Why anxiety isn’t the cause of demand avoidance

or

Why anxiety isn’t the cause of PDA demand avoidance in PDAers

The thing which makes PDA so different from all the other types of anxiety related disabilities is the root cause of demand avoidance in PDA. For years PDA was seen as an anxiety led need for control, with the cause of demand avoidance being anxiety. While there isn’t scientific evidence proving that anxiety isn’t the root cause of demand avoidance in PDA there are many points which show this to be true. I’ll list the points later as first it’s important to distinguish between PDA demand avoidance and ‘normal’ demand avoidance.

The difference between PDA demand avoidance and ‘normal’ demand avoidance

Every human on the planet will experience demand avoidance at some point in their lives. Some experience extreme demand avoidance for a myriad of reasons while others rarely experience any demand avoidance. Neurology plays an important part in the level and type of demand avoidance a person experiences, Autism for example often leads to avoidance of social demands due to difficulty relating to non-autistic people and being pushed away by others. Sensory processing as another example can easily lead to demand avoidance because some demands may contain sensory input which causes discomfort or pain which the individual will wish to avoid.

The many different reasons for demand avoidance range from neurological differences, sensory issues, learning disabilities, anxiety, intolerance of uncertainty, depression, physical disabilities, and many other types of disabilities and mental health issues to abuse, ostracization, bullying, peer pressure, too many high expectations, embarrassment, socio-economic differences, exclusionism, loneliness, etc.

Imagine a child refusing to go to school, they hide in bed refusing to get dressed because they don’t want to go to school. What’s the cause of this? Anxiety? OCD? Poorness? Bullying? They didn’t do their homework? PDA? They have no friends? Their timetable has changed? They said ‘mummy’ to a teacher the day before? Undiagnosed dyslexia making school work difficult? The lights are too bright and hurt their eyes? They went to bed too late and are too tired to get up? Their legs physically hurt and they have PE today? They struggle to hear what the teacher says and today they have the mean teacher who shouts when they don’t understand what they’re supposed to be doing?

There are so many reasons why a person avoids doing something. Adults have a bad habit of trying to figure out the cause of a child’s difficulty by looking at their behaviour and using their own experiences and interpretation of the world to figure out what is going on. This can lead to misunderstanding what is actually happening, especially when the child in question is unable to express their difficulties too. Adults have spent a long time trying to figure out the cause of demand avoidance in PDA, since anxiety is so prevalent in PDA and for many anxiety is the cause of avoidance then it makes sense they would see PDA demand avoidance as being caused by anxiety.

PDAers experience all of the other issues that other humans experience and so will have demand avoidance for all the same reasons that other people have, but this is on top of PDA demand avoidance. So a PDA child will have PDA demand avoidance but they can also have social anxiety leading to demand avoidance just like other Autistics, they can have sensory issues which cause demand avoidance just like other kids with sensory issues, they can experience anxiety from change or from negative past experiences or from uncertainty just like everyone else. They can also have OCD, bipolar, dyslexia, EDS, depression etc, etc just like everyone else.

The difference between all these avoidance issues and PDA avoidance is the cause. PDA demand avoidance isn’t caused by anxiety, rather, anxiety is a symptom of demand avoidance. For PDA, demand avoidance comes from the part of the brain which recognises what is dangerous and what is safe. For PDAers this part of the brain is overactive and sees everything as a danger even when logically the PDAer knows they are safe. There’s no trigger to this, the brain simply puts out an alarm every time the PDAer tries to do anything that says ‘we’re doing something dangerous, stop now!’, so the body responds by avoiding whatever it is the PDAer was trying to do. Regardless if that thing is actually dangerous or a completely safe, fun activity.

So for example, if a ‘normal’ child were to stand at the edge of a cliff and think about jumping off their brains would say ‘danger, don’t do it!’, if they were to then back away and join a picnic where their mother offered them a sandwich their brain would say ‘that’s safe, lets eat!’. Put a PDA child in the same situation and the brain would say ‘danger, back away!’ when they are near the cliff but the brain would also say ‘danger, don’t eat!’ when offered the sandwich.

Now if the same two children were standing on the edge of a cliff and their mother shouted ‘come away from their. it’s dangerous’ the ‘normal’ child’s brain would say ‘danger, back away!’ but the PDA child’s brain would say ‘danger, don’t listen to her, move closer’. When at the picnic if the mother told the child not to eat a sandwich the ‘normal’ child’s brain would say ‘danger, she said not to eat it so it must be dangerous’ whereas the PDAer’s brain would say ‘danger, she said not to eat it so you must eat it’.

