Badington House School

Pathological Demand Avoidance - what you need to know

Published by Isbi Schools on Friday 4th of June 2021 11:54:31 AM

What is pathological demand avoidance?

Pathological demand avoidance - or PDA for short, is a term used to describe a person whose main characteristic is to avoid all demands, to an extreme level. This is not something we would use to describe a toddler who has just learned the word “no” and likes to shout it at everything, or a child who doesn’t always do as they are asked. Rather, a person exhibiting pathological demand avoidance is someone of any age who avoids all demands and expectations, to the absolute extreme.

People with PDA feel driven to avoid everyday demands and expectations, and this is often (though not always) accompanied by feelings of anxiety

Is pathological demand avoidance part of autism?

Pathological demand avoidance comes under the umbrella of Pervasive Developmental Disorder and the categories Pervasive Developmental Disorders are now being replaced by autism spectrum disorders. For this reason, many people link autism with PDA. PDA is increasingly seen as a profile that is seen in some autistic people.

Many people prefer to use the term Extreme Demand Avoidance as this can feel like a more acceptable term than using the word “pathological” which has negative connotations.

What are the features of pathological demand avoidance?

Demand avoidance is seen in many different instances, not only in people with a PDA profile, so in order to be considered as PDA it must be seen with a number of other features.

Profiles of autism can vary considerably depending on a person’s strengths and difficulties around two key areas: how they relate socially and their need for sameness. Someone with PDA may appear to have better levels of social understanding and communication skills than some other autistic people, but these apparent abilities can often mask difficulty understanding and processing communication and social situations.

The main features of a pathological demand avoidance profile include:

  • Resisting and avoiding the ordinary demands of life
  • Using social strategies as part of that avoidance - for example distracting or giving excuses
  • Appearing sociable but lacking understanding
  • Experiencing excessive mood swings and being very impulsive
  • Appearing to be comfortable with role play and pretending
  • Displaying obsessive behaviour that is often focused on other people

People with a PDA profile can often appear to be very controlling and dominating and this increases when they feel anxious. When they feel secure and in control of their situation they can be more confident and engaging.

Someone with PDA will need a lot of support, and so it’s important to recognise signs of this early so that the appropriate help can be gained.

Identifying and diagnosing PDA

PDA will usually be identified as part of an autism assessment. It is important to have this as it can provide an accurate diagnosis, identifying all areas of specific support that are required.

Many diagnostic manuals and local authorities do not currently recognise PDA as a separate diagnosis, or as a sub group within the autism spectrum. However some diagnostic teams do use the term as a profile they recognise within the autism spectrum and the specific recognition of it can be helpful when signposting to other professionals for support.

Whether or not your diagnostic team recognises PDA as a specific diagnosis, as part of an autism assessment you should be able to get a detailed profile of your child’s specific strengths and needs.

What to do if you think your child has PDA 

The first and best step is to pursue a diagnosis of autism. To begin this, speak to your GP. They will be able to tell you the appropriate pathway as the specific details can depend on your local authority. It will also be beneficial to speak to your school’s SENCo who can help to guide you in the right direction.

Getting a formal diagnosis for your child will help you to access the right support. With a detailed profile of your child’s strengths and needs you can ensure you get the right support to help them.

Since PDA is not recognised as a diagnosis on its own, it is even more important to ensure there is a clear description of your child’s strengths and needs so that the support and strategies put in place can meet your child’s requirements.

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