Pathological Demand Avoidance
Pathological Demand Avoidance (PDA), while not officially recognized in the DSM-5, is a set of behavioral traits common among certain individuals with autism. It affects how they react to daily demands and expectations, both self-imposed and those from others.
Often, this phenomenon is referred to within the autism community as “Persistent Drive for Autonomy.” This term is considered more descriptive as it accurately encapsulates the core issue – an extreme need for autonomy. While most of us thrive with a moderate degree of autonomy, for some, this need can be so extreme that it disrupts their ability to function.
On the outside, such individuals appear to be resisting cooperation with others, even when it's beneficial for them. Internally, they might feel incapable of performing tasks that they themselves desire if these tasks are perceived as “demands.”
In this blog post, we'll delve into the specifics of PDA, its symptoms, its impact on those affected, and how to support adults fitting this profile.
PDA is defined by an intense avoidance of everyday demands and expectations, such as those related to work, school, daily life, or social interactions. It’s an extreme anxiety-driven desire to maintain control over one's own life.
Since PDA isn't recognized in the DSM-5, individuals exhibiting these symptoms may have been previously diagnosed with Oppositional Defiant Disorder (ODD), a diagnosis that unfortunately doesn't lead to productive treatment or intervention.
If you find that your conversations with someone often play out as follows, even if the request seems harmless or beneficial, you might be dealing with PDA:
You: “Do you want to...”
Them: “No!”
People with PDA might employ behaviors to avoid demands, such as avoiding social situations, excuses for non-compliance, distraction tactics, or even lying if they feel desperate to evade demands.
Demands, as perceived by individuals with PDA, can encompass a broad range of everyday situations that others might not consider as such. Some examples include simple requests, following routines set by others, social expectations, academic or work-related tasks, and personal care activities. It's crucial to understand that what appears to be ordinary situations for most, can feel overwhelming and anxiety-inducing for individuals with PDA.
PDA can significantly influence the daily lives of those affected. They may experience high levels of anxiety and stress, difficulty with cooperation, social challenges, emotional regulation difficulties, rigidity, inflexibility, and even engage in masking or camouflaging behaviors. The impact of PDA can vary greatly from person to person, each with a unique profile of strengths and challenges. Understanding and supporting their unique needs and perspectives are crucial in providing appropriate support and accommodations.
Supporting an adult with PDA starts with understanding that their behavior is not a choice. Biological, physiological, and sometimes genetic factors contribute to the observed behaviors. When you believe that the problematic behaviors are not intentional, it changes your approach.
Build A Relationship
Most people with PDA often feel misunderstood. Trust and mutual respect are critical in providing support. Connect with them by showing genuine interest in their interests, dislikes, passions, and aspirations.
GAIN PERMISSION TO HELP FIRST
Always ask and gain permission before offering help or creating a plan for goal achievement.
LEARN HOW TO USE DECLARATIVE LANGUAGE
People with PDA often feel that demands are being imposed on them. The key to engaging them in constructive conversations is to learn how to use declarative language, which makes them feel competent and understood rather than imposed upon.
GET THEM IN THE DRIVER’S SEAT
Encourage them to take control of their lives and achieve their goals. Imposing your goals on someone with PDA is not a winning strategy.
SUPPORT EXECUTIVE FUNCTIONING CHALLENGES
If they struggle with executive functioning, help them decide their priorities, create a plan, figure out the next steps, and keep the momentum going.
BE PATIENT AND FLEXIBLE
Patience and flexibility are critical when dealing with someone with PDA. Extend gentle, shame-free accountability when they are not feeling overwhelmed with anxiety. If it seems like they can never have a conversation, it may be time to seek professional help.
Final Thoughts
PDA is a relatively unknown profile that describes a subset of people with autism, significantly affecting their daily lives. By providing understanding and support, we can help individuals with PDA to lead fulfilling and meaningful lives.
For More Information
Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders by E. Newson, K. Le Maréchal, and C. David; BMJ Journals.
PDA North America: Support and resources for individuals and families living with pathological demand avoidance.
The PDA Paradox: The Highs and Lows of My Life on a Little-Known Part of the Autism Spectrum by Harry Thompson
PDA Society: Provides information, support, and training about PDA for individuals, families, and professionals. Aims to increase acceptance and understanding of a PDA profile and to improve outcomes for individuals and families by focusing everyone involved on “what helps.”
Sally Cat’s PDA Page: Includes an informal PDA test for adult