Pathological Demand Avoidance (PDA): A Comprehensive Overview for Parents and Educators

Pathological Demand Avoidance (PDA) is a term used to describe a profile of behavior characterized by an extreme avoidance of everyday demands and an obsessive need to remain in control. Individuals with a PDA profile often appear anxious and will go to great lengths to evade even ordinary requests or expectations. This pattern of behavior is currently the subject of considerable debate – PDA is not formally recognized as a distinct diagnosis in standard medical manuals (it does not appear in the DSM-5 or ICD-11), and experts disagree on whether it represents a unique condition or a variation within the autism spectrum. Despite the controversy, many families and professionals find the PDA concept useful for understanding certain children (and adults) whose extreme demand-avoidant behavior cannot be easily explained by typical autism or other diagnoses. This article provides a comprehensive overview of PDA, including its characteristics, relationship to autism, challenges in daily life and education, interventions and support strategies, and the ongoing debates surrounding it, with a focus on information from recent scientific research (primarily from the last five years). The target audience is parents and special education teachers seeking an in-depth, yet accessible, understanding of PDA.

Defining PDA and Key Characteristics

PDA was first described in the 1980s by British psychologist Elizabeth Newson, who noticed a group of children in her autism clinic who did not fit the usual profiles of autism. These children shared a persistent and marked resistance to demands unlike anything seen in typical developmental conditions. Newson believed this pattern warranted a distinct label (rather than lumping the children into broad categories like “atypical autism” or PDD-NOS) and published the first paper on PDA in 2003.

What does PDA look like? Newson and subsequent researchers have identified a range of hallmark behaviors that characterize the PDA profile. These include:

• Resisting and avoiding everyday demands – a chronic avoidance of ordinary requests or expectations, from simple instructions to daily routines.
• Using social strategies to evade demands – for example, distracting the person making the demand, giving excuses (even fantastical ones), negotiating, or pretending not to understand, all in service of avoiding compliance.
• Superficially sociable behavior – the individual may appear socially fluent or sociable, often using charm or humor, yet they show differences in social understanding (e.g. not recognizing authority or hierarchy, and difficulty following social rules).
• Intense mood swings and impulsivity – sudden changes in mood, often driven by the need for control or frustration with demands, leading to impulsive reactions.
• Comfort in role-play and pretence – an ease with imagination and role-playing, sometimes to the point of blurring reality and pretend as a means to avoid real-life demands (for example, adopting the role of an animal or another persona to escape expectations).
• Obsessive interests, often focused on people – having very strong interests or obsessions, frequently centering on particular individuals (peers, teachers, fictional characters, etc.), which can also serve as an avoidance tactic (e.g. obsessing over a person instead of doing schoolwork).

Not every individual with a PDA profile will show all of these traits, but extreme demand avoidance (and the anxiety that drives it) is the core feature present in all cases. Clinicians who see PDA-like behaviors often describe the child as “controlling” or “Jekyll and Hyde” in their moods – switching from calm to extremely resistant or panic-stricken when a demand arises. If avoidance strategies fail, the person may have a meltdown or panic attack, suggesting that their refusal is rooted in panic and overwhelm rather than simple disobedience.

Origins and Diagnostic Recognition

Historical background: As mentioned, PDA originated from Newson’s work in the UK. Newson observed that these demand-avoidant children had often been labeled as “atypical autism,” yet they differed from other autistic children in important ways (for instance, they were more socially engaging on the surface, and some had imaginative play skills not usually associated with classic autism). The central feature, however, was their obsessive avoidance of demands to alleviate anxiety, using what Newson called “social manipulation” as a key strategy. Newson argued that if these children were managed as if they were typical autistic cases, “the wrong advice will be given,” because the approaches that help most autistic children (like highly structured routines or strict behavioral programs) often backfired with PDA. She advocated for different strategies (for example, using novelty, humor, and flexibility instead of demands and compliance-based methods) for this group.

