The PDA Enigma: Unravelling the Paradox
- Amelia Loveland
- Oct 1, 2025
- 33 min read
Updated: Dec 18, 2025
Understanding the Need for Autonomy
(The Extended Version)
Abstract
Pathological Demand Avoidance (PDA), also known as Extreme Demand Avoidance (EDA), is one of the most complex and misunderstood aspects of neurodivergence. This comprehensive analysis explores the multifaceted nature of PDA, examining its neurobiological foundations, diverse presentations across populations, and its profound impact on individuals, families, and educational systems. Through an examination of personal narratives, clinical research, and evidence-based interventions, this paper argues for a fundamental paradigm shift in how we understand and support individuals with PDA—moving from compliance-based approaches to autonomy-affirming strategies that recognise the legitimate neurological basis of demand avoidance behaviours.
Section 1: Defining PDA
Understanding Pathological Demand Avoidance: a Neurobiological Profile
Pathological Demand Avoidance (PDA), also known as Extreme Demand Avoidance (EDA), describes a complex neurobiological profile typically associated with the autism spectrum, although it can manifest in other neurodivergent individuals (O’Nions, Christie, et al., 2014). The terminology has evolved significantly, with many advocates and researchers now preferring “Pervasive Drive for Autonomy”—a neurodiversity-affirming descriptor that captures the underlying neurological motivation without pathologising the individual’s differences (Newson, 2003).
Historical foundation
Professor Elizabeth Newson first conceptualised PDA in the 1980s at the University of Nottingham’s Child Development Research Unit. Her groundbreaking observations revealed a distinct group of children whose behavioural patterns defied existing diagnostic categories, sharing an intense, pervasive resistance to everyday demands and requests. Crucially, Professor Newson discovered that traditional autism interventions were not only ineffective for this group but often intensified their distressing behaviours. (Newson, 2003; O’Nions, Viding, et al., 2014)
The core paradox
At its essence, PDA involves an unconscious, pervasive resistance to perceived expectations—not simple defiance or disobedience. This resistance operates as an almost obsessive drive to avoid any social or daily demand, even for activities the individual genuinely wants or needs to pursue. (O’Nions, Viding, et al., 2014)
The fundamental paradox emerges here: individuals with PDA may desperately desire to engage in specific activities yet find themselves physically and emotionally unable to comply when those same activities become framed as expectations or demands (Newson, 2003). This creates a profound internal conflict between desire and neurological capacity.
Beyond behavioural explanations
This resistance represents far more than a behavioural choice or personality trait. It constitutes a neurobiological imperative—an instinctive drive toward autonomy and self-determination that operates as the brain’s attempt to restore equilibrium in environments perceived as threatening or beyond personal control (Stuart et al., 2020).
Understanding this neurological foundation is crucial for developing effective support strategies and moving beyond punitive, compliance-based interventions that can prove not only ineffective but actively harmful to individuals with PDA (Gore Langton & Frederickson, 2016a).
Section 2: The Neurobiological Foundation
The Anxious Brain: Understanding PDA’s Neurobiological Core
The neurobiological foundation of PDA centres on a hypersensitive threat-detection system that perceives demands as direct challenges to autonomy and survival (Kildahl et al., 2021). This understanding transforms how we interpret and respond to PDA behaviours, revealing them as neurological responses rather than conscious choices.
The threat response mechanism
When an individual with PDA encounters a demand — whether from outside (for example, "Please wear your shoes") or from within (for instance, feeling hungry) — their brain activates its threat detection process before they have consciously considered it (Christie, 2007). This subcortical response is primarily centred in the amygdala and views all demands as potential threats to self-determination and control (Stuart et al., 2020).
The brain responds as if there were actual survival threats, activating the same neural pathways that would be activated in life-or-death situations (Brede et al., 2017). It is for this reason that what may seem to others to be trivial requests may elicit extreme physiological and emotional reactions — the nervous system literally views these situations as emergencies that require immediate defence actions.
In terms of response:
Fight
Engaging in arguing, negotiation or opposition to a demand or perceived loss of autonomy. These are attempts to exert control over the environment in response to a perceived threat. In the case of PDA, this can lead to explosive meltdowns or absolute refusal to comply with a request (Porges, 2022).
Flight
Physically or emotionally withdrawing, avoiding behaviours (for example, procrastinating, distracting oneself), or shutting down to avoid the demand. Flight is a primary coping mechanism used to escape the perceived threat of a demand. When seen through the lens of PDA, this behaviour manifests as continually changing the subject of conversation, "forgetting" a request, or physically leaving the room to escape the request. The neurobiological drive behind this behaviour is an instinctual need to save energy and avoid perceived danger (Newson, 2003).
Freeze
Being "frozen," being unable to take action, or respond to a request, typically as a result of being overwhelmed by a perceived threat/demand. This state is a primitive, evolutionary defensive strategy where the body becomes "frozen" (plays dead) when fighting or fleeing is either not possible or will cost too much (O’Nions, Viding, et al., 2014). The person knows what they want to do, but is physically paralysed by the overwhelming nature of the threat/demand collision.
Fawn
Complying at excessive levels, trying to please others, and/or hiding/masking one's own needs and boundaries to avoid conflict or make demands less threatening. By doing so, the person is attempting to neutralise the perceived threat by becoming less threatening themselves. For many individuals with PDA, this type of masking is exhausting and can eventually lead to severe internal distress and burnout (Brede et al., 2017).
