Pathological Demand Avoidance: A Guide For Parents

Kids can be stubborn, especially when they don't want to put away their toys, take a shower, or empty the dishwasher. They may even refuse to do fun stuff now and then. But how can you tell when their refusal is more than just typical childhood defiance?

In some cases, it may be a sign of something deeper, like pathological demand avoidance (PDA), a behavioural profile often associated with autism. Kids with PDA go to great lengths to avoid everyday demands or requests, even those that seem simple or routine. It’s often driven by intense anxiety and a need to feel in control, making it difficult for children to comply, even with things they usually enjoy.

Children with PDA may resist everyday activities like eating, getting dressed, or going to school, and their avoidance can take many forms—distraction, negotiation, withdrawal or even meltdowns. These behaviours can disrupt daily routines and make even simple tasks feel overwhelming for both children and their caregivers.

To help you make sense of pathological demand avoidance syndrome, our guide is here to help. Ahead, you'll find everything you need to know about PDA, including key signs, strategies for supporting your child, and tips for caring for yourself along the way.

What is pathological demand avoidance (PDA)?

PDA was first described by British psychologist Elisabeth Newson in the 1980s to identify children who did not fit the typical autism profile, yet shared some overlapping traits. Today, the National Autistic Society recognizes PDA as a profile on the autism spectrum, though research is still evolving, and consensus has not been reached.

However, Amy Evan Bichelman, a licensed clinical psychologist, also points out that PDA is not exclusive to autism. It can also be seen in individuals diagnosed with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD).

“Some experts believe that PDA-related traits—such as extreme resistance to everyday demands and a strong need for control—can appear in people with these and other conditions,” she says.

PDA is not currently recognized as an official diagnosis in major diagnostic guides like the DSM (Diagnostic and Statistical Manual of Mental Disorders) or the ICD (International Classification of Diseases), which clinicians use to identify and classify mental health conditions. Because of this, there’s still debate among professionals, and it’s unlikely to be considered a separate diagnosis until more agreement is reached.

What is demand avoidance?

It’s completely normal for all children to show resistance to demands from time to time. But for some kids, experiencing demand avoidance isn’t about being stubborn or misbehaving. In fact, the PDA Society explains that these children may feel anxious or overwhelmed when asked to carry out everyday tasks, like brushing their teeth, completing homework or getting ready to leave the house. This distress can drive a strong urge to avoid the task at all costs.

Additionally, the PDA Society notes that a person’s level of demand avoidance can vary from day to day. Factors such as energy, anxiety, overall health and even the environment—including the people and objects around them—can all influence how much they avoid demand.

Key characteristics and signs of PDA in children

Individuals with PDA may exhibit a range of demand-avoiding behaviours. According to Kory Andreas, LCSW-C, a licensed clinical social worker and recognized specialist in neurodiversity and autism, these behaviours can include extreme reactions to demands, such as meltdowns, shutdowns, and significant pushback.

Andreas notes, “Some kids will look very silly while trying to avoid something they can’t do. Some will report physical struggles, such as saying, ‘My legs don’t work.’ Meltdowns can be very upsetting if the child is already triggered. Many kids may kick, bite or act in unsafe ways when caregivers place demands on them.”

Because children with PDA often work hard to hide their feelings and behaviours in public, Andreas explains, they may release their frustration at home, often directed at their parents. Unexpected changes—like finding their toys moved or noticing a parent’s new haircut—can also trigger overwhelming feelings.

“Since kids usually don’t understand what’s causing these big feelings, they often take it out on someone they feel safe with. It’s not a mood swing—it’s their nervous system becoming dysregulated. What we’re seeing is a real, physical response in the body, not just a change in mood. Their body is getting ready for a crisis, even if no one else can see it,” Andreas says.

What core features distinguish PDA from oppositional defiant disorder (ODD)?

Sometimes, pathological demand avoidance (PDA) is mistaken for oppositional defiant disorder (ODD), but there are important differences between the two.

Andreas explains, “PDA is different from ODD in that it is a systemic nervous system response that happens in the absence of trauma. The body lives with a heightened sense of nervous system involvement.” She also notes that neuroception—a subconscious process in which the body interprets environmental cues as safe or dangerous—plays a key role in PDA.

“For people with PDA, everyday situations can feel like life-or-death threats,” Andreas states. "Traits of autism, such as difficulty with social interactions, sensory sensitivities and unpredictability, can trigger this neuroception, causing the body to react as if it is in danger."

In contrast, ODD is characterized by ongoing defiant and argumentative behaviour, mainly directed at authority figures. PDA, however, is usually triggered by specific situations, such as being given instructions, interacting with authority or experiencing threats to personal independence. These distinct triggers set PDA apart from ODD.

