Pathological Demand Avoidance

What is PDA?

Relationship to autism and other neurodivergences

Demand avoidance is most often conceived as a characteristic experienced by and/or observed in autistic people. It has been characterised as the key characteristic of a proposed condition or profile of autism called Pathological Demand Avoidance (PDA), although this is a controversial label that is not recognised clinically (meaning it is not included in medical manuals) and is contested within the autism community.

Although advocates of PDA most often think of it as a potential profile of autism, some have suggested PDA may be a distinct neurotype or neurological difference, not connected to autism or the conditions listed below.

Besides autism, it has been suggested that the presentation of a persistent and marked resistance to demands may be connected with other conditions, including:

  • complex post-traumatic stress disorder (cPTSD)
  • attention-deficit/hyperactivity disorder (ADHD)
  • oppositional defiant disorder (ODD).

Context about demand avoidance and our understanding of autism

It is important to note that when demand avoidance was first described, some of the behaviours observed were considered uncommon in autistic people. However, as our understanding of autism as a spectrum condition has developed, a number of these behaviours are now understood to be more common.

For example, when demand avoidance was first described, it was thought that autistic people were largely not capable of employing some of the creative and socially sophisticated strategies listed above as ‘Forms of resistance’. Our current understanding of the autism spectrum acknowledges that many autistic people are indeed capable of these things.

This context is important when trying to understand the history of and debate around the label Pathological Demand Avoidance (PDA), which was proposed as a way to describe people experiencing demand avoidance alongside a group of behaviours that were then thought to be uncommon in autistic people (and therefore necessitated a new label, it was argued).

(Extract from National Autistic Society Website)

What support might look like

It is important that people experiencing persistent and marked demand avoidance are recognised and supported using strategies and approaches personalised to their specific strengths and needs.

Research suggests that the understanding and acceptance of demand avoidant behaviour is fundamental to accessing the right support.

There is limited research on support strategies; however, general advice from personal accounts and professional resources includes:

  • reducing and/or removing demands, where at all possible
  • a collaborative approach that flattens hierarchies (for example, between parent and child or manager and employee) to work with them rather than ordering them around
  • indirect communication styles (not making demands directly)
  • avoid potential stressors such as eye contact, touch and confrontational postures/physical stances
  • remove any spectators to a distressing situation (by asking people to give the distressed person space or by moving the person to a quiet space if possible)
  • a coordinated approach to support, with the person, family and professionals (i.e., from education, social care, healthcare, etc) involved.

Sources suggests people experiencing demand avoidance may benefit from:

  • identifying and understanding their demand avoidance (and its triggers)
  • managing, reducing and disguising demands
  • sensory regulation and creating a sensory environment that works for them
  • therapy, counselling, mindfulness and meditation

(Information taken from National Autistic Society Demand avoidance)

Resources

All of the above information was taken from this website, very helpful and examples of lived experience and what worked too.

https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance

 

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