Of course not everyone listens to the ‘danger!’ part of their brain, hence the ‘normal’ child might eat the sandwich even when told not to and the PDA child might comply. There are many other factors to take into consideration here like environmental factors, past experience, upbringing, ect. But basically that’s how the PDA brain functions compared to the ‘normal’ brain.

It doesn’t matter if the demand which the PDAer is avoiding is fun or uncomfortable, whether they’ve done it before or not, whether they like it or not, whether they want to do it or not, the brain will have the same reaction, because the PDA brain cannot differentiate between ‘safe’ and ‘danger’ so it thinks everything the PDA tries to do is dangerous (better to be safe than sorry right?).

How do we know PDA demand avoidance is not caused by anxiety?

Like I said, there is no scientific proof backing this theory (yet). There has been very little in the way of studies into PDA overall. The most recent research in this area was to see if intolerance of uncertainty is the root cause of PDA. We are hoping one day that someone will do a complete study to see if the root cause of PDA is a dysfunction in the brain, many of us are hoping for brain scans (fingers crossed). But until then we can only go off what us PDAers and parents of PDAers have discovered through observations (and let’s face it, who knows more about PDA than PDAers who have spent years researching, observing and learning about PDA?)

With this in mind, here are the reasons why we think PDA demand avoidance isn’t rooted in anxiety:

  • There are many times when PDAers have expressed a lack of anxiety around avoidance of a demand
  • Anxiety meds only work to a certain degree, and for some they actually increase demand avoidance. Surely if anxiety was the cause then removing anxiety would make it easier to manage demands?
  • Some demands are tasks that the PDAer has been completing fine for years and it all of a sudden became a demand to avoid with no noticeable trigger
  • If anxiety were the cause, then wouldn’t telling a PDA child not to do the task you want them to do result in them avoiding it just the same as if you told them to do it?
  • Saying to yourself (as a PDAer) that you aren’t going to do something wouldn’t make it easier to do it if there was anxiety around doing it
  • Would you hear this phrase is anxiety were the cause “I was going to do it but now that you’ve told me I have to do it I can’t do it anymore!”
  • It’s unlikely if anxiety were the case that there would be days when it’s easy for PDAers to complete a demand and days where they cannot complete the same demand at all.

Of course we must remember that anxiety can be different for everyone and that PDAers suffer from anxiety in the same way as everyone else. It can be difficult to work out which avoidance is caused by PDA demand avoidance and which is caused by an actual trigger such as anxiety, mental health issue, environmental issue, other disability or common life struggles. It doesnt help to presume all avoidance from a PDAer is caused by PDA demand avoidance because that may cause a very real issue to be ignored which could grow worse if left unattended.

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4 thoughts on “Why anxiety isn’t the cause of demand avoidance

  1. Wow, I’m learning so much but it’s so complicated as I always thought anxiety was the root. Really helpful post, thanks. I’m also looking forward to the day when they can learn more from brain scans, will be so interesting to learn more. Also for diagnosis in the future.

  2. Well done for getting all that down Riko. I agree with you. It is a maze and there is most defiantly a hard wire for pda My article about anxiety being a symptom also looks at this idea.I also like Harrys recent film where he sees anxiety as a call from the heart/ soul to find inner peace. More reason to keep fighting for pda awareness and studies from professionals to try and uncover the intricacies of the brain. x Well done. x

  3. My grandaughter is 13 and can’t manage school, she could have PDA, she won’t engage with CAMHS, LA have sent an OT to support her in education, however she’s not engaging, she’s just not wanting to discuss school other than home schooled. She is a LAC , I am also her foster cater. Any advice much appreciated.

    1. Is it possible to homeschool? I know many kids do better in that environment although it’s not always an option. Sadly most professionals don’t recognise PDA so they might not be understanding of the difficulties involved but I feel we should still try. Is it possible to explain PDA to the people who are working with her? I don’t understand why CAHMS always refuse to help people who ‘won’t engage’, surely that shows the individual needs more help :/ Have you spoken to your granddaughter about her maybe having PDA? Many find it easier to manage their own difficulties when they understand better what they are, although many also deny any difficulties so presenting the information in as non-demandy way as possible is key (leaving information out for her to find for example). If she has to stay in school then is it possible to give the school information on PDA? There are resources on the PDA Society website for schools. If the school is willing they could remove most demands and just let her do whatever she wants in school (within reason) and eventually she should start to take part herself. If this is possible then the school must ensure not to comment on anything she does regardless of whether it is positive or negative as this can set her back/make things worse.

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