From the Guidelines
Pathological Demand Avoidance (PDA) is a distinct profile within the autism spectrum, characterized by an anxiety-driven need to avoid everyday demands, and requires tailored support approaches to reduce anxiety and increase cooperation. PDA is marked by an intense need to resist or avoid demands and expectations from others, often due to extreme anxiety, and individuals with PDA may develop sophisticated strategies to avoid these demands, including distraction, making excuses, withdrawing, or becoming oppositional 1. Unlike typical autism presentations, individuals with PDA often have better social communication skills, which they can use to avoid demands, and may appear socially comfortable but struggle with rapid mood changes, obsessive behavior focused on people rather than objects, and sensory differences 1. The heterogeneity of autism spectrum disorder (ASD) is well-documented, with various genetic risk factors and phenotypic variations, including PDA, which can inform prognosis and treatment targets 1.
Key characteristics of PDA include:
- Anxiety-driven need to avoid everyday demands
- Sophisticated strategies to avoid demands, such as distraction or making excuses
- Better social communication skills compared to typical autism presentations
- Rapid mood changes, obsessive behavior, and sensory differences
- Requirement for tailored support approaches to reduce anxiety and increase cooperation
In terms of support approaches, reducing anxiety, using indirect language, offering choices, negotiating, and being flexible are crucial strategies to help individuals with PDA, rather than using rigid routines or direct demands 1. Understanding PDA as part of the autism spectrum can help families and professionals provide more effective support by adapting their communication style and expectations to reduce anxiety and increase cooperation.
From the Research
Definition of PDA in Relation to Autism
- Pathological Demand Avoidance (PDA) is a term used to describe a profile of obsessive resistance to everyday demands and requests, with a tendency to resort to 'socially manipulative' behaviour, including outrageous or embarrassing acts 2.
- PDA is thought to share aspects of social impairment with autism spectrum disorders, but autism spectrum disorder-appropriate strategies, such as routine and repetition, are described as unhelpful 2.
Comparison of PDA to Autism Spectrum Disorders
- The PDA group displayed comparable levels of autistic traits and peer problems to the autism spectrum disorders group, and anti-social traits approaching those seen in the conduct problems and callous-unemotional traits group 2.
- Emotional symptoms in PDA exceeded both comparison groups, highlighting the extreme behavioural impairment associated with PDA 2.
Interventions for Autism Spectrum Disorders
- Various interventions, such as Applied Behavior Analysis (ABA), Comprehensive Early Intervention, and parent-mediated intervention, have been found to be effective in improving symptoms of autism spectrum disorder 3, 4, 5, 6.
- However, there is limited research on the effectiveness of these interventions specifically for individuals with PDA, and more studies are needed to explore the best approaches for supporting individuals with PDA 2.