An Introduction to Pathological Demand Avoidance (PDA)
Pathological Demand Avoidance of PDA is becoming more widely recognized as a distinct profile of autism. British psychologist Elizabeth Newson came up with this term which describes an anxiety-driven need to be in control and avoid other people’s demands and expectations. Research done at the University of Newcastle in November 2016 found that Intolerance of Uncertainty (IU) was also associated with PDA, in fact even stronger than anxiety.
Demand avoidance in the PDA profile looks different from what others on the autism spectrum experience because of its extreme nature and obsessive quality. This extreme avoidance extends to the most basic demands of everyday living, not just the avoidance of unpleasant, difficult, specific anxiety-provoking or unappealing tasks. Someone with a PDA profile will also have tremendous difficulty complying with their own self-imposed expectations and with doing things that they really want to do. (PDA Society, UK)
PDA is seen in both genders equally. There are no prevalence rates available at this time. It is not caused by a how a person was raised or their social circumstances; it’s not the fault of the parents or the individual with the condition.
PDA is not recognized in the DSM-V so not all professionals agree with this profile. We have not heard much about PDA in North America yet, although the term is starting to become more known. The interest in PDA as a distinct profile is growing and more research is being done. Because PDA is a fairly recent profile, it’s often misdiagnosed as other conditions that look similar on the surface such as Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Reactive Attachment Disorder (RAD) and Attention Deficit Hyperactive Disorder (ADHD).
Features of Pathological Demand Avoidance (from the PDA Society, UK)
1)Resisting and avoiding the ordinary demands of life
This might include getting up, joining a family activity or getting dressed to name but a few. This may be the case even when the person wants to do what has been suggested, such as watching a film that they have been looking forward to. When initial avoidance strategies, such as those described below fail; the situation can quickly escalate and some individuals may resort to more extreme measures to avoid the demand such as shouting, swearing, hitting and damaging property. Others may, shut down, withdraw or run away. This is a meltdown and should be viewed as a panic attack.
2)Using social strategies as part of the avoidance
Distracting – “I like your earrings, where did you get them from”, giving excuses – “I can’t walk because my legs are broken”, delaying – “I’ll do it in ten minutes”, withdrawing into fantasy – “I’m a cat and cat’s don’t wear clothes” and drowning out your request with noise “I can’t hear you because I’m singing – la, de, la, de, la …..”.
3)Appearing sociable on the surface
People with PDA may have a more socially acceptable use of eye contact. Their conversational skills may appear better than others on the autism spectrum, but this is still often lacking depth in their understanding. For instance, not seeing a difference between themselves and an authority figure, having difficulty in adjusting their own behaviour in response to the needs of others and not always understanding how, or why their behaviour can affect others at an emotional level and thus have a negative impact on their relationships.
4)Excessive mood swings and impulsivity
e.g. They can have great difficulty in regulating their own emotions and controlling their reactions to situations and people. The individual can rapidly switch from happy and engaging – to angry or sad in seconds, often with no visible build up or warning to others. This may be in response to pressure of demands and perceived expectations.
5)Being comfortable in role play and pretense, sometimes to an extreme extent and the lines between reality and pretense can become blurred
e.g. Often adopting the persona of a figure of authority in role play scenarios to such an extent that they believe that they are that person. This role may often require them to oversee and direct others and as such, remain in control of the play e.g. taking on the role of a teacher when playing with peers. Role play can be used as a strategy to avoid demands made by others such as “I can’t pick that up because I’m a tractor and tractors don’t have hands” or role playing the compliant child in school to reduce demands by flying under the radar. Withdrawing into fantasy can also be a form of self-protection, a place where they can go to when real life becomes too difficult to manage and to cope with.
6)‘Obsessive’ behaviour that is often social in nature
People with PDA may often become obsessive about other people, either real or fictional, from either a love or hate perspective, which can make relationships very tricky. Newson et al, noted that the demand avoidant behaviour itself also has an obsessive quality.