Current diagnostic status: Importantly, PDA is not an officially recognized diagnosis in any international classification system. It does not appear as a condition in the DSM-5 or ICD-11, which means clinicians cannot formally diagnose « Pathological Demand Avoidance » as an independent disorder. In practice, what this means is that a child showing PDA traits will typically receive another diagnosis (often Autism Spectrum Disorder, sometimes with co-occurring conditions like anxiety or ODD), with some clinicians adding a descriptive note such as “autism with a demand avoidant profile” to acknowledge the presentation. In the UK (where PDA has gained the most recognition), professionals and parents increasingly use the term PDA profile to describe these individuals within the autism spectrum. Some clinicians are willing to mention PDA traits in their reports, whereas others remain skeptical or unfamiliar with the term, reflecting the lack of consensus in the field. Individuals and families who identify with PDA sometimes use the label “PDAer” to describe themselves. It should be noted that one cannot currently get a standalone medical diagnosis of PDA – any mention of PDA is typically informal or adjunct to another diagnosis.

Because of the controversies around the label, there have been suggestions to change the terminology. Many in the community object to the word “pathological” (which can sound judgmental) in PDA. As an alternative, advocates have proposed names like “Pervasive Drive for Autonomy” or “Persistent Demand Avoidance” to emphasize that the person’s extreme need for autonomy is a driving force, rather than implying the person is simply being pathological. Others, however, feel that “pathological” does capture the all-consuming nature of the avoidance for them. For now, PDA remains the widely used term in literature, but you may see these other phrases in some sources.

Prevalence: Due to the lack of official recognition, estimating how common PDA is can be tricky. Early research suggested that the PDA profile was quite rare – for example, a 2015 study in the Faroe Islands estimated about 0.18% of children showed an extreme demand-avoidant profile. This would be a small minority even among autistic individuals. However, more recent perspectives indicate that demand-avoidant traits might not be exclusive to a tiny subset of autism. Some researchers (notably the team of child psychiatrist Christopher Gillberg) have argued that PDA behaviors may be more common than initially thought and can occur across a range of conditions, not just in autism. For instance, pronounced demand avoidance has been noted in individuals with ADHD, complex PTSD, or oppositional defiant disorder, and even in some cases of other disorders like language impairments or anorexia nervosa=. In 2024, Gillberg and colleagues went so far as to suggest that research should focus on demand avoidance as a cross-cutting trait – meaning it could be a feature (or “extreme” phenotype) present in various neurodevelopmental or psychiatric conditions. While there is not yet a consensus on prevalence, it’s clear that interest in PDA has grown internationally in the last five years, with more clinicians acknowledging that a subset of children (especially autistic children) exhibit this distinctive demand-avoidant profile.

Underlying Causes and Theories

What drives the demand avoidance? A key insight into PDA is that the extreme avoidance of demands is rooted in anxiety. In fact, PDA is often described as an anxiety-driven need for control. The child isn’t avoiding demands simply to be defiant; rather, complying with demands triggers intense panic or stress, so avoidance becomes a coping mechanism. Research and clinical reports describe PDA behavior as an attempt to reduce unbearable anxiety by controlling the environment and the people in it . In other words, when an individual with PDA refuses a request or insists on doing things on their own terms, they are often subconsciously trying to create a sense of safety and predictability in a world that feels threatening to them. PDA behaviors (like negotiating, running away, or having a meltdown) can thus be seen as self-protective responses rather than intentional misbehavior.

Recent studies support the central role of anxiety. For example, one mixed-methods study in 2023 examined adults with PDA traits and reinforced that anxiety and intolerance of uncertainty are significant factors in the development and maintenance of PDA behaviors. In children, similar findings have emerged: O’Nions et al. (2018) found that a need for control and “anxiety about the unknown” were major triggers for behavioral meltdowns in children identified with PDA, highlighting that fear of not being in control or not knowing what will happen next can set off extreme reactions. Clinicians often observe that PDA children have an acute sensitivity to even subtle expectations – simply knowing that something is scheduled or expected of them can induce stress. As a result, these children might even avoid activities they normally enjoy if those activities are presented as obligations or put on a schedule (the moment it becomes a “demand,” it provokes anxiety). A parent of a PDA child might notice, for instance, that telling their child “We will go to the park at 3 PM” could cause the child to vehemently resist going, even if the child loves the park – because the scheduled nature of the outing feels like a demand and thus a source of anxiety.

