What is PDA? A Parent’s Guide Through the Mist

When parents first encounter the term Pathological Demand Avoidance (PDA) it is usually met with a look of confusion and possibly even some misguided associations with behaviour disorders such as ODD (Oppositional Defiance Disorder). As a parent of children with PDA and as a PDAer myself, I can tell you it is no picnic. It is complicated in nature and very helpfully isn't yet recognised in the DSM-5 - so not everyone understands it or even believes it exists. Uphill battle, right?

PDA is considered by many a profile of Autism that’s characterised by an intense avoidance of everyday demands and a need for control and equality that can be so strong that it overrides the individuals survival instincts. However, a very recent review by Haire, Symonds, Senior and Du'Urso (2024) explored the methods used to study PDA in children and teens. The article's conclusion looks at various studies and highlights the challenges researchers face when trying to define and understand PDA. There’s no clear agreement on whether PDA should be seen as a unique profile within autism or a behaviour related more to anxiety. Different studies use different ways to describe and study PDA, making it hard to have consistent results. Many researchers now agree that PDA behaviours, like avoiding demands, are driven by anxiety and a need to control situations, often because of feeling overwhelmed or uncertain. Some even suggest that the word "pathological" might not be helpful, as these behaviours could be a way for children to cope with stressful situations, rather than something being wrong with them. The article also points out that more well-designed studies are needed to really understand PDA and how it fits with other conditions.

Understanding PDA: An Overview

Pathological Demand Avoidance (or Pervasive Drive for Autonomy as many prefer it called), often referred to as PDA, was first identified in the 1980s by Dr. Elizabeth Newson and is distinguished by an overwhelming need to avoid demands and a drive to be in control. While PDA is not yet universally recognised as a distinct autism profile, increasing awareness is helping more parents and professionals understand its unique challenges. There is a lot more support out there for this than there used to be, so rest assured, we have your back.

Key Characteristics of PDA  

Children with PDA may display a range of behaviours that can be difficult to manage without understanding the underlying reasons. Some of the hallmark traits include:

- Avoidance of Everyday Demands: This goes beyond typical resistance and can include avoiding even simple requests, such as getting dressed or brushing teeth, or internal demands such as going to the toilet.

- Excessive Need for Control: Children with PDA often exhibit controlling behaviour, which can manifest in dictating the terms of play, conversations, or even the flow of the day.

- Social Strategies: Unlike some other autism profiles, children with PDA may use social manipulation or charm to avoid demands, making it harder to recognise the underlying issues.

- Anxiety-Driven Behaviour: Much of the demand avoidance is driven by anxiety. The child’s need to avoid demands is often a coping mechanism for the overwhelming stress these demands cause.

Identifying PDA: Signs and Symptoms

Recognising PDA can be challenging because its symptoms can overlap with other conditions, including oppositional defiant disorder (ODD) as mentioned previously and generalised anxiety disorder (GAD). However, there are some specific signs that may indicate a PDA profile:

- Intense Avoidance: This can range from distraction techniques to outright refusal and meltdowns when faced with demands.

- Emotional Outbursts: These often occur when a child feels that they are losing control or are being forced into a situation they cannot avoid, these can be verbally aggressive or even physically violent.

- Comfort in Fantasy: Many children with PDA retreat into imaginative play or fantasy worlds as a way to escape demands.

- Highly Social Yet Controlling: Unlike some autistic children who might shy away from social interactions, those with PDA might engage with others but do so in a way that helps them control the situation. Often people assume a child isn't autistic because they are socially motivated - this is where we may think to consider PDA.

Managing PDA at Home: Practical Strategies

Understanding that the behaviours associated with PDA are anxiety-driven is key to managing them effectively. In our 'Understanding Pathological Demand Avoidance (PDA): Parents and Carers' course we deep-dive into this nervous system disability and how regulating a PDAer's nervous system is essential to reducing anxiety based behaviours and allowing the child to thrive. I would strongly recommend taking a look at the course for in depth support in this area. For now, here are some strategies that can help:

1. Reduce Demands 

It might seem counterintuitive, but one of the most effective ways to manage PDA is by disguising or reducing the number of direct demands placed on your child. This may mean helping them to dress or undress, packing their bag or lunch for them, dropping household chore or pet care responsibilities, or even support with personal care such as brushing their teeth for them.

2. Offer Choices and Control  

Allowing your child to feel in control can significantly reduce their anxiety. This can be as simple as offering true choice and options for breakfast or letting them decide the order of their bedtime routine. By giving them a sense of agency, you help reduce the instinctive avoidance of demands.

3. Use Indirect Language

Direct instructions can often trigger anxiety in children with PDA. Instead of saying, “You need to put your coat on now", you could try holding the coat out ready to help them to put it on and using declarative language such as "I have your coat here."

4. Build Trust and Safety  

Establishing a trusting relationship is crucial. Make sure your child knows that you are on their side and that you understand their need for control. This can be done by validating their feelings, offering reassurance, and avoiding power struggles.

5. Embrace Flexibility  

Rigid routines can be challenging for children with PDA. While some structure is necessary, be prepared to adapt based on your child’s mood and needs. Flexibility can reduce the stress associated with demands and help your child feel more secure.

Seeking Professional Support

Managing PDA at home can be hugely challenging, and it’s important to know when to seek professional support. A psychologist or therapist with experience in PDA can offer tailored strategies and support. Additionally, schools may need to implement specific accommodations to help children with PDA thrive in an educational setting. The PDA Society has just released a PDF that can be printed out and given to schools to support staff in understanding PDA and the strategies that best support this profile - check them out!

Conclusion

Understanding and managing PDA requires patience, empathy, and a willingness to adapt your approach. By recognising the signs of PDA and implementing strategies that reduce anxiety and offer control, parents can create a supportive environment where their children can flourish. Remember, every child with PDA is different, and finding what works best for your family is key to success.

For more resources on PDA and supporting children with this profile, explore the links below and take a look at our 'Understanding Pathological Demand Avoidance: Parents and Carers' course which is packed FULL of practical strategies, information and guidance on supporting a child or teen with PDA both at home and in their education.

Further Reading

- [PDA Society: Understanding Pathological Demand Avoidance](https://www.pdasociety.org.uk/what-is-pda/)

- [National Autistic Society: PDA and Autism](https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/pda)

- [Autism Parenting Magazine: PDA Strategies for Parents](https://www.autismparentingmagazine.com/pathological-demand-avoidance/)