PDA in autism refers to pervasive resistance toward everyday demands. While this behavior can come across as defiant, it has more to do with feelings of anxiety and overwhelm.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder caused by changes in the way the brain develops during childhood. It features a variety of symptoms involving social interaction challenges and restrictive or repetitive behaviors.

ASD has a broad presentation of symptoms and severity, which is why it’s referred to as a spectrum disorder. Your lived experience with ASD may be very different from someone else’s.

If you live with ASD and notice significant demand resistance behaviors, you may be living with pathological demand avoidance (PDA) in autism. While not a formal diagnosis, many people consider this to be a profile on the autism spectrum.

Demand avoidance describes the urge to resist demands — actions, activities, responsibilities, and tasks that await completion in everyday life. It’s something almost everyone experiences occasionally for various reasons.

“Demand avoidance is a common behavior observed in many individuals, particularly children,” explains Ellie Borden, a registered psychotherapist and clinical director of Mind By Design, Oakville, New York. “It’s a typical response to a request or command they find difficult or unappealing.”

But PDA, also known as “persistent drive for autonomy,” refers to demand avoidance that exceeds what’s considered typical. It describes a persistent pattern of behavior where you excessively resist demands and seek a sense of control to neutralize anxiety.

PDA is usually associated with ASD but it’s also been noted among people living with attention deficit hyperactivity disorder (ADHD).

The history of PDA

The term PDA was coined in the 1980s by Professor Elizabeth Newson, a British clinical psychologist who worked extensively in developmental psychology. Newson used PDA to describe extreme avoidance behaviors and anxiety-driven control tactics seen among some autistic people.

While PDA is not a diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the clinical guidebook used in the United States, it’s a recognized lived experience within ASD.

“It’s important to note that PDA is not a stand-alone diagnosis but instead a specific profile within the broader autism spectrum disorder,” Borden says. “Individuals with PDA share common traits with others on the spectrum, such as social communication difficulties.”

Not much research on PDA exists, but a 2018 study found there was not enough evidence to support it as a syndrome independent from autism.

The same conclusion was reached in a 2023 review, which noted PDA was not separate from ASD nor was it a subtype; it was a behavioral profile within a complex presentation of ASD.

As a relatively new ASD profile and one not recognized under formal diagnostic criteria, the research on PDA is limited. Its exact causes are not yet fully understood.

Like other behavioral profiles in ASD, PDA may have unique genetic, neurological, and environmental influences.

What experts do know is that the behaviors in ASD appear to be driven by feelings of anxiety and overwhelm.

“It’s like having an intense anxiety-driven need to be in control and avoid other people’s demands and expectations,” says Jennifer Worley, a licensed marriage and family therapist and clinical director of First Light Recovery, San Juan Capistrano, California.

“This isn’t about being defiant or stubborn; it’s a profound discomfort that comes from feeling an overwhelming pressure to meet demands that seem impossible,” Worley adds.

Living with PDA in autism means you meet the diagnostic criteria for ASD but also experience symptoms related to persistent demand avoidance, such as:

  • extreme drive to avoid everyday demands
  • anxiety-driven need for control
  • dramatic responses to minor requests
  • use of social strategies to avoid demands (like distracting with affection, or changing the subject)
  • bossy or controlling personality

Demands aren’t just those given to you by others, either. Demands can come in many forms, including:

  • Direct: being told to do something
  • Indirect: an expectation, like responding to a question
  • Internal: demands made by your mind or body
  • External: demands given by someone else

Demands can be:

  • questions
  • plans
  • decisions
  • instructions
  • time constraints

There can even be “demands within demands,” such as the expectations and requirements that come with attending an event.

When you experience PDA in autism, demand avoidance is extreme and affects everyday life.

PDA characteristics in children

Autistic children and adults can have different lived experiences of PDA due to age-specific life circumstances.

PDA in children, for example, may manifest in ways related to school, extracurricular activities, or interactions with friends. But adults may notice symptoms at work, as a parent, or among adult relationships.

Children may be less skilled at navigating the feelings of PDA compared to adults, causing behaviors to appear more extreme.

Borden states that, in addition to general avoidance, common PDA behaviors seen among children include:

  • verbal and physical aggression when feeling a loss of control
  • self-injurious behavior
  • property destruction
  • school refusal
  • refusal to engage in self-care activities like bathing or brushing teeth
  • inability to attend social events
  • reluctance to allow parents to have friends visit the home
  • exerting control over permitted noises at home, such as no music or only certain music
  • often engaging in conflict with siblings
  • displaying control over food choices, meal times, and dining companions
  • excessive use of sarcasm or non-literal language
  • resistance to changes in routine

Can PDA be misdiagnosed?

Borden notes PDA in children is often misdiagnosed as oppositional defiant disorder (ODD). “This is not surprising, given the similarities in their external behaviors, such as refusing to comply with demands, rules, or requests from authority figures.”

The underlying causes of ODD and PDA are very distinct, she explains.

“Children with ODD consciously choose to assert their will and challenge authority, as they possess an innate understanding of hierarchy and expectations. In contrast, individuals with PDA, being on the autism spectrum, do not grasp inherent power dynamics.”

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When it comes to coping strategies for PDA in autism, Worley indicates it’s essential to work in a non-confrontational way that allows an autistic person to maintain a sense of control.

She says, for children, this can mean creating an environment that feels safe and predictable, providing choices, and not presenting demands as challenges.

Adults may be able to take a more awareness-based approach to coping with PDA that addresses underlying anxiety.

“Adults may benefit from structured support to develop strategies for managing demands and anxiety, perhaps through therapy that focuses on building tolerance to demands in a gentle and supportive way,” Worley adds.

For both adults and children experiencing PDA, Borden recommends:

  • collaborating and taking negotiate-based approaches that promote a feeling of empowerment
  • providing choices and flexibility to maintain a sense of control
  • using positive reinforcement and incentives to complete tasks
  • developing and maintaining a calm, supportive, predictable environment
  • learning to accept what’s within control and what isn’t
  • working with a professional to develop ways to approach everyday life with PDA

Pathological demand avoidance, or PDA, describes a specific lived experience in autism spectrum disorder (ASD) involving extreme aversion and resistance to everyday demands.

While not a formal diagnosis, PDA is considered to be a behavioral profile of ASD. People experiencing PDA in autism often have an intense anxiety response to the pressures of demand, to the point where they may even fight their own bodily needs to eat or use the bathroom.

Research is limited on PDA, but like other presentations of autism, it’s thought to have underlying genetic, neurological, and environmental causes.