Beyond anxiety, researchers have proposed broader models to explain PDA. One influential idea is the transactional model of PDA. This model suggests that extreme demand avoidance arises from a dynamic interaction between the individual’s predispositions and their environment. Certain neurological or psychological vulnerabilities in the person make them more prone to feeling overwhelmed by demands. These vulnerability factors can include: high sensory sensitivities (e.g., being distressed by noise, touch, or other stimuli, which makes environments overwhelming), a low tolerance for uncertainty (feeling very anxious when things are not predictable or when outcomes are unclear), a strong need for sameness and routine, difficulty with emotion regulation, and even a reduced sensitivity to typical rewards or consequences. When a person with some of these vulnerabilities encounters a world full of demands – many of which involve uncertainty or unwanted change – they may learn that avoiding or controlling those demands is the only way to feel safe. Over time, this avoidance behavior can become entrenched: each time the individual successfully avoids a demand and thereby sidesteps anxiety, that behavior is reinforced (it’s like the relief they feel rewards the avoidance). This can create a feedback loop where demand avoidance becomes the default response to any expectation.

Another way to look at PDA (especially advocated by some autistic authors) is that it might not be a separate “disorder” at all, but rather an adaptive response by an individual with autism (or another condition) who is overwhelmed by their environment. From this perspective, demand avoidance could be a rational behavior: if certain demands consistently lead to distress, the person learns to avoid them as a form of self-preservation. This view ties into the debate about whether the term « pathological » is appropriate – is the person’s avoidance truly pathological, or could it be seen as a logical reaction to circumstances that cause them extreme anxiety? We will discuss these debates shortly, but it’s useful for parents and teachers to remember that PDA behaviors have underlying reasons. The child is not simply being difficult; they are responding to genuine feelings of threat or panic, even if those feelings seem out of proportion to us. Recognizing this root cause (anxiety/need for control) is crucial, because it informs a more compassionate and effective approach to supporting the child.

Impact on Daily Life and Education

Living or working with a young person who has a PDA profile can be extremely challenging. The demand avoidant behaviors pervade many aspects of daily life, often in ways that outsiders might not immediately understand. Parents of children with PDA often report that even routine activities can become battlegrounds. For example, a mother might prepare her child’s favorite meal, only for the child to meltdown and refuse to eat it because “it wasn’t what I asked for” or “you used the wrong color bowl”. The child wants the food, but as one parent explains, “they just can’t [eat it] because it’s a demand.” Similarly, a child might cheerfully announce a plan to play a game or go to the park, but if a parent or teacher says “Please do this now” or formalizes it as a task, the child feels they no longer can do it. Some PDA children come up with very creative excuses or imaginary scenarios to avoid demands – for instance, insisting “I can’t get dressed because I’m a dog, and dogs don’t wear clothes!”. These examples illustrate that their avoidance is deep-seated and reflexive: it’s not about the specific task (they may truly want to do it) but about the control and expectation attached to it.

When avoidance is not possible and demands are pressed, the outcome is often a fight-or-flight response. The overwhelming anxiety of a demand that cannot be escaped may lead to a panic-driven meltdown or explosive behavior. During these episodes, the child is not in control of their reactions – they might scream, hit, run away, destroy property, or hurt themselves. It is essentially an acute stress response (some compare it to a panic attack or a fight/flight surge) rather than a calculated tantrum. These meltdowns are distressing for both the child and those around them, and they reinforce to everyone involved just how intolerable demands feel to the person with PDA.

