Pathological Demand Avoidance: What Is It?

Do you know of a child who refuses to listen, sometimes even to the point of affecting their happiness and well-being?

Pathological Demand Avoidance: What is it?

Do you know of a child who refuses to listen, sometimes to the point where it affects their happiness and well-being? Perhaps you’ve thought of them as ‘defiant’, ‘stubborn’, ‘confusing’, ‘difficult’... and the list goes on. You might’ve even wondered about Oppositional Defiant Disorder (ODD), which many of us have heard of, but there are lesser-known causes as to why a child might act that way.

One of them is Pathological Demand Avoidance (PDA).

PDA is not a diagnosis, but a term used to describe a set of unusual behaviours that are commonly seen in – but not limited to – individuals with an autism diagnosis (O’Nion et al., 2015). Similar to ODD, children with PDA exhibit resistance to demands (Miller, 2025; National Autistic Society, n.d.), but their underlying causes differ.

PDA stems from feelings of anxiety and the need for autonomy (Capanna-Hodge, 2024; 2025).

Children with PDA may perceive their autonomy to be threatened by:

• Direct demands (being asked to brush their teeth)

• Indirect demands (having a plate of food placed in front of them)

• Internal demands (feeling thirsty)

(National Autistic Society, n.d.)

Miller (2025) and O’Nion et al. (2015) discussed poorer social skills in individuals with PDA, as they struggle with understanding social cues and expectations. Therefore, they may also lack the ability to anticipate demands outside of their control, so normal routines may appear sudden to them.

Behaviours in individuals with PDA often serve as strategies to avoid demands and regain a sense of control over themselves or the environment, and it can look like:

1. Lack of cooperation

2. Strategic use of socially shocking behaviour, procrastination, or other behaviours to direct attention away from the perceived demand

3. Difficulties with others, such as challenges in respecting boundaries

4. Anxiety and sudden behavioural changes

5. Domineering behaviour toward others

6. Rigidity and fixation on specific interests

(Capanna-Hodge, 2025; O’Nion et al, 2015)

As Capanna-Hodge (2025) puts it, PDA is a “persistent resistance to meeting life’s everyday demands” and is likely to affect many aspects of one’s life. Avoidance of ordinary routines and demands - such as dressing themselves, eating or completing school work - can interfere with functioning and quality of life (Miller, 2025).

Their social relationships may be impacted as they often struggle to connect with peers and self-expression (Capanna-Hodge, 2025). Furthermore, they are also more susceptible to the effects of anxiety, the emotion that drives their behaviours (National Autistic Society, n.d.).

While PDA is not a recognised diagnosis by itself, the term is being increasingly used by professionals to describe children who fit the profile (National Autistic Society, n.d.; O’Nion et al, 2015). The encompassed behaviours differ from typical profiles of Autism, ADHD, and other conditions.

Hence, caregivers and providers will have to take a more collaborative approach to children with PDA. Identification will be the first step in finding appropriate intervention methods. If you believe your child may exhibit traits of PDA, it is advisable to consult with your psychologist.

Written by: Jia Hui

References

Capanna-Hodge, R. (2024, December 18). Pathological demand avoidance vs ODD in autistic children. https://drroseann.com/pathological-demand-avoidance-vs-odd-in-autistic-children/

Capanna-Hodge, R. ( 2025, January 14). Pathological demand avoidance checklist: a useful tool to understand PDA. https://drroseann.com/pathological-demand-avoidance-checklist/ 

Freepik. (n.d.). Expressive young girl posing in the studio [Photograph]. Freepik. https://www.freepik.com/free-photo/expressive-young-girl-posing-studio_13768487.htm

Miller, C. (2025, February 4). Pathological demand avoidance (PDA) in kids. Child Mind Institute. https://childmind.org/article/pathological-demand-avoidance-in-kids/

National Autistic Society. (n.d.). Demand avoidance. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance

O’Nion, E., Gold, J., Christie, P., Gillberg, C., Viding, E., & Happe, F. (2015, July 30). Identifying features of ‘pathological demand avoidance’ using the diagnostic interview for social and communication disorders (DISCO). Eur Child Adolesc Psychiatry,25(4), 407-419. 10.1007/s00787-015-0740-2