The neurochemical landscape
Several key neurochemical factors contribute to the PDA profile (Stuart et al., 2020):
Stress hormone dysregulation
Chronic activation of the HPA axis leads to elevated cortisol levels. Cortisol has many functions, including mood, sleep, immune response, and cognition. Elevated cortisol can lead to persistent hyperarousal and stress, affecting an individual's ability to respond to the demands of everyday life and maintain emotional homeostasis. (Kildahl et al., 2021)
Dopamine and reward processing
Altered dopamine function may be one of the underlying reasons PDA individuals have such difficulty motivating themselves to undertake tasks that do not inherently provide a sense of satisfaction or reward. It may also account for their difficulty starting or completing tasks they perceive as externally driven or forced upon them by others. (Marotta et al., 2020)
GABA and inhibitory control
Alterations in the GABAergic systems may impair the ability to regulate anxiety and establish emotional homeostasis. As a result of this impaired functioning, the ability to inhibit stress responses, calm oneself, and control impulses may be reduced. (Cellot & Cherubini, 2014)
Serotonin regulation
Aspects of an individual's serotonin system may be out of balance and affect their mood, anxiety level, and ability to regulate their emotions. An adequate serotonin system is necessary for maintaining feelings of well-being, and alterations in serotonin function may explain some of the emotional dysregulation associated with various complex behavioural patterns. (Marotta et al., 2020)
The autonomy imperative
This neurobiological understanding reveals PDA as a disability of autonomy regulation rather than willful defiance (Stuart et al., 2020). The brain’s primary concern becomes self-preservation through maintaining control, overriding rational thought processes and voluntary behavioural responses.
This constant neurological drive for autonomy creates the distinctive constellation of characteristics that define the PDA profile, forming a coherent pattern when viewed through this neurobiological lens rather than as separate behavioural issues (O’Nions, Viding, et al., 2014).
Section 3: Masking and Hidden PDA
The Hidden Struggle: Understanding Masking in PDA
Masking has become an essential aspect of the PDA profile that, on occasion, hides the PDA condition from external observers, yet creates substantial, long-term distress for the individual (O’Nions et al., 2021). The social adaptations of masking are dual-function; first, they serve as a protective barrier against inappropriate or excessive demands; second, they create prisons that limit our ability to express ourselves authentically and to access our actual needs (Duncan et al., 2021).
Masking allows us to meet society's expectations while suppressing our genuine needs at the neurological level.
Mechanisms of masking in PDA
Masking in PDA occurs in several ways simultaneously:
Conscious mimicry
Conscious mimicry is when individuals deliberately imitate typical behaviours and reactions of non-autistic individuals to adapt to social environments and avoid being noticed or having specific demands placed on them. It involves the intentional creation of socially acceptable body language, speech patterns, and emotional states to simulate such behaviour. (O’Nions et al., 2016)
Therefore, it may not replicate how individuals feel or think on an internal level. People who are conscious about their imitation are typically hiding their autistic traits and therefore have less opportunity for social conflict and social anxiety caused by the high cognitive load of identifying social norms and expectations.
Unconscious adaptations
Unconscious and automatic responses to environmental cues (people, etc.) are based upon past learning and coping mechanisms.
Although these adaptations may seem to require less effort than conscious imitation, they still reflect the individual’s need for safety and social acceptance. These adaptations can be so automatic that the individual may be unaware they are employing them, making them difficult to unlearn. (Porges, 2022)
Strategic performance
This refers to the advanced and strategic use of social skills and identity to either deflect requests, navigate social situations, or maintain relationships.
Strategic performance also includes planning social encounters and using learned "personas" or "scripts" to project a specific image to others (for example, being cooperative or competent).
Strategic performance is a deliberate, laborious process primarily intended to shape how others perceive an individual. As such, it can be particularly draining for the individual who is strategically managing their perceived identity in relation to the external world. (Newson, 2003)
Identity suppression
Identity suppression (also referred to as "concealment of thoughts, feelings, and expressions of self") is defined as the continuous concealment of a person's authentic thoughts, feelings and responses to meet societal expectations for conformity and normalcy. Identity suppression extends far beyond outwardly observable behaviour, and can involve concealing core elements of one's personality and internal reality. In doing so, identity suppression can lead to a profound disconnect between a person's internal reality and their outward expression.
Additionally, the chronic act of identity suppression can contribute to significant mental exhaustion due to the constant, prolonged suppression of one's natural inner experiences. (Haire et al., 2024)
The Jekyll and Hyde effect
This constant performance creates what many families recognise as the “Jekyll and Hyde” phenomenon (Duncan et al., 2021). Individuals may appear remarkably composed, compliant, and capable in public settings—schools, workplaces, or social gatherings—while experiencing intense emotional dysregulation, meltdowns, or shutdowns in the safety of home.
This pattern creates cascading challenges:
Parental confusion
Parents who have children with Demand Avoidance experience an inner conflict when trying to reconcile what they see as their child's public capability with the private distress they witness in their child. The parents experience a lack of belief by others when describing the intensity of their child's meltdown and demand avoidance behaviour, which can lead to feelings of self-doubt and isolation. These internal conflicts also make it difficult for parents to apply strategies to help their child consistently. (Duncan et al., 2021)
Professional misunderstanding
Healthcare and education professionals may minimise families' concerns or attribute issues at home to how parents are raising their children. Professionals may miss that the significant amount of anxiety and avoidance being managed by the child is occurring at home; they will see the child as cooperative and compliant in public, structured environments. (Newson, 2003)
Misunderstanding can delay the identification of a problem and the selection of an appropriate intervention for the child.
Delayed recognition
Masking prevents professionals from seeing the hidden needs of a child that would have been apparent earlier, thereby delaying the provision of help and interventions. While a child may appear to “be okay” during the day at school or during sessions with a therapist, this ability for them to “put on a good face” while hiding their actual needs can cause a professional to miss or inaccurately diagnose a child’s specific set of needs as being strictly behaviorally based.