School environment: In educational settings, PDA can be particularly impactful. School, by its nature, is full of demands – from following a schedule, to completing assignments, to adhering to rules. Children with PDA often struggle with the structure of school. They may refuse to follow teacher instructions, avoid participating in activities (even ones they ostensibly like, if they feel pressured), or they might become the “class clown” or use distraction in an attempt to derail demands placed on them. In some cases, the anxiety about demands at school becomes so intense that the child develops school refusal or phobia. Recent research from Ireland, for instance, has documented high levels of school-related distress and chronic non-attendance in autistic students with a PDA profile, especially when appropriate supports are not in place. Parents of PDA children frequently report that their child is in a constant state of stress around school mornings, often leading to frequent lateness, psychosomatic illnesses, or complete inability to attend school for periods of time. This can be misinterpreted by schools as willful non-compliance or bad behavior, when in fact it is the child’s extreme anxiety driving their avoidance of the school environment.

Family life: At home, living with PDA means everyday parenting strategies might not work as expected. Typical reward-and-consequence systems, or firm enforcement of rules, often escalate conflicts rather than resolve them. Parents describe walking on eggshells, having to carefully choose their battles, and constantly finding creative ways to make necessary things (like taking a bath, doing homework, or going out the door) seem nonthreatening and optional. This can be exhausting and isolating for families. Research indicates that families of children with a PDA profile often feel high levels of stress, and they may struggle to find understanding or support from professionals who are unfamiliar with PDA. The behavior of the child can also be misunderstood by extended family or the community – e.g. others might see the child as simply “spoiled” or the parents as failing to discipline, which adds to parents’ feelings of guilt or frustration. In reality, standard discipline often doesn’t work for PDA children, and alternative approaches are needed (as we discuss in the next section).

In summary, PDA can significantly impair a child’s ability to engage in normal daily activities and access education. It also affects siblings, peers, and parents. However, with the right understanding and accommodations, many PDA individuals can succeed in home and school life – but this requires adapting the environment and expectations to reduce anxiety, rather than expecting the child to simply suppress their avoidance. The next section will delve into strategies that have been found helpful in supporting individuals with PDA in practical settings.

Support Strategies and Interventions

Managing PDA requires rethinking traditional approaches to parenting, teaching, and therapy. Strategies that might work for other children (including autistic children without a PDA profile) often need to be modified or replaced with approaches tailored to the PDA mindset. The guiding principles of PDA support are to lower anxiety, reduce the feeling of being controlled or cornered, and to collaborate with the individual rather than confront them. Below are key strategies, backed by recent research and expert recommendations, for supporting children with PDA:

