As parents or caregivers to individuals with autism spectrum disorder (ASD), navigating the vast and complex landscape of diagnoses and syndromes possibly associated with your child’s condition can be difficult. Pathological Demand Avoidance (PDA) is a relatively new term in the field of developmental disorders, and the PDA meaning can be confusing for many.
Generally, the term refers to a distinct profile of behaviors and traits in individuals often experiencing PDA symptoms. PDA is closely related to autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), anxiety disorders, and other neurological conditions.
Psychologist Elizabeth Newson created the term Pathological Demand Avoidance to define an extreme form of resistance in individuals who have difficulty fulfilling typical demands and expectations from authority figures. According to Newsome, anxiety drives PDA in individuals to always remain in control and avoid the expectations or requests of others. Today, PDA is a widely recognized distinct profile of ASD.
More straightforwardly, when a PDA child or teenager perceives a demand or expectation as placed upon them, even minor or preferred, they powerfully avoid it. Their avoidance is pathological, meaning, in many cases, it is extreme, seemingly abnormal, and excessive. However, parents must understand that continuous refusal and avoidance of PDA expression is not a choice but a pattern of behavior specific to their profile, as described by the Child Mind Institute. Still, PDA can be challenging to detect and manage.
In this blog post by ABA Centers of America, we will discuss pathological demand avoidance, its meaning, and its associations with autism. Ultimately, understanding more about pathological demand avoidance helps ensure better outcomes for everyone experiencing these complicated features of human diversity.
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Pathological Demand Avoidance and How It Relates to Autism
According to the National Autistic Society, Pathological Demand Avoidance, or PDA, is a term used often to describe a particular profile of traits that children and adults on the autism spectrum may display. PDA presents a series of features like an intense and inexplicable fear of everyday demands, leading to avoidant traits such as refusing all requests set by authority figures like parents, educators, and even law enforcement or medical personnel. Additionally, those with PDA may refuse to comply with instructions, avoid situations they find triggering, and exhibit aggressive routines that can last for extended periods.
Sometimes, a PDA child or teenager may unintentionally exhibit manipulative behavior to achieve their needs. It is essential to recognize these signs early so families can receive the appropriate support and interventions to manage PDA behavior and enhance the child’s quality of life with adaptive skills suitable to their needs. In most cases, the individual, parent, or caregiver is the person to recognize PDA traits initially.
Core PDA Symptoms Include:
- High levels of anxiety
- Obsessive behavior
- A strong need for control
- Resistance and avoidance of daily living demands
Other PDA Features May Include:
- History of development delays
- Social manipulation
- Appearing sociable but lacking a sense of social identity
- Unstable moods and reactions
- Loss of touch with reality (i.e., only interested in living in an imaginative world or pretend internal state)
- Language difficulties
- Clumsy or generally uncoordinated
Studies have shown that PDA is closely related to autism spectrum disorder, as many individuals diagnosed with autism also display symptoms of PDA. Those with PDA who demonstrate rigid avoidance can go on to have trouble in everyday situations, including school, employment, and other community settings. However, not everyone with autism has PDA, and not everyone with PDA has autism.
Understanding PDA and its connection to autism can significantly benefit those on the spectrum and the families raising them, leading to more appropriate participation throughout life. Caregivers must recognize that pathological demand avoidance has nothing to do with defiance, stubbornness, or rebellion. In most cases, for a PDA child or teenager, “I won’t” really communicates “I can’t.” Some experts report that a pathological avoidant response is not an outburst but a panic attack.
What Causes PDA?
The reasons why individuals develop PDA remain unknown. However, some researchers have suggested that for those with PDA, their nervous system triggers their fight or flight response due to potential triggers, including the loss of autonomy and other demands. Other possible reasons individuals with PDA may exhibit avoidance behavior include feeling overstimulated and having difficulty processing information quickly or adequately.
As a result, these individuals may experience anxiety, stress, and an overwhelming need to avoid the requests at all costs despite their willingness to complete such tasks. For a PDA child or teenager, PDA means activities like getting dressed, doing homework, or brushing their teeth can threaten their sense of control and fuel impending stress.
It’s important to understand that for children with PDA, their avoidance is not a choice but a means of coping with overwhelming anxiety and uncertainty.
