking care for sensory issues from an occupational therapist
- Being flexible and adaptable when appropriate
- Reducing your child’s anxiety
What should you do if you think your child has PDA?
If you think your child may have PDA, check out the information and resources from the Pathological Demand Avoidance Society. They provide a lot of educational materials, and it should give you a better idea as well as information you can take with you to discuss PDA with your child’s doctor.
Does your child have pathological demand avoidance? What advice can you give to other parents who think their child may have PDA? Leave a comment so that we can share and encourage one another!
