PDA Explained: An introduction to pathological | extreme demand avoidance

Pathological Demand Avoidance (PDA) can alternatively be referred to as:

Extreme Demand Avoidance (EDA), or

Pervasive Drive for Autonomy (PDA)

The term "pathological" can be unhelpful because it implies something inherently ‘wrong’ or ‘disordered’. Some people in the PDA community prefer terms like "Extreme Demand Avoidance" or "Pervasive Drive for Autonomy," which focus on the individual's need for control and autonomy, without framing PDAers as inherently ‘negative’ or ‘disordered’.

PDA is a profile of autism, characterised by an extreme avoidance of everyday demands and a heightened intolerance of uncertainty. PDA is not recognised as a stand-alone diagnosis in the DSM-5 or ICD, but it is a distinct set of characteristics that co-exist for some autistic people (kids and adults). PDA is a nervous system disability, meaning that a person’s capacity to cope with demands can fluctuate from moment to moment.

PDA presents differently. Some people have a more externalised or active presentation, where they may argue, attempt to control situations or people around them, or experience intense meltdowns. Others have more internalised or passive presentation, where they may internalise their distress. This should not be viewed as "less significant" than an externalised PDA presentation. At the root of PDA is an anxiety-driven need for autonomy, control or independence.

Chronic high anxiety and stress in PDAers can trigger an almost constant release of stress hormones like adrenaline and cortisol. Over time, the constant hormonal surge can lead to exhaustion and burnout, which can have a severe impact on the PDAers mental and physical health.

Common characteristics of PDA include extreme avoidance of demands, such as requests to complete tasks. These demands may seem minor to others but can feel overwhelming and unmanageable to PDAers. For many, this experience goes beyond simple avoidance; it can lead to a state of dysregulation and overwhelm, where distress behaviours or meltdowns emerge. It’s important to recognise that distress behaviour is not a choice but is the result of a nervous system that is struggling to cope with loss of control or autonomy.

Demands can come from many sources, and they are cumulative. Direct demands include questions, instructions, or requests from others, while indirect demands can be internal - such as the need to eat, decide something, or plan ahead. Everyday tasks like getting dressed, drinking water, brushing teeth, or sitting in class may seem straightforward but are commonly experienced as demands by PDAers, making daily life incredibly exhausting.

PDAers have amazing strengths - just like every neurotype. Some PDAers are creative, have a strong sense of social justice, and show deep sensitivity to the emotions of others. PDAers often have excellent negotiation skills and view people equally, regardless of authority or age.

It’s also important to acknowledge that some PDAers will mask difficulties, appearing to manage demands outwardly while experiencing significant stress internally. This masking can lead to emotional burnout and, in some cases, "school can't," where attending school becomes too overwhelming to sustain. Understanding this dynamic is essential for teachers, therapists and parents/carers in order to provide effective support.

By embracing a deeper understanding of PDA and focusing on autonomy and strengths, we can offer more empathetic and attuned support that helps PDAers to thrive rather than simply survive life.