Pathological Demand Avoidance (PDA)

Pathological Demand Avoidance (PDA) is a condition which is part of the autism spectrum, and is characterised by an overwhelming need to avoid or resist demands.

Key characteristics of PDA

Along with other characteristics seen on the autism spectrum, a person with PDA may show the following features:

• An obsessive resistance to ordinary demands and requests

• Use of socially manipulative or outrageous behaviour to avoid demands

• Sudden changes in mood apparently associated with a need to control

• ‘Surface’ sociability, reflected in social peculiarity, difficulties with peers and lack of social constraint

• Comfortable in role play and pretending.

Like many other people on the autism spectrum, people with PDA experience high anxiety levels and can feel that they are not in control. This leads people with PDA to avoid and refuse any requests that are made too assertively. Sometimes this is due to how the person with PDA interprets the question or instruction. This can lead them to avoid tasks and activities that they would otherwise enjoy, which can be upsetting for the person with PDA.

 Some suggestions for adapting communication to better support people with PDA.

Allow the option of saying no

A person with PDA needs to feel they have some control. Using non-negotiable words gives the impression that you have made a decision for them and taken away their control. Avoid using ‘demand’ words such as:

• Need

• Must/Must not

• Will/Won’t

• Can’t

• Now

• By (a time/date)

Instead, make requests instead of demands. Try opening requests with phrases such as:

• Is it OK with you if…

• How do you feel about…

• Do you mind (doing/going etc.)…

• Would/could you…

• If you’re happy to…

• When you have finished with…, could you then…

Allow initiative

Some people with PDA enjoy making others happy or surprising them by doing things  that they know they would like. However, if we ask or remind them to do these things, we  take away their ability to demonstrate kindness and consideration for others. This can be  very upsetting, particularly for people who experience social difficulties. This can mean  they are unable to complete the task.  If there is a way to give a hint or a vague outline instead of detailed instructions, then try this first. Try to avoid showing there is an expectation. Share the responsibility As well as pleasing others, feeling part of a team is important. If there are several aspects to a task, working together or sharing the responsibility can help to make the person feel useful and needed. Try using words like:

• Us

• We

• Let’s

• Together

If you know that a task is particularly difficult for the individual with PDA, make sure that

you show your appreciation and say thank you, as it may help to motivate them next time  they need to do the task.

Acknowledge the aspects that they can control

Some people with PDA do not enjoy receiving praise or compliments, and yet crave positive attention and recognition when they have done something well. This may be because they prefer to be praised for things they have chosen to do, rather than something they can’t control.

Instead of commenting on a natural talent or feature, try finding something that they  have control over. You should also try to share these comments as your own opinion on the situation, instead of stating it as fact, which the person with PDA may see as untrue or even dishonest.

Create choice

There are times when things do need to be done. In these situations, think about what the person with PDA can control, and introduce that. The activity itself is usually not an issue.

However, if they feel they are being given no choice, they can be driven to say no.

Instead of telling the person what will happen, try and imply it instead.

Show reasoning

While direct, simple instructions are usually recommended for people on the autism spectrum, this lack of explanation can make people with PDA feel as though irrational demands are being made. Explaining both positive and negative consequences will give accountability and control of a situation. Where possible, use positive reinforcement rather than criticising the person or focusing on the negative.

Pick your battles

Decide on whether you need something or want it. Respect that everyone has different ideas of what is important. If something is important, decide on whether this is because it is practical or emotional. If it is emotional, be prepared that this may not be seen as a good enough reason for the person with PDA to change their actions. Explain that there will be occasions when you have to make a demand, but also that you will try not to make demands when you don’t need to. This will be useful when there is urgency or a definite outcome needed. In these situations, demands should have more impact as the person will know that you would not demand anything that wasn’t extremely important. Be sure to explain why the demand is being made and why it is necessary.