Pathological Demand Avoidance: Panic, Not Defiance
- Julian Vilsten
- 6 days ago
- 5 min read
The request seems simple enough. Put on your shoes. Reply to that email. Brush your teeth. Eat breakfast.
But for some autistic individuals, these everyday expectations trigger something that feels closer to panic than inconvenience. The nervous system registers “put on your shoes” the same way it might register genuine danger. What follows is not a choice to be difficult. It is survival mode, as overwhelming as a panic attack but often misread as willful disobedience.
This pattern has a name: Pathological Demand Avoidance, or PDA. While not a formal diagnosis in the DSM-5, it is recognised as a behavioural profile within autism by Australia's National Guideline for Autism Diagnosis. Research suggests that between 1 in 5 autistic individuals show PDA traits, with around 1 in 25 meeting the full profile criteria. While much early research focused on children, PDA persists into adulthood, with avoidance strategies often becoming more sophisticated while the underlying anxiety remains. Understanding this profile can transform how families and support teams respond to what looks like extreme non-compliance.
Why Traditional Strategies Backfire
Here is the puzzle that confounds many families and support teams: the strategies that work for others make things worse for someone with a PDA profile.
Star charts. Verbal warnings. “First this, then that.” Praise for compliance. Workplace performance reviews. Deadlines. These are standard behavioural and motivational tools. They work by creating clear expectations and consequences.
But for someone experiencing demand avoidance driven by anxiety, these approaches often escalate distress rather than reduce it. The star chart becomes another demand. The verbal warning increases pressure. Even praise can feel like surveillance, adding an expectation to perform again tomorrow. For adults, job requirements and social obligations can trigger the same overwhelming response.
The result is bigger meltdowns, more elaborate avoidance strategies, and families or workplaces that feel they have tried everything. When standard tools fail, people often hear that they are not being consistent enough, not firm enough, not following through. This is rarely the problem.
The problem is that the tools were designed for a different kind of resistance.
The Anxiety Underneath
PDA differs from typical oppositional behaviour in one fundamental way: its engine is anxiety, not defiance for its own sake.
Oppositional Defiant Disorder (ODD) is a recognised diagnosis involving a persistent pattern of angry or irritable mood, argumentative behaviour, and sometimes vindictiveness, typically directed toward authority figures. The causes are complex, involving temperament, environment, and learned behaviour. People with ODD often believe they are reacting to unfair circumstances or unjust demands. Structured behavioural approaches, clear boundaries, and consistent consequences can be effective because the person is responding to the external situation rather than experiencing an internal threat response.
Someone with a PDA profile is experiencing something different.
The avoidance is pervasive, extending to demands from anyone, not just authority figures. Crucially, it also extends to demands the person places on themselves. Someone with PDA might desperately want to eat their favourite meal but find themselves unable to do so because it has become an expectation. They might avoid brushing their teeth not because someone asked them to, but because they told themselves they should. Even internal bodily signals like hunger or thirst can feel like demands that trigger the same avoidance response.
For adults, this can show up as chronic difficulty meeting work deadlines, responding to emails, or attending appointments, even when they genuinely want to. The avoidance is not laziness or lack of motivation. It is an anxiety response to the perceived demand.
Research points to intolerance of uncertainty as a key driver. The unpredictability of demands, never knowing when the next expectation will arrive, keeps the nervous system on high alert. This constant vigilance is exhausting and makes even simple requests feel overwhelming.
This is why the behaviour can appear illogical from the outside. “Why won’t they just eat the food they asked for?” “Why can’t they just reply to one email?” Because doing it now feels like complying, and complying feels dangerous.
What Helps
When anxiety drives avoidance, reducing the sense of threat becomes the priority. The PDA Society uses the acronym PANDA to summarise helpful approaches: Pick battles, Anxiety management, Negotiation and collaboration, Disguise demands, and Adapt to the moment.
Lower the demand load. Not every battle needs to be fought today. Identify what is truly essential (safety, health) versus what can be flexible. Reducing overall pressure often increases cooperation in the areas that matter most.
Offer choices, not instructions. “Would you prefer the red shoes or the blue ones?” lands differently than “Put your shoes on now.” Choice creates a sense of control, which is precisely what the nervous system is seeking.
Disguise demands with indirect language. “I wonder if those shoes are ready to go outside” sidesteps the imperative tone. Using physical prompts (tapping a chair rather than saying “sit down”) or playful challenges (”I bet you can’t get dressed before the timer goes off”) can bypass the threat response.
Prioritise relationship over compliance. Trust takes time to build, especially when past interactions have been marked by conflict. A person who feels safe will eventually tolerate more. Rushing compliance before trust exists usually backfires.
Adapt to the moment. What someone can manage one day might be impossible the next. Checking in on their current capacity and having backup plans reduces pressure for everyone.
What This Means for Support
PDA can present differently depending on the individual. Some show externalised responses: visible meltdowns, aggression, or controlling behaviour when triggered. Others show internalised responses: withdrawal, perfectionism, or surface compliance that masks intense internal distress. Neither presentation is less serious than the other. Many adults with PDA discover the profile when seeking support for their children, recognising the patterns in themselves for the first time.
If someone in your life has a PDA profile, the path forward requires patience and a willingness to rethink assumptions about behaviour. The goal is not to eliminate avoidance overnight. It is to reduce the underlying anxiety enough that demands feel less threatening over time.
This is exhausting work. Research consistently shows elevated stress among families and partners supporting someone with PDA, with isolation being a common experience. Seeking support from professionals who understand this profile, and from others navigating similar challenges, can make a significant difference.
The person who cannot put on their shoes, or reply to that email, or show up to that appointment, is not choosing to be difficult. They are overwhelmed. They need people around them who can see past the behaviour to the distress underneath.
When that shift happens, progress becomes possible.
Outcomes Lab provides neuroaffirming Positive Behaviour Support, Psychology, and Neuropsychology services across Melbourne. If standard approaches have not worked for someone you support, and you suspect anxiety may be driving avoidance, our team can help develop strategies tailored to their specific needs.
About the Author
Julian Vilsten
Founder, Outcomes Lab | Clinical Neuropsychologist | Advanced Behaviour Support Practitioner. MClinNeuro, BBNSc (Hons)
With over a decade of clinical experience, Julian combines neuropsychology with practical behaviour support. He is dedicated to neuroaffirming practice and building support systems that champion autonomy and genuine well-being.
Comments