Last month, we celebrated Autism Awareness Month—a time to recognize not just autism itself, but also the less commonly known traits and diagnoses that can go with it. One of these is Pathological Demand Avoidance (PDA). It’s a profile seen in some autistic children that is often misunderstood or missed entirely.

 

Understanding PDA: A Different Operating System

Imagine comparing Apple and Android phones. Both make calls and send messages, but the way they work is completely different. This is similar to how neurodivergent brains, including autistic ones, process the world compared to neurotypical brains. Both are capable—just wired differently (Keeble, 2021).

So, what is PDA?

PDA is not yet a formal diagnosis in the DSM-5 (the guide most professionals use), but it’s a very real experience for many families, especially those with autistic children.

 

Key Characteristics:

• Avoid or resist everyday demands — even things they enjoy.
• Survival drive for autonomy that consistently overrides other survival instincts (e.g. eating, sleeping, hygiene, safety, toileting) in the moment or cumulatively (burnout).
• Exhibit controlling or defiant behaviour, caused by fight-or-flight responses to perceived pressure.
• Seek connection and comfort through fantasy and imaginative role-play characters, sometimes to an extreme.
• Experience intense emotions and need constant emotional regulation from trusted adults (e.g. nervous system coregulation).
• Experience frequent and reoccurring nervous system activation (shifts into fight-flight) from demands, over time. Often only recognised by parents when the child reaches burnout.
• Intense focus on others, often manifesting as social interests or fixations on real or fictional people.
• Mask their difficulties by seeming social or talkative. Often appearing socially capable but lacking deeper understanding (e.g., making eye contact and engaging in reciprocal conversations whilst masking underlying difficulties with social skills). The PDA child or teen often appears like two versions of themselves in different contexts.

 
Often, children with PDA are misdiagnosed with ADHD or Oppositional Defiant Disorder (ODD). Traditional parenting or behavior plans don’t help and may even cause more stress or emotional harm (e.g. complex trauma and nervous system burnout). (Ehrlich, 2022).
 

What Counts as a “Demand”?

Demands are anything that feels like an expectation. These include:

• Sensory overload, transitions, or even fun activities/hobbies.
• Direct requests like “put on your shoes” (referred to as declarative language).
• Questions – responding directly can be disabling.
• Internal needs like hunger or needing the bathroom.
• Praise, which can feel like pressure to repeat success.
• Uncertainty – needing to know and feel in control of what’s going on, to an extreme.

 

Wait.. what is the difference between Extreme Anxiety vs. PDA?

• Extreme anxiety = a cognitive process that involves thinking about the future and getting anxious/nervous about what might happen, which in turn, causes the fight-flight-freeze and/or avoidant response.
• With PDA, the child or teen may not have any anxious thoughts for future events, but the avoidance may be because they are perceiving that someone (e.g. parent/caregiver) is attempting to “make” them do it which creates a subconsciously perceived loss of autonomy and equality, which in turn, activates the fight-flight-freeze response or complete avoidance.

 

What Can Help?

What helps PDA children thrive is understanding, flexibility, and trust — not strict routines or rewards. Some helpful approaches include:

• Low arousal approaches that focus on recognising underlying anxiety and managing this.
• Keeping routines predictable (but being okay with changes too).
• Supporting sensory needs.
• Using visuals or visual stories to prepare for events.
• Using calm, non-threatening language – indirectly asking requests to the child
  (e.g. “I notice that…”, “I can see that…”, “how about we…”)
• Humour, distraction and role-play to reduce anxiety.
• Allowing choices and involving the child in decision-making – working collaboratively with the PDA child to find solutions to problems.
• Giving plenty of notice about any changes within reason or accepting that avoiding some things is perfectly OK.
• Establishing safe boundaries in the home and school setting.
• Building the child’s interception, self-awareness, self-esteem, resilience, and ability to self-advocate.

 

As Dr. Ross Greene says, “Kids do well if they can.” No child or teen chooses to experience crippling anxiety, panic attacks, melt downs and nervous system burnout.
 

For Parents

If you’re parenting a child or teen with PDA, you’re not “giving in.” You’re learning a different way to connect. As Dr. Casey Ehrlich reminds us: “You are making space in your brain and heart for a new way of parenting. And that is powerful.”

If you would like to know more about this topic or require professional support for your child dealing with pathological demand avoidance (PDA) , please contact our speech therapy team at High Hopes.

---

Sources:

• Keeble, C. J. (2021). [Seminar on neurodiversity and PDA].
• Ehrlich, C. (2022). Parenting strategies for PDA and demand-avoidant behavior.
• Website link – https://www.pdasociety.org.uk/
• Website link – https://www.atpeaceparents.com/
• Greene, R. (2016). The Explosive Child.