Pathological Demand Avoidance (PDA) is now widely understood to be part of the autism spectrum. Individuals who present with this particular diagnostic profile are driven to avoid everyday demands and expectations to an extreme extent. This is rooted in an anxiety-based need to be in control. While PDA is relatively uncommon it is important to recognise and understand the distinct profile because it has implications for the way individuals are best supported and managed. PDA is dimensional and affects individuals to a varying extent.

Individuals with PDA share difficulties with other people on the autism spectrum in terms of social aspects of interaction and communication, together with some repetitive patterns of behaviour. People with PDA often seem to have better social understanding than others on the spectrum, which means some of their difficulties may be less obvious at first.
 

The main features of PDA include

Resists and avoids the ordinary demands of life, which might include getting up, joining a family activity or other day to day suggestions. This may be the case even when the person seems to want to do what has been suggested.

Using social strategies as part of the avoidance. eg distracting, giving excuses

Appearing sociable on the surface, but lacking depth in their understanding.

Excessive mood swings and impulsivity.

Being comfortable in role play and pretend, sometimes to an extreme extent.

‘Obsessive’ behaviour that is often focussed on other people.

What are the differences between PDA and other conditions?

When conditions are defined by a number of behavioural features there will be connections and overlaps. This underlines the importance of detailed assessments including the taking of developmental history, direct observation and information about how the child behaves in a range of different settings.

Key features to supporting someone with PDA:

It is often the case that some of the strategies that are typically found to be effective for people with autism (such as the use of routine, predictability and structure) need considerable adaptation. Individuals with PDA respond better to less direct and more negotiative approaches, which may include the following.

Choosing priorities ; which demands are necessary and which can be avoided for now?

Reduction of demands where possible. eg certain requests and expectations.

 

Being very flexible and creative.

Giving choice and using negotiation.

De-personalising of requests. eg using written suggestions, attributing reasons for a request to other factors such as health and safety

Using indirect language, humour and games to obscure demands.

Use of indirect praise and affirmation.
 

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Written by Dr Phil Christie 2016