Pathological Demand Avoidance (PDA)

‘Demand avoidance’ means not being able to do particular things at certain times, either for yourself or others. It also refers to things we do in order to avoid demands. Avoiding demands is a natural human trait we all do at varying degrees and for different reasons.

Autistic individuals may avoid demands or situations that trigger anxiety and sensory overload. They may refuse, withdraw or shutdown in order to escape or avoid these situations that can provoke anxiety.

Pathological Demand Avoidance (PDA) is part of the autism spectrum and certain types of demands may be avoided for the same reasons. The PDA profile of autism can be difficult to identify as it’s often misunderstood. There is however some unique aspects, these include:

• Resisting and avoiding the ordinary demands of everyday life, such as getting up to get dressed, eating a meal. It even may include things that the individual might enjoy.
• Using ‘ social strategies’ in order to avoid. Usual strategies would include, saying no, running away or withdrawing. Other avoidance approaches would include distraction, making excuses, physical incapacitation, procrastination, withdrawing into fantasy, controlling or masking.
• Appearing sociable but lacking understanding – this means that they may appear more socially able than one might expect with conversational skills or eye contact, but this masks underlying differences and difficulties in their social interactions. PDA individuals often lack seeing any difference between themselves and an authority figure.
• Experiencing intense emotions and mood swings, thus having difficulty with regulating emotions. This can result in impulsivity and unpredictability.
• Appearing comfortable in role-play and fantasy – this can be extreme with other personas or characters (be it a person or animal) and can be adopted for a prolonged amount of time. Lines between reality and fantasy can become blurred.
• Focusing intently on other people – Restrictive and repetitive interests are often social in nature, relating to real or fictional people. 
• A need for control is often driven by anxiety or the threat response in the face of demands

Demand avoidance in PDA is a question of ‘cant’ not ‘wont’ Those often describe it as a tug of war between brain, heart and body.

Children and young people with PDA struggle with school attendance and it is known that individuals are unlikely to respond to conventional or traditional approaches in support, parenting or teaching. Helpful approaches for PDA are based on trust, negotiation, collaboration, flexibility, and careful use of language.

Autism can be multi-faceted, meaning it involves a complex and overlapping pattern of strengths, differences and challenges that present differently from one individual to another and in the same person at different times. This also applies to the different profiles of autism, meaning that PDA will present differently from one person to another.

If you or someone you care for is seeking support and assistance with demand avoidance and anxiety associated with autism, please feel free to contact BreakfreePsychology services for assistance.