Autistic Demand Avoidance vs Pathological Demand Avoidance

Autistic Demand Avoidance vs Pathological Demand Avoidance (ADA vs PDA).

Many people experience Demand Avoidance (DA), usually in regards to things like filling in tax forms or buying new furniture. People may leave these things to the last minute then panic and sort it in a rush. Every person on the planet will avoid at least one thing in their lifetime. For some neurotypes though, DA is more prevalent. Neurology, environment, experience can all contribute to the amount of DA a person experiences.

Autistic people are more likely to experience DA than neurotypical people due to heightened sensitivities, misunderstanding general societal rules and possible mismanagement. For autistics, the world can go against them and so they are left feeling anxious and scared about many things. Even when treated in the best way possible the autistic may still experience DA from various sensitivities, such as avoiding wearing socks due to them feeling sore and itchy. For some autistics, DA is so severe it impacts every moment of their life.

We know PDA DA is the highest of any other neurotype, this is shown by the trait ‘resists demands obsessively’, with 100% of PDAers meeting this trait.

So how do we tell whether a person has Autistic Demand Avoidance or PDA?

Some people have such high avoidance levels that it appears the same as PDA, especially since both have autistic traits and avoidance ranges in how it appears, it can be difficult to tell whether a person is autistic and experiencing DA or is a PDAer. Similarly, some PDAers are able to mask their difficulties so well and their avoidance shows as ‘quiet avoidance’ such as walking away or ignoring demands, that the PDAer will be seen as an autistic person struggling in certain situations. This isn’t always an issue if the people around such individuals are able to cater to their individual needs. For some though, not having a full understanding of where the issues are stemming from can cause problems with mismanagement. Autistic parenting can be quite different from PDA parenting so using the ‘wrong’ strategies could have a negative impact on the individual. So for some it is vital they have an accurate understanding of where an issue originates.

Nature/nurture – PDA is there from birth, PDAers are born with a natural need to avoid things. For some the avoidance is obvious from a young age whereas for others it is only noticed once the demands become too many for them to handle, usually after starting school. With ADA, while the autism is there from birth as they are born autistic, the DA won’t be. Some may be born more susceptible to DA but it won’t show until the anxiety becomes too much for them to manage. Sometimes just looking back to childhood can give people an idea of whether it’s ADA or PDA. Was DA always there? Did it show from a young age? Did something major trigger it?

Genetics – PDA and autism are both genetic (I feel), though there is an obvious line of PDA in PDA families, autism can in some families seem to come out of nowhere. It’s a bit like hair colour, brown being PDA and very obvious that there’s a genetic line, red being autism and can be seen in every family member or just one for centuries. Generally, if you can see a long line of demand avoidant people with autistic traits then it’s more likely to be PDA.

More than everyday demands – in some of the criteria for PDA it states that they ‘avoid everyday demands’. Whilst this is accurate it doesn’t quite convey just how deep DA runs. It’s a need to avoid anything and everything. This is why therapies such as exposure therapy would never work, because it’s impossible to make a person ‘okay’ with everything in life. With ADA, it’s more likely to be specific things which are avoided, not everything on the planet. It’s hard to see sometimes how much a PDAer avoids from the outside, so understanding whether it’s ADA or PDA might involve the individual ascertaining just what the problems are. If it’s just one or two things that are being avoided then it’s more likely to be autistic DA. Some autistics will avoid a great number of things, so many that it appears to be PDA. One way of figuring it out might be to tell the person they have do something they have no problem doing (like eating a sweet) and seeing what their reaction is. Most PDAers will still avoid when ordered, whereas most autistics wont’. Though it’s not a fallible test, it can be a good indicator.

Avoidance out of nowhere – with autistic DA, there’s usually a cause for avoidance, though it may take some searching to figure out what it is. With PDA there may not be any obvious reason other than ‘it’s a demand’. One of the things about PDA is that something can become a demand at any time. Someone who has been putting their shoes on fine all their life may suddenly out of nowhere become avoidant at doing so. Nothing has changed except that it suddenly becomes ‘a demand’. This is unlikely to happen with autistics, there is usually a reason for it.

