Rethinking Pathological Demand Avoidance (PDA)

Autism, ADHD, and the Drive for Autonomy

Pathological Demand Avoidance (PDA) is a concept that has sparked growing discussion across clinical practice, education, and the neurodivergent community. Described as a pervasive resistance to everyday demands, PDA is often associated with autism but many ADHDers also identify with its traits. While some see it as a helpful framework to explain distressing behaviour, others argue that the label is pathologizing, reductive, and fails to capture the underlying complexity of lived experience.

This article explores what PDA is, where it comes from, how it intersects with ADHD and trauma, and why many are reframing it as a persistent drive for autonomy rather than a disorder.

Understanding PDA: Origins and Controversies

The term Pathological Demand Avoidance was first coined in the 1980s by British developmental psychologist Elizabeth Newson. Working with autistic children who didn’t neatly fit existing profiles, Newson observed a unique cluster of behaviours: high sociability, imaginative play, emotional volatility, and above all, an obsessive resistance to everyday demands. She proposed PDA as a distinct diagnostic profile within the pervasive developmental disorders (Newson et al., 2003).

Despite early interest, PDA has never been formally included in diagnostic manuals like the DSM-5 or ICD-11. Clinical understanding remains fragmented and highly debated. Some professionals see PDA as a subtype of autism; others view it as a behavioural pattern shaped by anxiety, trauma, or unmet needs. Research by Kildahl et al. (2021) notes that a lack of consistent definitions and reliance on parent-reported data has made it difficult to develop reliable diagnostic tools or evidence-based interventions.

What Does PDA Look Like?

While PDA is not formally recognized, a growing body of literature and lived experience points to common traits, including:

• Intense avoidance of everyday demands, even when the person wants to comply

• Use of social strategies—charm, distraction, excuses—to resist expectations

• High levels of anxiety, especially in uncertain or unpredictable situations

• Sudden mood shifts, emotional reactivity, and difficulty with regulation

• Strong need for autonomy, control, and a sense of agency

These traits can easily be misunderstood. A child who refuses to brush their teeth or complete a school assignment may appear defiant or manipulative. In truth, many people with PDA traits experience profound distress in the face of demands. Their resistance is not oppositional in nature it’s protective.

Introducing Rational Demand Avoidance (RDA)

A growing number of researchers and neurodivergent advocates propose an alternative framing: Rational Demand Avoidance (RDA). This model suggests that so-called “demand-avoidant” behaviours are not pathological, but reasonable, adaptive responses to environments that feel overwhelming, coercive, or unsafe.

Coined by Milton and Woods, RDA shifts the narrative: rather than assuming something is wrong with the person, it asks what’s happening around the person that makes resistance necessary. If a classroom is loud and overstimulating, refusing to attend may not be a disorder—it may be a form of self-protection.

Pathologizing Resistance: Who Does It Serve?

The word pathological suggests something is inherently wrong within the person. But what if the problem isn’t the individual, but the context?

Dr. Damian Milton (2013) argues that PDA may be “nature’s answer to over-conformity.” In other words, refusal may be a healthy rejection of systems that ignore neurodivergent needs. Moore (2020) takes this further, challenging the very premise of PDA as a diagnosis: “What and who are being pathologized, and in whose interest?”

Many autistic advocates see PDA traits not as a clinical problem, but as a sign of self-advocacy in the face of coercion. Woods (2017; 2019) cautions that demand avoidance is often framed circularly in clinical settings: “If you avoid demands, you must have PDA; if you have PDA, that explains why you avoid demands.” This logic leaves little room for understanding the root cause of behaviour.

So Why Do People Avoid Demands?

There are several overlapping theories, none of which position the individual as broken, and all of which highlight the urgent need for reframing.

1. A Rational Response to an Overwhelming World

Many people described as having PDA aren’t avoiding demands because they’re oppositional they’re avoiding because they’re overwhelmed. In this view, demand avoidance is a logical and protective response to environments that are unpredictable, controlling, or invalidating.

Milton and Woods refer to this as Rational Demand Avoidance (RDA). If school is noisy, disorienting, and full of confusing social dynamics, refusing to attend may not be pathological it may be the most self-preserving option available.

2. Anxiety, Uncertainty, and the Need for Control

Research by Stuart et al. (2020) and Bishop-Fitzpatrick et al. (2017) connects PDA traits to high levels of intolerance of uncertainty, which often leads to anxiety and avoidance. When people don’t know what to expect, they may try to regain control by resisting demands, especially those that feel sudden, ambiguous, or externally imposed.

