The Problem with PDA - and a solution

The below is an opinion on a hot button issue – you are free to disagree and go your own way in peace.

If you’ve landed here, I imagine you may be feeling exhausted, frustrated, and heartbroken. Maybe your child—whether they’re thirteen, sixteen, or a young adult—seems to resist every request, no matter how small. Maybe routines fall apart, school is a battle, and nothing you try seems to work. And then, one day, you hear about Pathological Demand Avoidance (PDA), and suddenly everything clicks. Finally—words for what you’re seeing. Finally—a community of other parents who get it.

I see you. And I believe you. What you’re experiencing is real, and so is your child’s struggle.

As a mental health professional who has worked with many neurodivergent children and teens, including those who display strong avoidance of demands, I want to offer you support and also a few things to consider. Not to invalidate what you’ve found helpful, but to gently widen the lens. Because I know you’re here for one reason: you want to help your child.

PDA: Why it speaks to so many

There’s a reason PDA feels so validating. It gives language to a pattern that feels otherwise inexplicable. Your child’s intense resistance to ordinary requests can look like willfulness or defiance—but in your heart, you know it’s not that simple. PDA acknowledges that your child isn't just “being difficult.” That matters. It’s an important step.

But as a clinician, I want to invite us to go even further. Because PDA, while comforting in the short-term, can sometimes stop us from looking deeper.

Why I’m cautious about PDA

My concern isn’t with you finding language that helps—it’s with a system that often fails to ask the most important question: What is your child trying to tell us with this behavior?

The Labeling Issue: "Pathological"

The term "Pathological" in "Pathological Demand Avoidance" is problematic at its core. While some have rebranded the concept as "Pervasive Drive for Autonomy," which is a step toward better language, the original term casts a negative light on behaviors that could be understood differently. The word "pathological" itself suggests a medical or disorderly nature, implying that avoidance is inherently a flaw rather than a coping mechanism or a response to unmet needs.

Neurodiversity and exclusivity

Another significant concern is the fact that PDA is often exclusively ascribed to neurodiverse individuals, particularly those with autism. This exclusivity raises red flags, especially when the behaviors associated with PDA—resistance to demands—are commonly seen in children and adults across various neurotypes. By labeling this as unique to autistic individuals, we risk reinforcing a narrow, reductive view of neurodivergence that doesn't account for the complexity of the individual’s experience.

It's also worth questioning the premise that the very existence of PDA is defined by the unmet expectations of others. Why are we creating a behavior category that only applies when someone else’s expectations aren't met by the individual in question? That’s not a medical condition. In clinical work, it’s essential to ask: whose expectations are we really discussing, and how are they influencing our understanding of behavior? If the diagnosis only appears in the context of failing to meet others' demands, we are placing the burden of explanation on the individual rather than considering systemic or environmental factors that might be contributing. And in this paradigm it seems as if we choosing NOT to focus on the individual’s needs or “demands” in the given situation, even if unspoken—the needs that are not being met and are leading to the avoidant behavior.

This is not a diagnosis

PDA isn’t a formal diagnosis in the DSM-5, and its foundations are still debated in the clinical field. Be wary of people who use diagnostic language along with the term PDA.

A More Inclusive Understanding

What if we reframed PDA in ways that acknowledged the complex factors contributing to behavior? For example, instead of labeling this phenomenon as "Pathological Demand Avoidance," we could explore terms like "Social Trauma Demand Avoidance" or "Emotional Regulation Skill Deficiency Demand Avoidance." Or even, tongue in cheek, “life is always too much for my nervous system demand avoidance", or “I’m just a little kid and my nervous system can’t yet process all the input, yet” or “I’m an older kid/teen/adult and am trying on self-advocacy and missing the mark wildly” or “None of the adults in my life really understand what I need” demand avoidance.

But in all seriousness, more explanatory and person centered terms focus on the underlying experiences and skills that may be lacking, such as the inability to regulate emotional responses due to overwhelming sensory inputs or the struggle to advocate for one's needs in a social environment that lacks understanding.

Consider the way we once viewed "Hysteria" as a legitimate diagnosis for women, only to later recognize how this term served to delegitimize the lived experience of women facing social, economic, and gendered stress. In much the same way, I see PDA as potentially undermining the real, lived experiences of neurodiverse individuals. It offers an easy, external explanation rather than asking us to look deeper into the systemic barriers that may be at play—whether those be societal, educational, or relational.

