Pathological Demand Avoidance Syndrome


Warrior Mom since 2007
I stumbled upon this today and decided to look it up. It is something recognized in Europe that falls on the Autism spectrum. If you feel Asperger's or Pervasive Developmental Disorder (PDD)-not otherwise specified don't fit - you might look at this.

Features of PDA
1. Resisting demands obsessively
This is the over-riding criterion for diagnosis. People with PDA become experts at avoiding demands - they seem to feel an extraordinary amount of pressure from ordinary everyday expectations. It is often not the activity itself that is a pressure but the fact that another person is expecting them to do it. The person's threshold or tolerance can vary from day to day, or moment to moment. It is important to realise that the more anxious a person with PDA is, the less they will be able to tolerate demands. As a child, their avoidance of those making demands on them knows no boundaries and usually includes a level of social manipulation. Strategies range from simple refusal, distraction, giving excuses, delaying, arguing, suggesting alternatives and withdrawing into fantasy. They may also resist by becoming physically incapacitated (often accompanied by an explanation such as "my legs don't work" or "my hands are made of lava"). If pushed to comply, they may become verbally or physically aggressive, with severe behavioural outbursts, best described as a 'panic attack'.

2. Appearing sociable but with difficulties recognised by parents
People with PDA are often very sociable and can display degrees of empathy previously not thought to be consistent with autism. Sometimes it seems that they are able to understand other people at an intellectual level but not at an emotional one. However, despite their use of social niceties, their social interaction is very often flawed by their inability to see the bigger picture, their lack of boundaries and their desire to be in control of the situation. They often understand rules but don't feel they apply to themselves. As children, this can lead to playground peer group difficulties. One parent described how "to other children he will happily act as if he was their mother - 'have you washed your hands' or 'don't put your elbows on the table' - but he doesn't have a sense of needing to follow the same rules.

As adults, further education and employment difficulties may be apparent, but some adults with PDA enjoy success in both.

3. Excessive mood swings, often switching suddenly
People with PDA may switch from one state to another very quickly (e.g. from contented to aggressive), driven by the need to be in charge. This may be in response to perceived expectations. One parent described her 17-year-old son with PDA as "always imagining the worst case scenario" and this often being a trigger for outbursts.

4. Comfortable (sometimes to an extreme extent) in role playing and pretending
When they are younger, children with PDA often engage in a level of pretend play that would be unexpected from children with autism or Asperger syndrome. People with PDA are very good at taking on the roles and styles of others. The classic example is children who behave as if they were the teachers to other children. One mother described how her daughter would cope with a class of 30 or more imaginary children, commenting on them and talking to them; "She'll say, 'Oh, Callum's not here today, he's sick; Jason, you're not listening', then she will arrange pieces of paper for the class and move them from one room to another as a line of children." In extreme cases, children can become so engrossed in this role playing that they lose touch with reality.

5. Language delay, seemingly as a result of passivity
Although people with PDA may have some language delay at an early age, there is often a striking and sudden degree of catch-up. Certain elements of communication are not as disordered as in autism or Asperger syndrome, with more fluent use of eye contact (other than when avoiding demands) and better conversational timing. Some language difficulties remain, such as taking things literally and misunderstanding sarcasm and teasing. As an extreme form of avoidance, some children become selectively mute in many situations, yet their parents know they can speak when they want to.

6. Obsessive behaviour
The sort of avoidance that has been described is often linked to an obsession with a particular person (or less frequently, an object). Obsessions will vary from person to person but are often social in nature. Sometimes, obsessions with particular people can become problematic and overbearing for those who are on the receiving end.

Other related characteristics
Sensory sensitivities
Just as in autism and Asperger Syndrome, people with PDA can often experience over or under-sensitivity in any of their senses: sight, smell, taste, touch or hearing.

Other conditions and areas of overlap
PDA is often diagnosed alongside other conditions, such as ADHD, dyslexia, and dyspraxia. This may be a result of overlapping conditions but can also be due to confusion over the diagnosis. Before being diagnosed with PDA, some people will have already been diagnosed with autism, Autism Spectrum Disorders (ASD), Pervasive Developmental Disorder (PDD)-not otherwise specified or Atypical autism. PDA can also be present alongside more generalised learning difficulties and, at times, the apparent verbal fluency of people with PDA can mask genuine difficulties in understanding.

Severe behavioural difficulties
A large proportion of, but not all, people with PDA can have real problems controlling their temper. As children, this can take the form of prolonged tantrums and violent outbursts, as well as less dramatic avoidance strategies like distraction, giving excuses etc. It is essential to see these outbursts as extreme anxiety or 'panic attacks' and to treat them as such, with reassurance, calming strategies and de-escalation techniques.

Sometimes a child with PDA can appear very anxious at home but remain relatively passive at school (a learnt coping strategy). In situations like this, parents are likely to feel very isolated and inadequate. In other cases, outbursts are far worse at school, where demands may be much greater, and this can lead to multiple exclusions at an early age. For some children, this anxiety can develop to such an extent that they become school refusers.



Well-Known Member
Wow. My grandson has so many features of this. He's been diagnosed with ADHD, and yet that doesn't quite fit either. We've been through the Explosive Child books and they have been helpful, but the anger, violent meltdowns, constant irritability, social yet not, etc., excuse-making, blaming, lack of embarrassment of his public meltdowns (so lovely watching the neighbors reacting to this cute little boy calling you a F*****, freak, piece of s****, flipping the bird to us, kicking our cars, punching his fists on the windows, throwing things, kicking my husband in the groin, throwing punches at his mother. Truly lovely. And he's seven. And in between, he's so sweet, empathic, intelligent, and when the storm blows over, it's like it's never happened. Meanwhile, we are all shaking, on the verge of tears, and are in a state of constant worry. It's costing all of us relationships. I mean, who wants to sign up to deal with this day in and day out? He's aware that he does "bad things" to his friends at school so is mostly alone, and he says he's lonely. He's so strong now; what will it be like when he gets even stronger? He's always been somewhat like this, and he seemed better for awhile, but it's gotten so much worse lately. Sigh.

unc tarheel

New Member
@HMBgal my son is also 7, has been diagnosed with ADHD combined type, Sensory Integration Disorder (SID), and fits many of the characteristics seen.

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Well-Known Member
So now I know why my husband STILL hasn't finished my bathroom after7 years, forcing me to shower in the basement and go down 2 flights of stairs to pee in the middle of the night. Here I thought he was just lazy. Seriously, I don't mean to make light of this but my husband deliberately ignores every request I make and has trained my sons to do the same. I wish there was a cure for my situation. Wait, there is, it's called divorce.