This isn’t unique to autism. Many ADHDers and anxious individuals experience the same pattern: avoidance as an attempt to regulate stress and uncertainty.

3. Emotional Dysregulation and Trauma Responses

Avoidance can also be a sign of trauma. People who have experienced coercion, punishment, or persistent invalidation often develop fight/flight/freeze/fawn responses, and demand avoidance may fall into any of these.

-Avoiding a task might be a flight response.

-Meltdowns may be fight.

-People-pleasing or masking to avoid conflict could be fawn.

-Shutting down completely? That’s freeze.

These patterns are especially common among individuals with a history of developmental trauma, including autistic and ADHD children raised in rigid or non-affirming environments.

4. A Persistent Drive for Autonomy

Many in the neurodivergent community prefer to reframe PDA as a Persistent Drive for Autonomy. This shift in language moves away from shame and toward empowerment.

The need for control isn’t about manipulation, it’s about survival. For someone whose sensory environment is overwhelming, whose needs aren’t understood, and whose identity is constantly invalidated, autonomy becomes the only safe ground. Resistance to demands, then, becomes a way of saying, “I need space to be me.”

 Common Myths About PDA

Let’s dispel some widespread misconceptions:

Myth 1: PDA is just defiance or manipulation.
Truth: PDA behaviours often stem from distress, anxiety, or overwhelm, not a desire to oppose authority.

Myth 2: Only autistic people experience PDA.
Truth: Many individuals with ADHD, anxiety, or trauma histories relate to PDA traits. It may reflect shared neurocognitive patterns.

Myth 3: Demand avoidance means someone lacks empathy or responsibility.
Truth: People with PDA often care deeply but feel emotionally flooded. Their avoidance may reflect fear of failure or rejection, not apathy.

Myth 4: You just need to enforce firm boundaries.
Truth: Rigid approaches can escalate fear and lead to shutdowns. Collaborative, autonomy-respecting strategies are far more effective.

Myth 5: PDA is a fixed trait.
Truth: Like many behaviours, demand avoidance exists on a spectrum and can shift with context, safety, and support.

 PDA and ADHD: A Shared Profile?

Although PDA is most often discussed in relation to autism, many people with ADHD also report extreme demand avoidance. In fact, some traits traditionally associated with PDA may overlap more closely with executive functioning difficulties, emotional dysregulation, and rejection sensitivity seen in ADHD.

For example:

• An ADHD student may deeply want to do their homework but feel unable to initiate the task. This task paralysis can look like avoidance, but is actually an executive function challenge.

• ADHDers often experience emotional flooding, which can result in impulsive refusals, meltdowns, or shutdowns under pressure.

• Soler-Gutiérrez et al. (2023) identify emotion dysregulation as a core feature of adult ADHD—one that frequently goes unrecognized.

Given that up to 80% of autistic individuals also meet criteria for ADHD, it’s possible that what we call PDA may sometimes reflect AuDHD profiles, rather than a distinct autism subtype.

So What Helps?

Whether we’re talking about PDA, RDA, ADHD, trauma, or something else entirely, the core question is not what label fits best? but how can we support this person to feel safe, regulated, and empowered?

Here are strategies that research and lived experience suggest are most helpful:

• Validate the need for control and autonomy. Don’t take resistance personally—meet it with curiosity and compassion.

• Minimize non-essential demands. Use collaboration and scaffolding instead of directives.

• Provide structure and predictability while maintaining flexibility.

• Support emotional regulation through co-regulation, mindfulness, sensory tools, and relational safety.

• Avoid compliance-based therapies like ABA that can reinforce trauma responses.

• Listen to the neurodivergent community. The most valuable insights often come from those who live it every day.

Final Thoughts: Beyond the Label

Pathological Demand Avoidance is not just a clinical puzzle it’s a human experience. And like many human experiences, it defies neat categories.

Yes, PDA traits are real. They can be distressing, disruptive, and debilitating. But they are not signs of being broken. They are signs of living in a world that doesn’t yet know how to meet you where you are.

Whether you relate to PDA, RDA, ADHD, autism, trauma, or none of the above, what matters most is this: You deserve support that affirms your needs, honours your autonomy, and helps you thrive without needing to mask who you are.