Understanding Pathological Demand Avoidance (PDA)
Most kids resist doing things now and then. That’s normal. But some kids take it to the next level: they go out of their way to avoid anything that even feels like a demand. We’re not just talking about delaying homework or whining about chores. Avoidance here can look like sudden meltdowns, anxiety attacks, or pretending to be very, very interested in literally anything else—just to avoid doing what’s asked. This is called Pathological Demand Avoidance or PDA, and it’s most commonly seen in individuals with autism spectrum disorder.
PDA isn’t a separate diagnosis or an official subtype of autism, but many families and clinicians find the label helpful to understand a child’s extreme resistance to everyday demands. As Dr. Cynthia Martin, Clinical Director at the Child Mind Institute, explains:
“Any external demand that is coming from somebody else, or that the person perceives is coming from another person—that generates a lot of internal discomfort, which leads to the avoidance.”
(Martin, Child Mind Institute, 2023)
Children with PDA may appear capable of completing tasks like getting dressed, saying words in a book, or doing math worksheets—and they are capable—but only when they feel internally motivated. When asked by someone else, they may refuse, melt down, or do something else entirely (like drawing sharks instead of doing algebra).
This behavior is often misunderstood as defiance, but it usually stems from deep anxiety, difficulty with flexibility, and problems with executive functioning. That means kids may not anticipate demands unless they originate from their own interests. So when a teacher says, “Now do your worksheet,” the child may feel blindsided.
Importantly, PDA-like behaviors aren’t limited to autism. While common in autistic children, they also show up in kids with ADHD, anxiety, or no formal diagnosis at all (Newson et al., 2003; O’Nions et al., 2018). This makes identifying and supporting PDA profiles more complex—and essential.
Working with children who exhibit PDA behaviors requires a different approach. Direct instructions often backfire. Instead, flexibility, creativity, and motivation-based strategies work better. If a child is obsessed with sharks or pop music playlists, those interests become tools: build them into the tasks you want the child to complete.
Rather than butting heads over small tasks, the goal is to support adaptive skill-building—the daily-life skills that help children live independently. Research shows autistic individuals often have a significant gap between intellectual ability and adaptive functioning (Perry et al., 2009). Without support, children may continue to avoid demands and remain dependent, even when they’re fully capable.
That’s why interventions like Unstuck and On Target focus on building flexibility, teaching kids the value of compromise, and helping them learn when they have choices—and when they don’t (Kenworthy et al., 2014). The people implementing the programs, and their personalities and deeply adapted people skills are essential to achieving any type of sustained progress in self-management of PDA. These programs show long-term success when kids feel their ideas are heard and valued.
Because perception of demand is the triggering element, whether that is actually an immediate external force or an internalized demand, an internal dialogue that is both persuasive and accepting must be triggered along with the avoidance response. The most effective long-term indication of likely success is the ability to self-correct and adjust the reactive nature of PDA to an irritant.
To summarize: PDA is real, it’s challenging, and it demands thoughtful, individualized support. Not because kids are being difficult, but because the world feels overwhelming and uncontrollable. With the right strategies—patience, creativity, and mutual respect—we can help these children build the skills they need to thrive.
Key References:
- Martin, C. (2023). Child Mind Institute. https://childmind.org
- Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood.
- O’Nions, E., et al. (2018). Pathological Demand Avoidance: Symptoms but not a syndrome. Journal of Child Psychology and Psychiatry.
- Perry, A., et al. (2009). Predictors of outcome for children receiving intensive behavioral intervention. Research in Autism Spectrum Disorders.
- Kenworthy, L., et al. (2014). Unstuck and On Target: An Executive Function Curriculum to Improve Flexibility for Children with Autism Spectrum Disorders.
