Demand avoidance is a natural human behavior. To some degree, we all avoid doing things asked of us. We might avoid doing the dishes when our partner asks because the chore feels tedious or overwhelming after a long working day. Or maybe we shy away from compliments because we feel like they come with the expectation to keep performing well in a specific area in the future.
However, when demand avoidance is more significant and prevalent, there might be another explanation for the behavior. Pathological demand avoidance is just one aspect of a PDA profile and can occur alongside a physical, mental health, developmental, or personality condition. Demand avoidance turns pathological when it becomes all-encompassing.
It is estimated that about one in five autistic individuals presents with a PDA profile. Since more awareness is being built about PDA, many advocates have started to reclaim the term by calling it the “persistent drive for autonomy” instead. A persistent drive for autonomy has a more positive connotation and redirects people’s attention toward PDA-ers’ strengths instead of focusing on deficits.
Key Features of PDA Profile
Clinicians and researchers describe PDA as a “constellation of traits” within autism spectrum disorder. Like Autism, PDA profiles exist on a spectrum and will look different from person to person. For some individuals with a PDA profile, the avoidance might be internalized, subtle, or passive, whereas for others, it can be externalized and obvious. Also, although persistent demand avoidance is the most significant feature in a PDA profile, it’s not the only one.
Key PDA Traits:
- Resistance and avoidance of the ordinary demands of life. This resistance relates even to ordinary life demands, like making/attending appointments, washing hands, and getting dressed. Demands are avoided not just because they are unpleasant or have adverse outcomes, but simply because they are demands. The avoidance is commonly motivated by an inability to tolerate uncertainty, feelings of threats to their autonomy, or high anxiety.
- The use of social strategies as a means to avoid, such as distraction, giving excuses, refusal, threats, or entering into role play.
- Appearing sociable on the surface, but struggling to understand aspects of social interactions. For example, verbal ability might be very sophisticated, and difficulties in social communication and understanding might be less obvious initially, leading to an atypical presentation of autism.
- Experiencing excessive mood swings and impulsivity, such as a loss of control, going into fight/flight mode, or becoming very quiet/withdrawn.
- Presenting with “obsessive” behavior, commonly geared toward other people. In this PDA trait, people most likely have developed intense interests in topics that are often social in nature and, therefore, seen as atypical.
- Seeming comfortable in role play and pretending, sometimes to an extreme extent. This can be a key feature for some individuals, but it’s not always present. For some, role playing may become extreme, such as living as an animal for a prolonged period.
Autism and PDA
Research on PDA is in the beginning stages. More information is coming out each year and will likely alter how we understand PDA in the future. Right now, PDA is understood to be a profile on the autism spectrum, but even our understanding of autism is evolving as more awareness is built around how it looks in those assigned female at birth and people of color. What we do know is that autism is multi-dimensional and each autistic person’s experience is unique.
According to the PDA Society, a PDA profile in autism means that individuals have all the autistic characteristics in addition to:
- A need for control, which is often anxiety related
- A drive to avoid, to an extreme extent, everyday demands and expectations, including things they want to do or enjoy
- A tendency to avoid demands through approaches that are “social in nature”
- A presentation of many “key features of PDA” rather than just one or two
- A tendency not to respond to conventional parenting, teaching, or support approaches
There is a difference between autistic demand avoidance and pathological demand avoidance. Autistics who don’t have a PDA profile tend to avoid situations that are difficult or unpleasant. In contrast, autistics with a PDA profile avoid all demands regardless of whether they produce a negative outcome or not. This means PDA individuals will even avoid things they want to do or enjoy if they perceive it to be a demand.
How Do You Define Demands?
Demands can be direct or indirect. They can include all the “I shoulds…” of life. Direct demands can also be requests or questions, like “Please put on your shoes” “Pay this bill,” or “Would you like a snack?”
According to the PDA society, indirect demands are less obvious and can fall into the following categories:
- Time. Including time constraints and expected timetables by which things should be done
- Plans. Knowing there are plans in the future can increase anxiety as they draw nearer. Also, intolerance of uncertainty can make spontenous plans overwhelming.
- Questions. The expectation of the requirement to respond can be overwhelming or disabling.
- Decisions. Knowledge that a decision has to be made can be disabling, and having too many options can lead to decision paralysis.
- Internal bodily demands, such as needing to use the restroom, wash hands, or get a drink
- Managing internal feelings/thoughts/desires.
- Uncertainty. PDA autistics need to know and feel in control of what’s happening around them.
- Praise. With praise comes the implied expectation that the action should be successfully carried out again.
- Transitions. Having to stop and switch what you’re doing can bring uncertainty about what comes next.
- Expectations from both yourself and people around you.
- Sensory overload and other sensory integration challenges.
- The presence of other people.
- Things we want and have to do.
Can I Have a PDA Profile and Not Be Autistic?
PDA understanding and research is still in its infancy stages, meaning there is still so much we don’t know. Right now, a PDA profile is understood within the context of autism spectrum disorder.
However, with more awareness being built and more stories getting shared among neurodivergent individuals, we are learning that people with ADHD can also present with a PDA profile. This could be because 50-70% of autistic individuals also have ADHD, or it could be that ADHD and PDA can co-occur outside of autism. Hopefully, with more research, a deeper understanding of this overlap will emerge.
Additional Resources
If you found this information helpful and want to learn more, consider checking out the PDA society’s website. The PDA society has put together loads of resources for anyone interested in learning more about PDA.
I plan to explore PDA profiles in eating disorders in my next couple of posts.
