If you or someone you love lives with PDA, you know it’s not about being “difficult” or “defiant.” It’s about a nervous system on high alert, trying to protect itself—often by saying “no” when even simple tasks feel overwhelming. It can be lonely and misunderstood, especially when others don’t see the anxiety behind the resistance. 

Pathological Demand Avoidance (PDA)—also known as Persistent Drive for Autonomy—was first described by psychologist Dr. Elizabeth Newson in the 1980s. She observed a pattern of intense, often creative, resistance to everyday demands—especially among autistic children—driven not by defiance, but by anxiety and a need for control in a world that feels like too much. 

While not yet recognized in diagnostic manuals like the DSM-5, PDA is increasingly acknowledged through research and lived experience. The demands that trigger it aren’t necessarily big—brushing teeth, choosing lunch, or answering a question can all feel intrusive when autonomy is at stake. 

PDA isn’t stubbornness. It’s a protective response to overwhelm. And when we understand it that way, everything begins to change. 

The Many Faces of PDA 

Dr. Newson’s early research (2003) and later work by clinicians and PDA-informed practitioners outline key patterns that frequently show up in individuals with PDA: 

1. Avoidance driven by anxiety: It’s not just resistance—it’s often panic. Demands trigger overwhelming internal responses. 

2. Creative strategies of evasion: People with PDA often use humor, distraction, role-playing, or negotiation—not to manipulate, but to stay regulated. 

3. Rapid shifts in emotion: Big feelings surface quickly, often in response to a loss of perceived control. 

4. Masking and charm as control tools: Many can appear socially fluent—until something feels unsafe, and the protective shield goes up. 

5. Push or pull responses: Some withdraw quietly, others push back loudly, but both are responding to the same internal pressure. 

Why PDA Happens: The Dance Between Anxiety and Autonomy 

What causes PDA? While research is still catching up, many experts believe PDA behaviors emerge from a need to maintain control in order to manage underlying anxiety—especially in people who also struggle with intolerance of uncertainty. When the brain detects a demand, even a small one, it sounds the alarm. And once the “fight flight freeze” response is activated, reasoning often goes out the window. 

A scoping review by Haire and colleagues (2024) suggests that PDA traits commonly overlap with autism, and may also co-occur with ADHD, anxiety disorders, and even trauma-based responses. While PDA is not a formal diagnosis, understanding it as a functional profile—a way the nervous system and brain relate to perceived demands—can help guide meaningful, compassionate care. 

What It Can Feel Like from the Inside 

For people with PDA, the world can feel full of invisible traps. Everyday tasks that others do without thinking—greeting a friend, getting dressed, choosing lunch—can feel loaded with pressure. And the pressure doesn’t just live in the mind; it lives in the body. 

Here’s what people with PDA often report: 

• “Easy” tasks can feel huge. Not because they don’t care, but because they can’t tolerate feeling coerced. 

• Creativity becomes a survival strategy: humor, distraction, storytelling, or outright refusal become ways to stay grounded. 

• When pressure builds, it can lead to shut down, panic, or explosive meltdowns—not because they want to upset others, but because they’ve hit a wall. 

• Requests from loved ones can feel threatening, even when made gently, triggering shame or withdrawal. 

• Over time, this dynamic can create harmful internal narratives like, “I’m lazy,” or “I’m broken,” when what’s really happening is a highly sensitive nervous system doing its best to cope. 

How PDA Differs from Conduct Disorder 

One of the most common misinterpretations of PDA is when it’s mistaken for Conduct Disorder (CD). On the surface, both can involve opposition, refusal, or emotional outbursts—but their roots are very different. 

Conduct Disorder involves a consistent pattern of violating the rights of others or societal rules, often with little remorse or empathy (APA, 2013). Think aggression, deceit, or deliberate defiance. 

PDA, by contrast, is anxiety-based. People with PDA often want to do the right thing, connect, and succeed—but the fear of being controlled or overwhelmed overrides their ability to follow through. Their resistance is not calculated or callous; it’s protective. 

