Pathological Demand Avoidance

Although not recognised in the international classification systems (ICD and DSM), this label — also called Extreme Demand Avoidance — has been adopted by some clinicians and families in the UK and mainland Europe.

PDA has been used mainly to describe children who present with a behaviour profile characterised by:

• Avoidance of compliance with everyday demands, using a variety of social strategies (excuses, distraction, negotiation)
• Anxiety when demands cannot be avoided
• Attempts to control situations
• Impulsivity and sudden, extreme changes of mood

There is debate as to whether this behavioural profile is a variant of autism, whether it might be seen in other conditions, or whether it is a condition in its own right (Green et al., 2018).

Newson (1989) noted PDA can be considered part of the spectrum because of the social interaction and communication impairments; the presence of repetitive behaviours, obsessive interests, and lability of mood. Some crucial differences were identified: the obsession to avoid everyday demands; a high level of social insight ('surface sociability'); and a need for control (Newson, 1996).

Individuals identifying with PDA, and their families, are likely to be under unusual levels of stress. A detailed assessment and formulation is needed, aiming to help manage the presenting behaviour and varied underlying factors such as severe anxiety and sensory sensitivities.