Why traditional parenting methods often fail with PDA

Standard behavioural approaches often fail to help children with PDA because, as Andreas explains, these methods do not address the body's nervous system dysregulation.

"This is like telling someone who was just in a car accident that if they don’t calm down, they won’t get to go to the movies," she says. "The body is experiencing trauma, fear and anxiety. This can’t be punished or rewarded."

After outbursts, children with PDA often feel intense shame, which can lead to depression and low self-esteem. During meltdowns, they may also recall traumatic incidents inaccurately, making talk therapy less effective.

"Many PDA-ers become so flooded with emotion that it feels like they are reliving it," Andreas explains. "So, 'let’s talk about what you did and why' doesn’t work. It’s not about the last trigger, but the buildup of many invisible assaults on their body."

Understanding the anxiety driving PDA behaviour

Anxiety is a major driver of pathological demand avoidance (PDA) behaviour. For some children, this anxiety can build up, leading to intense episodes such as panic attacks, especially when demands feel overwhelming or inescapable. This is because demand avoidance is closely linked to neuroception, the brain’s way of detecting threats.

As Andreas explains, “All Autistic people and PDA-ers experience significant anxiety. Their bodies, because of neuroception, are constantly on high alert in our world. The world is designed for neurotypical people—it’s loud, harsh and can be a sensory nightmare for Autistic individuals and PDA-ers. Social interactions are often unpredictable and challenging, which only adds to their anxiety.”

Children with PDA can have a range of stress responses: Fight, flight, freeze, and flop. Andreas describes each response:

• Fight: “This can look like combative behaviours—hitting, yelling, using mean words, biting or throwing objects.”

• Flight: “Usually means running away. This can be impulsive and scary, especially for kids who are fast enough to outrun adults or young enough to be at risk if they're on their own.”

• Freeze: This response might make the child appear unresponsive or frozen in place. Often, they can't speak or react, even if someone tries to interact with them.

• Flop: “This is very common among children with PDA,” Andreas notes. “After school, big social events, trips, or any stressful situation, PDA-ers might ‘flop.’ They might fall asleep or just lie down, unable to do anything that takes energy. One family I worked with told me that cleaning the kitchen together almost always ended with their PDA-er falling asleep right on the floor. This isn’t manipulation or an attempt to avoid chores-it’s a nervous system response to the demand.”

Effective parenting and support strategies for PDA

Supporting children with PDA begins with understanding the real challenge. Neurodivergent therapist Polina Shkadron explains that the core issue isn’t simply demand avoidance. Instead, it’s the discomfort and dysregulation children feel when demands are placed on them.

Rather than focusing only on reducing demands, Shkadron suggests that parents consider both their child’s and their own capacity on any given day. For instance, there may be days when something as simple as putting on shoes becomes a struggle, even if the child has done it before.

“Putting on shoes involves body awareness and motor planning, which can be especially tough for kids with autism,” Shkadron explains. "On those tough days, a parent might say, “Today, I got you. I can tie the laces.” This approach reassures the child that support is available when needed, while gently maintaining routines, like wearing shoes outside, without turning it into a battle or making it about compliance."

Seeking diagnosis of pda and when to get professional help

According to Dr. Yann Poncin, Vice Chair of Clinical Affairs at the Yale Child Study Center, parents who suspect their child may have pathological demand avoidance (PDA) should consult professionals with expertise in autism.

“It’s important to find someone who understands autism,” Dr. Poncin explains, “because the relationship between PDA and autism spectrum disorder (ASD) is complex and sometimes controversial. PDA is considered a behavioural profile within autism, and children with PDA may resist structured routines that typically help those with ASD, due to their strong need to avoid demands.”

Supporting your child's well-being and emotional regulation

Helping children with pathological demand avoidance (PDA) manage anxiety and meltdowns involves more than simply avoiding demands. Parents can use a range of supportive strategies to nurture their child’s emotional well-being and reduce stress in everyday situations.

Be playful

According to Poncin, “Techniques like flexibility, humour, novelty and role-playing or pretending can make everyday tasks feel less like demands and more like collaborative, enjoyable activities.” For example, turning toothbrushing into a silly game, pretending to be astronauts suiting up for a mission while getting dressed, or letting your child "be the boss" and give you instructions for tidying up can lower pressure and increase engagement.

Create predictable routines

Creating a predictable yet flexible environment is also essential. Consistency in routines, such as having a visual schedule, can help children feel secure. But it’s just as important to offer choices and be ready to adapt plans if your child is struggling. A rigid schedule without room for flexibility may increase anxiety rather than ease it.

