Autism with PDA (Pathological Demand Avoidance): What to Know
Imagine have an extreme negative reaction or refusal to self-care or social interaction. That’s the case with many people who have autism with PDA (pathological demand avoidance).
The term is not familiar with many individuals on the spectrum, and I myself only learned about it recently, but it’s a critical description of traits worth learning about, especially if you feel it affects you or a loved one (child or friend, etc.) with autism.
While they are not mutually inclusive, autism with PDA is a co-occurring condition for some individuals. The reason PDA is so troublesome is that individuals who have the behaviors associated with it resist or defy self-care practices such as dressing themselves, eating, basic hygiene, and anything social.
A strong resistance to demands, often due to triggers of anxiety or sensory overload or disruption of routines, an create a low quality of life and prevent any level of independence and social acceptance.
While autism with PDA is being better understood today, experts say that research is still in the early stage of understanding and awareness as well how to best provide diagnosis, approaches, and support.
In fact, understanding how the traits fit into autism PDA syndrome overall is debated, as the condition is currently considered as a profile, or a group of behaviors, vs. a distinct syndrome or diagnosis.
Before exploring more of autism PDA syndrome, it’s important to know that Autism spectrum disorder (ASD) is a developmental disability characterized by challenges with social communication and interaction, as well as restricted or repetitive behaviors. People with ASD perceive and process the world differently than neurotypical individuals.
There is a great deal of diversity within the autism community, with each individual possessing a unique set of strengths and struggles. One subset within the spectrum that presents additional challenges is those who have pathological demand avoidance.
Currently, PDA isn’t recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR) or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). That means there aren’t any universal diagnostic criteria in place. Remember, I’m not a medical expert, so be sure to discuss autism PDA symptoms and questions with your physical and/or therapist.
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What Exactly is Autism With PDA (Pathological Demand Avoidance)?
Autism with PDA refers to a behavioral profile sometimes present in people on the spectrum. Those with autism with PDA display an extreme aversion and avoidance reaction to ordinary everyday demands and expectations. These individuals go to great lengths to avoid common activities like self-care, social situations, communication, and conforming to routine.
Individuals with pathological demand avoidance demonstrate autism PDA symptoms to a heightened degree:
Resists Ordinary Demands
They find daily activities that most people take for granted to be intensely overwhelming. Simple tasks like getting dressed, brushing teeth, eating meals, or going to school can trigger high anxiety. These demands may be actively resisted or refused.
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Mood Instability
When requests or prompts are placed on a person with PDA, they are likely to exhibit extreme emotional reactions. These can include excessive mood swings, crying fits, panicking, shouting, or shutting down entirely. Transitions between activities may also cause outbursts.
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Avoids Through Social Strategies
Social manipulation comes naturally to many people affected by autism with PDA. They may attempt to distract, divert attention, make excuses, withdraw into fantasy, use delay tactics, negotiate, or otherwise avoiding ordinary expectations placed on them. While this may give the impression of good social skills, those with PDA often struggle with reciprocity.
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Preference for Solitary Activities
Despite skill with negotiation strategies, people with PDA seem most content when left alone to engage in solitary activities focused intensely on specific interests or objects. They may become deeply frustrated if pressured to shift activities.
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Obsessive Behaviors
Intense, obsessive behaviors may emerge around certain interests, objects, or systems when considering autism PDA symptoms. These obsessions seem to provide comfort and safety from the anxiety brought on by demands. Rules and routines may be created around the workings of a particular object or game.
RELATED: Are You Organized or Obsessed?
Speculation Continues Around Autism with PDA Syndrome
There is still ongoing speculation in the psychiatric community about how autism with PDA fits into the landscape of diagnoses. While PDA clearly centers around extreme avoidance of expectations, there is debate over whether it should be considered its own condition or categorized as an autism subtype.
Here are 3 key considerations about autism with PDA symptoms:
Whether PDA Falls On Autism Spectrum
Many experts strongly contend that pathological demand avoidance falls on the autism spectrum as an extreme manifestation or subtype of ASD characteristics. The social difficulties, sensory issues, and need for rigid control found in PDA reflect autism. However, others disagree, and believe that connecting them could negatively impact autism as a diagnosis.
If PDA Should Be A Separate Diagnostic Category
Other thought leaders propose that the hyper-avoidance and manipulative tendencies seen in PDA are qualitatively different enough from the rest of ASD to warrant its own diagnostic label. This would give PDA status as a new diagnosable condition.
Hybrid Of Multiple Conditions
Additional theories put forth that PDA is not purely an ASD profile, but rather a hybrid combination of multiple conditions. Some research connects PDA features to obsessive compulsive disorder, anxiety disorders, and attachment disorders as well. Advanced genetic testing may help unlock connections.
Regardless of whether pathological demand avoidance ultimately becomes its own clinical diagnosis or nestles definitively within autism spectrum disorder, it is clear that the compulsion to avoid ordinary demands requires unique understanding and support.
RELATED: Reasons Why Pathologization Crushes Autism Acceptance
Support is Necessary for Autism with PDA Syndrome
Effectively supporting the needs of individuals with autism and extreme avoidance tendencies requires accommodating their experience of the world. The standard behaviorist tools of consequences and rewards are generally ineffective for those with autism with PDA. In fact, they may escalate distress by heightening a feeling of loss of autonomy.
The most successful interventions come from a place of radical empathy. This includes:
Personalized Approach
Each person’s sensitivities, triggers, preferred activities and methods of communication varies greatly. Avoid a one-size-fits all model in favor of deeply customized plans. Start from a place of respecting rigid behaviors while gently expanding comfort zones.
Build Autonomy and Identity
Frame requests or directives as suggestions or invitations, allowing the individual to exert more control. Shape environments to encourage self-determination and expression of preferences. This promotes a strong sense of self.
