What’s the connection between pathological demand avoidance and autism?

People living with pathological demand avoidance (PDA) have an extreme resistance to anything they perceive as a demand. It’s often seen in people with autism spectrum disorder (ASD).

PDA is also associated with other mental health conditions, including oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD).

What are demands, and how do they relate to autism?

When discussing demands, we often think of direct questions and requests. For example, “please fold the laundry” or “can you bring me that cup?” But with PDA, demands exist on a spectrum. Direct demands include things like rules, requests, instructions, and expectations. Indirect demands involve desires, implied demands, perceived expectations, and bodily cues like hunger. 

Many people with autism experience demand avoidance, meaning they have a strong aversion to demands. As a result, it’s common for them to avoid situations that trigger sensory issues or disrupt their daily routine. 

People with PDA will often use social strategies — like manipulation, negotiation, and creating elaborate scenarios — to avoid ordinary demands and expectations. Other avoidance techniques include making excuses, changing the subject, creating a distraction, and having a meltdown.

How to recognize the signs of PDA

There are several key features of PDA, including: 

• Avoiding and resisting ordinary demands
• Using social strategies to avoid demands
• Having a strong need for control over their environment
• Appearing sociable but struggling with deeper comprehension of social cues and the subtleties of interpersonal relationships
• Being prone to mood swings and impulsivity
• Having obsessive behaviors
• Creating elaborate scenarios and pretending to avoid demands

The exact experience varies by person and may affect people differently as they age. For example, PDA can cause fear and frustration in young children, while it’s been described as overwhelming and exhausting for adults.

Is there a test for PDA?

PDA is not a diagnosable mental health condition. However, it often occurs with other mental health disorders. And even without official recognition, PDA can still take a toll on a person’s daily functioning without access to the right support. 

If you believe that a child in your life is showing signs of PDA, consider using the Extreme Demand Avoidance Questionnaire’ (EDA-Q). The EDA-Q isn’t an official diagnostic tool, so it should never replace a diagnosis from a qualified mental health professional. But it can be a useful resource for learning how to support your child’s needs. If you are concerned about yourself or an adult, seeking guidance from a mental health professional can help you address these concerns.

Five ways to support someone on the autism spectrum who is living with PDA

Since autism exists on a spectrum, both the PDA Society and the National Autistic Society recommend taking an individualized approach to managing autism with PDA. Here are some strategies to help people understand and cope with PDA.

1. Identify triggers. PDA looks different for everyone, so consider what triggers a person’s symptoms. This may include environments that are overstimulating or situations where they lack control. 
2. Manage anxiety. Help them create healthy coping methods for reducing anxiety and stress, like journaling or reframing their thoughts.
3. Focus on collaboration and negotiation. Encourage your loved one to remain calm while collaborating with them to solve challenges. 
4. Use collaborative communication strategies. Be mindful of how you make requests by phrasing them in a way that respects the person’s preferences. Suggesting activities or tasks as collaborative efforts can help reduce resistance and make the experience more engaging for everyone involved.
5. Pick your battles. If you don’t have success rationalizing your request, accept that it’s best to let some things go.

Some people with PDA and autism may also benefit from talk therapy or group support services. Therapy offers a safe and confidential place to identify triggers and develop healthier coping methods. 

The exact type of therapy will depend on the person and their therapist but may include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or acceptance and commitment therapy (ACT). 

Joining a PDA support group can help people connect with others who understand the challenges of living with PDA. For some people, this is a valuable opportunity to share their experiences, find community support, and learn to manage their symptoms. 

Tips for caregivers of children with autism and PDA

Supporting a child with autism and PDA can be difficult, but access to the right strategies can help caregivers create a more stable and supportive environment. Here are four tips to manage or reduce your child’s PDA.

• Use gentle language. Avoid demanding language, such as the words “need,” “must,” “will,” and “can’t.” When you do need to make a demand, try to frame requests more gently. When making a request, consider using “please” to soften the approach.
• Find a balance. It’s important to create healthy boundaries while still allowing your child to experience some autonomy.
• Be flexible. Offer your child more control by keeping routines flexible and avoiding unnecessary rules.
• Show empathy. Experts suggest helping your child feel seen and heard, even during tough moments. For example, try validating their feelings by listening and repeating their words back to them.

Find care with Rula

If you or someone in your life struggles with demand avoidance or other signs of PDA, consider seeking professional mental health support. Although PDA is not a recognized mental health condition, it is associated with autism and other mental health conditions and may require treatment.

With Rula, you have access to a diverse network of therapists. In as little as three minutes, you can find a therapist who takes your insurance and offers the specialized treatment you deserve. And, our convenient online platform means you can get care from the comfort of home.  

Get started with Rula today