Sophie, a 10-year-old, avoids straightforward tasks like getting dressed or doing homework. When her parents press her to comply, she might have a meltdown or withdraw to her room. At school, Sophie finds group activities difficult and sidesteps assignments by distracting herself or bargaining with her teachers.

Initially, her parents viewed this behavior as defiance, but a psychologist diagnosed Sophie with pathological demand avoidance (PDA). They learned that Sophie’s behavior stemmed from anxiety about losing control over her environment. Using strategies to reduce demands and give Sophie more control helped reduce her anxiety and improved her ability to manage daily tasks.

Pathological demand avoidance (PDA) is a profile on the autism spectrum characterized by an overwhelming need to avoid everyday demands due to high anxiety levels. Unlike typical oppositional behavior, the avoidance in PDA is driven by anxiety rather than a desire to rebel. Individuals with PDA are hypersensitive to demands, even those they place on themselves, and they may engage in elaborate strategies to avoid them, such as distraction, negotiation, or outbursts.

PDA was first identified by Dr. Elizabeth Newson in the 1980s as a distinct profile of autism. According to her research, PDA’s key feature is an “obsessive resistance” to demands, which differs from the more rigid and repetitive behaviors typically associated with autism. While PDA is widely recognized in the UK, it is not yet universally accepted as a formal diagnosis, especially in other countries like the US. However, there is growing recognition that PDA represents a unique subset of autism spectrum disorder (ASD).

Individuals with PDA often exhibit heightened social understanding, which they may use to manipulate or distract others in order to........

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