Pathological Demand Avoidance (PDA) is a distinct profile within the autism spectrum, where children experience an overwhelming need to avoid everyday demands and expectations. PDA, sometimes called Extreme Demand Avoidance, is deeply rooted in anxiety and a need to maintain control in unpredictable situations.
Unlike typical childhood resistance, PDA involves avoidance that is all-encompassing. Traditional parenting strategies, which may work with other children, often fail with kids who have PDA. This can leave parents, carers, and educators feeling unsure of how to support their child.
This guide aims to explain the key features of PDA, how it is diagnosed, and the best strategies to help children thrive.
Life with Pathological Demand Avoidance
For children with PDA, life can feel like a constant battle between fight, flight, or freeze. Their overwhelming anxiety drives a need to resist demands, leading to meltdowns, shutdowns, and, at times, extreme behavior.
Kids with PDA may even avoid activities they typically enjoy. They develop social strategies and use distraction to resist demands, not out of stubbornness, but because their anxiety makes following through feel impossible. As their anxiety escalates, all suggestions—even those that seem minor—are interpreted as demands.
Once their anxiety reaches a breaking point, it becomes a case of *can’t* do, not *won’t* do.
As child psychologist Dr. Nicole Carvill puts it:
"PDA is a neurological power struggle between the brain, body, and heart.”
This struggle can impact every area of life, especially in school. The structure of school—with its rules, timetables, and expectations—can feel impossible for children with PDA. Tasks like arriving on time, wearing a uniform, following instructions, or participating in activities often lead to stress and anxiety. This daily challenge, sometimes called “school can’t,” can also affect the well-being of the entire family as the pressure spills over into home life.
However, living with PDA isn’t all about challenges. Children with PDA are often creative, resourceful, and quick-witted. Their determination and unique ways of seeing the world can be tremendous assets as they learn to navigate life in their own way.
Key Behavioral Features of PDA
The driving force behind PDA is anxiety. When children with PDA feel overwhelmed or out of control, they instinctively try to regain control. This need for control can lead to several distinct behaviors, including:
- An obsessive need for control: Children with PDA may insist on dictating how things should be done.
- Refusal to cooperate: Even simple requests can feel impossible to comply with.
- Mood swings: Their emotional state can fluctuate rapidly.
- Social challenges: Understanding boundaries can be difficult, and they may struggle with social interactions.
- Adult-like behavior: Some children with PDA will adopt adult language and tones, even as young children.
- Fantasy and role-play: They often create elaborate fantasy worlds to escape the stress of real-life demands.
Children with PDA tend to avoid tasks we take for granted, such as getting dressed or leaving the house. They may make creative excuses or sabotage situations to avoid engaging in tasks that trigger their anxiety.
Common behaviors include:
- Distraction: Using humor, conversation, or games to divert attention from a task.
- Sabotage: Creating reasons not to participate in an activity.
- Domination: Taking control during play with other children or adults.
- Blunt language: Saying things that may seem hurtful but are driven by an urgent need to manage their environment.
- Meltdowns: Shouting, saying “no,” or experiencing intense emotional outbursts.
- Escalation to aggression or self-harm: In extreme cases, anxiety can lead to more severe reactions.
As Riko, an individual with PDA, explains:
“PDA is like trying to face your phobias every waking moment.”
— Riko's Blog
When avoidance tactics fail, anxiety spikes, and distress often intensifies. Adults with PDA sometimes compare this experience to a full-blown panic attack.
The PDA Distress Scale
The following outlines how a child’s distress can escalate when demands or expectations are placed on them:
- Calm (Green Zone): The child can engage, but may use distraction or other strategies to avoid tasks.
- Social Withdrawal (Yellow Zone): They begin to retreat and reduce communication.
- Incapable of Meeting Demands (Orange Zone): The child feels overwhelmed and cannot meet expectations.
- Fight, Flight, or Freeze (Red Zone): Panic sets in, leading to anger, extreme behavior, or emotional shutdown.
Recognizing these stages of distress helps parents and caregivers intervene early, providing support before the child reaches the red zone.