What does extreme demand avoidance look like in PDA?
Triggers – demands or situations that will cause anxiety such as social situations or a change in routine but this will also extend to all everyday demands, expectations and suggestions, including activities that the individual would usually enjoy or want to do.
How someone with a PDA profile avoids a demand – usually uses social strategies to begin with such as making excuses, using distraction, incapacitating themselves, drowning out the request with constant interruptions or adopting the persona of another person or character. If these strategies don’t work, more extreme strategies can be used such as shouting, swearing, aggression or fleeing.
Strategies to Support – provide a flexible and adaptable approach that is constantly in sync with the person’s anxiety levels. The Low Arousal Approach encompasses these ideas for recognizing when arousal mechanisms are becoming engaged, when and how to reduce demands, and how to support a person who is highly anxious or stressed. Reasons for demand avoidance such as sensory overload, emotional overload, communication difficulties, fear of uncertainty can be addressed using autism strategies but they must be adapted so that they are delivered in a non-direct manner. Again, low arousal approaches will help here.
Most of the information for this post was taken from the PDA Society website in the UK. It is the most comprehensive website on this topic so please visit their page for more information. If you think your child may have PDA, the Society has a section with a questionnaire and webinar. There are also supports for teachers, professionals, adults with PDA, and families along with an extensive resource section.
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I just want to add this is often misdiagnosed as Borderline Personality Disorder. I also disagree that it’s not caused by interaction with others, it absolutely is. We learn very young that doing nearly anything someone asks us to is more likely to harm us than not and they will not respect our boundaries unless we say something they personally can relate to. We also tend to have alexithymia so a lot of the making up excuses for things is just a means to reinforce our boundaries before we understand why we need the boundary. Sometimes takes me days, months and years to know why I have a boundary but it’s been a valid and needed boundary even when I’m not 100% sure why. Ultimately listening to us and respecting us as equals is the best approach.
Thank you for sharing your viewpoint.
I’ve been struggling my whole life and found this today, and it all make sense now.. I don’t even have an official diagnosis only some “might be autism and Adhd” paper. Thank you 🖤 hopefully doctors in my country take this serious.
College is so difficult for me, constantly changing instuctions and schedule and unpredictability… multiple projects overlapping. I always missed the changing of fine details at school. Like a time date place or edit, but now it’s happening all the time with multiple projects via all different forms of communication and social media. I totally wig out.
What you need to work on here is executive function skills. https://autismawarenesscentre.com/supporting-executive-function-disorder-children-autism/ https://autismawarenesscentre.com/executive-function-what-is-it-and-how-do-we-support-it-in-those-with-autism-part-i/ https://autismawarenesscentre.com/supporting-executive-function-in-children-with-autism-part-2/
This is a huge topic, though. I would also recommend contacting your college services office as they will more than likely have supports for students with disabilities or additional needs.
How is this developed? Is it a response to Trauma? How do you work through it?
Ryan, I would recommend contacting PDA UK as they will be able to answer your questions better than I can as I am not an expert with this diagnosis. https://www.pdasociety.org.uk/contact-us/ The PDA diagnosis and criteria originates from the UK from the work of Elizabeth Newson.
I’m 53 years old and this sounds like me and the problems I’ve had all my life. I’ve always just thought I was a bad person. Is it possible to be my age and have this issue? Is there a way I can find out for sure and/or get help??
Tracy, you can be any age and have PDA. I am not sure where you are located, but outside of the UK and Europe PDA is not often recognized or understood. You will see that I listed a website in this article in the UK. They have the most informative website in the world on this topic. If you look here, this lists all of the resources worldwide, support groups etc. https://www.pdasociety.org.uk/resources-menu/
This is my daughter to a T. I think her teachers need to read this article, I am not sure if this can be dx in Canada but as I read this all I can think is yes that is her repeatedly. She also has an autism diagnosis and sensory processing disorder
I am 54 from Australia & have felt a disconnect most of my life. I am often away with the fairies/ruminating over situations unless I do something that totally immerses me. I have been diagnosed with OCD previously. & after a particularly bad year last year (working, looking after unwell mum & a 20 year old son with his own behavioral issues) . I went back on medication for anxiety. Difficulties with a demanding work colleague & almost walking away from my job. Of late I feel like I have no time & I will avoid self care, household chores, cooking & sit in a zombie state in front of the tv. I work full-time & tend to “mask”. Lately a struggle to get up to meet the demand of getting to work by 9am. PDA sounds so like me right now!
