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What is Pathological Demand Avoidance?


Author: Cynthia Gouveia Caria

7th March 2024 | 4 mins read

Pathological demand avoidance (PDA) was first proposed in the 1980s, and is a term used to describe a profile within an autism diagnosis, characterised by the regular refusal towards everyday demands and expectations. In this post, we will discuss what demand avoidance is, strengths associated with PDA and helpful approaches for parents, carers, families and professionals.

 

What is PDA?

Autistic people with this profile may typically display a combination of characteristics including:

  • Avoiding demands: Consistent resistance to meeting expectations or following instructions resulting in an impact in everyday life.
  • Anxiety: A need to control the environment, which can manifest itself through attempts to negotiate, non-engagement or task avoidance. Anxiety plays a significant role in the build up of demand avoidance in autistic people with PDA. Here is how anxiety and demand avoidance are interconnected:
    • Triggering anxiety: Demands, requests, fear of failure or uncertainty.
    • Avoidance as a coping mechanism: avoidance provides temporary relief from anxiety by removing the source of distress.
    • Cycle of avoidance and anxiety: avoiding demands may alleviate immediate anxiety but can also reinforce is a coping strategy.
    • Escalation of anxiety: The fear of negative consequences or the anticipation of future demands can increase anxiety levels.
    • Impact on everyday functioning: Academic performance, social interaction and relationships can become significantly impacted. This may lead to withdrawals from activities, isolation or difficulties in meeting responsibilities.
  • Social communication difficulties: Challenges around social interactions with others but may demonstrate superficially good communication skills when it serves an agenda.
  • Difficulties with flexibility: Transitions and changes in routine may be difficult, preferring to maintain a sense of control over the environment.
  • Masking: Internalising and externalising distress making it challenging to recognise the support needs.

It is important to note that demand avoidance presents differently in each person and the characteristics can vary widely. Diagnosis can be challenging due to overlaps of characteristics with other conditions such as ADHD.

 

Types of demands

There are a myriad of different types of demands. These include: questions, expectations, commands, signs, timetables, prompts, choices, laws, responsibilities and many more.

 

Strengths

While autistic people with a demand avoidance profile often face challenges in navigating daily demands and expectations, there are also many strengths associated with a PDA profile. Recognising and harnessing these strengths can be essential for supporting wellbeing and facilitating success. Some commonly associated strengths associated with a PDA profile include:

  • Creativity and imagination: Many individuals with a PDA profile demonstrate remarkable creativity and imagination. There may be a unique way of thinking and problem-solving, often approaching tasks and situations from unconventional angles.
  • Strong advocacy skills: Exceptionally skilled at advocating from themselves and others. There may be a strong sense of justice and fairness, advocating on what they believe is right.
  • Resilience: A strong inner drive to overcome obstacles and persevere in the face of adversity.
  • Adaptability in certain situations: Remarkable adaptability in situations where they feel comfortable and in control. Thriving in environments that allow for autonomy and self-direction.
  • Honesty and authenticity: Often valuing honesty and preferring to express themselves openly and directly.
  • Innovative problem solving: May excel in situations that require creative solutions and lateral thinking.
  • Strong emotional awareness: While navigating social interactions may be challenging, they may possess a keen emotional awareness. They may also be highly attuned to their own emotions and the emotions of others, even if they have difficulties with expressive language or emotional regulation.
  • Passionate interests: Intense and passionate interests in specific subjects or hobbies. Their enthusiasm and depth of knowledge in these areas can be remarkable, providing opportunities for skill development and personal fulfilment.

By understanding and embracing these strengths of demand avoidance, caregivers, educators and professionals can create environments that promote autonomy, creativity, effective communication and empathy, leading to improved outcomes and quality of life.

 

Helpful approaches

People with PDA require support due to the unique challenges they face in navigating everyday life. It is important to provide assistance in the following areas, to help them thrive.

Addressing anxiety is essential in supporting autistic people with a PDA profile. Strategies such as relaxation techniques, mindfulness practices, gradual exposure to demands can help develop coping skills to manage anxiety more effectively.

Low arousal approaches that aim to reduce levels of anxiety and increase feelings of control, are positive building blocks when thinking about partnership-based strategies that work with demand avoidance. A relationship based on collaboration, trust, and a balance between the types of demands work best.

Here we can begin to think about the PANDA approach.

When supporting an autistic person with a PDA profile, it is important for the person to feel seen, explore interests, and engage positively.

  • P – Picking battles
    • Reduce demands placed
    • Enable some level of choice and control
    • Explaining your reasoning
  • A – Anxiety management
    • Reduce uncertainty
    • Forward-thinking and plan ahead
    • Recognise anxiety triggers and support throughout
  • N – Negotiation and collaboration
    • Proactively collaborate to problem solve behaviours that challenge
    • Keep calm, be fair and trustworthy
  • D – Disguise and manage demands
    • Request words indirectly
    • Model positive behaviour you’d like to see
    • Monitor and reduce barriers where possible
  • A – Adaptation
    • Be flexible
    • Allow time and space to process information
    • Try to balance the amount of “give and take”

 

Supporting people with PDA can be challenging for parents, carers and families. Understanding the anxiety provoking triggers can help develop strategies to reduce the frequency of demand avoidance behaviour and support people more effectively. These strategies may involve providing choices through negotiations and collaborations, reducing environmental stressors using anxiety management techniques such as forward planning and offering support with emotional regulation. Research on demand avoidance is ongoing, aiming to better understand and develop more targeted interventions to support people with the profile. To find out more about PDA, watch our Lunch and Learn on the subject below or get in touch for a free conversation with our Outreach Team.

 

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