Pathological Demand Avoidance Checklist

By: Julie Landry
 

What is Pathological Demand Avoidance (PDA)?

Pathological Demand Avoidance (PDA) is characterized by an intense, anxiety-fueled resistance to the everyday demands of life. In adults, PDA often presents as an overpowering desire to maintain control over their environment and a tendency to steer clear of tasks that provoke stress. The impact of PDA on a person's life can be profound, influencing their social interactions and occupational functioning.

The term PDA is relatively recent, and ongoing discussion surrounds its categorization—whether it represents a distinct condition separate from autism or simply manifests as a variant presentation within the autism spectrum. Because of this ongoing debate, PDA is not currently included in the DSM as an official diagnosis. 

Several key characteristics commonly associated with PDA include:

• Intense avoidance and resistance of tasks and demands

• Use of social strategies as part of the avoidance

• High levels of anxiety, especially when facing uncertain situations

• A strong need for control

• Difficulty with self-regulation
   

It’s important to note that the features of PDA lack precise definition. The primary characteristics of PDA identified above have been established largely by those in the autistic community with lived experience. 
 

How is PDA related to autism or other conditions?

Pathological demand avoidance is predominantly understood and studied as a profile or subcategory of autism. As previously mentioned, there is debate about how to best categorize PDA and even how exactly to define it. There’s even controversy about the term itself since the use of ‘pathological’ doesn’t exactly scream neuro-affirming! While proponents of PDA typically consider it to be an autism profile, some propose that PDA might constitute a distinct neurotype or neurological difference unrelated to autism or the conditions mentioned below.

Apart from its association with autism, there have been suggestions and a recent study that indicate the persistent and pronounced resistance to demands might also, or instead, be linked to other conditions, including cPTSD, ADHD, and/or ODD.
 

How common is PDA?

We don’t actually know much about the prevalence of PDA. Reliable data is lacking for several reasons:  PDA is primarily regarded as one facet within an individual's neurodevelopmental profile; PDA is not officially a standalone diagnosis; and there’s no standardized assessment for PDA. 

Many of our clients, and a growing number of autistic lived experience advocates, educators, and creators online share about their experience of PDA. Searching online platforms with the hashtag #PDA or #pathologicaldemandavoidance reveals how common it is. As such, its recognition is growing and evolving along with ths increased representation.
 

The Pathological Demand Avoidance Checklist

I developed the following Pathological Demand Avoidance Checklist (adults) to help you identify your own traits that may be associated with PDA. The checklist covers various behavioral patterns and characteristics frequently associated with PDA. Please note this checklist is not diagnostic and there is no scoring system, but I hope you'll find this to be a helpful starting point for your self-reflection and PDA exploration. The checklist may also help guide discussions with mental health professionals. 

Avoidance of Demands:

• Strong, consistent resistance to everyday demands, task, or requests

• Anxiety, overwhelm, or extreme stress when faced with expectations

Need for Control:

• Struggles with relinquishing control in various situations

• May attempt to control others or manipulate circumstances to avoid demands

Social Challenges:

• Difficulty engaging in and maintaining social relationships

• Limited reciprocity in social interactions
   

Intolerance of Uncertainty:

• Excessive anxiety or distress in unpredictable situations

• Difficulty coping with changes in routine or unexpected events

Demand Avoidance Strategies:

• Uses distraction, negotiation, or defiance to escape demands

• Procrastinates in order to avoid tasks
   

Extreme Emotional Responses:

• Displays intense emotional reactions, such as anger or meltdowns, when demands are imposed

• May experience emotional overload in demanding situations
   

Difficulty with Transitions:

• Struggles with transitions between activities or environments

• Requires careful planning and preparation for changes
   

Resistance to Authority:

• Demonstrates defiance or opposition, particularly towards authority figures

• Challenges rules and instructions

Rigidity in Thinking:

• Adheres to specific routines or rituals, resisting any deviation

• Difficulty considering alternative perspectives
   

Communication Challenges:

• May have difficulty expressing needs and preferences verbally

• May have limited use of language in specific social contexts
   

Adaptive Strategies:

• Develops adaptive strategies to navigate daily life, such as using avoidance as a coping mechanism

• Engages in role-playing or 'masking' to navigate social demands
   

Impaired Coping Mechanisms:

• Limited ability to cope with stress or anxiety without resorting to avoidance 

• Struggles with problem-solving in demanding situations
   

Need for Rest/Recovery 

• After demanding situations, may need a period of several low-demand days to recover

Remember, this pathological demand avoidance checklist is not a diagnostic tool but can serve as a guide to identify potential signs of PDA. You can also find additional resources about pathological demand avoidance here. 

NeuroSpark Health supports pathological demand avoidance needs in adults.

If you’re looking for answers or PDA, you may decide to pursue formal assessment, or you may elect to pursue neurodivergent-affirming therapy or coaching. You don’t need to be formally diagnosed to access our services. 

If you’re not sure how we can help, please feel free to reach out or schedule a free consultation where we can learn more about your needs and identify how we can help you on your journey.