Research from the PDA Society and scholars like Christie et al. (2012) and Green et al. (2018) affirms that individuals with PDA can be deeply empathetic and social—when they feel safe. Mislabeling PDA as CD can lead to punishment-based approaches that increase shame and reactivity, rather than building trust and emotional safety. 

Therapy for PDA at Love This Therapy 

At Love This Therapy, we don’t view PDA as a problem to “fix.” Instead, we understand it as part of a person’s unique nervous system story—a story shaped by sensitivity, creativity, and a deep need for autonomy. While PDA may not appear in formal diagnostic manuals, it is very real—and therapy can be profoundly healing when grounded in curiosity, gentleness, and shared power. 

Traditional models that rely on compliance or rewards often backfire for those with PDA. What helps instead is an approach that respects autonomy, prioritizes connection, and builds trust at the individual’s pace. Here’s what that looks like in our practice: 

1. A Low-Demand, Low-Arousal Approach 

We reduce the emotional intensity of demands by softening how we communicate and interact. 

• Use indirect language: “I wonder if…” instead of “You need to…” 

• Offer real, meaningful choices: “Would you like to start by drawing or sitting quietly?” 

• Give clients permission to say no, without shame or pressure 

• Create unhurried space for participation at their own pace 

This approach helps calm the nervous system and invites openness rather than defensiveness. 

2. Building Trust Before Technique 

We know that connection comes first. Our therapists focus on relationship building as the foundation of all therapeutic work. 

• Show up consistently—without demands or expectations 

• Follow the client’s lead (even if that means talking about Minecraft or Marvel) 

• Use attunement, presence, and patience to build safety 

• Let the relationship unfold naturally before introducing tools or goals 

3. Supporting Emotional Regulation & Sensory Needs 

Since anxiety is often at the core of PDA, therapy includes tools to help clients understand and regulate their internal states. 

We support emotional and sensory needs with: 

• Grounding practices like deep breathing and muscle relaxation 

• Sensory tools  

• Co-regulation: therapists model calm presence and guide clients through dysregulation in real time 

4. Collaboration Instead of Compliance 

Rather than giving instructions, we co-create each step of the therapy process. 

• Ask open-ended questions like: “What would feel okay to try today?” 

• Offer flexible session options: drawing, talking, movement, or quiet space 

• Make plans collaboratively and leave room for change 

• Frame participation as an invitation—not an obligation 

This “power-with” rather than “power-over” model creates the conditions for true therapeutic engagement. 

5. Adapting ABA & CBT Tools with Care 

Some clients benefit from selected tools within ABA or CBT—but they must be sensitively adapted for the PDA profile. 

• Functional Communication Training (FCT) helps clients express needs safely 

• Visual aids and flexible routines reduce uncertainty without adding pressure 

• Playfulness, humor, and novelty support engagement in a low-demand way 

We don’t throw out structure—we reshape it to honor the client’s autonomy and nervous system needs. 

6. Educating and Empowering Families 

PDA doesn’t just affect individuals—it shapes family dynamics, school experiences, and caregiver stress. That’s why we offer psychoeducation and advocacy support alongside therapy. 

We help caregivers: 

• Understand PDA as anxiety-driven, not defiant 

• Shift from behavior management to empathy-based connection 

• Learn language and strategies that reduce conflict and build safety 

• Navigate school systems and advocate for appropriate accommodations 

7. What Support Looks Like at Love This Therapy 

Our PDA-informed therapy includes: 

• Comprehensive assessments that explore the roots of avoidance, anxiety, and control 

•  Therapists trained in neurodivergence, trauma, and PDA-sensitive care 

•  Practical tools like visual aids, sensory supports, and communication scaffolds 

•  Family coaching and school consultation to build a unified, compassionate support system 

• Strengths-based reframing that celebrates autonomy, resilience, and creativity as gifts—not deficits 

At Love This Therapy, we walk gently. We listen deeply. And we hold space for each client’s growth—without pressure, without shame, and always with the deep belief that autonomy and healing can go hand-in-hand. 