A Person-Centered approach

Rather than labeling this as a pathological issue, I believe it’s more responsible and helpful to approach these behaviors from a person-centered perspective. We need to get to the root of the avoidance. Why is it happening? Is it a reflex response, an unmet need, or a mismatch between the person’s coping skills and the demands placed upon them?

There’s a clear divide in how professionals view these issues: some lean into the diagnostic approach, while others, like myself, prefer a person-centered approach that acknowledges the complexity of the individual and focuses on building the skills needed to navigate challenging situations.

What might be happening instead

Your child/teen/young adult may not be avoiding demands because something is “pathologically wrong” with them. They might be:

• Experiencing sensory overload, and the demand is just too much for their nervous system to process at that moment.

• Needing more control over their environment because they feel unsafe or misunderstood.

• Struggling with transitions, especially if plans or expectations change unexpectedly.

• Exhausted from masking, and demands—especially social ones—just tip them over the edge.

These responses are not evidence of a disorder; they are valid, adaptive reactions to a system, experiences, or people who may not be meeting the autistic child or adult's needs. While some PDA-informed strategies attempt to support these challenges, it's essential that we frame our approach through a person-centered lens—one in which to goal prioritizes understanding, respect, and skill-building—rather than one that implies something is inherently “wrong” with the child/adult and the goal is still to work toward compliance.

Other ways to understand demand avoidance

Let me offer you a few alternative paradigms that I’ve seen help families and individuals move forward in healthier, more empowering ways:

1. The “No Reflex”

This term comes from this blog post by Cynthia Kim and was used by a wise autistic woman I’ve had the privilege of working with. She described a kind of automatic “no” that kicks in—not because she wants to say no, but because her brain is overwhelmed by the need to shift gears or meet an external demand. The key? It's not the “no” that’s the problem—it’s the reflex. With time, support, and skill-building, she learned to notice the reflex and decide whether “no” was truly what she wanted to say.

This insight reinforces the idea that avoidance isn't an inherent personality flaw, but rather an adaptive response to overwhelming circumstances. It's something that can be worked on with the right support—whether that’s through emotional regulation training, sensory accommodations, or more effective communication strategies.

2. Collaborative and Proactive Solutions (CPS)

Developed by Dr. Ross Greene, this approach is built on the belief that “kids (as well as teens and young adults) do well if they can.” It shifts the question from “how do I make my child comply?” to “what’s getting in the way of my child doing well?” You and your child work together to solve the problems causing the challenging behavior. It’s incredibly respectful, empowering, and effective—especially for neurodivergent individuals.

3. Low Demand, High Support Living

Rather than removing all expectations (which can backfire), this model encourages us to reduce unnecessary demands while still building essential skills. It asks: What demands are causing distress right now, and how can we create a buffer zone while gently supporting the child’s growth over time?

None of these approaches are quick fixes. But they are deeply respectful. They don’t label your child as broken, they recognize your child as doing their best with the tools they have.

Final Thoughts

As PDA gains acceptance in some circles, I understand why some individuals find it useful as a framework. However, I remain committed to the belief that we must prioritize a deeper understanding of the person’s experience rather than reducing it to a label. PDA may seem like a convenient explanation, but it risks oversimplifying the needs of neurodiverse individuals. Instead, we should be asking: What’s really going on here, and how can we help individuals develop the skills to manage their own reactions and assert their needs in a world that often doesn’t understand them?

You're Not Alone

If PDA has given you language for your experience, that’s okay. If it describes your or your child/teens/young adults experience and is helpful, then great. Use this paradigm.

But if it doesn’t feel quite right, or it doesn’t really resonate with you, if you’re ready to go deeper to get to the root of the distress and help your child/teen/young adult develop the skills they need to feel safe, regulated, and empowered—I’m here to say there are other paths. Paths that don’t rely on pathologizing their nervous system. Paths that support both of you.

Your love for your child is already the strongest tool you have. Pair that with a lens that sees your child not as disordered, but as overwhelmed and maybe not (yet) able to cohabitate with their nervous system, and you can begin to help them build the capacity to say “yes”—not because they’re compliant, but because they feel safe, heard, and in control.

You don’t have to choose between compassion and clinical wisdom. You deserve both.