Pathological Demand Avoidance (PDA) is a profile within the autism spectrum characterized by extreme avoidance of everyday demands and expectations, driven not by defiance but by intense anxiety and a need for control. As well as a neurological disposition making transitioning from one task to another difficult. Understanding PDA and providing compassionate, tailored therapy can significantly improve the quality of life for individuals and families affected by it.
What Is Pathological Demand Avoidance?
PDA is not a formal DSM-5 diagnosis in the United States, but it is recognized and supported by research, particularly in the UK, as a distinct profile within autism. Individuals with PDA often:
- Exhibit a high need for control and may avoid even small everyday requests.
- Use social strategies to avoid demands (e.g., distraction, excuses, negotiation, or withdrawing).
- Have intense, quickly shifting emotions, including severe anxiety.
- Display better social communication skills than typical in other autistic profiles, which can mask underlying distress.
- May struggle significantly in school and structured environments due to demands inherent in these settings.
It is important to recognize that the avoidance seen in PDA is not oppositional defiance; it is rooted in anxiety, sensory overwhelm, and fear of losing autonomy.
Why Demands Feel Overwhelming
Demands can trigger a fight, flight, or freeze response in individuals with PDA. Even positive requests, such as “let’s go to your favorite place,” may feel like a loss of control and can lead to panic or meltdown.
Parents and caregivers may find themselves in constant power struggles, and typical parenting strategies like increased structure or consequences often escalate distress rather than helping.
Therapy Approaches for PDA
While no single approach works for everyone, therapy for PDA often requires flexible, non-confrontational, and individualized approaches, including:
Behavior Therapy
Behavior therapy is a specialization at Triad Psych. Behavior therapy focuses less on the why of a behavior but more on the what. For example, if a child is avoiding his chores, a behavior therapist will determine the motivation for avoidance and then reinforce the child for engaging in completing his tasks. Very often someone who is stuck in getting something done just needs a new way to approach the task. Behavior therapy does just this.
Building Trust and Safety
Therapy should prioritize emotional safety. Establishing trust with the therapist and creating an environment where the child or teen feels in control is essential. Choice and predictability can reduce the perception of demands.
Supporting Autonomy
Instead of direct demands, therapists and parents can use indirect language, humor, and invitations to encourage participation without triggering avoidance.
Example: Instead of “You need to brush your teeth,” you might say, “Your dragon teeth need some sparkle; do you want the blue or red toothpaste?”
Addressing Anxiety and Emotional Regulation
Therapy often includes mindfulness, body-based calming strategies, and self-awareness building to help the individual recognize and manage their anxiety. Occupational therapy can help if sensory sensitivities contribute to demand avoidance.
Parent Coaching and Family Support
Families benefit from psychoeducation on PDA, parent coaching, and support groups. Learning to reduce direct demands, plan proactively, and use low-arousal responses during escalations can reduce conflict and stress at home.
Skills acquisition is key
Living with PDA can be exhausting for both the individual and their caregivers. At Triad Psych both Dave Glick who has a strong special education background, and Sheri Locklear who is a certified Mental Performance Coach, work very effectively with the disorder. What makes the Triad approach unique is that we put skills acquisition first. All behaviors are learned, including demand avoidance; and just as a person can learn one behavior, they can learn a new and better replacement behavior. With understanding, appropriate therapy, and tailored environmental support, individuals with PDA can thrive while maintaining a sense of autonomy and safety.
At Triad Psych, our therapists are committed to neurodiversity-affirming, flexible approaches that center the child’s, teens and young adults experience while supporting parents to reduce stress in the home.
Learn More or Get Support
If you suspect your child may have PDA or are struggling with extreme demand avoidance in your family, you don’t have to navigate it alone. Reach out to us at Triad Psych to discuss an evaluation or learn how therapy can support your family’s journey.