The longer the time frame between when a child begins to experience difficulties and when they receive proper diagnosis and treatment, the longer the child will continue to experience the emotional and mental distress and the longer the child’s anxiety and avoidance behaviours will develop and solidify. (Newson, 2003)
Relationship strain
When a child presents differently in public than they do at home, it creates stressors that affect family relationships and trust. Siblings and parents alike experience the adverse effects of this stress; parents are left with feelings of burnout and guilt and have to "walk on eggshells" at home while constantly managing their child's changing presentations, which ultimately harms the family unit's harmony and parents' confidence. (Gore Langton & Frederickson, 2016b)
The psychological cost
The sustained effort required to maintain a neurotypical facade exacts a severe psychological toll:
Chronic exhaustion
This depletion of the body's resources from the constant act of being mindful of social signals and naturally suppressing impulsive behaviours leaves an autistic person in a state of severe and all-encompassing exhaustion referred to as "Autistic Burnout". This exhaustion is more than just tiredness. It is a complete functional collapse, in which an autistic person will lose skills that they have learned previously, and be unable to cope with their environment (be it sensory or social), therefore needing extended periods of recovery to regain their functioning. (Raymaker et al., 2020)
Identity confusion
When an individual's life is comprised primarily of wearing a mask for protection or social approval, the line separating the true self from the 'mask' (the outward appearance) that has been developed begins to disintegrate. The resulting fragmentation will create a profound sense of isolation when individuals are unable to discern what they like/dislike as an individual versus the social pressures placed upon them. In addition, this disintegration will isolate their physical needs, which others' outward expectations may compromise. (Miller et al., 2021)
Mental health vulnerability
Masking is linked with higher rates of mental health issues, such as severe clinical depression and anxiety disorders. Due to the need for individuals to continuously suppress their emotions and experiences of sensory overload while trying to pass as neurotypical, masking can create an extremely stressful situation that puts them at a greater risk for suicidal ideation and other forms of psychological distress than others who camouflage less often. (Cassidy et al., 2020)
Emotional dysregulation
When one tries to suppress all emotional and sensory responses to the environment they are forced to interact with due to social pressures, this suppression creates internal pressure that will eventually find a way to release. Many people exhibit what has been called "the Coke bottle effect". They seem calm and compliant while interacting within environments that demand compliance (such as schools or workplaces). Still, once they feel safe enough to remove themselves from these situations, they may melt down or become unresponsive (shut down). (Brede et al., 2017)
Internalised PDA: the invisible presentation
For many individuals, particularly those socialised toward compliance, PDA manifests internally rather than through obvious external resistance.
This internalised presentation includes:
Passive Resistance
Instead of directly saying no, the individual can use passive resistance (such as negotiating, procrastinating, etc.) so they feel some level of control over the situation; this could be seen in the form of creating distractions, pretending that you are unable to do something, or simply walking away from the issue at hand - all of these examples allow the individual to avoid a face-to-face refusal but also protect their autonomy. (Newson, 2003)
Selective engagement
While many individuals demonstrate significant focus and capacity in areas that interest them personally, they can be unable to accomplish the very same work when it is viewed as a mandate by an outside entity. The difference here is not a lack of ability; rather, it is the inability to self-govern. A person's will to do their best work is only activated internally through an intrinsic flow state; therefore, it is never possible with an external mandate. (O’Nions, Viding, et al., 2014)
Perfectionism
PDA is inherently intolerant of the unknown that accompanies uncertainty. This results in individuals with PDA having an excessive need for total control over outcomes, which ultimately leads to crippling levels of perfectionism; if a task can't be done perfectly (and therefore provides safety and control) then the fear of failing will become an expectation unto itself and the fear of this outcome will cause the person to refuse to begin the task to avoid the emotional pain of creating an imperfect product. (Stuart et al., 2020)
Physical manifestations
The distress in the nervous system caused by an individual suppressing their fight or flight response so that they can behave appropriately for social reasons, is usually experienced as physical symptoms such as chronic headaches, nausea, digestive problems, and fatigue; all of which are ways the body communicates a 'stop' signal when the brain cannot verbally communicate refusal of a request, because of social pressures. (Brede et al., 2017)
Dissociation
When the immediate threat of a pressure-filled situation makes it clear that you cannot leave the problem, your brain may initiate an emergency response called "shutting down," which will cause a disconnection from the immediate world by utilising as few of your available mental resources (cognitive) as possible. Daydreaming, freezing or becoming unresponsive are all examples of what this looks like to others, but the reality is your conscious self has left the scene. At the same time, your body remains, even though you may be unable to remove yourself physically. (Kildahl et al., 2021)
The over-compliance trap
This is a typical trauma response where individuals are overly accommodating (often referred to as 'the fawn' response) because they will suppress their own desires to anticipate and prevent harm or conflict with others. What teachers and supervisors might see as success can be seen by many as an overactive coping mechanism driven by fear of injury. This type of excessive anticipation and vigilance leaves the individual disconnected from both their body and mind, eventually depleting those areas of cognitive reserve. Then, when the individual experiences too much stress at once, they experience an extreme form of what has come to be referred to as Autistic Burnout. (Pearson & Rose, 2021)
Recognition and response
Helpful support creates an environment of "autonomy support," rather than behavioural modification—often a way to encourage the wearer of masks to engage in the potentially damaging practice of “masking.” An autonomy-supportive environment will reduce the number of non-essential requests made of the individual and allow the individual to have some degree of control by recognising and validating the individual’s need to control the situation. Reducing this baseline anxiety minimises the threat response; therefore, the priority of support should be creating a safe, psychologically safe environment rather than requiring the individual to conform. This creates an environment where the individual can remove their defensive mask and interact at their own discretion. (Cage et al., 2018)
Section 4: The Low-Demand Framework
Standard behavioural interventions, which rely on positive reinforcement or punishment, do not work with PDA because they create an additional source of pressure to comply with a request and/or elicit the fight/flight response. Instead, this model identifies ways to minimise the number of stressors (e.g., how much you are looking at someone; how loudly you are speaking; whether you ask them questions directly) in the person's environment to maintain a regulatory state within the nervous system. The focus is therefore changed from compliance to collaboration/trust. This shift enables individuals to create a safe environment before engaging in conflict and to participate based on their own desire to collaborate. (Gore Langton & Frederickson, 2016a; Kildahl et al., 2021)
Core Principles in Action
The framework operates through six essential principles designed to reduce nervous system activation and honour neurological differences:
Minimise demands strategically
Demand dropping, or simply drastically reducing the amount of day-to-day directives (often referred to as "demand dropping") creates a buffer of available cognitive capacity and allows caregivers to provide a buffer of mental energy so that individuals can save their limited reserve of coping capacity for truly obligatory activities rather than socially expected ones. The caregiver also assesses the demands of each activity to determine which are necessary and must be completed, as opposed to those that are merely based on social expectations. (Gore Langton & Frederickson, 2016a)
Timing matters
Supporting an individual effectively depends upon observing their window of tolerance; asking for something from someone who has been dysregulated or in hyper-focus results in a threat response; successful engagement is based upon waiting for a moment of calmness/receptivity and recognising a demand made at the wrong time is as unmet (functionally) by that individual regardless of their capacity to perform the task theoretically. (Stuart et al., 2020)
Question everything
Continuous reflective practices occur among adults who continually question the legitimacy of each rule they enforce. The caregiver will ask themselves (and the PDA individual) whether the demand being made is necessary for safety, or if it is simply a habitual part of the culture from which they have come. When caregivers reflectively consider this type of question, they can identify unnecessary obstacles and show the PDA individual respect for his autonomy, which, in turn, promotes increased cooperation on issues important to the caregiver. (Christie, 2007)
Empower through choice
Offer genuine options whenever possible, even in constrained situations.
