“Stigma is the process by which the reaction of others spoils normal identity.” – Erving Goffman
When a child resists instruction, lashes out under pressure, or refuses school altogether, the dominant narrative still points toward oppositional defiance, behavioral reinforcement systems, or a lack of structure. But a growing body of families, educators, and clinicians now recognize a different story: one rooted in profound anxiety, a fragile sense of autonomy, and a desperate need for control. These are the hallmarks of Pathological Demand Avoidance (PDA) – a profile most commonly associated with autism and neurodiversity yet still mired in misunderstanding and dismissed due to stigma (Newson, Le Marechal, & David, 2003; Christie et al., 2012).
As a retired special education administrator, I’ve watched for years as behavioral approaches like PBIS and ABA failed to reach a small but significant group of students whose nervous systems weren’t simply oppositional—but dysregulated by the mere presence of a demand (Gillberg, 2014). These were the students educators described as “fine one moment, explosive the next,” or who seemed “charming, manipulative, and defiant.” These words—especially when spoken about neurodivergent children—are soaked in stigma. And that stigma is obscuring one of the most important emerging profiles in neurodevelopmental research (Stuart, Grahamslaw, & Dunlop,2020).
What is Pathological Demand Avoidance (PDA)?
Pathological Demand Avoidance was first described in the 1980s by Dr. Elizabeth Newson in the UK and is now recognized within the National Autistic Society of the UK as a profile on the autism spectrum (Newsom et al., 2003). Individuals with PDA experience an extreme anxiety-based avoidance of everyday demands and expectations, including those that are self-imposed. Behaviors may include socially strategic avoidance, need for control, intense mood variability, and episodes of “panic attack–like” meltdowns when demands are escalated (O’Nions et al., 2016).
While PDA is not yet formally recognized in the DSM-5 or ICD-11, international discourse continues to evolve. In the UK, educational and clinical systems increasingly make accommodations based on PDA-informed approaches (Christie et al., 2012). In the U.S., however, the profile remains largely off the radar—especially in school-based settings.
The Cost of Stigma
Stigma around PDA arises from multiple sources:
- Language: The term “pathological” itself evokes resistance. Yet calls to rename the profile to “Pervasive Drive for Autonomy” or “RDA—Rational Demand Avoidance” (Stuart et al., 2020) have not gained universal traction (Stuart et al., 2020).
- Behavioral Expectations: School culture rewards compliance, not adaptive resistance. When a child resists tasks using humor, distraction, negotiation, or shutdown, it is often seen as willful rather than protective (O’Nions et al., 2016).
- Invisibility in Policy and Training: Because PDA is not widely known or formally recognized in American diagnostic frameworks, most educators and clinicians are not trained to spot it, much less support it.
- Misdiagnosis or Diagnostic Overlap: PDA is frequently misread as Oppositional Defiant Disorder, Conduct Disorder, or misunderstood forms of ADHD or OCD (Green et al., 2018).
These systemic misreadings are not benign. They delay effective support, drive exclusionary discipline, and push families out of public education. In my work with PDA North America and homeschooling support networks, I’ve heard a steady stream of similar stories: students suspended, parents gaslit, truancy charges filed, and entire families derailed by a school system that doesn’t recognize what it’s seeing.
Resistance to Traditional Interventions
PDA is often resistant to behavioral approaches. Positive Behavior Interventions and Supports (PBIS), when not carefully adapted, can escalate anxiety. ABA, particularly when demand-based or rigidly structured, may reinforce distress and result in trauma. Some practitioners now recommend a low-demand, relationally driven, autonomy-supportive approach—built more around trust, co-regulation, and flexibility than control (Christie et al., 2012; Stuart et al., 2020).
These shifts can feel uncomfortable in rigid school systems. But, the discomfort of professionals should never outweigh the dignity and wellbeing of the child.
A Grassroots Movement Poised for Impact
What’s emerging is not just a clinical profile; it’s a movement. Parents, educators, and autistic self-advocates are collectively pushing for recognition, research, and reform. PDA support groups have exploded in number. Publications, webinars, and conferences now include sessions on PDA. Even TikTok has seen an influx of content creators describing their lived experiences of PDA, helping others name what they’ve always felt (Stuart et al., 2020).
This movement is especially critical at a time when educator burnout and attrition are reaching crisis levels. Students with undiagnosed PDA—who challenge standard interventions and demand creative, relational teaching—are often described by teachers as their most exhausting cases. But the problem is not the child. It’s the lack of fit between the child’s nervous system and the demands of the system (Green et al., 2018).
The Way Forward
If we want to understand and respond to neurodivergent children with integrity, we must be willing to confront the stigma and skepticism around emerging profiles like PDA. This includes:
- Expanding teacher training to include nuanced understandings of demand avoidance, trauma-informed practice, and nervous system-based behavior.
- Investing in research that centers the voices of those with lived PDA experiences.
- Reimagining discipline and intervention as tools of connection, not correction.
- Creating diagnostic flexibility that accommodates transdiagnostic patterns—like demand avoidance across ADHD, autism, and anxiety profiles (Gillberg, 2014).
PDA is not just an academic curiosity. It is a daily reality for thousands of families—and a call to action for professionals across disciplines.
Jennifer “Jenna” Glenn, Med, is Founder of Grace and Grit Life Coaching.
References
Christie, P., Duncan, M., Fidler, R., & Healy, Z. (2012). Understanding Pathological Demand Avoidance Syndrome in Children: A Guide for Parents, Teachers and Other Professionals. Jessica Kingsley Publishers.
Gillberg, C. (2014). Commentary: PDA – public display of affection or pathological demand avoidance? Reflections on O’Nions et al. (2014). Journal of Child Psychology and Psychiatry, 55(7), 769–770.
Green, J., Absoud, M., Grahamslaw, L., Stuart, L., & O’Nions, E. (2018). Pathological demand avoidance: symptoms but not a syndrome. The Lancet Child & Adolescent Health, 2(7), 455–456.
Newson, E., Le Marechal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600.
O’Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2016). Development of the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q): A parent-report questionnaire for identifying features of Pathological Demand Avoidance in children. Journal of Child Psychology and Psychiatry, 57(2), 229–235.
Stuart, L., Grahamslaw, L., & Dunlop, A. (2020). It’s not just the name: Exploring the lived experience of Pathological Demand Avoidance. Good Autism Practice, 21(1), 54–67.
