Key takeaways

  • Pathological demand avoidance (PDA) is an extreme resistance to everyday demands, such as getting dressed or brushing the teeth.
  • Researchers often associate PDA with autism, especially in children. However, there is some debate about whether this term is helpful or accurate.
  • Managing PDA in children may involve strategies such as increasing trust, offering choices, and trying alternative ways of phrasing demands. Mental health professionals may be able to offer additional support and help individuals with PDA learn positive coping skills.

A person with PDA may go to extreme lengths to evade certain requests. These can include everyday tasks that seem routine or trivial to others.

However, PDA is not a distinct diagnosis, and it is not part of the symptom criteria for any condition. There are also other reasons why a child or adult may avoid demands, so it is important to get insight from a health professional where possible.

This article looks at what PDA is, as well as its signs, causes, and management strategies.

Pathological demand avoidance (PDA) refers to an extreme aversion to the demands of daily life.

A person with PDA might feel distressed by sudden instructions, such as a parent asking them to get dressed. They may go to extreme lengths to avoid these tasks.

The psychologist Elizabeth Newson coined the term “PDA” in 1983. Researchers largely use the term to describe demand avoidance in children and adolescents, particularly those who are autistic.

A 2024 review of past research says that between 1% and 20% of autistic people likely experience PDA. However, some scholars have argued that the term pathologizes a reaction that makes sense to autistic people.

Autistic people perceive and experience the world differently from nonautistic people. Through an autistic lens, PDA may sometimes be a rational response to what an autistic person perceives as a threatening situation or environment.

There is no consensus about the features of PDA. It is not an official diagnosis, and does not appear in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a clinical handbook that healthcare professionals use to diagnose mental health conditions.

The following may be signs of PDA, although they are not definitive:

  • Extreme avoidance: This can involve lying and making excuses, intensely focusing on something else to ignore the demand, escaping, or creating distractions.
  • Strong emotional responses: If a person’s attempts to avoid a demand fail, they may experience an extreme emotional response, such as a panic attack or meltdown.
  • Anxiety: People with PDA may experience anxiety, which may motivate their avoidant behavior.
  • Obsessive behaviors: Obsessive behaviors, especially relating to social interactions, may be characteristic of PDA.
  • Lack of self-awareness: Individuals with PDA may exhibit a lack of self-awareness, shame, or pride.
  • Neurological traits: Some researchers describe neurological differences in individuals with PDA, including clumsiness.

Experts are still learning what causes PDA. However, researchers theorize that it may arise from autistic traits such as anxiety, a need for a predictable environment, and difficulty adapting to change.

Anxiety disorders commonly co-occur with autism. A 2018 review and meta-analysis concluded the current and lifetime prevalence is between 27% and 42% in autistic adults.

Some autistic people may also have inflexible patterns of thought and behavior. As a result, sudden demands or changes in routine can cause anxiety in autistic people.

A person may learn to cope with anxiety and regain control by avoiding a demand that causes them distress. Over time, this may reinforce avoidance as a coping mechanism. A person may also begin to respond to benign demands as if they are threatening.

There are various reasons a person may have an extreme avoidant response to demands or expectations. These include several conditions besides autism, such as:

  • Post-traumatic stress disorder (PTSD): Avoidance is a symptom of PTSD. It can be a way for a person to avoid things that remind them of a traumatic event, and so to avoid their symptoms. Some researchers believe PDA may occur because of trauma, but others believe they are distinct.
  • Obsessive-compulsive disorder (OCD): Someone with OCD may also exhibit avoidance as a way of avoiding things that trigger their anxiety, or that interfere with their compulsive behaviors.
  • Attention deficit hyperactivity disorder (ADHD): Some symptoms of ADHD, such as difficulty focusing, may lead to challenges with following instructions or switching between tasks.
  • Behavioral disorders: Some behavioral disorders, such as oppositional defiant disorder or conduct disorder, can lead to children refusing to carry out requests. However, children with these disorders will also exhibit severe or persistent defiance, hostility, or aggression.

It is important to note that people can have more than one of these conditions.

According to the PDA Society, a charity in the United Kingdom, the following strategies may be helpful for individuals who experience PDA:

  • Communicating: Whenever possible, it can be helpful to let others know about emotions or needs that make a demand feel difficult.
  • Setting expectations: Setting realistic expectations or boundaries for others can help them understand what is and is not possible.
  • Making suggestions: If a person has ideas for ways to make demands feel less threatening, they can try them out or share them with a caregiver. For example, getting dressed may feel easier if a person can wear soft, comfortable clothing.
  • Self-compassion: A person may find that PDA causes feelings of embarrassment or self-criticism. If this is the case, practicing self-compassion or positive self-talk can be beneficial.
  • Connecting with others: Connecting with people who have similar experiences may make a person with PDA feel seen and understood. A mental health professional with a background in working with neurodivergent people may also have experience to draw from.

Some practical ways of making demands feel less difficult could include:

  • reframing demands as choices
  • setting aside some demand-free time every day
  • pausing to process demands
  • exploring different ways of performing tasks
  • asking for workplace accommodations, such as flexible working hours

The PDA Society recommends the following for caregivers of children with PDA:

  • Rethinking the rules: Many people grow up with rigid rules and expectations, where parents make decisions and children obey. However, this approach can make people with PDA feel they have no control. Although it may feel uncomfortable, try to let go of what “should” happen.
  • Prioritizing trust: When children or adolescents feel they can trust adults, they feel safer, which in turn reduces their anxiety. Build trust by being warm, honest, and consistent. Remain calm and patient, ensuring body language is not threatening.
  • Softening demands: Disguise demands by changing the language. For example, instead of “put your coat on”, a person can say “your coat is here” or “I wonder where your coat is?”
  • Explaining why: Explain why a task is beneficial or necessary, especially if it relates to something abstract, such as the law.
  • Offering choices: Give the child a say in how or when something happens, and be willing to compromise.
  • Accepting “no”: Sometimes, a task is not possible or may push someone into burnout or a meltdown. If there are signs this may happen, pull back and let them calm down. It may be possible to try again later.

PDA can become problematic for the individual or those around them. If PDA affects an individual’s quality of life, or a parent or caregiver is experiencing distress, a professional may be able to help.

If a person does not already have a diagnosis, they may also benefit from an assessment to determine the cause of their PDA.

People can look for mental health professionals with experience working with autistic or neurodivergent people.

Pathological demand avoidance (PDA) refers to extreme resistance to demands, including everyday demands that may seem routine to the larger population. Researchers often link it to autism.

PDA is not a clinical diagnosis. Rather, it is a concept that describes a pattern of behavior. A person who experiences PDA may go to extreme lengths to avoid complying with a demand. They may have intense emotional responses if they cannot avoid a demand.

A neurodiversity-affirming mental health professional may be able to help a person learn to manage PDA. Strategies such as reframing demands as choices, reducing anxiety, and learning alternative ways to work and perform tasks may also be helpful.