What is Pathological Demand Avoidance Disorder (PDA)?
“Pathological Demand Avoidance Disorder (PDA) also known as Extreme Demand Avoidance, is considered by the National Autistic Society in the UK (autism.org.uk) to be a subtype of Autism Spectrum Disorder characterized by extremely high levels of anxiety, which result in an individual constantly trying to control their environment. This need to be in control and feel safe results in opposition and avoidance of everyday demands, difficulties with emotional regulation, and often severely challenging behaviour.”’ — Dundon, R.
PDA is an extremely debilitating disorder whereby individuals have difficulty living their lives without feeling the need to control their relationships, conversations and tasks to the point where they cannot function in a social environment without the right supports.
PDA in the Therapy Room
When working with children with PDA in the therapy room, we need to go slowly and make the children feel comfortable. Gaining trust is the most important thing, as is going at the child’s pace. It is important to let go of our preconceived ideas, agendas and structures as therapists and work with the child on their development, making them feel safe and secure in the therapeutic space.
What is a Demand?
To the individual who lives with PDA, a demand can vary from someone asking direct questions to making suggestions of what they may do. A choice may be a demand. Sometimes having a schedule whereby you need to get up and go to sleep can be a demand which can trigger great anxiety to the individual with PDA. Others have suggested that being hungry and needing to eat or feeling you need to go to the toilet (biological needs) can also feel like a demand to the person with PDA. Sometimes not having a schedule is a demand, whereby the person needs to create their own schedule, placing a demand on themselves.