Up and down – one of the confusing things about PDA is the up and down of DA and moods. In regards to DA, one day the PDAer may avoid eating breakfast like the plague and the next day they eat it fine. This is typical of PDA, but not typical of ADA. It still might happen, but not to the same extreme and is more unlikely to occur with every demand. Autistics are more likely to experience the same level of avoidance to a demand and in the same way.

Various avoidance tactics – PDAers tend to adopt varies tactics to avoid demands. From ignoring and walking away, to excuses and distraction, to lashing out. PDAers are also quite good at using the most effective avoidance tactic for each person. They are able to work out (unconsciously) which tactic will work for their teacher and which will work for their mother. This gives the impression of being socially able and manipulative. Autistics are less able to do this, they tend to rely on the same avoidance tactics for each demand and each person. If a wide variety of tactics are used and they differ depending on the people around then it’s more likely to be PDA as opposed to ADA.

Novelty – for some PDAers, the introducing of new things can help them cope with a demand. I have always found it easier to brush my teeth when I have a brand new, different toothbrush to use. For autistics novelty is less likely to work as the change may cause more anxiety. If a person is avoidant of something but is more able to manage when it’s changed in some way on a regular basis then it’s more likely to be PDA.

The other traits – it is worth considering the other traits that affect the person as they may be an indicator. While both PDA and ADA groups will have autistic traits, some traits are better indicators of one specific group. PDAers prefer novelty, change and only routine that the PDAer has created, whereas autistics tend to prefer things to stay the same and prefer strict routine. Although these vary from person to person, they can point to one group over the other. PDAers are more likely to ‘fit in’ socially although both groups can do this to a degree and both groups can mask. PDAers are more likely to switch emotionally from one extreme to the other, giving the appearance of ‘Jekyll and Hyde’ behaviour. PDAers are more likely to use imaginative play in an obvious way, using role play sometimes to avoid demands or to cope with demands. Autistic people can have brilliant imaginations but are less likely to role play to cope with demands.

It’s not always easy to tell whether it’s PDA or ADA, and for some it might not matter as long as the techniques they are using help the individual. But for some it’s vital they know what the cause of DA is as it impacts the techniques used. For PDA, it’s more about constant management of demands and stress levels whereas for ADA more specific techniques can be used to override the anxiety felt about certain demands. It is possible for some autistics to reduce and/or overcome their avoidance of some demands, but for PDAers, even if they reduce/remove one demand another one will take it’s place. That’s not to say  that DA is any easier for autistics than it is for PDAers, every person is unique and different and should be taken as such. If a person is struggling then comparing their struggles to others is only helpful in understanding where the struggles come from, not how much they impact on the person. Some PDAers may be able to cope okay whereas some autistics may be in constant distress over their DA, and vice versa.

Advertisements

13 thoughts on “Autistic Demand Avoidance vs Pathological Demand Avoidance

    1. This is bologna. Sorry – this doesn’t fit my daughter at all. She has ASD with PDA characteristics. She was a classic ASD baby but so high functioning and could hold eye contact, so doctors ignored my query of ASD. When she went to nursery, the teachers discribed her as the angriest child they had ever known. This persisted for years, daughter was put on mood disorder medications and then we moved to the UK where they don’t readily medicate children like where I was from in the US. She got better. I didn’t think about it as much although she was still anxious. Then she went to secondary school and it all fell apart. After a request to be assessed for autism by the Headteacher of her school, she was given an ADOS and (finally) diagnosed ASD with PDA characteristics. So your entire paragraph on ‘where did the definance come from’ doesn’t fit my child. There was no ’cause’. It was always there.

      Also: what qualifications do you have? Please can you cite the academic research you are quoting from? Thanks very much.