Talk about feelings

Encouraging open conversations about feelings is equally important. “A child should feel understood and validated,” Poncin explains. “If their avoidance doesn’t make sense to you, or your first instinct is to insist they do something, you may miss the chance to understand what’s driving your child’s behaviour.”

Simple phrases like, “It seems like this is hard for you right now. Want to tell me why?” can open the door to connection instead of confrontation.

Be compassionate and flexible

Empathy and self-awareness go a long way. Poncin advises, “Don’t lead with ‘no.’ Instead, first address the emotion behind the avoidance or impulse. Acknowledge it, then gently move on to your expectation—using humour, distraction, or other creative strategies.”

That might mean making a joke to lighten the mood, offering a silly alternative ("Should we have broccoli or pizza-flavoured toothpaste today?") or suggesting a five-minute break before trying again.

Regulate your own emotions

Most importantly, Poncin emphasizes the value of co-regulation—helping your child manage big emotions by staying calm and grounded yourself. This might mean sitting quietly beside them during a meltdown, using a steady, reassuring tone, and modelling slow, deep breaths to help them feel safe.

Over time, children may begin to mirror your calm presence. And remember, you don’t have to do it alone—seeking support from therapists, parent groups, or online communities can be invaluable when navigating the unique challenges of raising a child with PDA in a world built for neurotypical expectations.

Will PDA improve?

With the right support, these approaches can help reduce anxiety and meltdowns, strengthen the parent-child connection, and gradually increase the range of activities a child feels comfortable engaging in. While some level of support may always be needed, many families find that daily life becomes more manageable and stable as their child begins to feel safer and more understood.

Do kids grow out of PDA?

PDA traits don’t typically disappear with age, but children can grow into a deeper understanding of themselves and how to manage the world around them. As they mature, many teens and adults with PDA develop tools to navigate life more confidently and independently. They may learn to:

• Recognize what triggers their anxiety or avoidance
• Communicate their needs and boundaries more clearly
• Negotiate demands in ways that feel safer and more manageable
• Use structure, routines, or self-directed strategies to stay regulated

PDA is considered a lifelong profile, not something a child simply "grows out of." But with the right support, growth is absolutely possible. The goal isn't to eliminate avoidance entirely, but to help individuals navigate a demand-filled world on their own terms—with understanding, flexibility, and compassion.

Support and self-care for parents

Lila Low-Beinart, a licensed Professional Counselor Candidate (MA, LPCC) who specializes in neurodiversity-affirming therapy for adults and teens, notes that parents of children with PDA often face significant emotional challenges.

"These can include managing their feelings when their child resists societal demands, coping with isolation if other parents don’t understand their experience, and experiencing burnout when their child’s needs overwhelm their nervous system," she explains.

To find support, Low-Beinart suggests exploring resources such as PDA North America, which offers support groups, including ones specifically for neurodivergent parents of PDAers, and parent trainings to better understand and support their children. "Connecting with others through Facebook groups and following PDAers and PDA parents on social media can also help parents feel less alone," she adds.

Most importantly, Poncin emphasizes the value of co-regulation and seeking out others who understand the unique challenges of raising a PDA child in a society designed for neurotypical people. "Building a supportive community and prioritizing self-care can make a meaningful difference for both parents and their children," she says.

The bottom line

For children living with PDA and their families, daily life can often feel overwhelming, unpredictable, and emotionally exhausting. The constant balancing act—between reducing demands, managing meltdowns, and trying to maintain a sense of normalcy—can leave parents feeling isolated, depleted, and unsure of how to help.

To navigate these challenges, Low-Beinart recommends making your own well-being a priority, not just your physical health, but your emotional, mental and even spiritual well-being. Caring for a child with PDA is a marathon, not a sprint, and your ability to co-regulate depends on your ability to stay grounded and resourced.

She also encourages parents to focus on being emotionally present with their child. Co-regulation—staying calm and connected while your child is dysregulated—isn’t always easy, but it’s one of the most powerful tools available. Small moments of connection, like sitting together during a meltdown or validating a child's need for space, can build trust and safety over time.

Equally important is finding your community. Reach out to others who truly understand the PDA experience—whether that’s through online forums, local support groups, PDA-aware professionals, or other families on similar journeys. Knowing you’re not alone can bring both relief and perspective, and hearing how others have adapted can spark new ideas and renewed hope.

Experts

• Amy Evan Bichelman is a licensed clinical psychologist.
• Kory Andreas, LCSW-C, is a licensed clinical social worker and recognized specialist in neurodiversity and autism.
• Dr. Yann Poncin, MD, is Associate Professor and Vice Chair of Clinical Affairs in the Yale Child Study Center.
• Lila Low-Beinart, a licensed Professional Counselor Candidate (MA, LPCC) who specializes in neurodiversity.