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  • Dr. Brandy Ross

PDA: Pathological Demand Avoidance aka Pervasive Drive for Autonomy

You know how you first discover something and then you start to see it everywhere you go? Well, that has been PDA for me. Pathological Demand Avoidance (PDA), or a better term Pervasive Drive for Autonomy, is an anxiety-driven need for autonomy. It is generally considered a subset of autism although the presentation of autism for these kids looks different.

Key features of Pathological Demand Avoidance (PDA). Uses social strategies as part of the avoidance, appears sociable on the surface, but lacking in depth and understanding, experiences excessive mood swings and impulsivity, resists and avoids the ordinary demands of life, sometimes appears comfortable in role play and pretend (sometimes to an extreme exent), "obsessive" behavior often focused on other people. Designed by Sunshine Support.
Key features of Pathological Demand Avoidance (PDA)

I first encountered a child with PDA in my practice. I've known this child since birth and suddenly, she was refusing to come into my office. Her parent explained to me over zoom (because...refusal and need for autonomy) that she thought her daughter had PDA. I started looking into it, reading articles, books, webinars, etc. and discovered that at least two of my other patients likely have PDA as well. I also see a lot of neurodivergent kiddos in my practice so that tracks.

There is some misconception out there about PDA. Some people believe it is just Oppositional Defiant Disorder relabeled, some believe it is the same as Conduct Disorder, and some believe it doesn't even exist. Those that believe this don't have a solid grasp on the underlying reasons for the external behaviors.

PDA is characterized by an avoidance of everyday demands and an anxiety driven need to be in control. Their nervous system is in a constant state of "fight, flight, or freeze." Most of us don't recognize the demands placed on us every day. I'm not talking about the big demands of "my boss needs this report by tomorrow." I'm talking about demands within the mundane or activities we take for granted. Take, for example, sitting at the dinner table. The demands we don't see are: it's time to eat, must sit down, must use utensils, must have conversation with the others at the table, must eat this much or these things on my plate, must get the food to my mouth (especially problematic if there are fine motor skill issues), must not chew in a way that is offensive to others, don't burp, don't fart, etc., etc. Pile on top that most kids with autism also have sensory issues (smells, sounds, tastes, light sensitivity), that is a LOT for an over-taxed nervous system to handle!

There is much to be learned about PDA. It's been a diagnosis in the UK for quite some time but isn't recognized as a diagnosis in the USA so it's often referred to as a "profile." Behavioral approaches to a child with PDA is going to look a little different than a neurotypical child. There are a few experts on this topic and I encourage you to check them out. I'll list out resources below:

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