Understanding Pathological Demand Avoidance (PDA) in Autism: Resources & Tips for Support

Nobody likes being bossed around. Occasional demand avoidance is a natural response for many people and something that everyone does at one point or another. For people on the spectrum, demand avoidance can be pathological, getting in the way of daily activities and tasks. When you understand the causes of avoidance behaviors, you can start to build better communication habits and reduce triggering demands.

What is Pathological Demand Avoidance?

Pathological demand avoidance (PDA) refers to the resistance or rejection of ordinary demands in everyday life. 

PDA is sometimes recognized as a separate condition apart from autism. That’s because it can show up in people with post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). 

Still, PDA is recognized as a trait that often shows up in people diagnosed with autism. 

People on the spectrum often display demand-avoidant behaviors occasionally. However, this avoidance becomes “pathological” when the behavior disrupts daily routines and tasks.

These demands can be as simple as needing to change clothes, eat a meal, or transition from one activity to another. 

Someone might even avoid demands that involve a favorite person or thing—favorite foods and activities might be rejected simply because they are framed as a demand.

Why Does Demand Avoidance Happen?

People with autism may engage in avoidance behaviors when a demand disrupts their routine, involves a sensory trigger, threatens their autonomy, or causes anxiety.

We all have a need to feel in control of our lives, and when someone makes a demand of us, it implies a hierarchy that can be uncomfortable. Demands are more likely to be met with resistance when they are phrased harshly, don’t leave room for negotiation, or come without adequate warning.

Types of Demands & Resistant Behaviors

There are a few types of demands that might trigger a negative reaction in someone with PDA. These include:

• Direct demands: A straightforward instruction, such as “wash your hands” or “go to bed.”

• Internal demands: Bodily needs or demands that come from willing oneself to do something. Hunger, for example, is an internal demand to eat. 

• Indirect or implied demands: Something occurs that requires an action, though it may not be verbally acknowledged. This can take the form of a bill that needs to be paid or clothes laid out for you to put on.

Resistant behaviors can look like:

• Distraction: Changing the subject, creating a situation that needs more urgent attention, making a disruptive noise, etc.
  
  
• Excuses: These can be based in reality or fantasy (for example, “I can’t wash my hands because I don’t have any”)
  
  
• Outright refusal: An adamant “no” and a refusal to negotiate. 
  
  
• Ignoring the demand/withdrawal: Shutting down, refusing to engage with the person making the demand.
  
  
• Aggression: In certain cases, a person might lash out physically if other forms of avoidance have failed. This is also a stress response and usually comes as a last resort.
  
  

Tips for Handling Pathological Demand Avoidance

If your loved one displays PDA behaviors, here are some ways to support them and make it easier for them to accomplish things without feeling forced:

• Avoid making demands where you can. Use indirect communication methods and avoid any sensory/social stressors such as excessive touch or eye contact.
  
  
• Give plenty of notice when switching between tasks or activities. Abrupt changes are jarring and more likely to elicit an emotional response.
  
  
• Present options, ask for opinions or use “first-then” suggestions (i.e., “First we can clear the table, then we can play that game you like”). Collaboration removes the pressure of hierarchies.
  
  
• Phrase things thoughtfully. Make the demand a question, suggestion, or state facts rather than making demands. For example, instead of saying, “Get dressed,” one might say, “I put clean clothes in your closet.”
  
  
• If possible, discuss the behaviors with the person experiencing PDA. Ask how you can best support them. Help them find other beneficial resources such as therapy, practicing meditation, or other forms of stress relief.
  
  

Learn More About Behavioral Intervention and Self-Determination

For adults with disabilities experiencing disruptive behaviors, behavioral intervention methods can help provide self-management techniques and positive reinforcement. Communication and social skills can also be improved through Applied Behavioral Analysis (ABA) with the right approach. 

For residents of California who qualify for the Self-Determination Program, behavioral intervention is an option for adults with disabilities to improve their quality of life. Schedule a free consultation and see how NeuroNav can support you in your journey towards independence and self-sufficiency.