Create choice within structure
Offering specific choices rather than vague requests that could overwhelm an anxiety-prone mind helps the PDAer feel in control by allowing them to make decisions based on a set of guidelines or structure, thereby reducing perceived threats. This technique is commonly referred to as giving "structure with autonomy." For example, “Would you like to brush teeth before or after putting on pyjamas?” (Christie, 2007)
Honour preferences
Genuine Autonomy is defined by the availability of actual options and an expectation of respect for an individual's choice, regardless of whether their choice is in line with the caregiver's preferred outcome. The fact that the caregiver has overruled a choice they had previously made available will reinforce the individual's belief that the trustworthy source of control is still being withheld, leading to distrust and a heightened, defensive (vigilant) response by the nervous system toward future choices. (Stuart et al., 2020)
Build autonomy gradually
While the nervous system settles and a growing sense of safety in the environment develops, the scope of decisions one makes can expand to include more challenging or important life decisions. This will help build confidence, self-regulation, and safe navigation in the world, without creating "decision paralysis." (Kildahl et al., 2021)
Communicate indirectly
Replace commands with observations
Using declarative language, or stating facts about the environment (for example, "the bin is full"), this method does not give a command (for example, "empty the bin"), it allows the person to problem solve of their own free will as opposed to being in an automatic threat response when they perceive someone trying to take control of them. For example, “I notice the dishes need washing” instead of “Go wash the dishes”. (Christie, 2007)
Use collaborative language
The use of phrases such as "I wonder if...," or "How might we..." can be an effective way to transform the relationship from a hierarchical adult-to-child, to a horizontal co-partner. When you use this type of language with your child, it is an indication to their PDA nervous system that they are safe, and will have input in what happens next; thus, transforming a possible command into a collaborative question, or problem-solving exercise for them to engage with intellectually, rather than defensively. (Gore Langton & Frederickson, 2016a)
Embed requests in conversation
Delivering a request through silence (or "spotlight") is generally seen as being much more critical and threatening than if you had offered the same request with some form of humour or embedded in conversation. As such, embedding the expectation within the flow of a conversation or presenting it in a humorous/novelty format will reduce the perceived risk and, therefore, the perceived importance of the request. (Newson, 2003)
Respect processing time
PDA individuals tend to have elevated levels of anxiety (or will enter a "freeze" state) as soon as a request is made, which can take considerable time to recover from before they can respond. Applying pressure to a person to provide an instant response can create so much additional stress that it can turn their initial "freeze" into a "meltdown". Conversely, when silence is provided and a safe space is given to them, their Executive Function comes back online, and they begin to complete the task. (Stuart et al., 2020)
Prioritise connection over compliance
Relationship comes first
In the context of PDA, the relationship itself is the primary intervention tool. When the adult breaches trust, the nervous system perceives the adult as a danger, eliminating the ability of the adult and child to work together effectively. By giving priority to the warmth and safety of the relationship (over completing a specific task), this maintains the "social safety system," which allows the individual to be regulated enough to potentially continue with engagement at a later time. (Gore Langton & Frederickson, 2016a)
Validate experiences
When a PDAer resists a demand, in most cases, they are demonstrating their emotional state as being one of anxiety or overload. By recognising and acknowledging their internal reality (“I can see this is really difficult for you right now”) — without attempting to resolve or counteract their feelings quickly — reduces the threat response by showing that the adult is supportive rather than adversarial. (Brede et al., 2017)
Stay curious, not judgmental
The behaviours that appear as defiance, aggression or laziness are typically manifestations of an over-stressed nervous system. The use of a curious perspective ("What is the underlying fear/anxiety causing this reaction?") instead of "How can I eliminate this behaviour?" allows the support individual to address the foundation (the need for safety/control) rather than punish the surface-level manifestation. (Kildahl et al., 2021)
Repair when needed
High-stress situations can produce friction in any relationship; however, when you're trying to make a demand in that relationship at the same time that it's under stress, the resistance to the demand can become even greater. To be effective in supporting others, you have to press pause on whatever you need them to do until your emotional bond has been restored to a place of safety and trust. At this point, their ability to meet your demands will typically follow. (Christie, 2007)
Assess the nervous system state before issuing requests
An effective interaction with a PDAer who may have anxiety or avoid certain situations or transitions begins with a comprehensive and caring assessment of their nervous system. Before requesting anything, before making a transition, before imposing any demand, even what may seem to be low-stakes, it is necessary to take a valid reading of their present physiological and emotional state.
This proactive approach has multiple components.
Observe the physiological state
Note any physical manifestations of dysregulation. Is the PDAer showing symptoms of hyperaroused sympathetic activation (shallow, rapid breathing, fidgety, tight muscles, loud, elevated tone of voice, wide eyes/expanded pupils) or are they experiencing hypoaroused dorsal vagal activation (zoning out, flat face/mouth, withdrawn, slumping, soft or monotonous voice)? Regulated states include relaxed facial and body muscles, slow, even breathing, and active, engaged eye contact.
Acknowledge the context
Consider the most recent stressful event(s) or previous situation(s) that occurred before your encounter with the person. Was the person recently interrupted from a desired task? Has there been a previously identified stressor in the surrounding environment (noise, lighting, change)? Both recent and prior environmental and contextual factors directly influence the state of the nervous system.
