What is Pathological Demand Avoidance?
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PDA is now considered to be part of the autism spectrum with similarities to Asperger Syndrome and Autism, but is also significantly different. Individuals with PDA share difficulties with others on the autism spectrum in social aspects of interaction, communication and imagination. However, the central difficulty for people with PDA is the way they are driven to avoid demands and expectations. This is because they have an anxiety based need to be in control.
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Individuals with PDA are generally manipulative socially, highlighting its main difference with the other Autistic spectrum disorders.
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The following criteria are used to decide whether a child has Pathological Demand Avoidance:
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Passive in nature during their first year e.g. ignores toys, appears passive, usually delayed milestones for development.
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Strategies of avoidance are normally socially manipulative.
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Performs everything on their own terms, resists and avoids normal demands. May be incorrectly described as a 'difficult phase' as this behaviour will continue in to adulthood
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Lacks a sense of responsibility, appears very naughty. Praise and punishment are normally ineffective.
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Lack self-identity.
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Rapid changes in the intensity and modality of emotions.
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Tendency to be impulsive with a strong desire to be in control of situation.
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Enjoys role-play, with the interest in fantasy normally continuing in to adulthood.
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May frequently appear on the edge of violence.
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Complete lack of normal social boundaries.
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Early language delay. When speech has developed, its content is usually odd.
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Eye contact may be over-strong with vivacious facial expressions.
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Obsessive behaviour.
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Neurological involvement - signs may include clumsiness, awkwardness, or never crawling as a toddler.
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One of the main symptoms of PDA is the urgent desire to avoid the ordinary everyday demands placed on them, to a pathological degree that is not normal laziness. As they will have developed social skills it is common that these skills will allow the individual to use excuses; distraction attempts or controlling the situation by refusing to speak or by making noises to drown out the other person’s voice.
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Trying to keep a low profile within a school setting, unless they receive unwanted attention, which may lead to them becoming disruptive and aggressive. Individuals do not choose to behave in these manners; it is a result of their inability to cope with what they perceived as the stress of every day demands.
Instead of telling the person what will happen, try and imply it instead.
Instead of “I want you to do some writing” say “Which colour pen would you like to use?”
Instead of “We're going out at 10.00” say “How much time do you need to get ready?”
Here are some tips for talking with someone who has Pathological Demand Avoidance (PDA):
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Be respectful
Avoid using words like "need", "now", "must", or "urgently". Instead, try using declarative language, such as statements, comments, or observations. You can also rephrase things to talk about an object instead of a person, or start requests with the word "please".
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Be flexible
Be prepared to change your approach or scale back demands if the person starts to panic. You can also offer choices, but not too many, as this can be overwhelming.
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Be calm
Try to remain calm and don't take things personally. You can also try to reduce stimuli that might make the person feel overwhelmed, such as turning down the volume on the TV or radio, or asking others to keep quiet.
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Be appreciative
Try to make the person feel useful and needed. For example, you can say "thank you" for help, or offer indirect praise. Some people with PDA might not like compliments, but they can still appreciate positive attention and recognition.
Pathological Demand Avoidance
PDA or Pathological Demand Avoidance is a newly recognized presentation of ASD, particularly in the UK, though now gaining recognition in the US. For parents of children with PDA, there is no other diagnosis that quite fits, and it has been sorely misunderstood for too long by educators, physicians and clinicians alike.
It is also becoming common for adults to realize they are PDA, though they were not diagnosed in childhood, despite having full symptoms.
For more information on PDA please visit: https://www.pdasociety.org.uk/what-is-pda-menu/about-autism-and-pda/
Here are some ways to treat PDA:
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Reduce anxiety and stress
Rephrase requests to sound less triggering, use indirect requests, and minimize unnecessary rules.
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Create a calm and predictable environment
Reduce sensory stimuli by minimizing clutter, using neutral colors, and using sound-absorbing materials. Establish consistent schedules and routines, and designate areas for relaxation or sensory activities.
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Provide visual supports
Use visual schedules, social stories, and visual cues to help people understand expectations, transitions, and changes in routine.
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Offer choices
Give people with PDA a sense of control over their environment by offering choices.
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Use declarative language
Use statements, comments, or observations, or rephrase things to talk about an object rather than a person. Start requests with the word "please".
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Help people manage their emotions
Use cognitive behavioral and psychoanalytic therapy to help people acknowledge, comprehend, and express their emotions.
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Educate parents and teachers
Physiotherapists can play a key role in educating parents and school teachers of children with PDA.
About
Nicole Story, EDS, MED, LMFT, LMHC, NCC
Psychotherapist, Clinical Director
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A highly trained clinician (both US and UK/Ireland) for 20 years and Clinical Supervisor to over a dozen nonprofit agencies, military and veterans administration clinical staff, training therapists how to recognize, diagnose and treat autism, ADHD, AuDHD and PDA.
Mother of 2, familiar with the familial, emotional, social, behavioral and academic issues surrounding PDA for the child and the family.​