Practical Skills You Can Use Right Now 

If you’re living with PDA—or parenting someone who is—here are gentle strategies, you can use daily to foster connection and reduce stress: 

1. Speak Indirectly 

• Try, “I wonder when a good time would be?” instead of, “You have to do this now.” 

• Avoid language that sounds like an ultimatum. 

2. Offer Real Choices 

• “Do you want to do this now or in five minutes?” 

• “Would you prefer a shower or bath?”  

Choices increase agency and reduce the fight flight or freeze response. 

3. Use Visual Supports 

• Create soft, visual plans for the day with pictures or icons. 

• Use a “first…then…” structure: “First snack, then walk.” 

4. Make Things Fun 

• Turn transitions into a game (“Let’s hop like frogs to the car!”). 

• Use role play (“We’re on a space mission to tidy the room!”). 

This keeps nervous systems engaged without triggering avoidance. 

5. Teach Calming Skills 

• Practice deep breathing (e.g., in for 4, out for 6). 

• Use “body scan” relaxation before bed. 

• Try naming five things you can see, four you can touch… and so on (54321 grounding). 

6. Support Sensory Regulation 

• Offer headphones, weighted blankets, fidgets, or calming scents. 

• Let them retreat when overwhelmed—it’s not rudeness, it’s regulation. 

7. Build Predictability 

• Use timers or countdowns. (“We’ll leave in 10 minutes—want a reminder at 5?”) 

• Give forewarning for transitions. 

8. Validate Feelings 

• “I can see this feels really hard.” 

• “You’re not in trouble—you’re allowed to feel overwhelmed.” 

Validation helps reduce shame and repair connection. 

9. Make Collaborative Agreements 

• “Let’s plan what to do if things get tricky—do you want a code word or a break card?” 

• Involving them in the plan builds buy-in. 

Final Thoughts 

Living with PDA can be overwhelming—not just for the person experiencing it, but for their families and communities too. But it’s also a window into something powerful: a deep need for agency, a sensitivity to coercion, and a nervous system doing its best to protect itself. 

With compassionate support, informed therapy, and a shift in how we understand demand resistance, healing becomes possible. Patterns of shutdown and struggle can begin to soften. And relationships—when rooted in attunement and autonomy—can flourish. 

If this sounds familiar to you or someone you love, you’re not alone. And you don’t have to figure it out on your own.  

Reach out to us today at 604-229-4887 or info@lovethistherapy.com. We’re here to walk with you—step by step, at your pace, with kindness, creativity, and care. 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

Christie, P., Duncan, M., Fidler, R., & Healy, Z. (2012). Understanding pathological demand avoidance syndrome in children: A guide for parents, teachers and other professionals. Jessica Kingsley Publishers. 

Eaton, T., & Banting, P. (2012). Educational and management approaches effective for PDA reportedly differ from ‘typical’ ASD, including novelty, humour, and flexibility. Good Autism Practice, 13(1), 46–53. 

Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., & White, R. (2018). Pathological demand avoidance: Symptoms but not a syndrome. The Lancet Child & Adolescent Health, 2(7), 455–464. 

Haire, L., Symonds, J., Senior, J., & D’Urso, G. (2024). Methods of studying pathological demand avoidance in children and adolescents: A scoping review. Frontiers in Education, 9, Article 123001.  

Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600. 

PDA Society. (n.d.). What is PDA? Retrieved June 2025 from https://www.pdasociety.org.uk/what-is-pda/ 

PDA North America. (n.d.). What is PDA? Retrieved June 2025 from https://www.pdanorthamerica.org/what-is-pda/ 

Verywell Health. (2023, September 25). Pathological demand avoidance (PDA) in autism. Retrieved from https://www.verywellhealth.com/pda-autism-7963757 

Verywell Mind. (2023, February 20). Pathological demand avoidance in autism and beyond. Retrieved from https://www.verywellmind.com/pathological-demand-avoidance-7111530 

Wittkowski, A., Johnson, M., & Wright, A. (2019). Development and validation of the extreme demand avoidance questionnaire—Adult version (EDA-QA). Journal of Autism and Developmental Disorders, 49(2), 481–494.