What is Pathological Demand Avoidance (PDA)?
Pathological Demand Avoidance (PDA) was discovered in the United Kingdom during the 1980s as a subset of the autistic lived experience (PDA North America,2024).
PDA is defined as a continuous behavioral pattern of excessively resisting demands and seeking control of the situation to help neutralize the person’s anxiety (Gillette & Lawrenz, 2023).
PDA was first addressed and acknowledged in the United States in 2020; however, it has become commonly misdiagnosed and misunderstood (PDA North America, 2024). Individuals with PDA often face challenges that impact their engagement with their daily activities, such as difficulties with social communication, participating in repetitive interests or activities, and experiencing sensory input that can affect their responses to certain activities (PDA North American, 2024).
Types of Demands
A person with PDA may experience different forms of demands that can impact participating in their daily activities.
Direct demand: given instructions to complete a task (e.g., get dressed, do your homework, brush your teeth).
Internal demand: doing the tasks that your internal body needs (e.g., going to the bathroom, getting a drink of water when you are thirsty, or eating food when you are hungry).
Indirect/implied demand: expects to complete the task within a timeline (e.g., paying a bill or answering a question someone asks you).
(National Autistic Society, n.d.)
Characteristics of PDA
While everyone’s experience is unique, some common signs or characteristics of PDA include::
Impulsivity.
Language delay.
Frequent personality changes.
Extreme mood changes.
Refraining from attending school.
Limited social events.
Engaging in conflict with their siblings.
Resisting and avoiding demands because they need autonomy.
Hypersensitivity (e.g., auditory, tactile, visual, olfactory, gustatory, proprioception, vestibular, and interoception). Some individuals strive to control external noises, such as having no music playing.
(Gillette & Lawrenz, 2023; PDA North America, 2024)
Statistics
Many countries do not have PDA as a diagnostic category within ASD; however, the United Kingdom is one of the countries that has included it within their diagnostic manual (Occupational Therapy Helping Children, 2023). Some statistics in the United Kingdom have found that PDA is not only connected with ASD but with other conditions as well, such as Complex post-traumatic stress disorder (cPTSD), ADHD, and Oppositional Defiant Disorder (ODD) (National Autistic Society, n.d.). The school setting is a common barrier for individuals with PDA; children face and/or perceive many demands at school, which can impact their routine of attending school and completing school tasks(Miller, 2024). Studies in the United Kingdom have found that 70% of individuals with PDA struggle to attend school regularly or are currently not in school (PDA Society, n.d.).
Strategies for PDA at Home & School
Creating a routine: Together, you and your child can craft a visual schedule that outlines each day's activities, fostering a sense of familiarity and predictability. Here is a visual handout with cut-out pictures of different tasks to put in the morning or evening routine. It is a tool to help your child feel more confident and autonomous in meaningful activities. For more tips on creating a routine, check out this blog, Building a Routine! https://www.senseationalspaces.com/blog-1/blog-post-title-two-h34s5?rq=routine
Sensory supports: The school environment can be challenging as it simultaneously creates a lot of sensory input during demands. Some sensory tools that can help with self-regulation are fidgets, noise-canceling headphones, or coordinating with school employees to designate a sensory-friendly space to utilize if feeling overwhelmed. These are important to consider because they can help with self-regulation and increase focus while completing school tasks.
Offer choices: This enhances their autonomy in making decisions within structured limits. It can also give flexibility to accommodate their preferences and reduce the urge to resist the demand.
Mindfulness: Different mindfulness activities are a great grounding technique for reducing anxiety and frustration. Deep belly breaths, yoga, and meditation can help your child prepare for the school environment. Art, music, or journaling can promote self-expression and self-awareness and increase relaxation.
(Levi, 2024.; Occupational Therapy Helping Children, 2023)
References
Gillette, H., & Lawrenz, L. (2023). PDA autism: Definition, signs, and coping tips. Psych Central. https://psychcentral.com/autism/pda-autism#characteristics-of-pda
Levi, D. (2024). Navigating pathological demand avoidance (pda): A guide for parents to support their children’s return to school. School Avoidance Alliance. https://schoolavoidance.org/navigating-pathological-demand-avoidance-pda-a-guide-for-parents-to-support-their-childrens-return-to-school/
Miller, C. (2024). Pathological demand avoidance in kids. Child Mind Institute. https://childmind.org/article/pathological-demand-avoidance-in-kids/
National Autistic Society. (n.d.). Demand avoidance. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance
Occupational Therapy Helping Children. (2023). Pathological demand avoidance. https://www.occupationaltherapy.com.au/pathological-demand-avoidance/#:~:text=The%20Occupational%20Therapy%20strategies%20may,smaller%20steps%2C%20and%20offering%20choices.
PDA North America. (2024). What is pathological demand avoidance (pda)? PDA North America. https://pdanorthamerica.org/what-is-pda/
PDA Society. (2024). PDA in our words. PDA Society. https://www.pdasociety.org.uk/pda-in-our-words-2024/#:~:text=More%20than%2070%25%20of%20PDA,than%2050%25%20have%20experienced%20depression.