PDA, short for Pathological Demand Avoidance (or Pervasive Drive for Autonomy), is a concept predominantly acknowledged in the UK and not yet formally classified in the US. As a subtype of autism, it exhibits distinct characteristics characterized by a strong inclination to resist and avoid demands, even if the individual desires to fulfill them. The primary function of demand avoidance in PDA is to safeguard a person's autonomy. Let's explore the six core characteristics often associated with PDA:
<aside> <img src="/icons/report_red.svg" alt="/icons/report_red.svg" width="40px" /> PDA, Misdiagnosis, and Misunderstandings
Unfortunately, people with PDA often face misunderstanding and misdiagnosis. PDA can mask or influence the presentation of Autistic traits, leading to confusion and difficulty in identifying autism. Additionally, PDA can often go unrecognized and is frequently misdiagnosed with behavioral disorders (such as ODD and conduct disorder), leading to a blame game that puts the burden on the individual and their parents for their explosive meltdowns and responses to autonomy threats.
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<aside> <img src="/icons/science_blue.svg" alt="/icons/science_blue.svg" width="40px" /> The Core Characteristics of PDA
The following core characteristics commonly observed in PDA make it more difficult to observe autism:
The most widely discussed characteristic of PDA is demand avoidance, which means that individuals with PDA resist and avoid the ordinary demands of life to an extreme extent, including things they enjoy. However, there are other traits that cluster with the PDA profile, which can lead to confusion for parents and healthcare professionals.
The loss of autonomy is perceived as a threat that activates the fight-flight or freeze response. This results in increased anxiety, sometimes to the point of panic, particularly when they feel they are not in control or feel exposed in some way. If the child responds with a fight or flight response, this can lead to emotional outbursts that may cause a child to be wrongly diagnosed with Oppositional Defiant Disorder (ODD) or other behavioral disorders.
Another characteristic that can make PDA challenging to identify is the use of social strategies as part of avoidance. PDAers may be very good at 'masking' difficulties with certain people or in certain situations and may present differently in different settings depending on their anxiety levels.
For instance, they may employ various tactics such as distracting, excuse-making, outright refusal, or engaging in role-playing to avoid demands. At other times, their bodies may become immobilized in the face of the demand, and they will state, “my legs don't work” (note their bodies may truly be immobilized in these moments).
Another characteristic is that PDAers appear sociable on the surface, and difficulties in social communication and understanding may be less obvious than in typical autism presentations. They may have good verbal fluency, which can disguise difficulties in understanding and processing allistic communication. Additionally, they are likely to struggle to understand or perceive social hierarchy and may want to be co-teachers, and co-parents and have the same social role as authority figures.
Individuals with PDA experience excessive mood swings and impulsivity and have extreme emotional reactions. Some individuals become quiet/withdrawn, while others become externalizers and display obvious emotional reactions. Their flight, fight, freeze, or fawn responses are outward representations of the brain and body's instinctual response to physiological stress.
PDAers often exhibit 'obsessive' behavior that is often focused on other people, and they may have developed passionate interests and be able to be hyper-focused. This 'obsessive' behavior is often social in nature and may show up as extreme love or hate.
Obsessive behavior may also present as obsessive behavior with 'social' or 'performance-based' demands due to acute anxiety and/or because a demand conflicts with an intense need to be seen as independent and undependable.
They appear comfortable in role play and pretend, and their play can be quite imaginative. When they involve others in their role-play, they are usually controlling the themes, roles, and dialogue.