It’s Time to Rethink the “Anxiety Drives PDA” Narrative |
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PDA (extreme demand avoidance) isn't just confined to autism; it's present in ADHD, ODD, and other conditions.
PDA and anxiety are correlated, but anxiety might be a byproduct of high conflict, not the driver of PDA.
PDA may be a changeable personality profile: high reactivity, low agreeableness, and low conscientiousness.
Pathological demand avoidance (PDA) was originally described as a subtype of autism in which anxiety is the primary driver of extreme demand avoidance.
Currently, however, PDA is understood to be present among other mental health conditions, such as ADHD, oppositional-defiant disorder, and other externalizing disorders (Egan et al, 2020; Rai et al, 2026).
The “anxiety as the driver of PDA narrative” is often contrasted with the supposedly “anger-driven” demand-avoidant behavior seen in oppositional-defiant disorder (ODD). The distinction has influenced treatment approaches, particularly the rise of low-demand, high-accommodating parenting models marketed as “nervous system–affirming” care (Carlozzi et al., 2025; Ehrlich, 2025).
A closer examination of the scientific literature, however, suggests that this narrative is less secure than commonly assumed. While anxiety is consistently correlated with PDA-type traits, correlation does not establish causation. We know that anxiety and PDA go together, but we do not yet understand the directionality (what causes what) of the association.
Importantly, substantial research demonstrates that children with ADHD and ODD also frequently exhibit elevated rates of anxiety symptoms (Stein et al., 2015). Additionally, anger, irritability, and explosive outbursts—often characteristics of PDA—are also core features of ODD and are commonly observed in children with ADHD (Green et al., 2018; O’Nions et al., 2014).
Taken together, current evidence does not justify conceptualizing PDA as a uniquely anxiety-driven construct. Currently, no research exists that shows anxiety is the cause of PDA.
It is at least as plausible—and perhaps more clinically useful—to view anxiety as an outcome of chronic demand conflict, similar to how it is viewed in ADHD and ODD.
Unpacking ADHD, ODD, and the Myth of “Anger vs. Anxiety”
To emphasize PDA’s distinctiveness, many contrast “anxiety as the driver of PDA” with “anger is the driver of ODD” (Green et al., 2018; O’Nions & Eaton, 2020).
However, the broader literature challenges this dichotomy. Children with ADHD also exhibit markedly elevated rates of anxiety disorders, with comorbidity estimates ranging from 15% to 50% (Stein et al., 2015). Moreover, ODD also frequently co-occurs with anxiety (Martin et al., 2014).
Although it is frequently argued that anxiety drives PDA, I don’t think anyone would try to argue that anxiety is the primary........