Prioritise co-regulation
If a PDAer is in a clear state of high arousal or collapse, it is almost assured that introducing an expectation will elicit resistance or complete shutdown. Therefore, the primary goal is to establish co-regulation. Co-regulation can be achieved in many ways, including lowering your vocal tone, speaking slowly, providing gentle deep pressure (where possible), modifying the environment (lowering light levels, decreasing ambient noise), or merely being a calming presence without words. Once a minimal level of safety and regulation has been restored, expectations can be reintroduced with caution.
Safely introduce expectations
Once regulation has been established, expectations can be introduced safely, with the utmost flexibility and minimal perceived threat. This can be accomplished in two ways:
Low-demand language: Phrase requests as invitations, observations or shared goals instead of non-negotiable demands (e.g., “Let’s go take a look” instead of “Go now”).
Choice and autonomy: Offering choices, control, and independence minimises the perceived power of the outside world, which poses a significant threat to the nervous system.
Ultimately, the state of the nervous system serves as the "gatekeeper" to compliance and cooperation. Ignoring a dysregulated state is like sending a demand to a brain focused on survival, which will inevitably result in an oppositional or avoidance response.
Adapt the environment, not the individual
Modify physical spaces and social expectations
Physiological "demands" (e.g., loud noises, bright light, chaotic environments) in sensory-sensitive individuals can be invisible because they co-occur with PDA; these demands deplete the individual’s ability to cope. Reducing baseline arousal by adapting the environment to create a lower-sensory zone or by eliminating social expectations (e.g., forced eye contact) makes it easier for the individual to initiate tasks. (Gore Langton & Frederickson, 2016a)
Create predictability
Rigidly structured schedules can meet resistance, as they may be perceived as controlling. However, a complete absence of structure can also trigger anxiety due to an "Intolerance of Uncertainty," as the individual struggles to find predictability. The goal is to establish a sense of predictability through "predictable flexibility" to mitigate both issues. (Stuart et al., 2020)
Remove unnecessary pressure
Time limits (i.e., "You have 5 minutes") and performance requirements can function as acute threat stimuli that force a shift of the nervous system to a state of "fight or flight." Removing the "timer" and instead emphasising the task process rather than the task outcome typically enables individuals to perform at their natural pace, with the added benefit of reduced distress during task completion. (Christie, 2007)
Low-Arousal Implementation Strategies
Environmental design
Calm physical spaces
Anxiety in individuals with sensory processing issues is sometimes amplified by their unique way of processing the world. What would be normal to someone else might be overwhelming or even traumatic for the PDA person's nervous system, creating excessive stimuli that increase physiological arousal. Once we create a more comfortable environment (reducing visual distractions such as clutter and bright lights) while also reducing background noise, we can provide our clients with a sense of "sensory safety", which will allow them to regulate their bodies enough to participate. (Gore Langton & Frederickson, 2016a)
Quiet communication
The "Low Arousal" strategy calls for decreasing the volume and intensity of the supporter's voice as the individual's anxiety increases, to reduce the threat response effectively. By speaking in a flat, calm tone, one without the urgency or frustration that signals the amygdala there is a threat, to avoid a meltdown. (Kildahl et al., 2021)
Predictable routines
A rigid schedule could be perceived as restrictive ("a jail") and therefore creates an "autonomy threat", whereas a flexible, unstructured schedule would elicit the "intolerance to uncertainty" (IU). Thus, the aim is for "flexible predictability", i.e., knowing the overall rhythm of the day without creating excessive IU-related anxiety through a strict clock or excessive adherence to a schedule. (Stuart et al., 2020)
Escape options
The "flight" response is a primary safety mechanism; blocking an exit path, whether physical or social, increases panic and forces the brain into "fight" mode. Ensuring the individual always has a known, accessible retreat—whether a physical den or permission to leave a room without question—provides a psychological safety net that, paradoxically, makes them more likely to remain in the environment. (Brede et al., 2017)
Interaction approaches
Non-confrontational presence
Using a neutral body posture or tone when the child approaches you aggressively will help reduce the child's feeling that you are a threat. A child is less likely to escalate into a full-blown tantrum if you avoid fighting over a minor issue and instead lose the small battle to preserve the larger relationship of safety. The relationship can remain a safe base for further interaction. (Christie, 2007)
Patience with processing
The cognitive load from both managing perceived threat/uncertainty and social demand will likely significantly reduce processing speed. By providing an additional pause with no repetition or added pressure, the individual’s executive functioning can catch up in many cases. A “yes” may result from an initial “no” (a panic response) when the brain has assessed safety (Stuart et al., 2020)
Flexible expectations
Capacity in PDA is not a fixed resource. Still, it can vary significantly based on the person's overall level of anxiety, their current sensory load, and their total burnout from all of the stressors in their life. Therefore, a "flexible framework" will allow you to constantly adapt your expectations to the individual's current "battery" level at that moment. On those days when they are experiencing high levels of stress, you would expect less than you would on those days when they can be in control and regulated. (Kildahl et al., 2021)
Collaborative problem-solving
Instead of solving problems at the top of an organisation and thereby inviting a negative response, when individuals are involved in developing a solution for themselves, it creates a link between compliance and choice. The partnership model also honours the self-knowledge of their experiences and fulfils the need for personal autonomy, as the solution is selected by the person rather than imposed on them. (Gore Langton & Frederickson, 2016a)
Implementation Across Settings
Home environment
Morning routines
Mornings are usually when a PDAer’s anxiety spikes, as there is a high concentration of expectations (wake up, get dressed, eat) in a very short amount of time. When using flexible visual tools that allow task ordering to be altered and/or provide “choice time” to help build a sense of direction, it removes the feeling of being marched through a rigidly scheduled morning. It allows them to feel in control of their navigation, reducing the risk of “morning refusal.” (Christie, 2007)
Homework approaches
For a child who has spent all day masking at school, the demand to continue academic work at home often exceeds their remaining cognitive capacity. Shifting the focus from "completing the worksheet" to maintaining a positive relationship with learning—perhaps by scribing for them or exploring the topic via video instead of writing—prevents homework battles from contaminating the safe home environment. (Brede et al., 2017)
Household responsibilities