Grow Self-Understanding
Expand skills of self-awareness around personal triggers and effective regulation strategies. Enable opportunities for self-advocacy and sharing perspectives with others.
Teach Anxiety Coping Skill
Equip individuals with methods and tools to alleviate anxiety, calm emotional storms, or temporarily retreat when feeling overstimulated. This can prevent full demand avoidance meltdowns.
Accommodate Sensory Needs
Determine aspects of environment or activities that may cause sensory overload. Adjust these factors by allowing noise-cancelling headphones, flexible seating, regulating visual stimuli or lighting, or access to calming fidget items.
Establish Structure & Routine
Establish consistent routines and environmental design to minimize unexpected change. Prepare individuals for any shifts or breaks in regular schedules. Make clear guidelines for activities and expectations.
Reward Flexibility
Set up systems of positive reinforcement that reward small steps towards increased flexibility around triggers. This may increase tolerance of activities like new foods, social gatherings, or transitions between preferred activities.
Recognizing Traits in Loved Ones When Considering Autism with PDA Symptoms
For parents, teachers, or caregivers, identifying extreme demand avoidance tendencies can be puzzling or concerning at first. Because the avoidance strategies appear as defiance or manipulation, the root cause of sensory overload may be missed.
Here are 6 initial signs to look for:
Excessive Procrastination
Difficulty getting started or completing tasks, even enjoyable activities, may signal overwhelming feelings around expectations. Lateness, distraction techniques, and excuses mask anxiety.
Frequent Tardiness & Absences
Chronic lateness or missed school/work is common if demands cause feelings of powerlessness. The individual exerts control by not showing up or missing obligations.
Repetitive “White Lies”
Persistent minor lies crop up to get out of everyday obligations. These “fiblets” are told reflexively out of fear rather than with malicious intent.
Inconsistency
On good days, the person handles requests well, other days simple asks like showering spiral into multi-hour fights. Performance fluctuates drastically.
Roleplaying & Fantasy
Immersive roleplay, gaming or fantasy serve as pleasurable escape hatches from real-world expectations. The alternate worlds feel safer and more controllable.
Meltdowns & Shut Downs
Emotional explosions, crying fits or total withdrawal/silence may follow seemingly small transitions or demands. Episodes appear extreme relative to trigger.
Once patterns of extreme avoidance raise suspicion of PDA, professional assessment is key. Getting comprehensive psychological screening and diagnosis can point the way to appropriate interventions. Open, non-judgmental conversations help uncover which aspects of demands cause distress.
All behavior is communication – tuning into the underlying message opens doors to effectively supporting needs.
Autism with PDA: Navigating Education & Employment
Navigating educational and workplace settings poses unique challenges for people grappling with pathological demand avoidance. The inherent expectations to show up on time, socialize appropriately, follow instructions, and complete projects runs counter to the PDA urge avoid control.
Successful outcomes rest on proactive accommodations and open communication of limitations.
Needed supports may include:
Scheduling and Deadline Flexibility
Strict timelines overwhelm, while open-ended goals allow pacing work over time. Allow late start days or work from home options.
Provide Sensory Spaces
Access to quiet rooms with calming tools reduces sensory overload from workplace noise, lights, or crowds during high anxiety periods.
Set Clear Expectations
Keep job duties or class requirements unambiguous with examples of quality work. Vague directives heighten uncertainty. Structure brings security.
Enable Advocacy
Create openness for transparent conversations around sensory needs. Encourage speaking up when feeling overwhelmed before emotions escalate into shutdowns.
Build On Strengths
Note obsessive interests or skills that motivate and tap into those with assignments. Hyperfocus channels productivity. Passion fuels quality output.
Offer Alternatives
Where certain demands prove unmanageable, devise creative workarounds to bypass obstacles while still meeting core goals. Customized tools empower.
With supportive school staff and employers focused on harnessing strengths instead of forcing rigid compliance, those individuals exhibiting traits of autism with PDA can successfully develop autonomy and skills for advancement.
Seeking to understand and accommodate builds inclusive environments where neurodiversity is embraced as an asset. Progress is still needed in educating institutions and employers around conditions like PDA, but increased awareness combined with youth self advocacy holds great promise!
With greater understanding of conditions like PDA, we can design customized supports that acknowledge an individual’s unique neurotype without judgment.
Meeting people where they are at while providing tools to self-regulate and slowly expand boundaries leads to greater independence and personal happiness. Progress continues in autism research and improved societal acceptance of neurodiversity.
There is still work needed to advocate for the spectrum of support needed across the autism community, but learning about these traits and understanding the extreme spectrum of what it may mean to be autistic is a start.
I’d love to hear your comments about code switching and masking and any tips you can offer to individuals with autism about these behaviors or mental health in general.
I hope we can connect. Just leave a comment below, or feel free to email me directly at [email protected].
Other Common Autistic Behaviors
There are many behaviors associated with having autism. Keep in mind that everyone presents differently, which is why it is caused a spectrum disorder. However, there are common autism behaviors. Learn more about them.
- Autism Masking & Code Switching: How to Redefine Acceptance
- Autism and Eye Rolling: Why It’s Odd, But Perfectly Okay
- Eye Contact Avoidance: 8 Best Ways to See Eye to Eye
- 10 Proven Techniques for Managing Autism and Sensory Issues
- Talking as Fast As I can Mentality: How to Dial Back Speaking Speed
- Autism Social Skills: Inferencing and Body Language Hurdles to Overcome
- Autism and ADHD: Making Sense of the Overlap
- Autistic Stimming Behaviors: Why We Do and How It’s Important
- OCD and Autism: Could You Have One Condition or Both