• Collaborative and child-led approach: Building trust is essential. Rather than a top-down “you must do this” style, adults should aim to work with the child as a team. In practice, this means involving the child in decision-making as much as possible – for example, letting them help set schedules or choose between options (“Which of these two tasks would you like to do first?”). Giving the child a sense of control and agency can preempt opposition. In a school context, teachers might negotiate goals with the student or incorporate the student’s special interests into assignments to make them feel more autonomous. Research emphasizes that when students feel respected and heard, their engagement increases, whereas feeling forced breeds resistance. A collaborative approach also extends to communication style: use friendly, non-authoritarian language and tone. Instead of “Do your work now,” a teacher might say, “I wonder if we should tackle this math problem together – maybe we can make it fun?” Such techniques signal to the PDA child that the adult is an ally, not an adversary.
• Avoid direct demands: Because direct instructions often trigger the reflexive “No!”, a core strategy is to disguise or soften demands. This can be done by offering choices (“Do you want to brush your teeth before or after putting on pajamas?”), turning tasks into games or imaginative play, or embedding demands within the child’s interests (for example, if a child loves dinosaurs, a parent might roar like a T-Rex who also needs to put toys away, making cleanup part of the pretend scenario). Indirect approaches include making statements that invite participation without ordering it (e.g. “These toys are sure messy… I’m thinking of a fun way to sort them by color!”), or using humor and novelty to defuse tension. The goal is to reduce the perception of a demand, thereby reducing anxiety. Studies and practitioner reports show that when teachers used more indirect requests and provided structured choices, children with PDA were more likely to cooperate and less likely to erupt, as opposed to when they were given blunt commands. It’s also helpful to give advance notice for transitions in a casual way (without making it a demand) and to avoid sudden imposition of tasks whenever possible. However, even with the best planning, it’s wise to have a flexible plan B in case the child still resists – flexibility is key.
• Adapt the environment: Many children with PDA are also autistic or have sensory sensitivities, so a supportive environment can make a big difference. Reducing sensory stressors (such as loud noises, glaring lights, or chaotic clutter) can lower baseline anxiety. A well-structured but low-pressure setting is ideal – for instance, a classroom with visual schedules and a quiet corner for breaks, or a home with predictable yet relaxed routines. Environmental adaptation might also mean minimizing unnecessary demands: pick your battles and allow autonomy where you can. If a child is particularly sensitive to feeling watched or controlled, giving them a bit of space and privacy to do tasks in their own way can help. For example, a teacher might let a student with PDA do an assignment in a quiet hallway or a designated « chill » spot rather than insisting they sit with everyone, if being in the group feels too demanding. By making the environment PDA-friendly – low arousal, safe, and respecting the child’s need for control – we create conditions where the child’s anxiety isn’t constantly in overdrive, which in turn can reduce the severity of demand-avoidant behavior.
• Focus on anxiety management and emotional regulation: Since anxiety is the driving force behind PDA, addressing that anxiety directly can yield improvements. Therapeutic interventions for PDA often borrow techniques from Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), adapted to be neurodiversity-affirming and accepting of the child’s need for control. For instance, modified CBT might involve teaching the child about feelings and anxiety through their special interests or using visual supports, and introducing very gentle exposure to tolerating small uncertainties (always with the child’s consent and collaboration). Adapted DBT strategies, which focus on coping skills for big emotions, have also shown promise – therapists may use games, storytelling, or visual aids to teach PDA individuals how to self-calm during moments of overwhelm. Additionally, play-based therapies (including elements of drama or art therapy) can be effective because they allow the child to explore fears and practice control in a non-directive way. The common thread in these interventions is that they aim to reduce the overall anxiety level of the child and help them find alternative ways to feel in control (such as self-regulation techniques or gradual trust in supportive adults), thereby hopefully reducing the need for pathological avoidance. It’s worth noting that some clinicians have also experimented with medication (for example, using anti-anxiety or antidepressant medications) in severe cases – one small study (2024, under review) reported that an SSRI medication, fluoxetine, helped reduce anxiety and PDA behaviors in a group of adolescents. However, medication for PDA is not a clear-cut solution and is usually considered only as part of a broader, individualized treatment plan focusing on therapy and environmental accommodations.
• Support and educate families (and staff): Helping a child with PDA is a team effort. Parents often benefit from specialist coaching or training to learn PDA-specific strategies. This might involve sessions with a therapist or attending workshops (in person or online) about demand avoidance. Learning techniques like those described above (collaborative approaches, indirect demands, etc.) and being able to troubleshoot challenging situations can significantly reduce family stress. At the same time, it’s critical to support the well-being of caregivers. Studies note that parents of PDA children can experience high levels of anxiety, depression, and burnout if they don’t get support for themselves. Thus, part of intervention is ensuring parents have respite, support groups, or counseling as needed. In schools, staff training is equally important – teachers and aides should understand what PDA is (and what it isn’t) so they can approach the student with empathy and effective strategies, rather than using discipline methods that might escalate the situation. Consistency and communication between home and school are key: a child with PDA will cope best when everyone is on the same page, using similar approaches and sharing what works or doesn’t work for that individual. This might mean regular team meetings that include parents, teachers, and any therapists or psychologists involved (when possible) to fine-tune support plans. Overall, the mantra is “connect, don’t confront.” By building a trusting relationship and reducing pressures, adults can create an environment in which the child feels safe enough to learn and engage, gradually expanding their tolerance for everyday demands.

