How does Pathological Demand Avoidance or PDA fit with regular anxiety?

This week’s question is a pretty long one that I shortened for our title. The question in full is:

How does PDA, which some people prefer to call Demand Anxiety, fit with regular anxiety, and should it be treated any differently? The advice seems to be to reduce demands (for example, with my home-educated son who gets extremely upset whenever he’s put under any formal pressure to write or do maths, the advice is to do more child-led learning, games etc.), but is this a form of avoidance which will therefore make the problem worse? Or is waiting till the child is a bit older for these things harmless?

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I have been getting different versions of this question for some time and so I wanted to sit down and dig into the research and see what we really know about pathological demand avoidance or PDA. What I discovered is that we’re still figuring it out. There isn’t a clear definition for what constitutes PDA, there is still ongoing research to try to figure out which kids meet criteria and which do not, and because we are still looking at the criteria that means we’re still arguing about how to manage it.

When I say we hear, as in we’re trying to figure it out, I’m talking about people in the mental health and behavioral fields. That’s therapists, psychologists, educators, etc. 

This makes it really difficult for parents to find good information that’s appropriate for their particular child and their particular family. But difficult does not mean impossible.

It’s always true that as parents we have to figure out where to get our information. Who are we going to trust to help us figure out how to best parent our kids — anxious or not. There are as many good ways to raise kids as there are kids. Every child needs a different kind of parent.

For kids who have challenges — whether that’s  an anxiety diagnosis, a neurodifference, any kind of special needs — we need to be particularly discerning since you have the controversies and opinions of typical parenting and then you have the added complications of our child’s particular needs. This feels especially true when we’re talking about children who might fit a PDA profile.

And let’s talk about that PDA profile for a minute — there’s still a lot of discussion about who fits that profile. For those of you who aren’t aware, PDA is generally used to describe children who become anxious when faced with demands to the point that their everyday functioning is disrupted.

What is a demand? Well, just about anything can be a demand. Requests, commands, expectations from someone else or from the child themselves like needing to eat or go to the bathroom, and the general requirements of existing. So for some kids facing a cold day can be a demand if they are sensitive to cold. Putting on a sweater may be a demand because your parent asked you to. Going outside to play in the snow may be a demand because the child is looking forward to it and is afraid of being disappointed.

Every child — every person — will have some demand avoidance now and then and there does seem to be correlation with anxiety because the demand itself — the feeling of needing to perform or show up or respond in some way — can create anxiety.

Currently the belief is that PDA is under the autism spectrum umbrella but again, this is still being discussed and the woman who coined the term, developmental psychologist Elizabeth Newsome specifically argued that it did NOT belong under this umbrella. See? Controversial.

And while demand avoidance is discussed in the context of anxiety, there are those with lived experience — adults who identify as PDAers — who do not see anxiety as part of what’s happening for them. Which makes me think we need to be open to a more nuanced discussion about what PDA might be for individuals.

That said, I think there is value in thinking about demand avoidance as part of an anxiety profile. And I do not think we need to — at this moment — get hung up on PDA diagnoses since that’s still in flux. Remember that ultimately a diagnosis is a cultural construct as well and at this moment, at the time of this recording, a PDA diagnosis doesn’t really exist here in the states. Therefore children who might fit this PDA profile will not get supports like an IEP or a 504 because they fit that PDA profile. However, adults who care about, are taking care of or who are educating kids who have some PDA in their make up can benefit from considering this as they talk about how best to support and serve these children and their families.

Further, it’s not just PDA kids who might balk at demands. There are other kids with neurodifferences who are demand avoidant and there are neurotypical kids who are demand avoidant. Heck, we as parents may have — and likely do have — our own demand avoidance. The more we learn about it, the more we might bring new understanding to how we all function. 

In other words, let’s focus on understanding demand avoidance if that seems present in our children and — because this is The Child Anxiety FAQ — what does this mean for anxiety treatment.

My take and observation in working with families whose children fit this profile is that there may need to be some time for everyone to consider how seeing things through the lens of demands might shift our perspective. How might that helps us see where our child sturggles and where we struggle. 

Demands are often invisible so if we’re looking for them, might we better understand why our child might sometimes meltdown about quote nothing. Looking for demands might help us realize that mornings are more difficult than we realized. When we see that waking up is a demand, getting dressed is a demand, eating a breakfast our parents made fro us is a demand, we can recognize that our child is running an exhausting gauntlet every morning and isn’t just trying to be difficult. We may be more forgiving of ourselves recognizing that dragging a child through a series of demands is tough on any parent and no wonder then we are having such a hard time.

So what to do about it? That’s going to be very individualistic. A child who is demand avoidant may not fit the usual advice about parenting. In fact, I’m going to say they definitely to do not.

A lot of the advice I see among lay people around PDA is to dig into demand avoidance and help their child avoid demands. In talking to my clinical colleagues, I’m not 100% behind this approach. I think there still needs to be exposures to demands but I think those exposures need to be more judicious and go more slowly. I strongly feel that parents need space, too, and do not just need to be told to shape their life around their child’s demand avoidance. The family system is still a system and we need to be realistic and aware that parents have needs, too, that other siblings have needs, too, and that they need to be part of the equation.

Referring to the original which asked if demand avoidance — like homeschooling with child led learning would make things worse? The answer is complicated. There is nothing wrong with doing more child-led learning and in fact, I’d say that’s a great plan if you can do it because it will relieve some bandwidth to tackle other demands that you can’t avoid. And that’s really what we’re talking about here. Instead of twisting ourselves in knots to avoid all demands, we can and should start recognizing demands so we can prioritize them. We’re basically going to need to triage. 

I guess as I think about it, I’m uncomfortable with the word worse. Demand avoidant kids grow up to be demand avoidant people — at least as far as we can tell from the anecdotal research — but that doesn’t mean that they can’t learn to face and overcome necessarily demands or those demands they need to face to do the things they want to do. That’s what I mean about priorities. If we can avoid unnecessary demands or get creative in how we face them, then we can focus on skill building in the inevitable demands. Because we are going to have to face demands. We’re just going to have to. Demands are built into our lives. Like I said, cold weather can be a demand. So how we be creative? Maybe there are ways to keep warm or deal with cold that are less traditional. Maybe kids will want to wear footie pajamas instead of a coat and maybe that can work. 

Recognizing and facing demand avoidance is an opportunity to wrestle with what’s really important for us as individuals and as families? What is a cultural construct we can reject? Parents  of demand avoidance are going to need to be more flexible, more open to alternative solutions, and be more honest with themselves about their boundaries.

I created a training called Anxiety Through the Lens of Demands that digs into this topic further, looks at the controversies a bit more closely, and discusses what we do know and how we can apply it to anxiety. I encourage you to check it out and let me know if you have any questions!

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