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  • Cameron Mazzeo MSW, LCSW

Neurospicy Problems: Extreme/Pathological Demand Avoidance

Posted September 7th, 2023

Written and Researched by Mx. Rowan Quinn

 

If you have ADHD, Autism, or any other Neurodiverse brain setup, you may notice it's very hard to get things done. There are a ton of reasons for it – Lack of motivation, concentration, time, energy, and more. But sometimes, you are VERY excited to do a thing...


Until someone asks you to do it.

Then suddenly, your brain just goes “Welp, guess we're NOT doing that, then.”


Enter "Extreme/Pathological Demand Avoidance": a form of executive dysfunction where the pressure to do something, internal or external, makes that activity suddenly feel simply impossible. Sometimes it's a simple request, sometimes it's a looming deadline, sometimes it's just knowing you need to get something completed; A “Demand” can take many forms, and it can even be about something you normally enjoy or look forward to. It can be a planned event, questions, decisions, hobbies, or even just basic bodily needs. But the moment it's a "task that must happen", all motivation vanishes, and anxiety sets in. Many describe it as feeling an irrational reaction to expectations. The “Avoidance” part can show itself in many forms: distraction, bargaining, dissociation, hyper-fixation on other/unrelated tasks, and more – all the way up to a full meltdown.


While it was coined in the 1980s, the exact cause of Extreme/Pathological Demand Avoidance (or clinically, PDA for short) is still a matter of theory and research. The current working theory is that it's caused by “a combination of genetic and environmental factors”... Which, frankly, is a fancy way of saying “we have no idea.”

All that's known so far is that, while very few neurotypicals experience it, most of those dealing with PDA are on the ADHD or Autism Spectrums. Currently, it's considered a trait of Autism, with ADHD links still being studied.


Right now, most research is being focused on methods to accommodate, work around, or control the symptoms enough to let those with PDA function better.

Thankfully, there's a ton of resources out there! Everyone from The Huffington Post to The PDA Society has pages on ways to cope. Thrive, Neuroclastic, and High-Speed Training also have some great strategies. The PDA Society even has a page for helping kids struggling with PDA!


Personally, my highest success rates have come from turning things into games. I can dress up as Cinderella and clean. I can time myself for how fast I can shower. I can turn making the bed into an artistic storytelling tableau of plushies acting out my favorite plays. I can see how many acorns and cool rocks I can find while out walking the dog. I can make getting dressed into a literal dress-up game, making a gorgeous or fantastical look to wear out, neurotypical stranger's reactions be damned.

Even my partners and family help – my fiancee and our co-partner have a habit tracker app, where enough completed tasks add up to us getting each other IRL, tangible rewards. The app also keeps us accountable, because when one of us really, really struggles? We can turn to each other to do the task, or trade tasks as a form of bargaining. The biggest help, overall, though? Compassion.


Being able to say, “Hey, it's okay, PDA is making it so I can't do this right now. I'll do something else. I don't have to sit here beating myself up and staring at the wall just because I can't do this thing right now. I can do it later, or not do it at all. Let's focus on something else, and we'll get through the day.”


That has taken over a decade of practice, so I know it's easier said than done. But re-routing your thoughts whenever you have a negative self-thought to something more compassionate? It's exhausting, but makes a huge difference over time.


Good luck out there, Neurospicy Fam!

And best of luck doing whatever you want or need to, today.


 


Works Cited:

differentnotdeficient. (2019, December 6). 15 Life Hacks for PDA (Pathological Demand Avoidance). NeuroClastic. https://neuroclastic.com/15-life-hacks-for-pda-pathological-demand-avoidance/


Eaton, J., & Banting, R. (2012). Adult diagnosis of pathological demand avoidance – subsequent care planning. Journal of Learning Disabilities and Offending Behaviour, 3(3), 150–157. https://doi.org/10.1108/20420921211305891


Egan, V., Bull, E., & Trundle, G. (2020). Individual differences, ADHD, adult pathological demand avoidance, and delinquency. Research in Developmental Disabilities, 105, 103733. https://doi.org/10.1016/j.ridd.2020.103733


Egan, V., Linenberg, O., & O’Nions, E. (2018). The Measurement of Adult Pathological Demand Avoidance Traits. Journal of Autism and Developmental Disorders, 49(2), 481–494. https://doi.org/10.1007/s10803-018-3722-7


Ferguson, S., & Washington, N. (2022, December 9). Pathological Demand Avoidance and ADHD. Psych Central. https://psychcentral.com/adhd/pathological-demand-avoidance-adhd


Glazier, D. (2021). Demand Avoidance Vs Pathological Demand Avoidance (PDA). https://www.esht.nhs.uk/wp-content/uploads/2021/07/Demand-Avoidance-Vs-Pathological-Demand-Avoidance-PDA.pdf



Laushman, P. (2023, April 26). Pathological Demand Avoidance in Adults – How to Help Them Get Unstuck. ThriveAutismCoaching. https://www.thriveautismcoaching.com/post/pathological-demand-avoidance-in-adults-how-to-help-them-get-unstuck


Malik, O., & Baird, G. (2018). Commentary: PDA - what’s in a name? Dimensions of difficulty in children reported to have an ASD and features of extreme/pathological demand avoidance: a commentary on O’Nions et al. (2017). Child and Adolescent Mental Health, 23(4), 387–388. https://doi.org/10.1111/camh.12273


Moore, A. (2020). Pathological demand avoidance: What and who are being pathologised and in whose interests? Global Studies of Childhood, 10(1), 39–52. https://doi.org/10.1177/2043610619890070


Neff, M. A. (n.d.). What’s the Difference Between PDA and Demand Avoidance? Insights of a Neurodivergent Clinician. Retrieved September 1, 2023, from https://neurodivergentinsights.com/blog/pda-or-demand-avoidance


Newson, E. (2003). Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600. https://doi.org/10.1136/adc.88.7.595


O’Nions, E., & Eaton, J. (2020). Extreme/“pathological” demand avoidance: an overview. Paediatrics and Child Health, 30(12), 411–415. https://doi.org/10.1016/j.paed.2020.09.002

PDAadmin. (n.d.-a). Self-help, coping strategies and therapies for adult PDAers. PDA Society. https://www.pdasociety.org.uk/life-with-pda-menu/adult-life-landing/self-help-coping-strategies-and-therapies-for-adult-pdaers/


PDAadmin. (n.d.-b). What is demand avoidance? PDA Society. https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/



Ryuki, R. (2017, July 7). Adult Coping Strategies For PDA. HuffPost UK. https://www.huffingtonpost.co.uk/riko-ryuki/adult-coping-strategies-f_b_17412674.html


Stuart, L., Grahame, V., Honey, E., & Freeston, M. (2019). Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents. Child and Adolescent Mental Health, 25(2), 59–67. https://doi.org/10.1111/camh.12336


Watts, C. (2022, May 13). How to Support Children with Pathological Demand Avoidance (PDA). The Hub | High Speed Training. https://www.highspeedtraining.co.uk/hub/how-to-support-children-with-pda/


Woods, R. (2020, August 5). PDA – a new type of disorder? Www.bps.org.uk; The British Psychological Society. https://www.bps.org.uk/psychologist/pda-new-type-disorder


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