Implementing the above strategies doesn’t necessarily make PDA behaviors disappear overnight – progress is often gradual. But many families and educators report that with these low-demand, collaborative techniques, they see fewer explosive episodes and improved participation in daily activities. For example, a teacher might note that a student with PDA who used to spend most of the day in refusal now, in a more flexible classroom setting, is able to complete some work and build positive relationships. Parents often find that once they stop battling over every demand and start giving the child more control in acceptable ways, family life becomes calmer and the child’s anxiety decreases. It’s about meeting the child where they are. Success in PDA support is measured not by making the child comply with all demands, but by helping them feel secure enough that they can meet important demands (like attending school, basic self-care, etc.) in their own way, and by preserving the child’s emotional well-being and trust in others.

Debate and Controversies

Ever since PDA was first proposed, it has been surrounded by debate. Within the autism community and among professionals, there are stark disagreements about the nature and even the existence of PDA as a separate entity. Here we outline the main points of contention:

• Is PDA truly distinct from autism (or other conditions)? Critics of the PDA concept argue that there is not enough solid evidence to treat PDA as a separate diagnostic category. They point out that the behaviors described as PDA can often be explained by a combination of known factors. For example, an autistic child might avoid demands due to sensory overload, communication difficulties, or anxiety – all of which are already well-known issues in autism. From this perspective, PDA might simply be a profile of autism with more extreme avoidance, rather than a unique syndrome. Some researchers (e.g., Milton, 2013; Moore, 2020) have suggested that PDA lacks clear differentiation from autism and could even be seen as an expression of an autistic person asserting control in an overwhelming situation. The absence of a clear diagnostic boundary – and the fact that PDA isn’t recognized in manuals – supports their view that we should not rush to label it a new disorder. Additionally, skeptics note that pathologizing these behaviors might be misguided. They argue that calling it “pathological” demand avoidance implies the problem lies entirely in the individual, when in fact the behaviors may be a logical response to an environment or demands that are a poor fit for that person. In this vein, PDA behaviors could be reframed as a form of self-advocacy or self-protection by the individual, rather than a pathology to be “cured”. Moreover, some worry that the PDA label might lead parents or clinicians to selectively interpret a child’s actions as confirming PDA, a kind of confirmation bias or « looping effect » – for instance, once someone believes a child has PDA, they might overlook times when the child does comply and only focus on the avoidance, thus strengthening belief in the label without objective verification.
• If PDA is real, how should we categorize it? Among those who do believe PDA is a useful concept, there is still discussion on where it fits. One camp sees PDA as a profile on the autism spectrum – basically a subtype of ASD. This is the stance taken by the PDA Society and, to some extent, the UK’s National Autistic Society, which present PDA as a way some autistic people present, requiring different educational strategies. These proponents often emphasize that recognizing the PDA profile within autism can help autistic individuals who have been misunderstood or underserved. Another view is that PDA might be a separate (but often overlapping) condition – perhaps a comorbid condition that some autistic people have, but which could also occur in non-autistic individuals. The fact that some cases of extreme demand avoidance have been reported in people without autism (though perhaps with ADHD or other issues) is sometimes cited as evidence that PDA is not entirely subsumed under autism. A few have even theorized it could be its own neurodevelopmental disorder, but this remains highly speculative. On the flip side, the German review by Kamp-Becker et al. (2023) concluded that PDA is not a distinct disorder or an autism subtype, but rather a behavioral profile that can appear in various contexts – essentially advising that we focus on the behavior and its causes, rather than treating PDA as a separate disease. They caution that viewing PDA as an independent diagnosis might lead clinicians to overlook the bigger picture of a child’s condition (for example, focusing on PDA could mean not fully addressing the autism or trauma that underlie the avoidance).
• Usefulness vs. harm of the label: Beyond academic classification, there is a real-world debate about whether using the PDA label is helpful or harmful. Parents and some professionals often report that discovering the PDA profile concept was immensely helpful. It gave them an explanation for why standard autism strategies weren’t working and validation that their child wasn’t just « badly behaved » or their parenting wasn’t to blame. It also opened up a community of other PDA families and resources. These proponents argue that, semantics aside, recognizing PDA traits can lead to better support plans – for example, schools making accommodations once they understand the child’s avoidance is rooted in anxiety, not just oppositional defiance. Indeed, Newson’s original assertion was that identifying PDA is crucial because “if [PDA is] perceived as autism, the wrong advice will be given”, meaning a purely autism-standard approach (which might emphasize consistency, routine, and compliance) could backfire. Many who support the PDA concept feel this has borne out in practice and that acknowledging PDA has helped prevent inappropriate interventions for these kids. On the other hand, critics worry about over-labeling. Some autistic self-advocates feel that carving out PDA might inadvertently stigmatize those individuals further (as if they are even more “pathological” than typical autism) or might divert attention from the need to accommodate all autistic people’s anxiety and need for autonomy, not just those with a PDA label. They also question whether some professionals might use “PDA” to sidestep deeper issues – for example, labeling a child PDA when the real issue might be an unmet communication need or trauma history that could be addressed if properly identified.
• Community divide: Within the autism community, PDA can be a polarizing topic. Some autistic adults embrace PDA as part of their identity, or at least as a useful description of their childhood. Others are more skeptical, sometimes viewing PDA as a concept promoted by certain clinicians or parents without enough input from autistic individuals themselves. There have been strong voices on both sides – for example, the late autism researcher Zilda Milivojevic and others raised concerns that PDA was being promoted without scientific backing, whereas PDA advocates (including some autistic adults like Harry Thompson in the UK) have been very vocal about needing the profile recognized so people like them get the right support. The National Autistic Society (NAS) in the UK has taken a cautious stance: it provides information about PDA on its website and acknowledges the profile, but it also notes that its engagement with PDA concepts should not be seen as a full endorsement beyond what evidence supports. NAS highlights that more research is needed and has updated its materials to reflect the ongoing debate. Meanwhile, the PDA Society (a charity in the UK) actively advocates for recognition of PDA and supports families, operating on the premise that PDA is a real and distinct profile.