Direct commands to "clean your room" or "empty the dishwasher" are frequent triggers for the threat response because they feel like imposed servitude. Reframing these tasks as "family contributions" or "helping the team," and modelling the behaviour without demanding immediate participation, often invites genuine collaboration rather than resistance. (Newson, 2003)
Bedtime strategies
Sleep issues in PDA are frequently driven by the "Intolerance of Uncertainty" regarding the loss of consciousness and the loss of control that sleep represents. Prioritising a low-arousal "wind-down" phase over a strict "lights out" time allows the nervous system to settle naturally, reducing the bedtime anxiety that often leads to prolonged insomnia. (Stuart et al., 2020)
Educational settings
Classroom modifications
Traditional classrooms are usually full of stimuli that can be overwhelming for PDA students and quickly deplete the child’s ability to cope with the environment before the first lesson. Modifying the classroom by implementing a quiet area (low arousal) for students to relax, flexible seating options (bean bag chairs, wobble stools, etc.), and scheduled sensory breaks during lessons allows the child to control their body’s response to stress. It therefore prevents an accumulation of stress, which may lead to violent outbursts. (Gore Langton & Frederickson, 2016a)
Assignment adaptations
When students are told "you have to do it this way," it usually creates some kind of opposition, regardless of whether they understand the material. When educators provide a variety of ways in which students can show their knowledge (e.g., creating a video instead of a written paper; selecting one's own topic to research), educators tap into the student's intrinsic desire to be motivated and his/her need for autonomy; by providing options, the educator can turn the command into a student-led project. (Christie, 2007)
Social navigation
Support for students with PDA during unstructured periods, such as recess, should prioritise fostering connections through low-pressure activities, such as a Lego club. This is because free time presents complex and unpredictable peer expectations that can be overwhelming. Rather than focusing on general socialisation, this approach allows the student to engage with other children on their own terms, without the pressure to socialise or "mask." (Brede et al., 2017)
Crisis prevention
Meltdowns are rarely sudden events but the culmination of accumulated pressure, often signalled by the "rumble stage"—subtle physiological shifts like increased fidgeting, verbal sharpness, or withdrawal. Proper prevention requires identifying these individual-specific precursors and intervening with immediate demand reduction and sensory de-escalation before the "point of no return" is reached, rather than attempting to manage the crisis once it has already begun. (Kildahl et al., 2021)
Professional contexts
Workplace accommodations
The traditional workplace can create a "perfect storm" of sensory overload, combined with the rigidity of hierarchical expectations and demands; these are both PDA triggers. Providing accommodations to the individual by creating flexibility in the scheduling of work (i.e., focusing on performance rather than hours worked), or providing options for remote work, will enable the individual to control their surroundings better and manage their energy levels to prevent the rapid development of burnout that is typically experienced when individuals mask in an occupational setting. (Raymaker et al., 2020)
Meeting modifications
Unexpected questions or "on the spot" demands during meetings can trigger the freeze response, making the individual appear disengaged or incompetent. Providing agendas in advance reduces uncertainty (the core PDA trigger). At the same time, allowing written contributions enables the individual to share their expertise without the social-performance pressure of speaking in real-time. (Stuart et al., 2020)
Task management
Break large projects into smaller components with built-in choice points. Large and imposing projects can be daunting and overwhelming at times, creating paralysis in the nervous system. Breaking large, looming tasks into small, individualised, stand-alone tasks and providing choice points (for example, "What do you want to tackle in this report first?") allows individuals to regain autonomy and manage the task by making independent choices. (Christie, 2007)
Communication preferences
Direct, verbal instructions can feel confrontational and harder to process due to the immediate social demand. Honouring a preference for asynchronous communication (email, Slack) or indirect feedback allows the individual to process the information intellectually without the emotional interference of a threat response, leading to greater clarity and productivity. (Cage et al., 2018)
Measuring success
Success in the low-demand approach is measured not by compliance rates but by:
Nervous system regulation
Actual progress is reflected in the biology of the individual—specifically, a shift from a chronic state of fight-or-flight to a "rest and digest" baseline. Success looks like a tangible reduction in the frequency of meltdowns, a faster recovery time after stress, and a decrease in the hyper-vigilance (e.g., constant scanning for threats) that characterises the anxious PDA brain. (Stuart et al., 2020)
Relationship quality
In a PDA context, the relationship is the intervention. Success is marked by the restoration of trust, where the individual no longer perceives the support person as an adversary or a source of demands. This is evidenced by increased spontaneous interaction, a willingness to seek comfort from the adult, and the re-emergence of humour and playfulness in the dynamic. (Gore Langton & Frederickson, 2016a)
Authentic engagement
Compliance is often a mask; authentic engagement is voluntary. Success is measured by the individual initiating tasks or hobbies because they want to, driven by intrinsic motivation rather than external coercion. This shift often results in "deep flow" states and passionate learning, which are far more sustainable and educational than rote obedience. (Christie, 2007)
Self-advocacy development
As safety increases, "challenging behaviour" (which is often a crude form of communication) should be replaced by nuanced self-advocacy. Success is when an individual can say, "I can't do that right now, I'm overwhelmed" or "I need a break", instead of resorting to aggression or shutdown, indicating they understand their own needs and trust that those needs will be respected. (Brede et al., 2017)
Overall wellbeing
The ultimate metric is quality of life, not productivity. Improvements in basic physiological functions—such as deeper sleep, better digestive health, and stable mood—indicate that the chronic stress load has lifted. When an individual reports feeling "safe" and "happy" (even if they are achieving less outwardly), the intervention is working.
Common implementation challenges
“But they need to learn to follow directions”
Long-term agency and mental well-being are very frequently compromised when an organisation prioritises immediate compliance. By developing critical thinking skills, internal motivation rather than rote obedience, and negotiation abilities to interact safely and independently in their environment, we empower individuals to function and thrive in their world rather than create a dependence on others. (Christie, 2007)
“This seems like giving in”
The concept of accommodation as “sacrificing” or "giving in," fundamentally misrepresents the impairment; we would never say a visually-impaired person is lazy for wearing glasses. The low-arousal support provided is an essential prosthetic for a nervous system that views all perceived demands as survival threats, thereby enabling the individual to participate in educational experiences and family life rather than fleeing from both. (Kildahl et al., 2021)
“What about real-world expectations?”