Why Pathological Demand Avoidance Can Go Undetected and Untreated
In a PDA child, teenager, or adult, some features that may make the condition more difficult to detect include increased sociability, “masking,” and eye contact, which are not always typical among neurodiversity but common in the PDA profile. Even though these behaviors can help children with PDA appear socially aware and adapt, it is essential to note that they are not the only indicators of PDA.
Diagnosing Pathological Demand Avoidance
A licensed medical health professional like a pediatrician, psychiatrist, or psychologist typically identifies Pathological Demand Avoidance in patients. According to the PDA Society, PDA can be more difficult to detect. Challenges identifying pathological demand avoidance can happen because the patient may demonstrate imaginative play, social interests, and socially appropriate language, leading many to diagnosis at an older age or not at all. In other cases, clinicians can misread symptoms.
While Pathological Demand Avoidance is not a standalone diagnosis in the DSM-5, children with a PDA profile can be given a more detailed diagnosis, like autism with a PDA profile or ASD with demand-avoidant traits. The diagnosis involves looking at the individual’s behavior and symptoms to determine whether they fit the criteria for PDA.
When a qualified provider identifies PDA in the patient, the individual must receive ongoing care from an experienced clinician. Treatment for PDA may include psychological therapy, behavior management strategies like Applied Behavior analysis, and, in some cases, medication to help manage symptoms.
It is also vital for individuals with PDA to have access to support services such as respite care and family counseling whenever possible, which can be offered by various programs.
Strategies for Parents Supporting Their Loved One with Pathological Demand Avoidance
When it comes to managing PDA in the home, here are some strategies parents find helpful, including, but not limited to:
- Create a supportive environment that provides consistency, routine, and predictability.
- Develop positive communication techniques such as active listening and non-judgmental support.
- Establish clear boundaries for behavior with consequences.
- Build a trusting relationship, including open communication with your child.
- Teach problem-solving skills to help children learn how to cope in challenging situations.
- Encourage using positive self-talk and relaxation techniques for managing anxiety.
- Promote regular breaks throughout the day for relaxation and self-regulation.
By following these strategies and seeking professional help, parents can provide their children with the best care to manage the PDA experience.
Therapy Options for Those With PDA
Unfortunately, currently, no cure for PDA exists. Therapy for PDA can be complicated, given the interlinking features of the disorder. In many cases, treatment for PDA must include a multi-dimensional approach. However, therapists and providers working with PDA individuals should focus on improving adaptive skills that enhance autonomy and quality of life. During therapy, goals should include improved processing, following praise that celebrates their talents instead of failures. Treatment providers should typically conduct sessions in a client-centered setting to be most effective.
While ABA therapy, also called Applied Behavior Therapy, is generally prescribed for those with autism spectrum disorder, in many cases, it can support PDA symptom management as PDA is a subtype of ASD. However, it is not the best fit for everyone, and reward systems can be ineffective or triggering for some, so flexibility and adaption are pivotal to any ABA program supporting a PDA child or teen. It’s crucial to discuss your circumstances with the ABA therapy Agency or treatment team you are considering, highlighting the needs and obstacles your child is facing.
Therapy for PDA may also consist of the following additional providers:
- Speech and language therapists
- Occupational therapists
Supporting Your Child with PDA and Autism
It is important to remember that Pathological Demand Avoidance is a complicated condition that affects everyone differently but can be profoundly challenging. Therefore, parents and caregivers must understand their child’s unique needs and seek appropriate tailored support. For many, that includes ABA therapy, among other treatments.
Finally, it is essential to remember that PDA does not define a person but explains why they may exhibit certain behaviors. With the proper care, individuals with PDA can lead a fulfilling and meaningful life full of purpose and positivity.
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ABA Centers of America stays updated with the evolving autism diagnostic framework, profiles, and differences. Our highly trained ABA team can help to reduce and redirect problematic features of autism for children and teenagers also experiencing PDA in many cases. We believe in providing the most innovative and compassionate care to individuals experiencing neurodiversity and other associated experiences.
Call us now at 844-969-4222 or click here to learn how we can help you and your child or loved one on the spectrum experience genuine progress and flourish today and tomorrow.