Exploring the Underlying Pressures of PDA (Pathological Demand Avoidance)

Mar 8

Exploring the Underlying Pressures of PDA (Pathological Demand Avoidance)

-Written by Rachel Durban, Occupational Therapist and owner of Autistic Adult & Teen Consulting

PDA. Pathological Demand Avoidance. Persistent Demand for Autonomy. There is not a ton of agreement about what it is, or even what the name should be. The profile was identified by British Psychologist Elizabeth Newson in the 1980s (Gillete, 2023.) While it is not considered a diagnostic label in the U.S., more and more autistic individuals and their families are identifying with and finding insight in the PDA profile. Not as familiar with PDA? You can read more about it on the PDA Society website here.

However, PDA is not well researched and is considered to be far more rare than common. Dr. Donna Henderson, a Psychologist and PDA expert, defines PDA in this way:

“The core of PDA is an anxiety-driven need for autonomy. PDA causes someone to avoid demands and expectations for the sole purpose of remaining in control (Henderson 2023).” (Read more here)

Dr. Megan Anna Neff, an autistic Psychologist and creator of the resource hub Neurodivergent Insights, defines PDA in a similar way:

“People with PDA can experience a fight, flight or freeze response when faced with demands that threaten their autonomy, which can trigger intense emotional reactions (Neff 2023) “ (Read more here)

This is not a foreign concept for many, those with anxiety often experience some relief with increased feelings of control. While autonomy seems to be the center of the conversation, especially among some of the leading experts on the topic, I think we’re missing some other facets that are worth exploring, especially those related to performance-based pressures (either internalized or externalized).

A lot of people who identify as PDAers do not necessarily feel driven by autonomy (or at least solely driven by autonomy). Yet, this does not diminish or mean that their struggles with demands are any less. They still have significant challenges with avoiding ordinary life demands. Some may not even have the avoidance feature, but struggle with crushing anxiety as they push through day to day demands.

Still, as more and more autistic individuals are finding relevance and insight in PDA for themselves, the question remains, what are we missing?

Is the need for autonomy still at the center of everyone who finds themself identifying with PDA? Is the traditionally defined PDA profile a limited subset in itself of autistic individuals who struggle with demand pressure? In our practice, we see PDA features and demand avoidance EVERYWHERE. While we tend to work with a niche subset of the autistic population, particularly high-masking individuals, we see elements of PDA in most individuals we work with. However, while we definitely see anxiety as a driver, the need for autonomy does not seem to be the only co-pilot. This has led us to explore a side of PDA that we’ve started calling Performance-Based PDA.

What Other Underlying Factors Might Increase Demand Pressure?

Just like anything, understanding the underlying mechanisms can be so helpful for identifying strategies that can help. Let’s take a look at some underlying processing differences that can up the demand pressure, and examine how anxiety related to performance of demands might be a factor.

Pressure Cooker Number One: Black and White, All or Nothing Thinking Style

This thinking style can increase the pressure in a few ways. Let’s explore.

A tendency to approach things in more of a perfectionist way, feeling that something is either done “perfectly” or is a “failure.” Like a kid learning to drop kick a ball who makes his first attempts and makes contact but doesn’t launch the ball into the air as expected. This attempt can feel like a full failure rather than a step in the learning process. This processing difference can make resiliency with learning new things just plain harder.

More clearly defined and unrelenting rules. When you’re doing laundry, do you usually stick to all the things that are technically suggested you do, or do you kind of do an in-between that is good enough? Many neurotypicals follow a more “good enough” approach because life happens, laundry builds, and it just needs to get DONE. Hand wash only? Gentle cycle is probably fine. Sort by color? These clothes aren’t new so the darks can probably go in with the lights. Lay flat to dry? I’m out of space on the drying rack so it can hang on the back of the chair. Neurotypicals are always figuring out an “in between” of suggested rules and what makes things doable. But for those who process things in more of a “black and white” style, rules tend to feel like something that can’t be bent or compromised. If you’re not a “black and white” processor, imagine how much more pressure you might feel about laundry if you did all the laundry rules PERFECTLY, all the time. It feels like a LOT.

