A Parent's Guide to 'Pathological Demand Avoidance'

Photo: Ground Picture (Shutterstock)

All kids need occasional (or constant) coaxing to complete the hundreds of tasks we expect from them in a day. Having to tell your kid to put his shoes on three times before school every day is not necessarily pathological, it’s within the typical range of developing attention spans and independence. However, kids with pathological demand avoidance (PDA) traits truly find it difficult to do what’s expected of them—even when they really want to. These kids struggle to the point that it interferes with getting through the day at home or at school.

The label “pathological,” referring to the regular disruption of daily functioning, can be stigmatizing. Some people prefer the term “pervasive (or persistent) drive for autonomy” to acknowledge that the child’s behaviors are driven by anxiety so overwhelming that they lose the power to decide for themselves.

According to the Child Mind Institute, people with PDA go to extreme efforts to avoid tasks that feel like demands to them, and it can be a trait of children with autism. There’s still some debate about whether PDA traits are directly tied to autism, and PDA can exist without an autism diagnosis.

PDA research began about 20 years ago, and experts are still not sure why some people experience it. Explanations include:

• Children with PDA may not recognize the social power structure of adults over children.
• It’s caused by a difference in social learning, not defiance.
• Children with autism may not be motivated by social expectations in the same way that neurotypical kids are.
• It may be connected to anxiety, trauma, or other psychological issues.
• Behavioral expectations are perceived as a threat to the child’s autonomy that triggers a neurological reaction of anxiety, attempting to gain control, and meltdown or panic.

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A 2021 systematic review of 13 studies of PDA in children and adolescents highlighted one problem with understanding PDA in kids: researchers rely on reports from adults instead of investigating the viewpoint of the child.

How can you recognize PDA in your child and try to see things from their perspective instead of butting heads?

Signs your child might have PDA

Developmental psychologist Elizabeth Newson pioneered the study of PDA with her 2003 publication that included 8 traits she had observed in children with PDA:

1. As babies, they were passive and less engaged (or uninterested in toys) during their first year.
2. They use “social manipulation” to avoid tasks, like making excuses, distracting, withdrawing from conversation, or intensely focusing on something else.
3. They can appear sociable on the surface but may have inappropriate social responses.
4. They show extreme mood swings and impulsivity.
5. They are comfortable with pretend play and role playing.
6. They sometimes had an early speech delay that they made up for in early childhood.
7. They can show obsessive behavior, particularly with a person.
8. They may have epilepsy or neurological symptoms like clumsiness and delayed gross motor skills.

If you notice that asking your child to do a task leads to what seems like an extreme level of excuses, distractions, and withdrawal on a regular basis, consider talking to a child development specialist about PDA. Avoidant behaviors may escalate to meltdowns, aggression, running away from you, or panic attacks.

PDA can also cause kids to resist implied expectations, even when they are not direct demands (for example, the whole class eats lunch in the cafeteria at 11:15 a.m.) Refusal to comply with some tasks should not be confused with a lack of ability. This can be especially challenging at school when kids avoid school work and grades suffer, even though they are intellectually capable of doing the work.

In fact people with PDA may actually want to do what’s expected of them, but struggle with the anxiety that comes up when they face demands.

How you can help your kid with PDA

If it seems like your child’s reaction to a “normal” request is extreme, try recognizing their discomfort with demands as anxiety. The PDA Society has developed this mnemonic device to help you learn skills for parenting a child with PDA. Try P-A-N-D-A:

• Pick battles: That may look like loosening rules, gently explaining why some things need to be done, and accepting that not all tasks are possible.
• Anxiety management: Keep in mind the challenges your child has with anxiety, sensory input, and socializing. Reduce uncertainty and keep arousal low. Support their distress like you would a panic attack.
• Negotiation and collaboration: Invite your child’s input on how to get a task done, and stay calm.
• Disguise and manage demands: Rephrase so it doesn’t sound like you are demanding. (Talking about expectations might trigger anxiety and increase avoidance.) Complete the task together.
• Adaptation: Use humor, distraction, and pretend play to make a task more novel or fun. Allow extra time so the clock doesn’t add pressure, and have a Plan B.

If your child is not motivated by expectations, figure out what does motivate them so the task feels more self-directed. For example, they may practice spelling words if it earns their favorite stuffy points for an adventure afterward.

Finally, adapt what you consider a “win.” You may need to break small tasks into even smaller steps, and celebrate any progress.

The PDA Society has compiled an extensive list of tips for helping children with PDA. They cover the following:

• Understanding PDA behaviors
• Adjusting your mindset
• Optimising the environment
• Reducing the perception of demands
• Being cautious with rewards, praise, or punishment
• Supporting your child’s sensory needs
• Supporting social interaction and communication
• Supporting emotional well-being

Trying different approaches will help you come up with an individualized strategy that works for your kid.

Check out these resources to help both you and your kiddo better understand PDA:

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