This post you made about these painful revelations in a deeply truly loving relationship mirrors exactly my journey over the last 8 years. Its tragic to come across the same findings you’re suffering
Hello, Is the webinar on March 25 here in the United States? I will register but couldn’t tell if it’s hosted from the UK. Thank you!
Connie, I am hosting this webinar here in Canada at 10 am Mountain Time. You can also watch it on demand later if the time doesn’t work for you. The speaker just happens to be from the UK.
Please let me know if you have any further questions.
Thanks for posting this. I was referred to your site by someone in my facebook twice exceptional group. I am very curious about how to move forward if this is what my son has. He’s been diagnosed with autism for 5 years and is 9 now. Is there hope to maintain an independent life at any point? it can’t always be this hard to parent these kids, right? Please?
The key is to get the anxiety under control to minimize stress. This is done through providing structure around the person. If you want to learn more about this and how to help your son, I would highly recommend that you take the SPELL Frameworks webinar on March 25th with UK lecturer Richard Mills- https://autismawarenesscentre.com/shop/webinar/using-the-spell-framework-to-understand-respond-and-work-effectively-with-children-and-adults-on-the-autism-spectrum/
There is hope for independence but you have to have the right supports around a person in order to do this. There is no such thing as independence for any person. All of us live interconnected lives and rely on family, friends and community members to make our lives run.
This subtype of Autism got my attention because my 23 yr old son has become so anxious now that any expectation sends him in to an anxiety attack. Just mentioning that I want him to take the trash out will most likely cause him to become very agitated and stop whatever he is doing because he says he can’t think of anything else. Most times he will go in to some tirade or another about how I mistreat him or how the world is ending, That lasts for 20 minutes or so and if he becomes angry enough with me then he uses that as an excuse to not do what I ask of him. This is just one example. Does this sound like what the Demand avoidance is?
Shelly, it’s really hard for me to comment on whether this is PDA or not. Have you had a look at the site in the UK? Here is a really good section of that website on how to identify PDA. https://www.pdasociety.org.uk/what-is-pda-menu/identifying-pda/
This describes my life struggles to a T. I’ve looked into other conditions (BPD, ADHD, GAD, etc) to try to make sense of my obsessive behaviors but none has been able to pinpoint it quite like PDA. I’m 19 and currently trying to get diagnosed. I live in a country with limited mental health access and PDA is also not very well known around here. Extremely worried I would not be taken seriously if I do bring this up. Is it still possible to get a diagnosis in countries outside of the UK?
Yes- it is possible to get a PDA diagnosis outside of the UK. Not sure where you are writing from, but there is an international section on the PDA UK website – https://www.pdasociety.org.uk/resources/resource-category/international/
Blown away… my sweet kind-hearted daughter has been struggling for years with Sensory processing disorder, ADD and HFASD Sensory processing disorder, ADD and HFASD. I usually shake my head when I’m talking about “high functioning”, she is not functioning as she should be. This is Gold, I can’t wait to read more! Thank you!!
Yes!
I am doing a course about SEN students and this condition was mentioned without explanation, so I had to search for it. This article is a good introduction but it leaves more questions than answers, for example how to differentiate between similar conditions, as mentioned in the article. Luckily this article also gives a link to the website, maybe I’ll find the answers there.
Nika, this article was only meant to be an introduction. Please visit the PDA site in the UK that I mentioned in the blog. It is the most comprehensive site in the world on this topic. They can probably answer any questions you have as well.
