Neurological Disorders Pathological Demand Avoidance in Autism and Beyond By Amy Marschall, PsyD Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. Learn about our editorial process Published on February 20, 2023 Print J.A. Bracchi/The Image Bank/Getty Table of Contents View All Table of Contents Definition Signs Impact Coping Support Pathological demand avoidance (PDA) is defined as when an individual goes to great lengths to evade or ignore “demands.” Although PDA is not a formal mental health diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, it can cause functional impairment and interfere with an individual’s quality of life. Learn about the signs of PDA, how it develops, and how to support someone who experiences PDA. What Is Pathological Demand Avoidance? While everyone is sometimes faced with tasks we would rather not do, for some people, anything seen as a demand or request can be overwhelming. Elizabeth Newson coined the term pathological demand avoidance in 2003 and noted that individuals with pervasive developmental disorders (PDD) tended to exhibit these traits. Since that time, PDD has been reconceptualized as part of the autism spectrum. Although some researchers have suggested that non-autistic people can experience PDA, it seems to be most common in autistic folks. Although PDA can cause functional difficulties, proponents of the neurodiversity-affirming movement have expressed concern that the term tends to, well, pathologize people who experience it. Alternative terms proposed include extreme demand avoidance, rational demand avoidance, or persistent drive for autonomy. Since PDA manifests as ignoring or avoiding requested tasks, it is often misidentified as defiance or oppositionality. Adam Lodestone shared his experience growing up with misunderstood PDA traits. He also shared that he was assigned female at birth, which likely impacted how his behavior was interpreted in childhood: “When I was a child, I was misdiagnosed with ODD (oppositional defiant disorder] and that framing made me view demand avoidance as a character flaw or some kind of failure on my part to be a ‘good kid.’” Since he preferred to focus on tasks surrounding his interests, Adam struggled with school avoidance and communicating his needs effectively. Elizabeth shared her experience of PDA as well, including noting that although she has had challenges related to her PDA, she also sees it as an asset: “That may sound strange because it's often seen as a ‘downside,’ but for me it's been my anchor to my creativity. It gives me courage to listen to my instincts because sometimes I am right. It allows me to understand why someone else may be pressing back hard on me. Once I figured out it was just part of how I worked, non-judgmentally, I started to love it.” Signs of Pathological Demand Avoidance Just like each autistic person is unique and looks different, PDA can manifest in a variety of ways. Traits associated with PDA include: Behavior that appears obsessive Strong need for control over their environment Mood swings Impulsive behavior Difficulty completing non-preferred tasks Avoidance of life demands Some providers use questionnaires to identify signs of PDA and differentiate it from “defiance” or an impulse control disorder. However, since PDA is a set of traits and behaviors but not a formal diagnosis, limited information about diagnosing or identifying PDA is available. People who experience PDA often do not respond to reward systems in a typical way, meaning that reinforcing or rewarding “preferred” behaviors and punishing non-preferred behaviors tends to be ineffective in changing patterns of behavior. For Elizabeth, PDA manifested as argumentativeness, including finding ways to push back that did not get her into trouble: “I can't tell you if I ever had any good arguments, but I can tell you I was and am persistent when I want and this led to me wearing down adults during conflict. I also learned early [that] keeping a calm demeanor meant I could be much more defiant without punishment.” She additionally attributed some rule breaking and rebellious behavior to PDA: “In high school my antics got a little more out of hand. We broke into an abandoned building to play with the equipment left behind. We replaced the school office waiting room magazines with inappropriate materials. Things like that.” The Impact of Pathological Demand Avoidance PDA can create challenges that interfere with functioning. For children, demand avoidance that is misinterpreted as “defiant” behavior can lead to punishment or being labeled as a “problem.” When adults label children’s behavior as “bad” or “naughty,” children might internalize this message, impacting their mental health and self-esteem. For Adam, “I definitely grew up believing that I was ‘bad,’ ‘willful,’ ‘defiant,’ ‘lazy,’ and ‘a brat.’” PDA can also impact learning. According to Elizabeth, “Despite being smart and able to perform very well on tests, I didn't do any work I didn't find important, regardless of how important my teacher or professor saw it or how much it mattered to my grade. I also attended school for the bare minimum of required instructional hours and missed a lot of educational time.” In adulthood, Adam said that PDA traits have made employment challenging: “In my 20s, my demand avoidance impacted how I related to my co-workers and managers and it would eventually cause me to abruptly quit jobs, often leaving me in a financial crisis.” Living With Pathological Demand Avoidance Since PDA presents differently for different people, approaches to cope with difficulties related to PDA vary. Working with supportive, neurodiversity-affirming professionals can help those who experience PDA determine accommodations and supports that help them live their best lives. Identifying individual interests and strengths while creating a supportive environment where the individual can lean into what works best for them can alleviate some of the difficulties that can come with PDA. Supporting Someone With Pathological Demand Avoidance It can be tempting to “take it personally” when a person exhibits PDA, but it is important to remember that they are not “refusing” a task because they want to be difficult or cause problems. Elizabeth shared, “Let me go. Let me fizzle out or amp up or do my own thing. And don't take it personally, assume the best intentions and I'll often prove you right.” In fact, shaming people with PDA and trying to force them to comply can often backfire. Many autistic scholars who study PDA have stated that “pathological demand avoidance is better understood as rational demand avoidance - an understandable and rational response to the circumstances that one finds oneself in.” Finding healthy ways to identify and meet needs rather than emphasizing “correcting” behavior can help reduce the individual’s anxiety around their PDA symptoms. If you or someone you love has traits of PDA, these resources might help you understand the behavior: Harry Thompson PDA Extraordinaire PDA Society Sally Cat’s PDA Page Sonny Jane’s Lived Experience Studio 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Newson E, Maréchal KL, David C. Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood. 2003;88(7):595-600. doi:10.1136/adc.88.7.595 Reilly C, Atkinson P, Menlove L, et al. Pathological Demand Avoidance in a population-based cohort of children with epilepsy: Four case studies. Research in Developmental Disabilities. 2014;35(12):3236-3244. doi:10.1016/j.ridd.2014.08.005 O’Nions E, Viding E, Greven CU, Ronald A, Happé F. Pathological demand avoidance: Exploring the behavioural profile. Autism. 2014;18(5):538-544. doi:10.1177/1362361313481861 Butler, Emily. Reframing PDA: The Power of an Autistic Perspective. October 27, 2021. O’Nions E, Christie P, Gould J, Viding E, Happé F. Development of the ‘extreme demand avoidance questionnaire’ (Eda-q): preliminary observations on a trait measure for pathological demand avoidance. J Child Psychol Psychiatr. 2014;55(7):758-768. doi:10.1111/jcpp.12149 National Autistic Society. PDA - A Guide for Autistic Adults. Moore A. Pathological demand avoidance: What and who are being pathologised and in whose interests? Global Studies of Childhood. 2020;10(1):39-52. doi:10.1177/2043610619890070 By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health. 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