Pathological Demand Avoidance (PDA) Position Statement

PDA (Pathological Demand Avoidance) is widely understood to be a profile on the autism spectrum.

A PDA profile describes a continued and extreme avoidance or resistance to everyday demands and expectations.  Children and young people with this profile may use a range of behaviours and strategies to avoid demands and expectations that trigger anxiety.    

 Some features of a demand avoidant profile include: 

• Resisting and avoiding the ordinary demands of life
• uses social strategies as part of avoidance e.g distracting, giving excuses
• appearing sociable but may lack understanding
• experiences excessive mood swings and impulsivity
• appears more comfortable in imaginative and role play
• displays obsessive behaviour that is often focused on other people. 

 This profile can be understood as persistent demand avoidance.

 Children and young people with this profile can sometimes appear excessively controlling and dominating, while others may mask their anxiety   - demand avoidance is a spectrum of behaviours.   These behaviours can be a form of ‘panic attack’, often referred to as ‘fight, flight or freeze’ responses and are caused by feelings of anxiety. When children and young people feel secure and in control, they can also be confident and engaging.  It is important to acknowledge that those who have demand avoidance behaviours have a hidden disability.

Research suggests that early identification and tailored support is the best predictor of positive long-term outcomes. Recognising these profiles signposts the approaches or support that will be most helpful for each individual.

Central Bedfordshire recognises that there are different clinical viewpoints across health services and that whilst PDA is not included within the current diagnostic tools for Autism – DSM 5 and ICD 10 - the NICE guidelines on recognition, referral and treatment for autism spectrum disorder in under 19’s does identify demand avoidant behaviour as a sign and symptom when considering autism spectrum condition NICE Guidelines CG128

Children and young people with a PDA profile will require effective, personalised support with a more flexible approach, that focuses on and understands their individual needs. In addition, we know that individuals with a PDA profile do not always respond to the traditional strategies recommended for autism.

Bedfordshire and Luton CAMHS recognise that these behaviours can be identified within the diagnosis of ASD. Clinicians within CAMHS are able to work with parents, carers and other professionals to try and understand these difficulties and tailor a package of care and personalised support for the individual needs of children.  

Information about assessments, support and diagnosis of autism spectrum can be found by accessing Luton and Bedfordshire's Neurodevelopmental Disorder (NDD) pathway. Working with partners from local charities, community services and parents, we've created a pathway of early intervention and support. We've mapped out the pathway of assessment, should you or your child be referred into either community health services or CAMHS for an assessment of:

• a possible neurodevelopmental difficulty or disorder such as autism or attention deficit hyperactivity disorder (ADHD)
• a learning disability

Find out more about the NDD pathway and support available.

This eLearning module provides an overview of Pathological Demand Avoidance (PDA) for children and young people of different ages.

It consists of several modules and covers;

• What is PDA,
• the impact PDA has on a child, teenager or young person,
• how to support and communicate effectively and
• understanding the effects that it has on learning and other situations.

The modules contain case studies, videos, and demonstrate conversations.

At the end of each module, you will complete a short quiz to test your knowledge.

Visit My Learning Central to sign-up for an e-learning account and then search for ‘PDA’.