Our oldest son is 15, and we have just learned about PDA in the last few months. We always had an inkling that he might be on the spectrum because of things like his rigidity and massive meltdowns. But he didn’t have typical signs (for example, he makes eye-contact and seems quite social). He was tested for autism at age 7, but what came of it was that he has a “difficult temperament.” At our wits end. How can one get a diagnosis of PDA in America?
Alicia, a colleague of mine has started PDA North America – https://www.pdanorthamerica.com/ . Please visit her USA based website and you can contact her through there as she will know who may be diagnosing. This diagnosis is not well known in North America nor is it officially recognized because it is not listed in the DSM-V.
My now-19 year old daughter was diagnosed with mild oppositional defiant disorder at age 8. I now wonder if it is PDA – which I had never heard of before. I’m not sure it is really acknowledged in the US. Is this a newer diagnosis?
PDA is not in the DSM-V which is the manual that is used to diagnosis of mental disorders. The term was first coined in the late 80’s in the UK so it is well known over there, but not in North America. Very psychologists in North America would even know about or recognize this diagnosis. PDA UK has the best website for information on this topic so I would recommend you have a look at their site – https://www.pdasociety.org.uk/ . There is one Facebook group in the USA – https://www.facebook.com/groups/pdausa/
Joanna Panzera said “Definitely not enough awareness about this out there.”
About a year ago my ex-wife and I became aware that both our boys, ages 14 and 12, are on the autism spectrum, my younger son worse so. This after a battery of neuropsychological testing. It has been eye opening and it’s helped me to understand their behaviors so I can be a better father. And over the course of this last year as I’ve been reading, researching and generally coming to grips with it all I’ve learned about myself. And what I’ve learned is that I indeed may also be on the spectrum. I find myself checking my behaviors, attitudes and actions all the time now. And frankly joking about being OCD! Of course at my age of 60 it seems fruitless to expect change, but I also wonder what may be able to help me thru it all.
Mark, there are many people in your age group that get diagnosed later in life. The assessment tools just weren’t there when you were a child. Seeking a diagnosis at a later age can help you to understand more about who you are and why you do the things that you do. It’s not imperative, though, and it’s a personal choice. We have articles on our website about receiving a late diagnosis – https://autismawarenesscentre.com/the-relief-of-a-late-autism-diagnosis/
What about us elderly diagnosed, undiagnosed, self-identified, or self-realized autists? Any research on us “forgotten ones”?
Dario, research on an older diagnosis is just emerging. Wenn Lawson is doing some good writing on ageing and autism and writes on the other aspects that you’ve mentioned – http://www.buildsomethingpositive.com/wenn/ Some more information on autism and ageing- https://www.autismeurope.org/what-we-do/areas-of-action/ageing/ and a good book to read – https://autismawarenesscentre.com/shop/adulthood/understanding-autism-adults-aging-adults-improving-diagnosis-quality-life/
I fell in love with a protective and charming adult male (50+). Along our relationship I increasingly sensed chaotic overloads of emotion affecting me through empathy. I sensed dark moods in him making me paranoid. He is in love with me but cannot manage it. His strategy is to domineer me but I refuse, promoting reciprocity. I understand him deeply as I am highly empathic. I have instinctively been flexible and non-demanding. We have built mutual trust but after five years of developing friendship with him now I know he will never be able to be my partner. I treasure his friendship and restrict myself to the narrow margins he can cope with. I’m so sad but once I accept the loss of the man I thought he was initially, I’ll be able to stay by him as a life-long friend. Thanks for this compassionate, balanced and accurate description which so well describes the real man my friend is. So often high functioning autistic PDA people are described as verging criminality. Misunderstandings are rife, they are so complex. To maintain a loving relationship with them is truly intense and rewards subtle. Thanks so much. Bless.
I would like to see this all over linkedin please.
O.M.G. Nailed it.