Pathological Demand Avoidance
It’s important to start off by acknowledging that Pathological Demand Avoidance (PDA) is not an official diagnosis found in the Diagnostic and Statistical Manual (DSM) in the USA. Since the late 1980s, this was a moment within the UK for parents with children with Autism. It wasn’t until the 2020s until this really crossed the pond over into the US. When I speak with parents who have a young adult with Autism, it’s more common than not that those parents also ask me if I’m familiar with PDA. Yes, I’m familiar with it, and I’m also familiar how it’s not necessarily indicative of this being the accurate diagnosis for that young adult. Sometimes it absolutely does align. Most of the the time though, it’s questionable.
This would be like me sending an email to all my ex-colleagues telling them I’d learned I was allergic to spruce trees and that why I always had trouble breathing near fires on the job. True story. Was I ever actually tested for an allergy to spruce trees? No. Did I get excited when I theorized that something I learned made something in my past make sense? Sure did. I don’t deny that you get relief from learning something new and connecting it with what you’ve known. The concern is that we’re potentially over-self-diagnosing, and we’re focusing on the behaviors, not what’s at the core causing it all.
It's important to talk about common signs for what people would connect with PDA before we jump into the “how to help” parent of this article. Here are some common struggles:
First, the types of “demands” fall into three main categories: direct, internal, and external. Within those categories, are more sub-categories that I won’t dive deeper into. If you want to learn more, feel free to use Google and look up PDA.
A common response, no matter the type of demand, is that a young adult will go to extreme lengths to avoid or refuse a request from an external (or authoritative) party (i.e. parents). This can look like delay tactics, falling on the ground, distractions, saying body parts don’t work, escaping, negotiating, and some dangerous behaviors (i.e. threats of suicide). It will look different if you are dealing with a child. With a young adult, this can also fall into the category of a highly dependent young adult, failure to launch, or stuck situation. No matter, this young adult is riddled with anxiety to the point that they cannot even have a conversation about the idea of moving out, let alone take steps to move out. So the best way to support this young person is for the parents to learn different ways to speak to their loved one to help decrease anxiety.
To recap, when a family contacts me who has a young adult with Autism, my first wave of support or recommendations will be for the parents. They’ll ask me to make sure I connect them with an expert in PDA, just for good measure. Diving right into parent coaching, they will learn more about parenting a young adult with Autism and Anxiety, and how we help them transition out of the home and motivate to live an independent (or interdependent) life. If there is a need for therapeutic support for the young adult because their dangerous behaviors that level of care, we will get to that down the line. For now, it’s about helping the parents shift from their current pattern of parenting, regardless of PDA. And knowing that the young adult has historically rejected direct or external demands, the journey to helping them move out of the home will be a marathon not a sprint.
For questions or comments contact Joanna.
