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What is Pathological Demand Avoidance (PDA) and How is it Diagnosed?

Pathological Demand Avoidance (PDA) is a condition that we’ve noticed becoming increasingly common over the last five years. For parents, teachers, and health professionals there is still a lot to learn about this condition and how to best support individuals with it.

If you’ve found yourself wondering what is Pathological Demand Avoidance and how is it diagnosed, you’ve come to the right place. Let’s explore this condition, behavioural indicators and what treatment is available for children and adults with Pathological Demand Avoidance.

What is Pathological Demand Avoidance (PDA)?

The term Pathological Demand Avoidance was first coined by Professor Elizabeth Newson in 1983. At the time, Professor Newson was working at the Child Development Research Unit at Nottingham University. This condition is considered to be a part of the Autism Spectrum, and is characterised by an overwhelming or obsessive need to resist or avoid demands. This can often lead to prolonged tantrums and even violent outbursts.

The key underlying factor in Pathological Demand Avoidance is the extreme levels of anxiety the individual with the condition has when demands are placed on them, which can feel like a loss of control, and can lead to panic attacks and avoidant behaviours. For parents with children who have suspected Pathological Demand Avoidance, they may notice that their child will say no or refuse tasks or activities they usually enjoy if demands or requests are made to engage in those activities.

Something that sets Pathological Demand Avoidance apart from the Autism Spectrum is the proficiency that those with the condition have for social interaction. Many children and adults with PDA have strong social understanding and use this to be ‘socially manipulative’ as part of their avoidance of demands.

What demands may trigger someone with Pathological Demand Avoidance?

People with Pathological Demand Avoidance struggle with direct demands, indirect demands, and internal demands. Here are some examples of demands that may trigger someone with PDA:

Verbal instructions

Social rules
Requests
Questions
Written instructions
Implied demands

Prompts
Orders
Timetables
Star charts
Laws

Decisions
Uncertainty
Internal bodily demands (i.e. hunger, thirst)
Planning ahead

For more information on behaviours of someone with Pathological Demand Avoidance check out this helpful resource.

What demand avoidant strategies might someone with Pathological Demand Avoidance use?

Both children and adults with Pathological Demand Avoidance utilise a variety of demand avoidant strategies to escape or avoid things in the present moment.

Initial avoidant strategies in Adults might include distraction (changing the subject in a conversation), procrastination, excusing themselves from a situation, incapacitating themselves (saying ‘my legs don’t work’ when asked to do something) or withdrawing into role play. Children may run away, incapacitate themselves (saying ‘my arms don’t work’ when asked to pick something up) or curl up in a ball and avoid interaction with their caregiver.

If initial avoidant strategies don’t successfully help the individual to avoid the demand being placed on them, they may rapidly escalate into panic due to the instinctive flight/fight/freeze response that arises when someone with PDA feels out of control. This can look like a panic attack. Overall, this Pathological Demand Avoidance ‘Meltdown’ response can be very distressing for both the individual with the condition and for family, friends, and teachers.

How is someone diagnosed with Pathological Demand Avoidance (PDA)?

Generally, the first step in getting a diagnosis for Pathological Demand Avoidance is seeking out a referral from a GP or a Paediatrician. Unfortunately, PDA is currently not recognised in Australia so it cannot be formally diagnosed. However, psychologists and other clinicians are starting to recognise that some individuals with a cluster of symptoms, such as Autism Spectrum Disorder with high anxiety and aversion to demands, can be described as having PDA.

Below are some of the behaviours that make up the defining criteria for diagnosis of PDA, as described by Professor Elizabeth Newson in her research.

Passive early history in the first year (of life)
Continues to resist and avoid ordinary demands of life – strategies of avoidance are essentially socially manipulative
Surface sociability, but apparent lack of social identity, pride, or shame
Lability of mood, impulsive, led by need to control
Comfortable in role play and pretending

Language delay, seems the result of passivity, good degree of catch-up
Obsessive behaviour
Neurological involvement

Is there a cure for Pathological Demand Avoidance?

Pathological Demand Avoidance is an all-encompassing experience that is not the choice of the individual. It is a condition that will remain with an individual for their lifetime. With the understanding and care from a reliable support network paired with helpful approaches and coping strategies, Pathological Demand Avoidance can become more manageable.

It’s so important to diagnose PDA correctly, especially in young children, so that families and parents can find the best approach to support their child and help them to thrive in the world.

One way that parents and professionals can support individuals with Pathological Demand Avoidance is through access to targeted Speech Therapy.

How Speech Therapy can help individuals with Pathological Demand Avoidance

Because children with Pathological Demand Avoidance tend to have the appearance of being very sociable (to the point where they can be manipulative to avoid demands) many parents wonder why Speech Therapy would be useful.

As mentioned earlier, one of the key behaviours of PDA, as described by Professor Elizabeth Newson, was a language delay. It’s also been noted that children with PDA can experience difficulty with language processing, so working with a Speech Pathologist can be very beneficial.

It is very important when seeking Speech Therapy for your child with Pathological Demand Avoidance to ensure that you find a clinic and professional who are knowledgeable in this area. Creating a safe, welcoming space and a therapy approach that considers your child’s needs is crucial in ensuring an enjoyable experience for all. At SpeechEase Speech Therapy, we have three clinics across Queensland and a team that are aware of the therapy approach required for children, teens and adults with Pathological Demand Avoidance.

For more information on Speech Therapy options for your child, get in touch with our friendly team today.

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