Neuro-resilience does not develop as a result of chronic exposure to excessive stress, which results in a person becoming overwhelmed or traumatised and shutting down. Neuro-resilience develops as a result of gradually building a scaffold — establishing a safe base first, then incrementally increasing the "window of tolerance" as the person becomes increasingly confident and skilful in regulating themselves. (Stuart et al., 2020)
“Other people won’t understand”
The responsibility for creating a new way of doing things will be placed on the neurodiverse individual; that is why we need to advocate for them so that schools and workplaces can evolve in how they think about neurodiversity. To build support plans, educating peers, extended family members and professionals about what it means to have a neurodevelopmental disorder is key to changing the way these individuals are viewed in society, from being judged to being included. (Brede et al., 2017)
The low-demand framework requires patience, creativity, and a willingness to challenge conventional approaches. However, it offers the most effective path toward supporting individuals with PDA in developing their full potential while honouring their neurological differences.
Section 5: The Paradigm Shift
Transforming Understanding: From Compliance to Compassion
The recognition and support of Pathological Demand Avoidance demands nothing less than a revolutionary shift in how we understand human behaviour, neurodiversity, and the fundamental right to autonomy (Milton, 2013). This transformation challenges deeply embedded assumptions about compliance, control, and what it means to support another person’s development and well-being.
The critical reframe: from “won’t” to “can’t”
At the heart of this paradigm shift lies a profound reframe that changes everything: moving from viewing PDA behaviours as willful defiance (“won’t do”) to understanding them as neurological incapacity (“can’t do”) in the face of perceived threats to autonomy (O’Nions, Viding, et al., 2014).
This isn’t semantic wordplay—it’s a fundamental recognition that PDA represents a disability of autonomy regulation, not a behavioural choice (Milton, 2013). Just as we wouldn’t expect someone with a visual impairment to see clearly without appropriate support, we cannot expect individuals with PDA to respond to demands in a typical way without neurologically informed accommodations.
The transformation imperative
Why change is essential, not optional
Traditional approaches don’t just fail individuals with PDA—they actively cause harm. Compliance-based interventions trigger the very threat responses they aim to eliminate, creating cycles of escalation, trauma, and relationship breakdown. (Gore Langton & Frederickson, 2016a)
The stakes couldn’t be higher.
Without this paradigm shift, we risk :
Systematic trauma through repeated activation of threat responses
Identity suppression that disconnects individuals from their authentic selves
Relationship destruction between individuals and their support networks
Missed potential as unique strengths remain unrecognised and undeveloped
Mental health crises stemming from chronic stress and misunderstanding
(Brede et al., 2017)
The Five Pillars of Transformation
Acknowledge the harm of compliance-based approaches
Traditional behavioural models rely on the fear of consequences to shape behaviour, but for a PDA nervous system, this fear is the exact trigger for the fight-or-flight response. Persisting with these methods does not "teach a lesson"; it actively sensitises the individual to trauma, creating a conditioned panic response to authority that creates barriers to learning and severe mental health decline. (Brede et al., 2017)
Old Thinking:
“They need to learn to follow directions like everyone else.”
New Understanding:
Compliance-based approaches trigger neurological threat responses, causing trauma and preventing genuine learning and growth.
Action Required:
Audit current practices, eliminate punitive measures, and retrain professionals in neurodiversity-affirming approaches.
Embrace neurological reality
Labelling PDA behaviours as "manipulative" suggests an intentional decision made at an executive level. In actuality, PDA behaviours are fast-acting, automatic responses to perceived threats of harm, controlled by the Amygdala. The shift in understanding from a "won't" (they can do it) to a "can't" (they cannot help themselves) removes the basis for moral judgments, thereby requiring all stakeholders to be re-educated to view PDA behaviours as distress signals rather than defiance. (Stuart et al., 2020)
Old Thinking:
“This is attention-seeking behaviour or manipulation.”
New Understanding:
Behaviours stem from neurological differences in threat perception and autonomy regulation, not conscious choice.
Action Required:
Educate all stakeholders about the neurobiological basis of PDA and implement support strategies that address underlying neurological needs.
Revolutionise reward and consequence systems
Extrinsic rewards usually fail in PDA as they increase stress (pressure to get the reward) and uncertainty (fear of losing it), whereas 'revolutionising' the system involves eliminating the "stick and carrot" model in favour of an environment that encourages low-stress intrinsic motivation and collaboration with less arousal cost for the nervous system. (Christie, 2007)
Old Thinking:
“Consistent consequences will teach appropriate behaviour.”
New Understanding:
Traditional behavioural systems often backfire, increasing anxiety and resistance while failing to address core neurological needs.
Action Required:
Replace behavioural modification programs with relationship-based, regulation-focused approaches that honour individual neurological differences.
Recognise and cultivate strengths
The extreme need to be independent ("opposition") is, in fact, a driving force behind many of the strengths we see in individuals with PDA, such as leadership, creativity, and a determination to succeed. To adopt a positive, or strength-based, approach, these behaviours need to be viewed as strengths rather than weaknesses. When a PDAer has self-directed motivation and can remain focused on one area of interest (monotropous), they have a greater ability to think creatively and learn deeply than what would be expected from a neurotypical individual. (Milton, 2013)
Old Thinking:
“Focus on fixing deficits and problem behaviours.”
New Understanding:
Individuals with PDA possess sophisticated cognitive abilities, creative problem-solving skills, and unique perspectives that benefit communities.
Action Required:
Identify and nurture individual strengths, create opportunities for meaningful contribution, and value neurodivergent perspectives.
Commit to autonomy-honouring relationships
The PDA person will be resistant and feel unsafe when there is an adult over them (vertical) and they will have a sense of safety and therefore may choose to comply with a request when there is a peer relationship (horizontal). The development of this kind of commitment by adults, involves eliminating their own ego-based need to control others and trusting that the authority is earned by establishing a mutual agreement and protecting the individual’s right to make choices. (Gore Langton & Frederickson, 2016a)
Old Thinking:
“Adults know best, and children/students should comply.”
New Understanding:
Genuine growth occurs through collaborative relationships that respect individual autonomy and decision-making capacity.
