Reframing Behavior: Pathological Demand Avoidance

Many of us have known a child who simply will not comply with adult requests - at school, at home, during extracurricular activities. They frequently have loud meltdowns and refuse to engage in required activities, even if they normally enjoy those exact same activities. It can be baffling for parents and caregivers, who struggle to understand the intensity of their child’s moods.

These children, when seen by therapists or school counselors, might be given the diagnosis of Oppositional Defiant Disorder (ODD), which indicates exactly what it sounds like, opposition to instructions and plenty of seemingly angry defiance. I contend that there is likely a more complex explanation than the punitive label of defiance or simply “bad behavior” for many of these children.

The psychologist and author, Ross Greene, outlines the concept of children’s behavior in this way: “Kids do well if they can,” meaning that children, for the sake of human survival, are hardwired to want to please their caregiving adults. In some tantruming children, there is an actual psychological inability to comply that reaches far beyond just “not wanting to”. If a child is misbehaving, Dr. Greene argues, it’s usually because they have an unmet need coupled with the lack the skills or language to express it properly.

In studying this kinder, gentler category of reframing, I came upon a theory, which is well-researched in the United Kingdom and not yet as prevalent in the United States. Many clinicians in the UK believe the alleged defiance they see in some children would be better categorized as something new, Pathological Demand Avoidance (PDA). PDA is a proposed diagnosis for some children (and adults) with Autism Spectrum Disorder (ASD), and could possibly be a diagnosis that would apply to some people with other neurodiversity profiles. Neurodiverse individuals are currently considered people with autism, ADHD, and other sensory sensitivity characteristics.

Some key characteristics of PDA include:

• Resists and avoids the ordinary demands of life
• Experiences excessive mood swings and impulsivity
• Uses social strategies as part of avoidance, for example, distracting, giving excuses
• Appears comfortable in role play and pretense
• Appears sociable, but lacks some understanding

This first several bullet points sound a lot like ODD, but there is a clear difference. The proposed diagnosis of PDA, rather than assuming nefarious intent, suggests that these behaviors are brought about by a perceived lack of autonomy. This creates a flood of anxiety when the person is met with a demand, even if the request is something they usually enjoy doing. Commence the fight, flight, freeze response. The need for autonomy is so overwhelming that the person enters a state of panic when faced with the request. In fact, some adults in the PDA community are lobbying to change the name of PDA from Pathological Demand Avoidance to a less judgmental sounding (and more descriptively accurate) Pervasive Drive for Autonomy.

Children with the PDA profile can differ greatly from others diagnosed with ASD, and in fact, may more often be misdiagnosed. This is because they may not appear to exhibit the same need for routine or the inability to pick up on social cues, both of which are typical characteristic of autism. These differences in presentation can make PDA a difficult diagnosis to pinpoint.

According to the CDC website, about 1 in 36 children in the United States has been identified with autism spectrum disorder (ASD). It is reported to occur in all racial, ethnic, and socioeconomic groups. Autism is a huge category covering many types of characteristics, so obviously, not all the children diagnosed with ASD fit the PDA profile; however, some of them do, so it’s worth knowing how to identify it.

In most cases, diagnosis or not, by thinking of a child’s behavior as communication, we can better understand how to successfully guide them without the frustration and judgement that often comes with parenting a strong-willed child, and we can help teach the child better coping and communication skills in order to get their often-misunderstood needs met. 

Look for an upcoming post on Low-Demand Parenting for a deeper look into this subject. 

Resources:

https://www.cdc.gov/ncbddd/autism/data.html

https://drrossgreene.com/

https://www.pdasociety.org.uk/what-is-pda-menu/about-autism-and-pda/

https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/pda

https://neurodivergentinsights.com/blog/low-demand-parenting

By Roberta Howell, LMFT