Pathological Demand Avoidance (PDA) in Autism: history, controversy, treatment approaches, and practical tips for parents
Welcome to my fridge. No, i’m not allowed to move the dinosaur or the felt trivet he sits on. I’m pretty sure my son is planning some Jurassic Park-style event.
If you’ve come across the term pathological demand avoidance (PDA), you’re not alone — it’s a label that’s been doing a lot of quiet, steady traveling from clinics in the U.K. into conversations among clinicians, schools, and families in North America. For parents trying to make sense of baffling meltdown cycles, daily refusals, and behaviors that look like “defiance” but feel different, PDA can be a helpful way to understand what’s going on. Below I’ll explain what PDA typically looks like, where the idea came from, how treatment approaches (including adaptations of ABA) differ for PDA, and straightforward, practical strategies parents can use at home and at school.
What is PDA?
PDA describes a behavioral profile often seen within the autism spectrum characterized by an extreme, persistent drive to avoid everyday demands and expectations. That avoidance is usually not about deliberate opposition so much as intense anxiety triggered by perceived loss of autonomy or control. The surface behaviors — arguing, distracting, using negotiation or role-play, sudden shutdowns, or explosive meltdowns — can look similar to oppositional behavior, but the cause is often a high-arousal anxiety response to demands rather than a desire to be oppositional. PDA is therefore usually framed as a profile or presentation within autism rather than a separate diagnostic category.
A short history: from the U.K. to the wider world
The term was first used by British developmental psychologist Professor Elizabeth Newson in work done from the 1980s and more formally described in publications in the 1990s–2000s. Newson noticed a group of children who shared autistic characteristics but who were especially resistant to ordinary daily demands — an “obsessional avoidance of the ordinary demands of everyday life.” Over time the concept became more widely discussed and investigated in the U.K., where clinicians, charities, and schools developed practice guidance and support resources focused on the PDA profile.
In the U.K., PDA has gradually gained more formal attention: national charities, specialist clinicians, and the PDA Society have produced practice guidance and assessment resources designed to help multidisciplinary teams. That doesn’t mean universal consensus — the label remains debated among professionals — but the U.K. has been the epicenter of most research, guidance, and clinical tools for PDA.
Recognition in the U.S. and Canada has been slower but is growing: parent-led and clinician networks (for example PDA North America) and professional articles/resources are increasingly raising awareness, translating U.K. practice into local contexts, and prompting clinicians to think about PDA-informed strategies instead of defaulting to disciplinary or standard “behavioral” responses. Still, PDA is not a separate diagnosis in major diagnostic manuals (DSM-5 / ICD) and many clinicians treat PDA as a profile or presentation within autism rather than a formal subtype.
Why PDA is controversial (and why the label can still help)
Two things drive the controversy. First, PDA is not formally listed in DSM-5 or ICD-10/11 as a standalone diagnosis, which makes international clinical acceptance uneven. Second, some professionals worry that labeling a child PDA could lead to misattributing other causes (e.g., trauma, anxiety disorders, unmet sensory needs, or classic behavioral explanations). That said, many families and clinicians find the PDA frame useful because it centers anxiety and the need for autonomy — which changes how you respond. NICE and clinical reviews have considered queries about PDA and how to reflect it within guidelines, illustrating that it’s a live clinical question.
How therapies approach PDA — where ABA fits (and how it’s often adapted)
Traditional, reward-and-consequence models of behavior can backfire with PDA. Because demand avoidance is often anxiety-driven, direct demands, bribes, punishments, or firm “do this” structures may escalate resistance or shutdowns.
That said, modern, compassionate, and person-centered applications of principles from Applied Behavior Analysis (ABA) can be useful if they’re adapted for PDA: approaches that prioritize relationship, choice, motivation, and reducing perceived demands — rather than coercion — are far more effective. Clinicians who work with PDA often blend strategies from several frameworks:
Low-arousal / anxiety-reducing approaches: reduce sensory load, tone down adult anxiety/frustration, and create predictable calm routines so demands don’t trigger high arousal. (U.K. practitioners have emphasized low-arousal approaches in PDA practice guidance.)
Collaborative and indirect demand strategies: requests framed as choices, using humor, removing or softening the overt “demand” quality (e.g., “Shall we try the socks now or in five minutes?” or embedding tasks in play, or using indirect language).
Motivation-based or interest-led work: building skills through the person’s interests so participation feels self-directed. Some ABA-informed clinicians emphasize functional assessment and skill building, but adapt techniques to avoid controlling or pressuring the child.
