What Is Pathological Demand Avoidance?

For some people, the idea of being asked to complete a task can be overwhelming and distressing to the point that they avoid all thoughts, reminders, or behaviors related to the demand. These individuals might be experiencing pathological demand avoidance (PDA), which can be common in people with neurodevelopmental conditions like autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Understanding PDA can be helpful for these individuals and their loved ones. Therapy may be helpful for overcoming pathological demand avoidance.

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What is pathological demand avoidance (PDA)? 

According to the Pathological Demand Avoidance Society (PDA Society), demand avoidance generally occurs when someone struggles significantly to complete tasks for themselves or others. 

This symptom is usually considered pathological when it causes distress, procrastination, burnout, emotional pain, or a build-up of responsibilities. Pathological demand avoidance tends to be compulsive and challenging to work through. PDA is usually most common in children and adults with autism, but demand avoidance itself can be typical on an occasional basis and can happen to anyone.

Common examples of pathological demand avoidance

The demands a person avoids can depend on their personality and lifestyle. Some people may thrive in areas where others struggle. Below are a few examples of pathological demand avoidance, starting with those that frequently impact children in early childhood and beyond: 

• A child becomes distressed and has a meltdown when their parent asks them to clean their room. 
• A child refuses to do the dishes because their parent reminded them to do so, and they didn’t need a reminder. 
• A child with attention-deficit/hyperactivity disorder (ADHD) struggles to get started on their homework because the mounting pressure to do so is overwhelming. 
• A parent asks their child with ADHD to clean the cat’s litter box, but they avoid doing so because it doesn’t incite a dopamine release and isn’t “fun.” 
• A child avoids brushing their teeth in the morning because they are tired, and it would take significant mental effort.
• An Autistic child avoids going with friends to complete a school project because they are going to a beach, and sand incites sensory issues for them.

Pathological demand avoidance (PDA) examples in adults 

Adults can also experience PDA behaviors. Below are a few ways this symptom might present in adult life: 

• Avoidance of college schoolwork, leading to low grades, missed classes, or even dropping out of school
• Difficulty completing tasks at the end of the day if one has missed or forgotten tasks at the beginning of the day 
• Having the sense that their day or week has been “ruined” because they messed up once, missed an appointment, didn’t work enough hours, or changed one’s schedule, leading to a cycle of further avoidance and distress
• Avoiding showering and putting on a nice outfit even if one wants to due to the sense that it would take too much time or energy 
• Calling out of work for the entire day instead of calling in late because being late causes distress 
• Avoiding difficult conversations with others 
• Avoiding reading a new book or watching a new series because someone suggested it
• Avoiding tips from other people about productivity 
• Avoiding cleaning and organization tasks by ignoring messes or spending time outside of the home to avoid seeing them 
• Challenges with personal hygiene tasks 
• Difficulty making meals throughout the week, sometimes leading to increased spending on fast food or food delivery 
• Difficulty completing forms 
• Difficulty making appointments
• Avoiding any request to hang out with friends or family that seems to create pressure

Why does PDA occur? 

Pathological demand avoidance is often associated with autism spectrum disorder (ASD) and ADHD. Identifying PDA may help loved ones understand certain symptoms in those with communication, organization, and emotional regulation challenges. People with neurodevelopmental conditions often struggle to cope with pressure and demands, which may arise from factors like the following: 

• A fear of losing control
• A fear of being misunderstood
• Difficulty coping with change 
• Sensory difficulties, such as sensory overload
• Social anxiety
• Learned helplessness 
• Generalized anxiety 
• A desire to understand why a task is necessary 
• Difficulty partaking in tasks that are not fun, enjoyable, or dopamine-producing 
• Poor memory and focus 
• A past traumatic experience 

How to push past task avoidance

If you’re experiencing pathological demand avoidance, regardless of the cause, the following strategies might help you complete the tasks or demands while regulating your emotions.

Put your own spin on the task 

If you have been asked by someone else or are required to complete a task for school or work, you might experience a sense of distress in response to the idea of doing something entirely because someone else has commanded you to do so. 

Putting your own spin on a task may help you push past avoidance and take control over the situation. For example, if your professor requires you to organize your binder in a specific way for their class, you might decorate the binder with fun stickers or doodles to make the task more fun.

Don’t pressure yourself or entertain negative self-beliefs related to pathological demand avoidance (PDA) 

Adults with pathological demand avoidance often have a history of similar challenges. As children, they might have received messages from their parents, teachers, and other authority figures that they were “unruly,” “defiant,” “lazy,” “dramatic,” and “rude.” These messages can stick with someone into adulthood, and an adult may repeat them to themselves when they struggle to complete a task. For example, if you don’t clean your apartment for a week and the dishes pile up, you might tell yourself, “I’m so lazy and dirty.” These thoughts can contribute to emotional pain and may lead to less of a desire to make a change. 

Instead of pressuring yourself and labeling yourself as “bad,” try to remove pressure from yourself altogether. Telling yourself, “I am a hardworking person, and I know I’ll get to this task when I’m ready,” may remove enough pressure to regulate your emotions, allowing you to do the dishes that same night. 

Pathological demand avoidance often serves the purpose of helping an individual avoid an underlying fear, such as the fear that one is incapable of completing the task correctly. When you remove shame from the equation, the fear may be reduced, and the task may seem easier to complete.