      1. What I’ve written is based on my own experiences plus what I’ve read/heard from others so it might not be accurate for every individual. I’m not sure which paragraph you are referring too, but if you daughter has PDA then like you say there is no cause, it would have always been there. That is the point I was trying to make with that blog post, that for PDAers the demand avoidance has always been there (although many don’t show it until they are placed in an environment of many demands such as school), whereas with Autistics the demand avoidance usually forms from a source, whether that’s sensory issues, deviation from routine, executive functioning or any other issue.
        I don’t have any qualifications in Autism or PDA, I doubt there are many that do have qualifications in PDA. Although I do have qualifications in other areas. I’ve found those that do have relevant qualifications in areas pertaining to mental health issues (especially Autism and such) know far less than those who don’t. There currently isn’t any research on the differences between Autism demand avoidance and PDA. If they do do research in this area and it conflicts with what I’ve written then I will happily change it, but until then this is the most accurate information available (however inaccurate it may seem).

    1. There’s no facts to cite from. If there had been a study done comparing the two then I would cite from that or simply post a link. As it is there are very few studies on demand avoidance, let alone PDA. Everything I write is based on my own experience or information I have gathered elsewhere. If I stuck to proven facts there would be little to write about. If a study were to be done on the comparisons of ADA and PDA I will be happy to correct anything wrong I have written.

  1. Perfectly written and explained. I agree with you wholeheartedly and with your response to the above comment. There is most definitely a very big difference, which is why correct diagnosis is so imperative to living in harmony with PDA, traditional Autism and Neuro typical mind sets.We are still so uneducated in PDA and it is your experience and selfless mission to educate and share your knowledge that we can learn and bridge the gaps that we all hold. Well done, love your work, love you. xx lovepda. xx

  2. There is research in the UK on PDA, see here http://adc.bmj.com/content/88/7/595.full. And there is the Elizabeth Newson Centre in UK – who appears to have carved a tidy profit from PDA assessment/diagnosis when in my in view & experience of raising Asperger son and married 10 yrs to ex-husband with all characteristics of ASD/PDA, ASD and PDA are each others ‘alter egos’. They are one of the same – variations of expressions of Autism. My son has had 4 top experts (one world leading) all concur Asperger diagnosis (done for court purposes) – yet Education chiefs kept calling it PDA forcing assessment of PDA – which Newson’s assessment was ‘inconclusive’ for PDA and biggest baloney I’ve ever read. It was ‘inconclusive’ because of top experts showing what was ‘conclusive’ – its AUTISM. How do you get 4 top experts all agree on autism diagnosis with I add strong demand avoidance, and Newson centre fail to make any conclusive diagnosis? At least have the decency to conclude it’s not PDA if one is assessing this. For what my opinion is worth it is some ‘clever’ person’s thesis on Demand Avoidance – a feature of autism, built on over years to justify building a business in PDA by exploiting and splitting autism into sub sections.Demand Avoidance gets worse in autistics the more they forced into environments/schools they simply cannot cope with. It is cause and effect – Demand Avoidance becomes pathological when one keeps forcing a square peg into a round hole.

    1. Your last sentance is fully right. But PDA is definitely different to autism alone, you only have to get 2 PDAers and 2 non-PDA autistics in the same room to see the difference. PDA is a type of autism yes, but there are subtle differences which mark PDA out as different.
      I can’t comment on the assessment ftom the Newson centre, while they do charge for private diagnosis there are many trying to get public companies like CAHMS to recognise PDA. Perhaps the reason an Aspergers diagnosis was continually given was because they don’t diagnose PDA? I don’t know since I wasn’t there.
      The parent strategies used for PDA are very different to those recommended for autism, using autism strategies on PDAers has been shown to have a negative effect, that alone shows a need for PDA to be diagnosed seperatly to autism with demand avoidance. The underlying cause of avoidance is different in PDA though anxiety and mishandling can also cause avoidance in PDA. It’s important that professionals understand the differences between pathological demand avoidance in PDA and extreme demand avoidance in autism.

  3. Riko,

    so true about novelty and the connection with Pathological Demand Avoidance.

    And then there is “avoidant coping” which doesn’t quite fit these two profiles – using avoidance, say, to cope with trauma or a loss of safety or satisfaction.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s