Psychological therapies for anxiety/rigidity: when appropriate, CBT adapted for autism, acceptance and commitment strategies, or coaching around emotion-regulation can support older children and teens.
In short: ABA principles (functional assessment, skill teaching, environmental modification) can be helpful — but the style matters. With PDA, heavy-handed, demand-focused behavior plans usually worsen the problem. PDA practice guidance emphasizes collaborative, low-demand, and anxiety-aware methods.
Practical tips for parents and caregivers
Here are concrete strategies that families often find useful. Pick what feels doable for your family — consistency helps, but so does flexibility.
Reduce the “demand” tone. Make requests indirect or embed them in choices: “Do you want breakfast before or after the cartoon?” rather than “Eat your cereal now.” Use gentle, low-key language and don’t pile demands together.
Offer real choices and control. Avoid yes/no forced choices that still feel like pressure. Let the child pick sequence, timing, or method (within safe boundaries). The goal is to restore autonomy.
Lower arousal in the environment and your own delivery. Use a calm voice, reduce sensory triggers, and plan for breaks. If you feel frustrated, step out for a minute if safe — emotional contagion escalates arousal.
Use novelty, role-play, or humor as tools. Some children with PDA respond well when tasks are framed as games, silly scenarios, or role-play roles (e.g., “You’re the boss of shoes today — show me how the shoes should behave”).
Teach skills through the child’s interests. Build routines and independence slowly, using topics the child loves so learning feels self-directed. Break tasks into tiny, negotiable steps.
Plan for transitions and have scripts. Predictable, gentle warnings (not abrupt demands) and clear scaffolding help. Visual timers used carefully can be helpful for some children, but avoid using them as authoritarian countdowns.
Look for anxiety, sensory needs, or masking. Sometimes what looks like avoidance is unaddressed sensory distress, panic, or exhaustion. A multidisciplinary assessment (occupational therapy, psychology, speech) can identify contributing factors.
Find peer and professional support. Parent networks, PDA-specialist clinicians, and regional resources (e.g., PDA societies or PDA-informed practitioners) can offer practical, day-to-day tips and reassurance. In the U.S. and Canada, PDA-focused groups have been forming to translate U.K. practice for local systems.
PDA is not a tidy label, and it will likely remain debated as research and clinical practice evolve. But for many families, thinking in terms of PDA — where anxiety and need for autonomy drive demand-avoidant behavior — changes the whole interaction: it shifts the strategy from confrontation and consequence to curiosity, regulation, and collaboration. If you think your child might fit a PDA profile, seek assessment from clinicians who will listen to the story behind the behaviors, consider anxiety and sensory contributors, and work with you on low-demand, relationship-centered strategies — not just strict behavior modification.
References
Attwood, T., & Garnett, M. (n.d.). PDA: Current understanding and future research directions. Attwood & Garnett Events. Retrieved from https://www.attwoodandgarnettevents.com/blogs/news/pda-current-understanding-and-future-research-directions
Child Mind Institute. (n.d.). Pathological demand avoidance in kids. Child Mind Institute. Retrieved from https://childmind.org/article/pathological-demand-avoidance-in-kids/
Fidler, R., Christie, P., & PDA Society. (2021). Identifying and assessing a PDA profile: Practice guidance (v1.1). PDA Society. Retrieved from https://www.pdasociety.org.uk/wp-content/uploads/2025/05/Identifying-Assessing-a-PDA-profile-Practice-Guidance-v1.1-1.pdf
National Autistic Society. (n.d.). Demand avoidance. The National Autistic Society. Retrieved from https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance
PDA North America. (2023). PDA for teaching professionals: Guidelines for good practice. PDA North America. Retrieved from https://pdanorthamerica.org/wp-content/uploads/2023/08/PDA-for-Teaching-Professionals-1.pdf
PDA North America. (n.d.). Other resources. PDA North America. Retrieved from https://pdanorthamerica.org/other-resources/
PDA Society. (n.d.). What helps? guides. PDA Society. Retrieved from https://www.pdasociety.org.uk/what-helps-guides/
Sherwin, J. (2015). Pathological demand avoidance syndrome: My daughter is not naughty. London: Jessica Kingsley Publishers.
Thompson, H. (2019). The PDA paradox: The highs and lows of my life on a little-known part of the autism spectrum. London: Jessica Kingsley Publishers.