Pathological demand avoidance is a proposed disorder and sub-type of autism spectrum disorder, defined by characteristics such as a greater refusal to follow the requests of others.
All kids avoid doing things they're asked to do from time to time. But some go to extremes to avoid or resist anything they perceive as a demand. Avoidance can take many forms, including making excuses, creating a distraction, intense focus on something else, withdrawing, escaping, or having a meltdown or panic attack.
Pathological (“extreme”) demand avoidance (PDA) involves obsessively avoiding routine demands and extreme emotional variability. It is clinically linked to autism spectrum disorder (ASD).
Demand avoidance is a natural human trait – avoiding demands is something we all do to different degrees and for different reasons. It involves not being able to do certain things at certain times, either for yourself or for others, and also refers to the things we do in order to avoid demands.
meltdowns – an 'out of control' state which may include shouting, crying, throwing or breaking things. physical or verbal aggression directed towards others. self-injurious behaviours. shutdowns – individuals may hide or curl up in a ball, withdraw to a space that feels safe or stop communicating/moving.
PDA (Pathological Demand Avoidance) is widely understood to be a profile on the autism spectrum, involving the avoidance of everyday demands and the use of 'social' strategies as part of this avoidance. PDA individuals share autistic characteristics and also have many of the 'key features' of a PDA profile.
Young people with PDA are more likely to: resist demands obsessively (100%) be socially manipulative (100% by age of 5)
The underlying cause of demand avoidance in autistic children is said to be a high level of anxiety, usually from expectations of demands being placed on children, which can lead to a feeling of not being in control of a situation.
Using declarative language (statements, comments or observations), or rephrasing things to talk about an object rather than a person, and even simple things like starting rather than ending requests with the word 'please' can all make a big difference.
Some research suggests that PDA can be explained by interaction of various common co-occuring conditions, and the majority of these conditions are associated to childhood trauma/ aversive experiences.
Pathological Demand Avoidance is usually associated with autism, but it can also affect people with ADHD. Pathological Demand Avoidance (PDA) is a profile associated with autism and ADHD. If you have PDA, you may find it challenging to carry out demands, even if you want to.
There is no cure for PDA. Treatment interventions can be difficult for individuals with PDA as the nature of the disorder means that the individual is obsessively concerned with avoiding any demands placed upon them, including treatment methods.
Treatment Options For Pathological Demand Avoidance
Areas of need include sensory support, help with identifying emotions or managing anxiety, or support with speech and communication.
Children with PDA often:
engage in a level of pretend play not commonly seen in typical autism. However they may dominate play, so causing hostility with friends. have an ability to mimic and take on the roles of others. This is often used as a means of taking control or avoiding demands.
One of the main traits of PDA is described as an anxiety-based need to avoid demands. There is some research to suggest that underneath the anxiety is an 'intolerance of uncertainty' and a need for control. Whatever the mechanism, the fact that anxiety and demand avoidance tend to go hand in hand isn't in doubt.
Pathological Demand Avoidance can be provisionally diagnosedin the preschool years, however, it is more difficult to diagnose than Autism as the child normally shows more social interest, increased imaginative play and more age appropriate language than that of Autistic children.
It seems likely that genetic factors are similar to those in autism, but refer to inheritance of an autism spectrum condition rather than PDA specifically. Thus perhaps six per cent of children with PDA are known to have a sibling with either PDA or autism.
PDA demand avoidance isn't a choice and is lifelong – it's seen in infants and remains part of the experience into old age. With understanding, helpful approaches from others and finding self-coping and coping strategies, it can become more manageable.
Avoidant personality disorder is part of a group of personality disorders that can have a negative effect on your life. If you have avoidant personality disorder, you may be extremely shy, unlikely to speak up in a group, have trouble in school or relationships, have low self-esteem, and be very sensitive to criticism.
Children who develop an 'avoidant' attachment pattern are thought to maintain proximity to their caregiver by 'down-regulating' their attachment behaviour: they appear to manage their own distress and do not strongly signal a need for comfort.
Narcissistic personality disorder is a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others.