Testing and Diagnosing Pathological Demand Avoidance
PDA is not yet formally recognized in the DSM-5 Diagnostic Manual, which means that in countries like Australia, a formal diagnosis cannot be made. However, a knowledgeable psychologist familiar with PDA traits can still assess your child, providing a framework for understanding their challenges.
It’s important that your child has a confirmed Autism Spectrum Disorder (ASD) diagnosis before considering PDA. Unfortunately, many children with PDA are initially misdiagnosed with Oppositional Defiant Disorder (ODD) because of the overlap in behaviors, particularly around defiance and resistance to authority.
However, while ODD focuses on deliberate defiance, PDA behaviors are driven by deep-seated anxiety. This distinction is critical for appropriate support and intervention.
The PDA Assessment Process
PDA profiling typically forms part of a wider autism assessment, and if your child already has an ASD diagnosis, you may not need a referral. The process generally follows these steps:
1. Parent Consultation: The psychologist meets with parents to discuss the child’s development, challenges, and behaviors. A parent questionnaire is often part of this step.
2. Child’s Assessment: The psychologist interacts with the child in a comfortable environment, using non-directive language and activities that engage their interests to identify potential PDA traits.
3. Feedback from Teachers and Professionals: Educators and other professionals are consulted to understand how the child presents in different environments.
4. Diagnosis or Profiling: Based on the findings, a psychologist may determine that the child fits the PDA profile. For younger children, the diagnosis may indicate a “high risk” of PDA rather than a confirmed profile.
Though the process can feel long and sometimes overwhelming, many parents find relief in having a clearer understanding of their child’s needs and the tools to move forward.
Supporting Children with PDA: Strategies and Approaches
Once PDA is identified, the primary goal of support is to reduce the child’s anxiety. Shifting your mindset from seeing your child’s behavior as defiance to recognizing it as a response to overwhelming anxiety can make a big difference.
As Dr. Nicole Carvill explains:
“There is no one-size-fits-all approach to PDA care. Often, strategies that work well for children with autism can make things worse for children with PDA. Flexibility is key.”
Here are some effective strategies:
- Reframe your language: Use indirect phrasing to reduce pressure. For instance, instead of “You need to do this,” say, “I wonder if we can try this together.”
- Offer choices: Give your child a sense of control by letting them choose between options or allowing them to say no when possible.
- Reduce sensory stress: If your child struggles with sensory overload, working with an occupational therapist (OT) to manage sensory challenges can help.
- Increase familiarity: The more familiar a child is with an environment or task, the less anxious they are likely to feel.
- Align tasks with their interests: Whenever possible, incorporate activities that your child enjoys into their daily routine to help reduce avoidance.
- Be flexible: Adjust your expectations and be prepared for things to change. PDA is unpredictable, and strategies that work one day may not work the next.
It’s also important not to take negative comments personally. Children with PDA may say hurtful things in moments of high anxiety. Understanding that these behaviors are not intentional can help you respond with empathy.
Medication and Additional Resources
For some children with PDA, anxiety-reducing medications may be helpful. This is a personal decision that should be made in consultation with a psychologist and a pediatrician.
If you’re seeking more information, here are some excellent resources:
- PDA Society UK
[https://www.pdasociety.org.uk](https://www.pdasociety.org.uk)
Offers a wealth of information, support, and strategies for parents and educators.
- PDAANZ (Australia and New Zealand)
[https://www.pdaanz.com](https://www.pdaanz.com)
A valuable resource for parents and carers in Australia and New Zealand.
- The Naughty Autie
[https://naughtyautie.com](https://naughtyautie.com)
A blog and advocacy platform raising awareness of autism and PDA.
- Dr. Nicole Carvill – Think Psychologists
[https://www.thinkpsychologists.com.au](https://www.thinkpsychologists.com.au)
Offers expert services for autism and PDA assessments.
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References
1. PDA Society UK
Website: [https://www.pdasociety.org.uk](https://www.pdasociety.org.uk)
2. PDAANZ (Australia and New Zealand)
Website: [https://www.pdaanz.com](https://www.pdaanz.com)
3. The Naughty Autie
Website: [https://naughty
Written by: CL Hub Team.