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Pathological Demand Avoidance (PDA)

What is Pathological Demand Avoidance (PDA)?

‘Pathological Demand Avoidance’ is a term which has been used to describe behaviours which involve being unable or unwilling to comply with normal social rules and boundaries, which may include the ordinary demands and expectations of everyday life e.g. getting up, going out or taking part in an activity.

This sort of demand avoidant behaviour can often be an anxiety-driven response in the context of a neurodevelopmental disorder, particularly an Autistic Spectrum Disorder. However, demand avoidant behaviour can also be a symptom of other difficulties/disorders such as trauma, attachment/relationship difficulties, language disorder, other anxiety disorders and conduct problems.

Difficulties arise from the extreme nature of some of these demand avoidant behaviours.

Is PDA a diagnosis?

PDA is not recognised as a separate diagnostic category by the national and international classification systems for mental health, and developmental disorders: DSM V and ICD 10, or by the Royal College of Psychiatry. Neither is it recognised by national and regional centres such as the Evelina Children’s Hospital or Great Ormond Street Hospital. This is because demand avoidant behaviour can already be explained within the categories of existing diagnoses such as those mentioned above, including an Autistic Spectrum Disorder.

What happens next?

Demand avoidant behaviour of whatever type can be very difficult to manage at home, at school and within the community, and needs to be fully investigated so that the right treatment and management strategies can be identified.

Sussex Partnership Foundation Trust therefore works closely with its partner agencies in Health, Education and Social Care to undertake a comprehensive assessment of the child or young person, in order to provide a diagnosis that will result in the necessary level of help and support for them and their family.

A note to parents/carers:

It is really important that the reasons for your child’s behaviour are fully investigated so that treatment can be targeted. If we consider PDA behaviours alone when developing a care plan we may not offer the most effective treatment. That is why we will work with you and your family to identify the problems that your child is experiencing and will focus our treatment on managing those symptoms.

We are here to help. We understand that this type of behaviour can be challenging and upsetting and, will work closely with you to help your child.

Article provided by Children & Young People CDS - 18th October 2017

Review date: October 2018

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