Pathological Demand Avoidance (PDA) is a proposed disorder and sub-type of autism spectrum disorder. It is characterized by a greater-than-typical refusal to comply with requests or expectations and extreme efforts to avoid social demands. Children with PDA display a resistance to everyday demands that goes beyond typical behavior, until it interferes with their everyday lives, and their resistance is obsessive and extreme. PDA is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) . To be recognized, a sufficient amount of consensus and clinical history needs to be present, and as a newly proposed condition, PDA had not met the standard of evidence required at the time of recent revisions.
Children with PDA tend to have an adverse reaction to being told how to behave or what to do, even when it’s something that’s an ordinary part of their daily life, and even when it would benefit them. They resist ordinary demands of life, and their resistance is extreme and interferes with functioning at home or at school. They may use strategies that can be seen as socially manipulative to avoid demands, such as making excuses, distracting, procrastinating, using threats, and physically incapacitating themselves. PDA behaviors can be analogous to sensory processing challenges, and children with PDA may find it difficult to find their place within the social hierarchy.
PDA has never been clinically recognized, which means that it does not appear in the international medical manual, the ICD, nor in the American medical manual, the DSM. However, it is a complex, challenging, and misunderstood condition that is often ignored or not even recognized by many professionals.