Less clearly defined, vague rules. A lot of “black and white” processors feel a similar level of anxiety, or sometimes even more anxiety, when the rules are vague. Maybe you’re given a writing assignment in school such as “Write about something you are passionate about.” Questions remain of how to do it “right.” What are the unspoken rules in the assignment? Is one paragraph ok or are several pages expected? Do I need to use traditional paragraph structure or can I do a deep dive into my deep interests and lay it all out there in a more natural, stream-of-consciousness kind of style? What other elements are you looking for that I’ll be graded on? Use of bigger words? More complex sentence-styles, metaphors, similes, expansion of my thoughts? Please be direct and clear on what you’re expecting, or it may feel so vague and daunting that black and white processors can’t approach it at all.
2. Pressure Cooker Number Two: Bottom-Up Processing (And Seeing “The List”)
First of all, what is Bottom-Up vs. Top-Down processing? Bottom-up processing is more of an autistic processing style. It means that you see the “bullet points” before the category, or the details before the big picture. These details can feel unique and completely different so they’re not assumed to be part of the same category in the same way that non-autistic individuals tend to assume things in a category-first approach.

For example, think of a neurotypical mom telling her autistic 3-year old to wait to jump into the pool until she says “Go,” making sure he is waiting until it’s all-clear and safe to jump in. The mom is signaling that she’s ready and says “Alright,” “Come on,” You can jump,” meanwhile her kid is waiting to take the plunge. Then the child says “Mommy, say GO,” the magic, specific words that your child is waiting for, what you’d thought you’d been saying under the GO category the whole time. Different processing, different interpretations.

This bottom-up processing style can be amazing for promoting innovative thought and novel ideas since new concepts aren’t immediately placed into a preexisting box or category. It can also make communication between neurotypical and autistic individuals more challenging at times.
So what does bottom-up processing have to do with pressure on demands or tasks? Imagine you are thinking about the things you need to get done today. A non-autistic brain might visualize something like:
1) Do some laundry
2) Empty the dishwasher
3) Get started on a work project.

However, if you are a bottom-up, detail-oriented processor, it’s likely that you see “the list” rather than the “to do” categories (as well as “the rules”).

Let’s take another look at laundry and what a bottom-up processor might visualize on their “to do” list:

1) Gather dirty clothes

2) Sort the laundry by wash cycle

3) Sort the laundry by color

4) Treat the clothes for stains

5) Start the first load of sorted laundry

6) Return to the task and dry clothes as instructed (hang dry, hang flat, begin dryer cycles high vs. low heat)

7) Return to the task when drying is complete and put the hanging clothes away

8) Fold the remaining clothes correctly and put them away in drawers

That is just ONE thing on your “to do” list today and already the list feels long. SO. MUCH. PRESSURE.

What can be gleaned from understanding other underlying factors?

First of all, many of the typical PDA strategies can still help: Read more about self-support tips for adult PDAers from the PDA Society here.

Second, we can use guiding principles to identify other strategies that can help decrease demand pressure.

These guiding principles are building ways to try to:

Increase the flexibility of tasks
Decrease the weight (or inherent pressure) of a task
Improve clarity of what’s expected (sometimes, and without increasing pressure!)
Find balance (or ways to manage demand-related anxiety).

(See visual below that explores these strategies further.)

How might we differentiate other forms of PDA from the way it’s traditionally defined?

In our practice, we’ve shifted towards talking about Performance-Based PDA in addition to the more traditionally defined PDA. By this we mean that Performance-Based PDA has performance-based anxieties at the center (as outlined above), rather than anxieties centered around autonomy (as with traditionally defined PDA). Because the more we understand the “why,” the more we can form specific strategies that help.

Would love to know your thoughts. Do you find yourself struggling under the pressure of some of the performance-based aspects of tasks? Do you see factors contributing to PDA, for yourself or others, that we missed here?

You can share your thoughts at info@autisticadultandteen.com.