Understanding Persistent Demand Avoidance (PDA): What Families, Adults, and Clinicians Should Know

At The Refuge, we work closely with neurodivergent individuals and their families, which means we often encounter presentations of autism that don’t fit the traditional picture. One profile that has received growing attention is Persistent Demand Avoidance (PDA), sometimes referred to as Pathological Demand Avoidance. While not yet a formal diagnostic category in the DSM-5 or ICD-10, PDA is increasingly recognized as a distinct profile within the autism spectrum by clinicians, researchers, and advocacy groups.

What is PDA?

Persistent Demand Avoidance is characterized by an extreme resistance to everyday demands and expectations. This avoidance is not simply oppositional or defiant behavior. Instead, it is driven by an underlying need for control, anxiety regulation, and nervous system protection. Individuals with PDA often experience demands—even simple ones like “please put on your shoes”—as threats to their autonomy, leading to a fight-flight-freeze response.

Clinical Example: A child with PDA might respond to the simple request, “Please put on your shoes,” with a meltdown, humor, distraction, or outright refusal. What looks like defiance is often a dysregulated nervous system signaling that even a small request feels overwhelming.

Relational Example: A partner might ask, “Can you take out the trash tonight?” and the adult with PDA, feeling pressured, might immediately change the subject, joke, or become defensive. The partner may interpret this as unwillingness or avoidance of responsibility, when it is actually an anxious response to perceived loss of autonomy.

Key Features of PDA

• High levels of anxiety that drive avoidance

• Surface sociability—individuals may appear socially skilled but often struggle with deeper social understanding

• Intense need for autonomy and control

• Sudden mood shifts linked to perceived loss of control

• Use of social strategies (humor, distraction, negotiation) to avoid compliance

• Extreme reactions when pressured or when avoidance strategies fail

  
  

PDA in Children

Children with PDA often display:

• Resistance to ordinary requests (getting dressed, brushing teeth, completing schoolwork).

• Use of humor, distraction, or negotiation to avoid tasks.

• Meltdowns or shutdowns when pressured.

• A deep need for flexibility and choice in their daily routines.

Clinical Example: A parent might ask their child to get ready for school. Instead of complying, the child suddenly insists on a game, pretends to be sick, or begins a tantrum. The avoidance is not willful disobedience but a way of coping with intense anxiety triggered by the demand.

Relational Impact: Parents and caregivers of children with PDA often report feeling exhausted, isolated, and misunderstood. Traditional parenting strategies like strict boundaries or behavior charts can backfire, escalating avoidance and distress. Instead, families benefit from approaches that prioritize collaboration, flexibility, and relationship-building over compliance.

PDA in Adults and Relationships

While PDA is most often discussed in the context of children, many adults live with PDA traits—sometimes without ever having a name for their experiences. In adulthood, demand avoidance may show up as:

• Difficulty with workplace expectations, deadlines, or hierarchical authority

• Struggles in partnerships, especially if a partner perceives avoidance as rejection or lack of commitment

• High stress in parenting roles, where everyday demands can feel overwhelming

• Cycles of burnout and withdrawal, followed by bursts of high productivity or relational engagement

In intimate relationships, PDA can create unique challenges. A partner may feel dismissed or neglected when requests are consistently avoided. The person with PDA may experience deep shame for not being able to meet expectations, even when love and commitment are present. This cycle can lead to misunderstandings, conflict, and distance if the PDA profile is not understood.

Relational Example in Couples:

• Scenario: One partner says, “Let’s plan our weekend together.”

• Partner with PDA Response: They might suddenly feel overwhelmed, change the topic, or say, “I don’t know, why are you always pressuring me?”

• Impact: The other partner may feel rejected, unloved, or that their needs aren’t being valued.

• Therapeutic Reframe: What’s happening is not lack of care—it’s a nervous system flare-up in response to perceived pressure, even if the request is neutral.

Additional Impacts on Relationships:

• Difficulty following through on commitments can create tension.

• Avoidance of conversations about finances, intimacy, or conflict may feel like emotional withdrawal.

• A cycle of pursuit and retreat can emerge, with one partner pushing for clarity and the other pulling away to regulate.

Relationship support for PDA often focuses on:

• Open, compassionate communication around needs and triggers

• Creative negotiation that honors autonomy for both partners

• Reducing pressure-based interactions and finding collaborative ways to share responsibilities

• Therapeutic interventions that address underlying anxiety, trauma, and relational dynamics

Recognizing PDA in adults not only provides self-understanding but can also deepen compassion in relationships, shifting the focus from blame to shared problem-solving.

Supporting Individuals with PDA

At The Refuge, we emphasize:

• Safety and trust first – creating environments where individuals feel secure and not coerced

• Reducing unnecessary demands – allowing choice and agency whenever possible

• Using indirect language – phrasing requests as invitations or options rather than commands

• Emotional regulation support – helping clients notice early signs of anxiety and practice self-soothing strategies

• Family and couples coaching – guiding partners and caregivers in adapting communication, pacing, and expectations

Why PDA Awareness Matters

Many individuals with PDA are misdiagnosed or misunderstood. They may be labeled as “difficult,” “defiant,” or “manipulative,” which only deepens shame and isolation. Recognizing PDA as a profile of autism helps shift the lens from blame to compassion, paving the way for interventions that actually work.

Final Thoughts

At The Refuge Marriage and Family Therapy, we are committed to neurodiversity-affirming care. This means honoring the lived experience of individuals with PDA and supporting families, couples, and individuals with practical tools rooted in empathy and collaboration. While PDA may present unique challenges, it also offers opportunities to rethink how we approach demands, autonomy, and relationships in ways that nurture resilience and connection.

If you are parenting a child who may fit the PDA profile—or if you are an adult who resonates with these traits—you are not alone. Reach out to us to learn more about how therapy can support your journey.