Pathological Demand Avoidance (PDA)

Many of us sometimes avoid tasks that need to be completed – from household chores to studying for a test.

But for some people, persistent and wide-ranging avoidance can be a symptom of a deeper psychological condition. When it starts to significantly impact someone’s life, it may be a sign of Pathological Demand Avoidance (PDA).

In this guide, Dr Lisa Williams explores the history of the term PDA and why its symptoms are often associated with other conditions such as autism and ADHD.

‘Pathological Demand Avoidance’ (PDA) is a term coined in the 1980s by psychologist, Professor Elizabeth Newson. 

It describes the resistance of certain individuals to do what’s asked of them. This may include everyday demands – like attending school or work – as well as more simple requests from others, like “could you pass the salt?”. 

Some people may even avoid tasks that they ask of themselves, such as eating when hungry, drinking when thirsty and maintaining personal hygiene.

Unsurprisingly, PDA can cause significant challenges for people in their everyday lives – impacting their academic or professional career, relationships and even their health.

PDA is regularly linked to other conditions, like attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and post-traumatic stress disorder (PTSD). But it is most often considered as a potential profile of autism spectrum disorder (ASD). 

This is due to the widely held belief that PDA can result from high anxiety, intolerance of uncertainty, sensory overload and a pervasive need for control. 

However, research is still uncertain surrounding exactly what causes these challenges. 

PDA is still heavily debated within the neurodivergent community, by professionals and in the research field.

There is some difference of opinion regarding the status and use of the term. And it is not clinically recognised as a standalone diagnosis within the DSM-5 or ICD-10 – the manuals used by healthcare professionals to assess mental health and neurodevelopmental conditions. 

While Professor Newson proposed that PDA represented its own distinct condition with its own specific features, research studies have yet to provide evidence for this.

So, PDA cannot be diagnosed, as there are no standard criteria or definition and no formal guidance on how it should be assessed.   

For this reason, those presenting with symptoms of PDA often benefit from an ASD assessment, which explores their specific strengths and challenges and formulates whether demand avoidance is relevant for them. 

While some professionals find PDA to be a helpful way of describing and understanding people’s experiences, others find the term generates unhelpful connotations.

Some psychologists and other professionals have therefore advocated for a reframing of the phrase ‘PDA’.

This stems from a desire to move away from the term ‘pathological’, towards the term ‘pervasive’. The alternative phrase suggested by this community is Pervasive Drive for Autonomy.

Ultimately, the symptoms and characteristics of PDA aren’t debated by this new definition. It simply focuses on a less negative view of the condition – instead around a desire to pursue freedoms rather than to avoid responsibilities.

For people with PDA, many day-to-day demands are avoided simply because they are demands. 

What constitutes a demand can be different for each person. But some examples can include: 

• Direct demands – from others, such as “you need to do your homework”, “put on your shoes” or “submit your invoice”. 

• Internal demands – from the person themselves. This may include responding to internal experiences like hunger or thirst, or a person’s expectations for the day, such as “I should brush my hair” or “I need to respond to that email”. 

• Implied demands – even when they’re not directly commanded. For example, a drink being handed to you, or the demand to remain seated at the theatre.  

It’s important to remember that everyone experiences demand avoidance to some degree. What defines PDA can include the extent to which the person avoids requests, and their behaviour when something is demanded of them. 

They may simply refuse to complete a task or even walk away or withdraw from the situation. Others may show more subtle attempts to avoid demands – such as procrastination, changing the subject, redirecting attention to something else or offering excuses.

If anxiety is particularly high, a person may panic, shut down, self-harm or become aggressive. 

Professor Newson also hypothesised some other specific characteristics of PDA, including:

• An ability to roleplay and pretend. 
• Mood swings and impulsivity. 
• Appearing sociable or using social strategies, despite difficulties with social understanding. 

It was originally conceived that these additional characteristics were uncommon for autistic people. But, as our understanding around autism has grown, it has become clear that this is not the case.

When it comes to supporting people experiencing PDA, it’s important to remember that everyone is different. And what might work for one person may not work for another. 

If demand avoidance is suspected, it can be helpful to seek further assessment from a professional to formulate what variables might be most relevant in understanding a person’s individual challenges. 

Although each person’s support should be specific and individualised, certain strategies have been suggested as being more helpful for those with PDA. 

Some of these are contrasting to those most commonly used for, with or by, people with autism. In fact, the PDA Society suggests that conventional support strategies for autism are often ineffective and counterproductive for those with a PDA profile. 

Many people with autism benefit from support in the form of structure, routine, firm boundaries, praise, reward and consequences. However, those displaying signs of PDA may prefer a “person-centred approach based on negotiation, collaboration and flexibility”.

The PDA Society also uses the mnemonic ‘PANDA’ to highlight potential helpful strategies, including:  

• Pick battles – by accepting that some things can’t be done, limiting rules and offering choice and control where possible.
    
• Anxiety management – using tools such as planning ahead, reducing uncertainty and considering what might be underlying anxiety in a person, such as sensory challenges or social discomfort.
    
• Negotiation and collaboration – prioritising fairness and trust, and working together to overcome challenges.
   
• Disguise and manage demands – by doing things together or using indirect phrasing rather than giving a direct instruction. Assess a person’s tolerance for demands in each moment. What they can manage one day might be different the next, depending on how they are and what’s happening around them.
   
• Adaptation – for example, having a back-up plan, giving them extra time or trying humour, distraction or novelty.  

Additional strategies for dealing with PDA in others include: 

• Asking for reasonable neuroaffirming accommodations at work.
• Engaging in therapy, counselling or mindfulness.
• Protecting ‘demand-free’ time.
• Using sensory regulation strategies.
• Connecting with others with the same challenges. 

While there is no standard criteria or definition of PDA – and no formal guidance on how it should be assessed – that doesn’t mean there is no support available to those presenting signs.

Autism assessments should be comprehensive enough to fully explore a person’s specific strengths and challenges – and to formulate whether demand avoidance is relevant for a person.

A professional assessment gives you more knowledge and understanding of a person’s needs, as well as how to help them daily. 

If you know someone who is struggling with signs of PDA, our Child ASD Assessment or Adult ASD Assessment services can identify signs of autism and help get them the right support.

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