Rethinking Pathological Demand Avoidance

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A parent came into my office recently seeking help for her 12-year-old son.

“I don’t know why everything with him has to be such a fight. He argues with everything I ask him to do, no matter how small. Every morning when I wake up, I have no idea what terrible thing will happen. From the minute I wake him up for school until he finally goes to sleep at night, everything in between is a living hell for our family. His brother and sister do what we ask; why can’t he? It makes no sense. I’ve read up on PDA, and I’m here to see if he can be evaluated for it because I’m sure he has it.”

What Is Pathological Demand Avoidance?

The term pathological demand avoidance (PDA) was coined in the 1980s by British developmental psychologist Elizabeth Newson, who worked with autistic children. She used the term to describe what she believed to be a subtype of autism marked by an extreme and persistent resistance to everyday requests, which did not fit the typical presentation of autism.

The Rise of PDA Awareness

The concept of PDA did not gain much traction within the mental health community. It wasn’t included in my graduate textbooks, and there were no questions about it on my licensing exam. However, around 2010, PDA rapidly spread via social media within autism parenting communities.

Parental Struggles and Social Media Influence

It’s understandable how this might happen. Exhausted parents trying to raise a much more difficult-to-parent child were desperately trying to understand what was going on and find some relief from their daily chaos. PDA is typically described as a biologically based disorder, and so many parents are comforted by the idea that PDA represents a neurological difference, not something caused by their parenting. I agree with this.

Platforms like TikTok and Facebook allowed parents to share personal experiences and discuss approaches that seemed helpful for their highly demand-avoidant children. However, many of these strategies lack scientific grounding, and a cottage industry of parent “coaches” has arisen to monetize PDA by offering “solutions” such as so-called low-demand parenting.

Controversies Surrounding PDA

PDA is highly controversial for several reasons. It is not a formally recognized mental health diagnosis, but I believe that is the least of its problems. More importantly, although research on PDA has increased, much of it is of low quality, often relying on samples of children whose parents have already identified them as having PDA, which introduces the possibility of strong biases into the studies’ conclusions (Green, 2020).

Expansion Beyond Autism Parenting Communities

An additional source of controversy is the expansion of the PDA concept outside of autism parenting communities into other parent groups whose demand-avoidant children have different diagnoses. It is becoming common to see PDA proposed as an explanation in support groups for parents of children with attention-deficit disorder, disruptive mood dysregulation disorder, oppositional defiant disorder, intermittent explosive disorder, and even major depressive disorder. For example, in a support group for parents of teenagers with major depressive disorder, someone recently suggested PDA as the explanation when a teenager stopped going to school.

The Role of Anxiety and Alternative Theories

Another major controversy concerns the supposed underlying issue driving demand avoidance. The dominant narrative, originating in the parent autism community, is that anxiety fuels the resistance to demands. There is some recent empirical evidence suggesting that anxiety may play a role (see Johnson & Saunderson, 2023), but this is far from an established certainty. Compelling counterevidence exists. For instance, Malik and Baird (2018) argue that cognitive inflexibility is a core feature of PDA, and other research suggests that PDA is less correlated with autism than it is with attention-deficit/hyperactivity disorder, emotional instability, and antagonistic temperament (Egan et al., 2020).

Clinical Observations

In my more than 40 years of clinical experience working with at least a thousand neurodivergent children and their families, my observations do not support the anxiety-driven PDA hypothesis. Many PDA-identified children refuse adult requests without showing signs of anxiety. Typically, their demeanor is matter-of-fact when declining to comply (“No, I’m not doing that, and you can’t make me”). When adults persist, children's responses often shift rapidly to anger—likely an adaptive function to get parents to withdraw their requests. When parents stop asking, the anger dissipates, a clear example of the parent’s behavior being negatively reinforced.

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Anxiety as a Byproduct

If future research confirms that anxiety plays a role in demand avoidance, I suspect it will be as a byproduct of chronic conflict with loved ones and authority figures, rather than a primary driver. Living in what feels like a daily war zone is likely to generate anxiety in both children and parents. I bet everyone in the system quickly gets anxious when a kid is asked to do something, given how badly that’s gone for the family in the past.

Definitional Challenges and Treatment Recommendations

When PDA discussion became prevalent in the parent autism community, I suspect many parents were unaware that demand avoidance is common among children with various mental health conditions. What is now called “demand avoidant” has long been described by psychologists as “oppositional” or “noncompliant,” and there are established evidence-based treatments for such behaviors. Parents in this community insist that PDA is distinct from other oppositional presentations, but there is currently no research evidence to support this claim.

These evidence-based treatments do not include the low-demand parenting approaches popularized by social media influencers, most of whom have little to no psychological training. Currently, there is no scientific support for low-demand parenting, although that may change with future research. Critics argue that while it may reduce short-term conflict, it could cause long-term harm by failing to prepare children for adult life in a more demanding world.

Evidence-Based Approaches

As Victoria Grahame and colleagues (Grahame et al., 2020) suggest, if PDA is fueled by intolerance of uncertainty or of being controlled, effective treatment should include opportunities for children to gradually build tolerance for both through repeated practice and success.

Children can only improve their ability to cope with control and demands by being placed in situations that require mastering these essential life skills. Part of growing up involves learning how to effectively deal with external control; anyone who’s worked a job knows the importance of this. Furthermore, treatment should not involve reducing conflict in families at all costs. Instead, it should include reducing conflict while still maintaining age-appropriate expectations (“demands”).

Conclusion

Ultimately, it probably doesn’t matter that much if we give PDA its own name and diagnostic classification or if we just stick with the word oppositional as we have for decades. Either way, we can agree that demand-avoidant kids exist, and that the task is to use science and common sense to figure out how to best help these struggling families.

In the end, I don’t think that the mom who came into my office asking for help is going to care much about whether PDA is its own “thing” or not. She just wants to know what to do about it.