Action Required:
Develop partnership-based approaches, involve individuals in decisions affecting them, and create environments where authentic self-expression is safe and valued.
The Call to Action
For Families:
Embrace your role as advocates and allies. Trust your instincts about your loved one’s needs, seek out neurodiversity-affirming professionals, and connect with communities that understand and support your journey.
For Educators:
Question traditional approaches that prioritise compliance over wellbeing. Advocate for training in neurodiversity, implement low-demand strategies in your classroom, and become a voice for systemic change in your school.
For Healthcare Providers:
Commit to understanding the neurobiological reality of PDA. Move beyond behavioural explanations to address underlying nervous system needs, and support families with compassion and evidence-based approaches.
For Policymakers:
Recognise that neurodiversity is a civil rights issue. Invest in research, training, and systemic supports that honor the full spectrum of human neurological diversity.
For Society:
Embrace a broader definition of normal that includes and values neurological differences. Challenge ableist assumptions about behaviour and compliance, and advocate for inclusive communities where everyone can thrive.
The Vision: A Neurodiversity-Affirming Future
Imagine educational environments where individual learning differences are celebrated rather than pathologised.
Picture workplaces that harness the unique strengths of neurodivergent minds
.
Envision communities where different ways of being are understood as natural variations rather than deficits requiring correction.
This vision is not utopian—it’s achievable through committed, systematic change guided by understanding, compassion, and respect for human neurological diversity.
The Time is Now
The paradigm shift from compliance to compassion, from control to collaboration, from deficit-focused to strength-based approaches isn’t just beneficial—it’s a moral imperative.
Every day we delay this transformation, individuals with PDA continue to experience unnecessary trauma, families struggle without adequate support, and society loses the valuable contributions of neurodivergent minds.
The research exists.
The knowledge and understanding are available.
The strategies are proven effective.
What’s needed now is the courage to challenge existing systems and the commitment to create something better.
The future of neurodiversity support depends on our willingness to embrace this paradigm shift today.
Together, we can create a world where every individual—regardless of their neurological profile—has the opportunity to thrive, contribute, and live with dignity and autonomy.
Linked Posts
References
Brede, J., Remington, A., Kenny, L., Warren, K., & Pellicano, E. (2017). Excluded from school: Autistic students’ experiences of school exclusion and subsequent re-integration into school. Autism & Developmental Language Impairments, 2, 239694151773751.
Cage, E., Di Monaco, J., & Newell, V. (2018). Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473–484.
Cassidy, S. A., Gould, K., Townsend, E., Pelton, M., Robertson, A. E., & Rodgers, J. (2020). Is camouflaging autistic traits associated with suicidal thoughts and behaviours? Expanding the Interpersonal Psychological Theory of suicide in an undergraduate student sample. Journal of Autism and Developmental Disorders, 50(10), 3638–3648.
Cellot, G., & Cherubini, E. (2014). GABAergic signaling as therapeutic target for autism spectrum disorders. Frontiers in Pediatrics, 2, 70.
Christie, P. (2007). The distinctive clinical and educational needs of children with pathological demand avoidance syndrome: guidelines for good practice. Good Autism Practice Journal. https://positiveaboutautism.co.uk/uploads/9/7/4/5/97454370/strategies-for-teaching-pupils-with-pda.pdf
Duncan, M., Healy, Z., Fidler, R., & Christie, P. (2021). Understanding pathological demand avoidance syndrome in children. John Murray.
Gore Langton, E., & Frederickson, N. (2016a). Mapping the educational experiences of children with pathological demand avoidance. Journal of Research in Special Educational Needs: JORSEN, 16(4), 254–263.
Gore Langton, E., & Frederickson, N. (2016b). Parents’ experiences of professionals' involvement for children with extreme demand avoidance. International Journal of Developmental Disabilities, 64(1), 16–24.
Haire, L., Symonds, J., Senior, J., & D’Urso, G. (2024). Methods of studying pathological demand avoidance in children and adolescents: a scoping review. Frontiers in Education, 9, 1230011.
Kildahl, A. N., Helverschou, S. B., Rysstad, A. L., Wigaard, E., Hellerud, J. M. A., Ludvigsen, L. B., & Howlin, P. (2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism: The International Journal of Research and Practice, 25(8), 2162–2176.
Marotta, R., Risoleo, M. C., Messina, G., Parisi, L., Carotenuto, M., Vetri, L., & Roccella, M. (2020). The neurochemistry of autism. Brain Sciences, 10(3), 163. https://doi.org/10.3390/brainsci10030163
Miller, D., Rees, J., & Pearson, A. (2021). “Masking is life”: Experiences of masking in autistic and nonautistic adults. Autism in Adulthood Knowledge Practice and Policy, 3(4), 330–338.
Milton, D. (2013, March 27). “Natures answer to over-conformity”: deconstructing Pathological Demand Avoidance. Autism Experts.
Newson, E. (2003). Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600.
O’Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2014). Development of the “Extreme Demand Avoidance Questionnaire” (EDA-Q): preliminary observations on a trait measure for Pathological Demand Avoidance. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(7), 758–768.
O’Nions, E., Gould, J., Christie, P., Gillberg, C., Viding, E., & Happé, F. (2016). Identifying features of “pathological demand avoidance” using the Diagnostic Interview for Social and Communication Disorders (DISCO). European Child & Adolescent Psychiatry, 25(4), 407–419.
O’Nions, E., Happé, F., Viding, E., & Noens, I. (2021). Extreme Demand Avoidance in Children with Autism Spectrum Disorder: Refinement of a Caregiver-Report Measure. Advances in Neurodevelopmental Disorders, 5(3), 269–281.
O’Nions, E., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2014). Pathological demand avoidance: exploring the behavioural profile. Autism: The International Journal of Research and Practice, 18(5), 538–544.
Pearson, A., & Rose, K. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood Knowledge Practice and Policy, 3(1), 52–60.
Porges, S. W. (2022). Polyvagal Theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227.
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout. Autism in Adulthood Knowledge Practice and Policy, 2(2), 132–143.
Stuart, L., Grahame, V., Honey, E., & Freeston, M. (2020). Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents. Child and Adolescent Mental Health, 25(2), 59–67.
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