Where does the debate stand now (2025)? Broadly, we can say that PDA is still a contested concept, but it is being taken increasingly seriously as a subject of research. Five years ago, there were only a handful of studies on PDA; now there is a growing body of work – including psychological studies, qualitative research with families, and even special issues of journals dedicated to PDA – trying to clarify its nature. There is an emerging consensus on at least one point: more high-quality research is needed. Both skeptics and proponents agree that questions like “How do we reliably identify PDA?”, “What causes these extreme avoidance behaviors?”, and “What interventions help the most?” require further investigation. Recent reviews call for standardized assessment tools for PDA traits and more longitudinal studies to understand outcomes. Until such evidence is available, the diagnosis debate will likely continue. In practice, many professionals adopt a middle-ground approach: they don’t issue formal “PDA diagnoses,” but they do recognize the pattern and adapt their support strategies accordingly – essentially addressing the needs of the child (which everyone agrees are very real) without getting too hung up on the label.

Conclusion

Pathological Demand Avoidance is a complex and evolving area of understanding in the autism and neurodevelopmental field. For parents and teachers, the term PDA offers a framework that can explain why a child might go to extraordinary lengths to avoid demands and why typical strategies often fail with these children. Whether or not one views PDA as a separate syndrome, the practical implications are clear: these individuals need approaches centered on reducing anxiety and respecting their need for autonomy. Label aside, the profile highlights an important reality that one size does not fit all in autism support – some children will not thrive under conventional behavior plans or educational methods, and may even worsen if their unique profile is not recognized.

