The PDA Controversy

A recent review by Kildahl and colleagues (2021) examined the currently available research on Pathological Demand Avoidance (PDA) in children and adolescents. The authors assessed methodological quality, diagnostic criteria, and how PDA relates to autism and other psychiatric conditions.

PDA is a profile that describes children who feel extreme anxiety when faced with everyday demands and expectations, often leading to avoidance behaviours. It differs from ODD – have a look at our article here.

What did the review find?

• PDA is controversial – There is a growing demand for PDA diagnosis. And, while more parents and professionals are asking about PDA, there is no clear agreement on whether it is a separate condition, part of autism, or better explained by anxiety and other factors. Critics argue it may undermine autistic self-advocacy and overlook the role of anxiety as a driving factor.
• The evidence base is very small – Only 13 studies were found, and most relied on parent reports. Importantly, none asked children or young people themselves about their experiences.
• Definitions are inconsistent – Different studies used slightly different ways to describe or measure PDA, making it difficult to compare results or know if everyone is talking about the same thing.
• Links to other conditions are unclear – Research has not properly explored how PDA overlaps with autism, ADHD, or anxiety disorders, or whether it might be explained by these. Studies generally failed to consider alternative explanations (e.g., anxiety, sensory processing issues, oppositional behaviour).

What does this mean for parents?

For families, this uncertainty can feel frustrating. Some parents find the PDA description very helpful in understanding their child’s behaviour, while others worry that the label is stigmatising or not recognised by schools and professionals.

The review highlights the need for:

• Listening to children and young people’s voices about their own experiences.
• Developing clear, consistent assessment tools.
• Exploring the role of anxiety and how it drives demand avoidance.

Takeaway

At present, PDA is under-researched and is best understood as a descriptive profile rather than a formal diagnosis. What is clear is that children who strongly avoid demands often do so out of high anxiety and a need for control, and they benefit from understanding, flexibility, and supportive strategies.

Have a look at our article on PDA and the Polyvagal Theory and Low Demand Parenting.

Reference: The original journal article: https://journals.sagepub.com/doi/full/10.1177/13623613211034382

Kildahl, A. N., Helverschou, S. B., Rysstad, A. L., Wigaard, E., Hellerud, J. M., Ludvigsen, L. B., & Howlin, P. (2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism, 25 (8), 2162–2176.