Ensure you have plenty of free time 

Free time can reduce some of the distress associated with completing the tasks you’ve been avoiding. Try not to load up your day with too many appointments, responsibilities, and requests, as this can lead to a sense of overwhelm. Instead, try to evenly space out your responsibilities and leave time to decompress. Completing one or two small tasks may be better than scheduling five and doing none due to the associated pressure. 

Anticipate tasks before they are asked of you 

If you often avoid doing what others ask you to do, try anticipating some of the requests you might hear from others. For example, before your roommate returns from vacation, you might clean the apartment so she doesn’t comment on the mess. If you have a big project due at work, consider submitting it early so you don’t have to worry about your boss reminding you before the due date. This strategy is more short-term but may be helpful when your initial emotional reaction to demands leads you to avoid them. 

Remove unfair demands from your life, including masking as a person with autism 

People with autism often mask themselves or try to hide their Autistic traits in an attempt to fit into society. You might notice that you’ve taken on some responsibilities in your life because you believe you “should” or because it is expected of you. Look at ways you might become more authentic by reducing the time and energy demands that don’t necessarily add to your life. 

For example, if you have friends who aren’t understanding of autism or frequently pressure you to spend time together when you’re uncomfortable doing so, you might consider ending those friendships or expressing how the friendship could be more accommodating. 

If you are a student or employee, consider seeking reasonable accommodations that allow you to function in a way that works for you. You can also accommodate yourself at home by changing how you organize and fit tasks into your schedule. For example, some people with ADHD purchase bins for their clothing instead of folding or hanging them up to reduce the pressure associated with doing laundry the “right” way. 

Place no expectations on yourself or a task

Setting expectations before a task or responsibility has been completed can lead to unnecessary pressure and fear. For example, if you expect yourself to be able to pre-make seven meals for the week ahead each Sunday, struggling to do so could incite a slew of negative self-beliefs. Instead, set out with the primary goal of preparing meals and allow yourself to make as many as you can at that time. Whether you make one meal or seven, you have still made an effort. 

How to support your child or loved one with pathological demand avoidance

If you are the loved one of someone with pathological demand avoidance, you may find their avoidant behavior frustrating, confusing, or difficult to understand. Below are a few ways you may be able to support them and avoid conflict: 

• Avoid using labels like “lazy,” “ungrateful,” “dramatic,” or “spoiled” to describe them 
• Avoid shaming them for their behavior or using social comparisons (Ex: “Your sister knows not to do that!”) 
• Avoid demands that have no room for conversation or flexibility 
• Don’t tell them they’re overreacting or making a scene out of nothing 
• Try to understand the cause of their behavior, such as anxiety, past trauma, shame, a sense of pressure, or sensory difficulties
• Role-play a task with them beforehand 
• Ask how you could help them make the task easier for themselves 
• Give them control over when and how they do certain tasks (for example, tell your child they can choose which day of the week they clean their room and at what time of day) 
• Offer children rewards for completing tasks that are challenging for them
• Try giving indirect demands without any implied expectation 
• Educate yourself on common neurodevelopmental challenges and neurodiversity

How to make a request seem less demanding 

To remove pressure from a request to someone with marked demand avoidance tendencies or a PDA profile, consider the following: 

• Give them autonomy over their own space, body, and boundaries
• Allow them the option to say “no” and make it clear that they can refuse 
• Give them choices (when it’s completed, how it’s completed, etc.) 
• Offer a reward 
• Avoid labels and shameful language
• Don’t push the matter frequently if they are still thinking about it 
• Explain why the request is important to you emotionally and logically, and talk about why completing the request would benefit you, them, or the situation 
• Be honest, direct, and upfront about the details involved in the request 

If you’re a parent, and your child is declining to complete tasks that are essential to their health or well-being, such as brushing their teeth, showering, or throwing away old food in their bedroom, you may want to work with a therapist and child developmental specialist to support them in overcoming their barriers to self-care. 

However, do not try to physically or emotionally force them into any activity, and avoid yelling at them. Emotional distress may worsen avoidance and could cause panic attacks or an emotional meltdown. 

Mental health support options for pathological demand avoidance 

Therapy can be helpful for those with pathological demand avoidance and caregivers of children with this trait. A therapist can guide you through techniques that may reduce your avoidant behavior and improve your daily life without causing extreme distress. However, adding another task to your to-do list can be challenging. In these cases, online therapy appointments through a platform like BetterHelp may be more accommodating. 

Through an online platform, individuals can connect with a provider from home via phone, video, or live chat sessions. These options and ease of access may make attending therapy seem like less of a demand. In addition, the app gives users control over their support needs, providing other tools like group sessions, worksheets, and journaling prompts for those who want to use them. 

Studies have found that online therapy can be exceptionally effective, especially in supporting people with ADHD, who often struggle with demand avoidance. In a 2022 study, internet-based interventions improved attention and social function in children and adults with ADHD. 

Takeaway 

Pathological demand avoidance generally refers to the extreme avoidance of perceived demands, whether they are self-imposed or imposed by others. This trait can be common in children and adults with autism and those with ADHD but can present in anyone, regardless of whether they have a neurodevelopmental disorder diagnosis. Strategies like avoiding pressure, rewarding oneself, and taking tasks one at a time may be helpful. Consider contacting a therapist online or in your area to develop a tailored strategy to address this challenge.