Pathological Demand Avoidance is usually associated with autism, but it can also affect people with ADHD.
Pathological Demand Avoidance (PDA) is a profile associated with autism and ADHD.
If you have PDA, you may find it challenging to carry out demands, even if you want to. You might go to extreme lengths to avoid complying with demands of all kinds. PDA is also called Extreme Demand Avoidance.
To others, a person with PDA might seem like they’re being deliberately antagonistic or rebellious, but there isn’t enough information about PDA available to know where this is true or not. Treatment is generally necessary to manage demand avoidance behaviors.
Pathological demand avoidance is a term that was coined by Professor Elizabeth Newson in the 1980s. It’s a proposed subtype of autism spectrum disorder (ASD), but it’s also seen in people with ADHD. Additionally, this behavior can appear in both adults and children.
PDA is not recognized as a condition by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) or the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
According to the PDA Society, it’s thought by some to be a profile on the autism spectrum. But according to a
People with PDA may go to extreme lengths to avoid complying with demands. This demand avoidance is associated with high levels of anxiety.
These demands can be:
- External: imposed by others, like a deadline or an instruction from a teacher.
- Internal: imposed by yourself, like a plan you’ve decided to follow.
- Explicit: such as a direct demand.
- Implicit: such as a polite request or unsaid expectation.
Not only might people with PDA reject doing things they don’t find interesting, but they also may avoid their favorite activities and hobbies.
Although this can be frustrating for others, it’s important to remember that PDA isn’t a choice.
According to PDA Society, there are anecdotal reports that many people with PDA also meet the diagnostic criteria for attention deficit hyperactivity disorder (ADHD), but “research is needed to establish whether there is any connection.”
Generally, the traits associated with PDA can overlap with the traits associated with ASD. The connection between ADHD and PDA might be because ADHD and autism often co-occur together.
To others, ADHD might seem like PDA and vice-versa. Both ADHD and PDA can cause executive dysfunction: both can make it difficult to initiate tasks, complete tasks, and control impulses.
But, with PDA, people avoid demands simply because they are demands. Although people with ADHD might avoid demands from time to time, extreme demand avoidance isn’t a typical symptom of ADHD.
A 2020 study found that ADHD was a better predictor of PDA than autism. In other words, ADHD might have a stronger relationship to PDA than autism. But more research is needed to explore this connection.
Although PDA isn’t recognized by diagnostic manuals, the PDA Society has established a few key features of PDA.
The symptoms of PDA are as follows:
- resisting and avoiding ordinary demands
- using social strategies to avoid demands
- obsessive behavior, often focused on other people
- being superficially sociable but lacking depth in understanding
- excessive mood swings
The PDA Society notes that PDA presents differently in different people. Everybody with PDA is different; some people might find certain demands easier to cope with than others. Additionally, PDA can be more extreme in some people than others.
In addition to the features of PDA mentioned above, someone can experience symptoms of ADHD.
There are three main types of ADHD symptoms:
- combined (both inattentive and hyperactivity-impulsivity symptoms)
The symptoms of inattentive ADHD include:
- difficulty paying close attention to detail
- difficulty sticking with or finishing tasks
- difficulty following instructions
- challenges with staying organized
- difficulty with time management
- memory problems
- easily being distracted
The symptoms of hyperactive-impulsive ADHD include:
- fidgeting and restlessness
- interrupting others often
- having difficulty waiting or sitting still
- a need to keep moving
Combined ADHD can include a mixture of all of the above symptoms.
PDA is often considered a profile on the autism spectrum, meaning that some people who meet the criteria for ASD have the traits of PDA.
The PDA Society notes that people with PDA might have an ASD diagnosis that “doesn’t quite fit.” Or, they might be close to but don’t actually meet the ASD diagnostic criteria.
Although most people with PDA meet the criteria for an autism diagnosis, the PDA society notes that people with PDA tend to have:
- superficially better social skills (including feeling more comfortable with eye contact) than most people with autism
- fewer repetitive behaviors and less obvious routines than most people with autism
- interests that may be intense but are not as long-standing as the “special interests” many people with autism
It’s important to note that not everybody with PDA is autistic, and not everybody who is autistic fits the PDA profile.
PDA autism symptoms
The PDA Society notes that people with a PDA profile of autism:
- Experience persistent difficulties with social interaction.
- Engage in restricted, repetitive patterns of activities or interests that impair everyday functioning.
- Are sensitive to sensory experiences.
- Have an anxiety-related need for control.
- Go to extremes to avoid demands and expectations, including things they want to do.
- Tend not to respond to conventional parenting or teaching approaches.
Because PDA isn’t recognized by the DSM-5-TR or the ICD-10, there aren’t any universal diagnostic criteria.
In 2013, PDA researchers developed the
The questionnaire is used for research purposes and is based on parental reports of their children’s behavior. As such, the EDA-Q is not a diagnostic tool.
There’s no “cure” for PDA, but the symptoms can be managed.
If you fit the PDA profile, understanding PDA can help you cope with the demands of daily life. If you’re a loved one or teacher of someone who fits the PDA profile, learning about PDA can help you support them better.
PDA Society and the National Autistic Society both recommend taking an individual approach. Because not everybody who fits the PDA profile is the same, working to understand your specific situation is best.
This can include:
- recognizing triggers (for example, noticing what kinds of demands tend to trigger avoidance and anxiety)
- figuring out which sort of demands work
- finding methods to relieve anxiety and stress
You might benefit from:
- trying to reduce anxiety and stress, which can worsen demand avoidance
- rephrasing requests to sound less triggering (for example, using indirect requests if they work)
- minimizing unnecessary rules
- trying to depersonalize requests
- helping yourself/your loved one with PDA feel more in control by collaborating and mutually agreeing on boundaries and nonnegotiable rules
- being flexible and making alternative arrangements when demand avoidance kicks in
- giving plenty of notice before an event/upcoming demand
If you have a co-occurring condition, like ADHD, you might want to consider speaking with a doctor about trying ADHD medication. This may help you manage the symptoms of ADHD, which can improve your well-being and your executive function.
Researchers affiliated with PDA Society note that many people who fit the PDA profile learn to manage their demand avoidance and create successful lives for themselves, often by being self-employed and working in independent roles.
Pathological demand avoidance is a profile associated with autism and ADHD. Although demand avoidance can be a challenge, it’s possible to learn to manage it in a healthy way.
If you fit the PDA profile, or if you think a loved one does, you might want to contact a PDA-friendly mental health practitioner. PDA Parents has a list of US-based clinicians that provide therapy to people with PDA.
You might also benefit from the following websites, which have a range of PDA resources:
- PDA Society
- PDA Parents
- National Autistic Society – Pathological Demand Avoidance
- Harry Thompson, Kristy Forbes, and Sally Cat for adult PDA perspectives
These books may also be helpful: