Pathological Demand Avoidance Syndrome and Autism

Pathological Demand Avoidance Syndrome (PDA) is the term for an obsessional avoidance of the ordinary demands of everyday life. The child with PDA exhibits a level of social understanding and ability that makes them able to be manipulative in their avoidance. Coupled with a capacity for imaginative play, early appreciation was that PDA was a stand alone diagnosis. More recently, however, clinicians recognize it as a feature of autism spectrum disorders.

Children with PDA require a different approach, particularly in the educational environment. The school environment, with its incessant demands and expectations and concomitant system of rewards and punishment, is a minefield of anxiety for the PDA student. Educators need to be less openly demanding and more negotiating, abandoning the tenet of uniformity in dealing with all students. Flexibility is required, as classroom expectations need to be modified according to the child’s given emotional state and situation. Rather than being head-on in their dealings, teachers need to be oblique, avoiding a clash of wills. A relationship of trust and respect between the teacher and student is the cornerstone of success.

Learning about PDA rings like a bell for me personally. My fifteen-year-old son is the perfect embodiment of this condition. His tumultuous educational experiences are a direct product of teachers being unwilling and/or unable to modify their approach to him based upon his extreme anxiety around everyday demands of school life. Almost with out exception, his teachers felt the best course of action was to face him down over work expectations, thinking this would lead to the “extinguishing” of his behaviors. What it lead to was more and more explosive behaviors and the triggering of his dangerous Crohn’s symptoms. As I write this, he is going to high school online because of the failure of yet another school placement.

Counter-intuitive to the training and beliefs of educators and administrators, it’s going to require a lot of work to bring our schools up to speed on PDA. Even the teacher in the psychiatric ward of the hospital where my son was twice confined for his anxiety, left him convulsing on the floor for an hour when he refused to do a math worksheet.

There is real urgency to this problem. Educators need to realize that individualizing their approach to a child with PDA is not a capitulation to that child’s manipulations, but the honoring of their distinct and very real condition.