Pathological demand avoidance in autism – everything you need to know

If your child is experiencing panic attacks or meltdowns when expected to do something, it could be this little-know autistic trait

Are you someone who hears the term “pathological demand avoidance” (PDA) and rolls their eyes, thinking it’s just another newfangled way of describing laziness, contrarianism or just plain disobedience?
It is true that “demand avoidance”, whereby people avoid doing things that are expected or asked of them, is a normal human trait and happens for a range of reasons in neurotypical individuals.
But a condition called pathological demand avoidance – or PDA – is an extreme form of this behaviour, in which the impulse to avoid demands becomes all-encompassing and can trigger fear, panic attacks, anxiety and meltdowns.
The PDA Society defines the condition as “a profile on the autism spectrum, involving the avoidance of everyday demands and the use of strategies as part of this avoidance”.
The National Autistic Society, meanwhile, notes that forms of resistance can include giving fanciful excuses such as “I can’t because I am a tractor and tractors don’t have hands” or “I can’t because my legs are broken” (even though they aren’t).
For those with PDA, the demand or expectation does not even have to be made by another person to trigger a response. It can be a societal expectation, such as the expectation that you will get dressed to go outside, or even a biological demand, such as the need to drink when thirsty or sleep when tired.
Individuals with the condition sometimes refer to themselves as ‘PDAers’. They may avoid everyday actions such as dressing, washing and eating because there is an expectation that these tasks should be done.
There can be an irrational quality to the avoidance, for example a seemingly dramatic reaction to a request to put shoes on, or the feeling of hunger preventing someone from being able to eat. The avoidance impulse can even stop individuals doing things they enjoy.
Sally Russell OBE, the chairman and research lead of the PDA Society, explains: “PDA is about avoiding the notion of a demand itself rather than avoiding the action, and that’s quite critical. People avoid things that they feel they ought to do through their own personal expectations, not just things that have been asked of them.”
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The term was developed by Elizabeth Newson, a British psychologist, after she observed children who exhibited behaviours that were not typical autism traits, and gave these behaviours a distinct identification rather than classifying them as “atypical autism”. While PDA is not clinically recognised, some people are diagnosed with autism with a ‘demand-avoidant profile’ or a ‘PDA profile’. Others self-identify with PDA.
Some experts argue there is not enough research to confirm PDA as a separate condition to autism and that the demand avoidance behaviours may instead be explained by factors such as an individual’s social, sensory and cognitive sensitivities, or their environment, or by another condition.
It has also been argued that labelling someone as a PDAer unnecessarily pathologises traits in autistic people. However, those who identify with PDA argue that critics do not have lived experience and that the views of people with lived experience are being invalidated.
There is scant research. One 2023 paper published in the Journal of Child and Adolescent Psychiatry and Psychotherapy, argued that PDA is a behaviour profile that can be associated with several mental disorders and can be influenced both by external factors such as environment and relationships.
All parties call for more research. The dearth of information leads to significant misunderstandings about the condition. Elizabeth Archer, PDA Society’s chief executive, says common misconceptions include that child PDAers are naughty, that the condition is a result of bad parenting, and that individuals grow out of PDA.
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PDA is commonly triggered when there is a demand or expectation to do something. This can either be from an external person or source, or an internal or societal expectation.
Archer explains: “It could be that someone is feeling thirsty. That feeling of thirst is perceived as the body demanding the individual has a drink. That demand triggers the avoidance response so the individual can no longer drink.”
She adds that this can also apply to hunger and tiredness, which can lead to panic attacks.
“It can have a very profound daily impact on people’s lives, making it impossible for them to function,” she says.
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Demand avoidance is a common human trait and is displayed for a range of reasons in a range of circumstances. Just because an adult or child has demonstrated a resistance to follow instructions or requests does not imply that they exhibit PDA behaviours.
One small scale study on PDA prevalence suggested that as many as one in five autistic people may have PDA traits. Russell suggests it is more likely to be one in 10.
Resources and communities exist online for those who have been told they have PDA or who have self-diagnosed themselves as having PDA. The ‘PDA Autism’ community on Reddit has over 7,000 members.
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PDA behaviours can be misinterpreted as naughtiness. Russell says that it’s important to understand that avoidance behaviours – which can be extreme – are a result of a state of panic and that de-escalation is important.
She says: “It is always worth exploring what issues might be causing demand avoidance problems, such as bullying or mental health problems. 
“If the child is struggling to do the things that you might expect them to be able to do when they’re at home and in other environments such as when going to friends’ houses, then it’s worth thinking about PDA and reading up to see whether that might be a possibility.”
Archer adds that rather than concentrate on a diagnosis and a ‘label’, the most important thing is to recognise the behaviour and help the child. “Rather than ask if they have PDA, ask if this is a child who is autistic and who is having an anxiety or fear response to demands.”
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Adults with PDA can tend to internalise the fear response, as opposed to child PDAers who can exhibit external behaviours such as panic attacks and meltdowns. Adults tend to try to escape from the source of the demand. 
This can lead to social isolation. Sometimes teenagers will drop out of school – an environment full of demands – and older teenagers and young adults will move away from parents and family.
With the right coping strategies, however, some adults with PDA can hold down good jobs. Perhaps unsurprisingly these are often jobs where they are in control of themselves and their own time, and involve doing something that they are passionate about.
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Riko Ryuki, 37, from Durham, was diagnosed with Asperger’s aged 27, but had never come across PDA before. 
“I had never heard about PDA and started to research my daughter’s behaviours online and realised that not only did PDA apply to her, it applied to me too,” says Riko. “I saw a GP and they also looked it up and agreed. They gave me some information, but I was largely left to develop my own coping strategies.
“Day to day it stops you doing things, but also compels you to do things counter to what your brain is telling you. 
“For example, you might see a hot plate and your brain tells you not to touch it. But that protection impulse is recognised as a demand and that demand is interpreted as a danger, so you feel compelled to avoid the demand and touch the plate.
“My coping strategies include doing something else useful when I feel anxious about a situation, for example if there are dishes to wash, I will do some other cleaning instead. Day-dreaming also helps, as does pretending and role play.”
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