Understanding PDA (Pathological Demand Avoidance)

Sep 11 / Katie Hodgkins
What is PDA? Let's take a look.

Pathological Demand Avoidance (PDA) is a highly misunderstood profile of autism that is characterised by an extreme avoidance of everyday demands and expectations. This behaviour isn’t due to a desire to be defiant or disobedient, but rather is a result of high levels of anxiety. Children with PDA often struggle with the pressure of demands placed upon them, whether explicit (e.g., requests, instructions) or implicit (e.g., social expectations), leading to behaviours aimed at avoiding these situations.

Pathological Demand Avoidance (PDA) is currently widely believed to be a profile of autism that is characterised by an extreme avoidance of everyday demands and expectations. This behaviour isn’t due to a desire to be defiant or disobedient, but rather is a result of high levels of anxiety. Children with PDA often struggle with the pressure of demands placed upon them, whether explicit (e.g., requests, instructions) or implicit (e.g., social expectations), leading to behaviours aimed at avoiding these situations.

Characteristics of PDA

1. PDA is a complex condition and is not yet universally recognised as a distinct profile within the autism spectrum, though awareness and understanding are growing in the UK. Children with PDA often display the following traits:

2. Resisting ordinary demands: This can range from avoiding simple tasks like getting dressed or going to school to refusing to engage in daily activities, including playtime.
Using social strategies to avoid demands: Unlike many autistic children, those with PDA are often socially aware and may use tactics such as distraction, negotiation, or creating diversions to avoid doing something.

3. Sudden mood changes: These children may experience intense emotional responses, swinging from calm to extreme anxiety or anger in a short period.

4. Role play and fantasy: Children with PDA may immerse themselves in imaginary roles, often as a way to exert control over situations and manage their anxiety.

5. Comfort with novelty, but difficulty with routine: In contrast to many autistic children who thrive on routine, those with PDA can find routines restrictive and may seek out novelty instead.

Understanding the Anxiety Behind PDA

The key to understanding PDA lies in recognising that the child's avoidance behaviours stem from overwhelming anxiety. Demands, however small, can feel like a loss of control, triggering a stress response. This heightened anxiety can lead to what appears as oppositional behaviour, but is actually a coping mechanism. Recognising PDA as a part of the autism spectrum, but with its distinct challenges, can be instrumental in providing appropriate support.

Tips for Supporting Children with PDA

1. Create a low-demand environment: To help reduce anxiety, avoid direct instructions and demands when possible. Instead, offer choices and flexibility. For example, rather than saying “It’s time to brush your teeth,” you could ask “Do you want to brush your teeth now or after breakfast?”

2. Use indirect language: Phrasing things as a question, or making a suggestion, can feel less confrontational to children with PDA. Statements like “I wonder if we should tidy up” or “Do you think it might be a good time to head outside?” can reduce the feeling of pressure.

3. Offer control: Giving the child a sense of control over their environment can help alleviate anxiety. You might give them some autonomy in deciding their schedule or let them pick how they want to approach a task. Even small decisions can help them feel more in control.

4. Be creative with engagement: Role play and imagination can be useful tools. Some children with PDA are more likely to comply with a request if it’s framed as part of a game or story. For example, pretending they are a superhero who needs to get ready for a mission could be a fun way to encourage them to dress themselves.
Stay calm and patient: Children with PDA may have sudden emotional outbursts. Remaining calm during these moments is crucial. Validate their feelings and provide them with the time they need to regain control. Trying to force compliance during an outburst will often escalate the situation.

5. Work with their interests: Engaging a child with PDA through their specific interests can be a helpful way to motivate them. Tailoring tasks and activities to what they enjoy may reduce their need to avoid demands.

6. Collaborative problem-solving: Involve the child in decision-making and problem-solving. If there’s a challenge, ask them how they think it could be solved. This method empowers them and can reduce their resistance.

Conclusion

Supporting a child with PDA requires a flexible and understanding approach. Acknowledging the anxiety that underpins their avoidance and adjusting strategies to reduce pressure and offer choices is key. With patience, creativity, and a focus on building trust, you can help a child with PDA feel more secure and less overwhelmed by the demands of everyday life. They can thrive and achieve their dreams, with the right support behind them!
Watch our webinar on Supporting The PDA Profile here, and alternatively, check out Understanding & Supporting PDA in Schools here.