Pathological Demand Avoidance: Understanding This Silent Mental Condition

Pathological Demand Avoidance (PDA) is a developmental disorder that is part of the autism spectrum disorder. It affects all aspects of the development of an individual, which means it is a pervasive disorder. 

Pathological Avoidance Disorder was identified by a British developmental psychologist,  Elizabeth Newson in the 1980s. She founded the term pathological avoidance disorder. Some time ago this was a term little known to the public. But with the increase in awareness about mental health, it is now being recognized by many people. However, PDA is still not considered a distinct disorder and falls under the umbrella diagnosis of autism. Some clinicians use PDA as a descriptive diagnosis alongside the clinical diagnosis of Autism Spectrum Disorder.

Children with PDA share some similarities with the children on the autistic spectrum. They have difficulties in relationships, social communication, and showing obsessive and rigid behavior. PDA is a very complex and challenging condition, it is often misunderstood and ignored by mental health practitioners. And more often than not, it is also overshadowed by other mental conditions. 

It is also important to know that treatment plans including psychotherapy and strategies that might help learners with autistic spectrum disorder may not be beneficial for children with PDA. 

What Are The Features Of PDA? 

Someone with a PDA profile will avoid the usual, day to day demands of life. For example, they will resist joining friends or family for dinner or other activities. They will try their best to avoid any situation demands made by others. They might also react in this way even when the person wants to do what has been asked. 

They also use other social strategies to avoid such situations. They will try to distract people and change the subject. Some may even try to delay and say something like ‘ I’ll do it in 20 minutes, I am busy right now’. Others may withdraw into fantasy. And if everything else fails, they start hitting, swearing, and damaging property to get themselves out of the situation. 

Individuals with PDA appear sociable on the surface. Unlike autistic people, learners with PDA are manipulative and use social skills for their benefit. However, these skills are on a more superficial and logical level rather than an emotional level. Their conventional skills appear better but there is a significant lack of depth in their understanding. For example, they may not understand how their behaviors can negatively affect their relationship. They may not see the difference between themselves and an authority figure. They have difficulty understanding other’s behaviors or adjusting their behavior to cater to the needs of others. 

How Is Pathological Demand Avoidance Diagnosed? 

Pathological Demand Avoidance is more relatively difficult to diagnose than any other mental condition, especially autism. PDA can be diagnosed in the preschool years but is confused with Autism and the child doesn’t receive the appropriate treatment. And that happens because a child with PDA has better imaginative play, increased social interest, and more age-appropriate behaviors and language than an autistic child.  A lot of children fail to receive a formal diagnosis

until they are much older. 

A qualified health professional such as a pediatrician or Child Psychologist usually makes the diagnosis of Pathological demand avoidance. Proper diagnosis of the disorder at the right time will enable them to seek professional help immediately. They can then get appropriate service and support that can alleviate some of their problems. They will be provided with advice and management strategies to help control their problematic behavior. Also, the proper diagnosis will allow their families to understand their problems better and support them through their difficulties. 

What Is The Treatment For Pathological Demand Avoidance? 

Sadly, there is no permanent cure for pathological demand avoidance but therapists can treat pathological demand avoidance or control it by using a multi-therapy approach. But even treatment interventions can be difficult. The nature of this condition makes it hard for the person to respond well to the treatment methods. Just like any other demanding situation which they obsessively avoid, they try to escape therapy too. But with appropriate wording of demands, the therapy can be more effective. The demands should be indirect, short, and clear.

Psychotherapists dealing with PDA  clients are very well equipped with techniques to prevent the avoidance tactics used by the clients to overcome avoidance demands. Clients should be given enough time so that they can process all the information they are receiving. It can sometimes get very overwhelming for the clients, so the therapist should enable them to understand their feelings.

If the client with PDA does something good or performs a task according to the set rules, they should be appreciated to strengthen their personal qualities. And it is important to note that their failure should not be emphasized as that will not only reinforce the negative behavior. 

Therapists might also administer some psychological tests to better understand the severity of the condition. The assessment will be used to guide the treatment and to evaluate whether the client is facing difficulties in the following areas: 

1. Communication Skills 
2. Motor Skills ( Fine And Gross) 
3. Social Skills 
4. Learning Ability 
5. Sensory processing

Physiotherapists, Occupational therapists, Speech/Language Therapists, and Clinical psychologists are the professionals involved in the treatment of people with pathological demand avoidance. They use a team approach to treat and assess this mental condition.

Individuals with pathological demand avoidance need extensive care and support. It is crucial for the parents/caretakers and the professionals to be patient and consistent. They should also know that due to the changing nature of the disorder, what may be effective on one day may not be useful the other day. 

Learners with pathological demand avoidance need great help when it comes to education. To meet their educational needs, they must have one-on-one interaction and support through the key worker or a teaching assistant. 

Therapists provide valuable help to parents and strategies to children with Pathological Demand Avoidance, therapists can also help them deal with a tough situation that may arise. They enable individuals to deal with tough situations and maintain a healthy home environment. So in conclusion, professionals can diminish some of the symptoms but can not completely cure it.