Pathological Demand Avoidance (PDA) and its Relationship to Other Conditions
If you or your loved one have pathological demand avoidance, you may face challenges complying with demands, even when you want to. Based on the PDA Society, pathological demand avoidance is considered a profile of Autism Spectrum Disorder, although it can appear with other learning differences and mental health challenges.
However, researchers are yet to prove the relationship between PDA and the Autism spectrum, and PDA is not listed as a condition in the Diagnostic and Statistical Manual of Mental Disorders. PDA is also known as rational demand avoidance and the first signs are usually presented with avoiding demands from an early age.
It’s important to highlight that people with pathological demand avoidance can sometimes avoid their everyday demands and needs, as well as activities and hobbies they like. To other people, this may seem nothing more than an antagonistic attitude and rebellion. However, it’s crucial to understand that PDA is not a choice, and individuals do not intentionally exhibit the behaviour.
These demands can be:
- External: Asked by others, such as instruction from a teacher or a deadline
- Internal: Imposed by the person themselves, like a plan or a goal
- Explicit: A direct demand
- Implicit: Polite request, social expectations
Extreme demand avoidance can appear in children and adults and is often associated with other challenges outlined in the following guidepost.
Autism Spectrum Disorder (ASD) and PDA
Experts suggest that people with PDA may have an Autism diagnosis due to the common symptoms of a lack of flexibility and difficulty grasping social cues. Also, Autistic children and adults may be prone to demand avoidance or events that disrupt routines, trigger anxiety or cause sensory overload. Similarly, individuals may avoid demands or situations that include transitioning from one activity to another or activities and situations they are not interested in.
Demand avoidance can appear in many forms, including distraction, making excuses, ignoring, withdrawing, or panic attacks. Helpful practices in managing PDA may include:
- Identifying and addressing sensory challenges
- Encouraging people to adapt to new situations, following predictable routines
- Working collaboratively to solve challenges
Attention-Deficit Hyperactivity Disorder (ADHD) and PDA
Following PDA Society reports, many people with attention deficit hyperactivity disorder (ADHD)show signs of demand avoidance, but more research needs to be done to assess the link. The relationship between attention deficit hyperactivity disorder and pathological demand avoidance involves overlapping ADHD and PDA traits.
The connection between ADHD and PDA may be due to the co-occurrence of Autistic Spectrum Disorder and ADHD. Executive dysfunction is common for both ADHD and PDA, including difficulties initiating tasks, completing tasks, and impulse control.
However, people with PDA tend to avoid demands because that’s how they naturally react to demands. With ADHD, people may avoid demands from time to time, but extreme demand avoidance is not a symptom of ADHD.
Sensory Processing Disorder (SPD) and PDA
Sensory processing disorder (SPD) affects how our brain processes sensory information or stimuli. Sensory stimulation includes things we see, hear, smell, taste and touch. With sensory processing disorder, people can be overly or under-sensitive to stimuli. Children are more susceptible to sensory challenges, but adults can experience them too. However, most adults have developed effective coping mechanisms for SPD, and many people around them cannot notice their difficulties.
The relationship between pathological demand avoidance and sensory processing disorder is related to the potential disruption of the ‘comfort zone’ that people with sensory processing disorder tend to use as a coping mechanism. For example, some demands may require children or adults with SPD to do something that may cause over-stimulation and disrupt their emotional balance. This can also appeal to ordinary demands, and this is often classified as rational demand avoidance.
Anxiety Disorders and PDA
PDA can be triggered by anxiety. Based on a survey, the state of anxiety is closely related to the “fear of uncertainty’ and an unconscious need for control. Whatever the background, there is no doubt that anxiety and pathological demand avoidance go hand in hand.
It’s important to mention that this kind of anxiety is different from the classical form of anxiety that people are used to experiencing. PDA anxiety doesn’t usually cause people to feel nervous or withdrawn, rather, it appears with behaviours such as distracting people or postponing doing things. In some more extreme situations, it may result in challenging behaviour.
Eating Disorders and PDA
Daily life examples show that pathological demand avoidance may lead to people developing serious eating difficulties, along with other social, educational, and relationship challenges.
The core feature of PDA is intense resistance to ordinary demands and daily life activities. This can include resistance to getting dressed, leaving the house, or eating meals. Frequently, usual parenting strategies do not help and it can be challenging for the parents to cope with the behaviour. Similarly, in resistance to a demand the child may exhibit behaviours of concern.
If the PDA starts reflecting on the eating habits of the child or young person, it can lead to extreme food restriction which can lead to serious physical and mental health consequences. For example, food-associated demand avoidance can appear similar to anorexia nervosa, but the core reason is not a negative self-image. Therefore, it’s very important to identify and address the challenge as early as possible.
Impact of PDA on Daily Life and Functioning
Pathological demand avoidance can affect our daily life and functioning in many ways, from family and peer relationships to school and employment perspectives. Completing day-to-day activities, such as chores, homework, or personal care, can also be challenging for people with PDA.
The impact of pathological demand avoidance can be reflected on:
- Social interactions and communication: People with PDA may struggle with social interaction and communication, finding it challenging to initiate or sustain conversations, interpret nonverbal cues, or understand social nuances. This can lead to difficulties forming and maintaining friendships, feeling socially isolated, and being misunderstood by peers.
- Persistent anxiety: Individuals with PDA often experience high anxiety levels, particularly in situations involving demands or expectations. This anxiety can further affect social interactions and make it challenging to participate in everyday activities.
- Challenges in school and employment settings: The difficulties with demands and anxiety in social situations may impact academic performance and functioning in a school or work environment. Individuals with PDA may have trouble adhering to routines, following instructions, and adapting to changes, leading to struggles in educational or professional settings.
It’s important to note that each individual with PDA is unique, and the impact can vary widely from person to person. Early assessment, intervention, and tailored support can play a crucial role in supporting people with PDA to live a balanced and rewarding life. Strategies such as using person-centred approaches, reducing demands, providing clear and concise instructions, and creating supportive environments can be beneficial in easing the challenges associated with PDA.
Leaf Complex Care Supports Individuals with PDA
At Leaf Complex Care, we build and maintain a supportive and nurturing environment that promotes confidence and a positive self-image of people with pathological demand avoidance, Autism Spectrum Disorder and related developmental differences.
Our experienced support workers collaborate closely with the people we support to foster independence and self-reliance. Our goal is to empower people to thrive and reach their full potential with our person-centred and humanised approach.
If you are looking for a committed and reliable healthcare provider, Leaf Complex Care is the right choice for you. For more information about our tailored support services, contact us now.
You can find our offices located in Bristol, Slough, the Midlands and Somerset.
