Definition of Pathological Demand Avoidance (PDA)
Pathological demand avoidance is a neurodevelopmental difference that affects a person’s ability to comply with ordinary demands and socially accepted requests. The PDA profile is associated with extreme demand avoidance, often interfering with a person’s functionality and quality of life. Other terms proposed for PDA include extreme demand avoidance, rational demand avoidance and persistent drive for autonomy.
Pathological demand avoidance is not a matter of choice and often occurs due to anxiety triggered by everyday demands. Additionally, this demand avoidance is associated with an intense need for control and a lack of flexibility and adaptability skills. While it takes time and effort to learn how to cope with PDA, several social strategies show promising results when addressing extreme demand avoidance.
For people in need of support and guidance, Leaf Complex Care provides person-centred and humanised support to people with pathological demand avoidance, pervasive developmental disorder and complex care needs.
Emotional Challenges in PDA
Understanding the core factors behind PDA is the most important step towards finding the best strategy to meet and prevent the emotional challenges of pathological demand avoidance. This can help us focus our support approaches and also help with early intervention and create a supportive culture to foster emotional well-being.
Key features of PDA and it’s emotional challenges include:
- Intense need to have control of the environment and the surrounding people
- Difficulty regulating emotions or the capability to grasp the emotional experience
- Trouble with adaptation to standard teaching methods due to unrealistic expectations about themselves and others
Impact of Demand Avoidance on Emotional Well-Being
Pathological demand avoidance can have a significant impact on a person’s psychological and emotional well-being.
Key features of PDA and its impact on emotional well-being include:
- Constant anxiety about real, perceived or expected demands that are part of daily life and the surrounding people
- Trouble making or maintaining positive or reciprocal relationships with family, friends, or peers
- Low self-esteem is due to the lack of adaptive skills and flexibility to work and function in their peers' environment
- Feelings of disappointment by people around them
PDA and Mental Health
Pathological demand avoidance is not considered a mental health challenge and is not listed in the Diagnostic and Statistical Manual of Mental Disorders. However, in most cases, it can lead to functional challenges and interfere with a person’s quality of life.
This involves a considerable impact on a person’s mental health as well. While many people may perceive the PDA profile as a ‘defiant’ behaviour’, children with PDA often struggle to perform the tasks of their own interest, including school or hobbies. In many cases, this can go to extremes, where people with PDA may object to getting dressed, maintaining personal hygiene or even consuming food and drinks. If left untreated, this can have life-threatening consequences.
Similarly, children and adults with a PDA profile often face trouble in social interactions and school and work environments. For example, they might use many strategies to avoid demands, including interruption while speaking, changing the subject, or even having an emotional outburst. This behaviour may seem unusual to other children or peers, and they may start avoiding the person with PDA. Consequently, this can have a negative impact on a person’s emotional and mental well-being.
The lack of understanding of social cues is another factor that can make the person feel uncomfortable about themselves, often leading to misinterpretation of people’s reactions. For that purpose, the key to finding the best practices and strategies for supporting people with PDA is to understand well what the person feels, wants and how they want to be treated at home and in the community.
Strategies for Helping Individuals with PDA Recognize and Manage Their Emotions
When choosing the best strategy for supporting people with PDA, it’s crucial to understand that the person is not ‘refusing’ the remand or request because they want to. This resistance is just a mechanism they use to cope with anxiety. Finding meaningful ways to identify and meet the person’s needs rather than correcting behaviour can help relieve the person’s anxiety related to the PDA symptoms.
Here you will find the most effective and person-centred strategies when caring for a person with pathological demand avoidance.
Creating a Supportive Environment
Everyone can thrive in the right environment; we just have to create it. If you have a child or a family member with PDA, you might need additional education on how to create the best nurturing environment that will improve a person’s self-image, life skills and overall quality of life.
Many parents believe that setting firm boundaries and the use of rewards and consequences could help their child ‘obey’ the requests. However, these practices do not seem to work in the case of PDA. Instead, you may try approaches based on collaboration, negotiation and giving a choice instead of limitations.
