PDA: Pathological Demand Avoidance / Persistent Drive for Autonomy

The Persistent Drive for Autonomy (AKA Pathological Demand Avoidance)

Pathological Demand Avoidance (PDA) is frequently known in neurodivergent circles as the Persistent Drive for Autonomy, which feels like a more accurate name to those who experience it.

Before we even get into defining what PDA is, I think the most important thing for parents of neurodivergent kids with PDA to understand is that this is not defiance. 

It is not bad behaviour. It is not aggression. It is not a choice!

So What is PDA?

While PDA is defined as a “rare phenotype” exhibited by autistic people, my own experience is that it appears to be very common but in varying degrees of severity across the entire neurodivergent community. 

It is generally considered to be an obsessive or overwhelming need to avoid or resist demands. This does make it sound like a decision or choice, however, which it is not. The result of the PDA response is an extreme feeling of anxiety, overwhelm (which is experienced in different ways by different people), or even panic attacks.

In short, someone makes a demand (“Go brush your teeth now, please.”), PDA kicks in, anxiety and overwhelm looms large, and the neurodivergent person pushes back. 

The Reaction

Some people will respond with a direct “No” (especially kids) or get angry or violent. Others will argue as to why the request is wrong/unfair/incorrect/rude/aggressive. Some will negotiate or offer compromise, or offer excuses, even as extreme as saying they physically can’t do something they’re clearly capable of. And some will say yes (read: people who have been forced to learn neurotypical behaviours) then either avoid the activity or do the activity despite it causing them considerable distress. The range of responses is about as diverse as you can imagine – think of how you might respond if someone asked you to do something you genuinely didn’t want to do (which, as we’ve discussed, is not the case with PDA) – and it’s probably on the PDA response list. 

There are generally 7 categories of response: Fight, Flight, Freeze, Fawn, Flop, Fib, and Fun.

• Fight: argue, fight, actively defensive behaviour. “No! I won’t!”

• Flight: fleeing, literally running away or removing self from the situation

• Freeze: paralysis, decreased heart rate, inability to respond

• Fawn: people-pleasing, suppressing own needs to focus on others’

• Flop: physiological shutdown where the body goes floppy, sometimes including diminished brain function

• Fib: lying or denying

• Fun: playing the clown

One of the most frustrating things about PDA is how often neurodivergent people find themselves resisting things they enjoy or wish to do, as a PDA reflex. It is not simply a physiological response to being asked to do something you don’t want to do.

It can even kick in when you’re asking yourself to do something! I’m really rubbish at eating breakfast, and if I push myself too hard to do it when I don’t want to, I get a self-induced dysphoric response.

The Lightswitch

Think of reflex behaviours like PDA as the wire that carries the current to a lightbulb once someone presses a light switch. It is not the lightbulb. The lightbulb is the conscious or informed decision as to how the person behaves, or wants to behave. But between that switch being flicked, and that rational response, there is a stream of automatic response – in this case push back – which then makes it incredibly hard to respond naturally.

Take a moment to appreciate what it would do to your self-esteem and mental health to hear something, react in one way, then immediately want to say or do the opposite. You either have to apologise constantly, be judged for something you have minimal control over, and acknowledge an aspect of yourself you don’t like; to backtrack and look hypocritical at best, and crazy at worst. Or you have to own it, and run with your reflex, being far more demand avoidant, negative, and difficult than you actually are; accepting that people’s impression of you is not your authentic self, and that they have a negative perception of you. You shoulder remorse, guilt, and self-hatred.

The Aftermath of a PDA Response

All of that is if the current makes it to the lightbulb in a timely fashion. PDA often interrupts the flow, sending information onto a tangent, drawing the focus to the reflex behaviours rather than the initial request/demand. It can be long after the interaction that the lightbulb turns on, and the autistic person is left frustrated by what appears to be a finalised interaction in which their request/demand was denied or met with “bad behaviour”. Met with kindness and calm, many children often apologise later, unprompted, once the physiological reaction has left their little bodies and they have the ability to regulate again. While at home we can establish an environment where that eventual apology is a safe and beautiful outcome, society in general is not so quick to forgive, or to praise for the bravery that is required to make an apology. People’s judgement is usually based on the reflex, which in this case can be perceived as very negative.

Isn’t this Oppositional Defiant Disorder (ODD)?

In medical terms, the difference between ODD and PDA is that ODD is technically a behavioural condition. It presents similarly to PDA, with additional vindictiveness that does not appear in PDA. With the correct interventions and environmental changes, it is believed that ODD can be overcome or reprogrammed. PDA is an inability to comply, opposed to a decision not to, so cannot be unlearned in the same way.

That said, both ODD and PDA can present in the same child.

So how do we work with PDA?

Children who experience PDA need to be met with patience and love, and preemptive changes rather than only with understanding responses. 

Avoiding direct demands can be of huge benefit. Using language such as “Would you like to brush your teeth or make your bed next?” to avoid triggering PDA, can also increase their sense of autonomy (which is pretty much PDA’s kryptonite). If they’re facing a sticking point, skirting around it entirely can help (“After you brush your teeth, are we going to do your hair or back your bag?” making the tooth brushing a given rather than a demand). 

If a PDA response is triggered unintentionally, well that’s just as much on the communicator as it is on the person with PDA. Neither needs to feel guilt or responsibility. 

Offering hugs or space, helping regulate her emotions, and reminding the person they’re a good person with a difficult reflex, can all be of benefit. When a PDA response results in a sense of inability, you can assist by offering to help, to be with them while they try, or to find an alternative option. Yes, this does mean sometimes helping a grown child get dressed, or holding an adult’s hand while they take some deep breaths before taking out the garbage. So what?

This can go hand in hand with:

• Autism
• ADHD
• Anxious behaviour
• Mood swings
• Controlling behaviours
• Appearing more NT-social than expected (surface sociability)
• Role play and pretending (losing touch with reality, extended play as a character ie being a cat)
• Obsessive behaviours

Favourite PDA Resources:

Cath Ehrlich PhD: https://www.atpeaceparents.com

Kristy Forbes: https://www.kristyforbes.com.au