What is Pathological Demand Avoidance (PDA)?

There is emerging understanding of a developmental disorder called Pathological Demand Avoidance (PDA) which can lead to serious eating difficulties, together with many other social, educational and relational problems.

A key feature of PDA is overwhelming resistance to the ordinary demands and activities of daily life. Activities such as getting dressed, leaving the house and eating meals are met with complete opposition; regular parenting strategies will not help. The child is likely to seem controlling, dominant and impossible to persuade. In resistance to a demand, they may become suddenly aggressive or go into a form of lock down.

If the avoidance of food becomes a core feature of a child or young person’s PDA, the restriction can become severe and very harmful to physical and mental health. Restrictive symptoms towards food in PDA may appear to have some similarities with anorexia nervosa, but if pathological demand avoidance is the primary profile, it is very important for this to be identified and incorporated into care and treatment. Unlike anorexia, poor body image is not a precipitating or maintaining feature of PDA. 

Is PDA a type of autism?

PDA is now recognised as being a sub-type of Autistic Spectrum Disorder (ASD). However, there are some significant differences: a child or young person with PDA may seem to have social and communication skills which are within normal parameters. There may be little or no appearance of ‘autistic traits’ and as such, PDA may persist as a hidden disorder, with parents feeling they are failing and ineffective, while the child’s behaviour becomes increasingly entrenched and controlling.

In PDA, it is anxiety that drives the expression of inflexible, oppositional behaviour: unable to process and adapt to their environment, the individual expresses a rigid, overwhelming expression of control. Negotiation technqiues, using concepts of rewards and best interests, will be ineffective.

What works for people with PDA?

At Newbridge, we are experienced in working with young people who have a PDA profile and equally, in undertaking clarifications of the diagnosis for an individual. To test for a PDA profile, the same assessment will be undertaken as for ASD, evaluated by a multi-disciplinary team.

If a person has a PDA profile, it is important to recognise the relationship between the disorder and anxiety. For parents, this means reframing the perspective: they are not acting primarily in opposition to you, they are struggling to adapt to their environment and expressing this as a need for absolute control. Supporting a child to feel less anxious will enable them to gradually take a more flexible approach to situations.

For professional services (health and education), a person with PDA may not respond well to routine and rules but may be more accepting if relationships improve and their anxiety is reduced. Care, treatment and support needs to consider the PDA profile and how it frames a person’s experience of their world.