Pathological Demand Avoidance(PDA)

What is Pathological Demand Avoidance(PDA)?

PDA stands for ‘Pathological Demand Avoidance, however is often better understood when reframed as ‘Persistent Drive for Autonomy.’

PDA is not a diagnosis within the DMS-5, but rather a descriptive profile, which exists as a feature of Autism. PDA occurs as a fight, flight, or freeze response, caused by anxiety that arises from ‘demands.’ These demands can include direct demands such as being told what to do, but also perceived demands, or a feeling of expectations placed upon oneself.

What are the common features of PDA?

PDA will present differently in different people (e.g. some people may have a typical ‘fight’ response, whereas others may experience ‘flight’ or ‘freeze’ – task avoidance) but common traits of PDA are;

Unwillingness to engage with academic tasks
Difficulty engaging in play directed by others
Greater challenges completing something when reminded, or instructions repeated
Unable to engage in something, even if it’s something they want to do, due to anxiety
Difficulty following a schedule with strict time lines
Frequently gives excuses in an attempt to preserve others view of them self, by deflecting blame

What does a PDA profile really mean for the child?

How to best support a child with PDA?

To support a child with a PDA profile, the PDA society (hyperlink to their site?) have developed the ‘PANDA’ Framework:

Following the PANDA Framework, a PDA child may have most success when supported through;

A focus on connection
Doing a task together with someone, rather than an authority figure telling the child what to do
Authentic autonomy given to the child as much as possible
Non-negotiable rules are decided based on health and safety, and explained to the child, while they are well regulated e.g. ‘the non-negotiables in this room are; no throwing of hard objects, no hitting people, no leaving the clinic, this is so that no one gets hurt, and there are no damages to the property’
Language of instructions used is non-direct and non-blaming, e.g. ‘hard objects aren’t thrown in this room’ instead of ‘you can’t through hard objects in this room’ or “it’s time to pack up now’ instead of “you need to pack up”
Additional time is allowed, or time pressures aren’t applied

When should I seek therapy for my child with PDA?

If you don’t feel you have the tools or strategies to support your child.
If your child is experiencing difficulties with the school structure, and you would like support in navigating this.
If the difficulties associated with PDA are causing stress in your family.
If the PDA presentation is controlling or impacting other areas of your life.
If you child has difficulties with other skills (e.g. literacy, and you require a therapist who understand PDA to be able to support them.

How to best support a child with PDA?

The child to understand what PDA means, and how this presents for them (e.g. what demands result in anxiety, what response they typically experience)
The family around the child to understand how they can alter their communication and expectations to create an environment in which the child can succeed and engage
Identify individualised accommodation needs