The past five years have seen an uptick in research shedding light on PDA. Contemporary studies tend to support the idea that PDA is best thought of as a profile of traits (especially within autism) rather than a standalone disorder with a clear-cut boundary. The extreme demand avoidance seems to arise from an interplay of autism-related characteristics, anxiety, and possibly other co-occurring factors, and it can be present (to varying degrees) in different conditions. Interventions, therefore, are focusing on those underlying issues: anxiety management, flexibility, and environmental accommodations, rather than trying to enforce compliance. Encouragingly, many families who implement PDA-friendly approaches report improvements – not a “cure” of demand avoidance, but better wellbeing and functionality for the child (for example, being able to attend some school, or have calmer mornings at home). Children with PDA can learn and achieve, but they need trust, creative support, and patience from the adults in their lives.

Looking ahead, experts widely acknowledge that there is much more to learn about PDA. Ongoing research aims to develop more objective ways to identify PDA traits, understand the prevalence in the population, and test which interventions yield the best outcomes. Neurodiversity-focused perspectives are also enriching the conversation, ensuring that the voices of autistic individuals (including those who identify with PDA) are heard in shaping how we understand and support these behaviors.

For now, parents and educators dealing with PDA are encouraged to stay informed (through reputable sources and support organizations), be flexible, and prioritize the relationship with the child over rigid expectations. By creating an environment of safety and understanding, we can help a young person with PDA gradually expand their tolerance for demands and navigate the world with less fear. In essence, demand avoidance is not about “won’t”, it’s about “can’t” – and when we recognize that, we can shift our approach from trying to force compliance to working together with the child toward positive outcomes.

References

1. Attwood, T., & Garnett, M. (2025). What Does the Research Say About Current Best Practice to Support Individuals With PDA? Attwood & Garnett Events – Blog post (July 15, 2025)attwoodandgarnettevents.comattwoodandgarnettevents.comattwoodandgarnettevents.comattwoodandgarnettevents.comattwoodandgarnettevents.comattwoodandgarnettevents.comattwoodandgarnettevents.com. (Insights on PDA as an anxiety-driven profile within autism, prevalence, and best-practice support strategies.)
2. Kamp-Becker, I., Schu, U., & Stroth, S. (2023). Pathological Demand Avoidance: Current State of Research and Critical Discussion. Zeitschrift f. Kinder- und Jugendpsychiatrie und Psychotherapie, 51(4), 321–332pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. (Review article in German with English abstract, concludes PDA is not an independent diagnosis but a behavior profile; emphasizes anxiety-driven control and need for more research.)
3. Haire, L., Symonds, J., Senior, J., & D’Urso, G. (2024). Methods of studying pathological demand avoidance in children and adolescents: a scoping review. Frontiers in Education, 9, Article 1230011frontiersin.orgfrontiersin.orgfrontiersin.org. (Summarizes PDA as a contested construct not in DSM/ICD, originated from Newson’s work; notes families struggle and calls for more research.)
4. National Autistic Society (2023). Demand avoidance – NAS Information Pageautism.org.ukautism.org.ukautism.org.ukautism.org.ukautism.org.ukautism.org.ukautism.org.uk. (Provides an overview of demand avoidance and PDA, including history, proposed characteristics, the debate around the PDA label, and perspectives from the autism community.)
5. Frontiers in Education – PDA Special Issue (2023). Johnson, M., & Saunderson, H. Examining the relationship between anxiety and pathological demand avoidance in adults: a mixed methods approachfrontiersin.orgfrontiersin.orgfrontiersin.orgfrontiersin.orgfrontiersin.org. (Research finding that anxiety and intolerance of uncertainty play key roles in PDA; discusses conceptualizations of PDA vs. autism and the transactional model of demand avoidance.)
6. Examples from Lived Experience. Quotes illustrating PDA behaviors and parenting insightsautism.org.ukautism.org.ukautism.org.uk (sourced from personal accounts compiled by the National Autistic Society). These provide real-world context for how PDA can manifest (e.g. avoiding even desired activities if demanded, meltdowns from anxiety, and the need for flexible parenting).