Building Emotional Regulation Skills
Being different from the people around you can sometimes be overwhelming. From challenging relationships at home to school, work and social environment, the person with PDA may need support to help them build emotional regulation skills.
Recognising and regulating emotions is probably the most challenging process of a child’s development. While children are young, adults around them need to help them develop emotional regulation skills. Books can be a great way to learn about emotions and empower children to build understanding and skills in an indirect way.
Teaching emotional awareness can help the individual recognise and identify their emotions. You can use visual aids, such as emotion charts or social stories, to aid their understanding of various emotions and how they might manifest.
Developing Social Skills and Relationships
Children with PDA may need support regarding processing language and social interactions. In this case, it is recommended that a speech and language therapist evaluate the child’s communication and interaction skills and create tailored detailed strategies.
In relation to social strategies, there are several ways which can help children understand people’s feelings, perspectives and actions, including:
- Role play is an excellent way to show our children how someone's words and actions can make other people feel and how this can impact interactions and relationships
- Books and educational programs can aid children in comprehending emotions, relationships and social dynamics and encourage our children to build and develop social skills
- Interactive activities and games can help your child learn how to act in particular social situations through indirect examples of other people, animals, and objects
Promoting Self-Esteem and Positive Self-Image
PDA can significantly impact an individual’s self-esteem and self-image, especially for young people. Being different from the rest of their peers may cause the young person to feel isolated and unaccepted.
Besides raising awareness of PDA in the social community, we can implement many strategies to promote a positive self-image and empower our children to thrive and reach their full potential.
Here’s how you can support your children in building positive self-image and self-confidence:
- Identify and focus on the positive qualities, skills and talents
- Try to support your child with the challenges that they face on a daily level
- Regularly remind your child that they are valued for who they are and that we are all different in our virtues, skills and talents
- Support your child with the things that make them happy instead of imposing things that may provoke anxiety and irritability
- Speak positively about your child in front of others, e.g., 'David has a great sense of humour, he's such good fun to be with'
Therapeutic Support
Given the unique characteristics of PDA, specific strategies aimed at reducing demand avoidance and anxiety can be implemented. These strategies often involve using indirect language, offering choices, and providing flexible approaches to tasks and routines.
- Cognitive-Behavioural Therapy (CBT)- helps to develop coping strategies for reducing anxiety and stress related to demands and expectations
- Occupational Therapy- helps to address sensory sensitivities and help people with PDA develop adaptive strategies to manage sensory overload and improve their ability to engage in daily activities
- Applied Behaviour Analysis (ABA)- ABA practices can be adapted to support individuals with PDA in a positive and person-centred way, helping them to build skills, reduce anxiety, and manage challenging behaviours
- Social Skills Training - many individuals with PDA experience difficulties in social interactions. Social skills training can assist them in understanding social cues, perspectives of others, and appropriate responses in social situations
Supporting Families and Caregivers
Supporting families and caregivers of individuals with PDA requires a compassionate and collaborative approach. By working together and providing the necessary resources, information, and emotional support, we can help families better navigate the journey of caring for loved ones with PDA.
Empowering Individuals with PDA
Empowering individuals with pathological demand avoidance involves providing support, understanding, and accommodations that address their unique needs and challenges. PDA is related to the Autism spectrum and is characterised by an extreme anxiety-driven need to avoid everyday demands and expectations, leading to difficulties in social communication and interactions. With the right support, diagnosis and self-care strategies, individuals with a PDA profile can overcome challenges and learn to participate in ordinary demands.
Leaf Complex Care Puts Emotional and Mental Well-being First
At Leaf Complex Care, we create pathways for people with pathological demand avoidance, Autism, and complex care needs to reach their full potential. With a team of highly trained and experienced professionals, we strive to empower every individual to thrive and overcome their challenges.
Implementing innovative and person-centred practices is our priority, and we ensure that every individual feels valued and respected for who they are, fostering their skills and talents to reach the best possible outcome.
We provide services across the UK, with offices in Bristol, Somerset, the Midlands and South East.
