‘Pathological Demand Avoidance’ or
‘Powerful Drive for Autonomy’
As with RSD, I don’t care for the name pathological demand avoidance as it is pathologizing. Members of the autism community have likened PDA to a strong desire for autonomy, so I will go with Powerful Drive for Autonomy to capture that – but this name may also change as I learn more and continue to strive to do better.
Those who experience a powerful drive for autonomy may have the following features:
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Desire to avoid the demands of life (e.g., showering, eating, following a schedule)
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Use social strategies to get out of demands placed upon them
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May experience intense emotions and/or emotion changes
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May be focused on other people, such that a preferred interest may include interest in relating socially to real or fictional people
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A desire for control in one’s life, which may be driven by anxiety
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May not respond ‘conventionally’ to support or criticism
There are some unique aspects to the powerful drive for autonomy
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Demands may be avoided simply because they are demands – the demands can be expectations from others and even from yourself that can lead to a feeling of anxiety, panic, or loss of control
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The need for autonomy may be so strong that the avoidance of the demand may appear as a large reaction (getting REALLY upset about being asked to put on clothes)
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How one may react to the same request or demand may differ depending on the person’s capacity at that time (energy, health, wellbeing) and their environment
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Powerful drive for autonomy is not a choice and is a lifelong experience; with coping strategies the impacts of PDA can be managed
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What Do Demands Look Like?
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Direct requests or questions from others
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“Take a shower” or “Put this laundry away”
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“Do you want a snack?” or “Do you want a drive to work?”
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Indirect demands
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Praise can lead to expectations for future performance (a demand)
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Uncertainty intolerance of the unknown (uncertainty pushes against the need to control one’s environment and self)
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Meta-demands
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Smaller demands within a larger demand
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For example, when going to a restaurant, there is the expectation to be seated at the table, to eat a meal that may have hidden ingredients, not be too loud, to perform a social routine, etc.
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Daily demands
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Expectations of getting up, having a shower, brushing one’s teeth, wearing ‘appropriate clothing, etc.
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Internal demands
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Interoceptive cues, such as thirst and hunger
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Thoughts that come with ‘should,’ such as ‘I should do X, I should do Y’
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Demands from the things that we like, not just the tasks we don’t like
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Seeing friends, working on our hobbies, preferred interests
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What Approaches are Used to Strive for Autonomy?
Research from Newcastle University suggests there is a hierarchy of approaches that people with a powerful drive for autonomy will employ. People may try social approaches first but can escalate quickly up the hierarchy if demands persist:
Distraction may include changing the subject or starting an interesting conversation, they may procrastinate, or give an excuse as to why they cannot fulfill the request, which can include incapacitation (I’m sick, this may aggravate my tennis elbow…).
Next, the person may withdraw into fantasy or limit responses in conversations. If the demand persists, the person may start to enter a very distressed period that can quickly escalate.
This distress and escalation are not a choice! The instinctual stress response of flight/fight/ freeze/fawn kicks in and can be associated with overwhelming distress, which often looks like a panic attack.
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Understanding this hierarchy can help with identifying and managing responses to demands.
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Strategies to Help Manage a Powerful Drive for Autonomy
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As noted above, conventional responses to avoidance behaviours may not work with those who experience a powerful drive for autonomy (these ineffective strategies include firm boundaries, rewards, consequences, or praise, as well as strategies that are recommended for the autistic phenotype, such as routines, predictability, and structure)
Instead, approaches that evoke low arousal (i.e., keep anxiety to a minimum) may be more effective. These approaches include:
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Picking your battles – this looks like keeping rules to a minimum, offering choices to promote a sense of control, explaining the reasons why you would like the person to engage in a behaviour or task, and accepting that some things you would like to get done may not get done
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Adapting – this can look like injecting some humor, distracting, and role playing of your own; may also include being flexible with the person who has a powerful drive for autonomy, and allowing them plenty of time to complete a task
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Negotiate and collaborate – this looks like keeping calm, working together to collaborate and solve problems, and promote a sense of fairness in decision making and demands
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Disguise demands – this can look like making requests using indirect words (e.g., your clothes are on the floor, here is a basket), doing tasks together, and monitoring the persons tolerance for demands
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Anxiety management – this looks like taking a low arousal approach and reducing uncertainty in the persons environment, treating meltdowns as panic attacks, and supporting them through the experience
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Source: PDA Society link
