Pathologic Demand Avoidance

Now considered a subtype of autism, pathologic demand avoidance (PDA) has been recognized for a few decades, initially by British psychologist Elisabeth Newson in the 1980s, and helps us better understand children and adolescence who might otherwise be considered challenging or resistant. This really is suitable for many adults as well, in my opinion, and I am postulating this is true for many of my clients, maybe even several, if not every single person in my own family. We are not compliant. We resist. We don't like to be bossed. It can be extreme and bump up against our sense of safety, even create panic.

For these children, every day demands like chores or homework are avoided to the point that these individuals will use inappropriate behavior to avoid or control interactions that ask demands of them. It's a true challenge to recognize this as a nervous system response and not fault of character or poor decision-making. These individuals need to be in control to feel safe. Post-traumatic stress, complex Post-traumatic stress disorder, even Attention Deficit Hyperactivity Disorder can also present with pathologic or extreme demand avoidance. An aspect of demand avoidance is exhibiting socially strategic behaviors to avoid meeting demands, having an intense need for control, and if pressured to comply, these individuals will present with significant emotional dysregulation or whatever otherwise looks like rage and defiance (Nawaz & Speer, 2025).

PDA is a developmental disorder or a trait occurring in those with autism (Kildahl et al., 2021), or at least this is where we most often recognize the disorder, but again, trauma can also result in PDA. There are experts in the field though that would argue that PDA is a set of symptoms rather than a syndrome in itself. While the incidence is not known, upwards of 20% of individuals with autism spectrum disorder present with extreme demand avoidance (Nawaz & Speer, 2025).

For children who exhibits PDA behaviors, traditional parenting approaches and structured approaches designed for children with autism that utilize expectations or rewards based on performance are not often effective, even counterproductive because they can be experienced as demands (Nawaz & Speer, 2025). A more effective approach is a low-demand approach or indirectly, reducing or rephrasing demands. If you want to remind your little one to brush their teeth, you might say, "Your toothbrush is loaded," in effort to avoid triggering a sense of demand.

This is quite complex however, as children may have meltdowns even when offered their favorite toys or foods, because it wasn't what they asked for, or they can't eat right now, or even because it isn't in the right color bowl. They want to eat it, but they just can't because for whatever reason, it feels like a violation. This doesn't even always make sense to them, so they create a story in effort to rationalize their behavior. It's really disheartening to witness your kid self-sabotage in that they get mad about waking up in the morning, because you woke them to prepare for an outing they have been quite excited. If my son fell asleep in the car and I woke him to come inside, this would cause rage, even crying but he was as confused as I was. When offered a meal, a drink, or even a movie or toy they would otherwise enjoy, if there is any sense of demand to partake, this can trigger their fight-or-flight and cause intense demand avoidance. It is uncontrollable and all encompassing; this is not defiance.

In an adult, this may look like failing to file tax returns, opening their mail, return phone calls, or even answer the phone. They may not sleep, struggle with self-care, not be able to maintain a clean and organized home, and may have intense emotional distress or experience panic attacks. They may have difficulty with relationships and may struggle with employment or have severe burnout.

Another way this may present is that they may want to do an activity, for example, be excited about it, but once they write it in their calendar, now it becomes a demand and they can't do it. Their anxiety freezes them, and they avoid. At first this may seem like performance anxiety or part of their ADHD. "To do' lists trigger the same response, or work projects. When they say they are unable to do it, this isn't a refusal; it's an inability. Imagine being told, "If you wanted to, you would," but you absolutely do want to but are frozen, even consumed by panic.

Interestingly, this can even show up as an internal demand, such as avoiding bodily needs - not eating when hungry or avoiding using the restroom (Nawaz & Speer, 2025). Even an implied demand can trigger those with Extreme or Pathologic Demand Avoidance (PDA), such that when asked a question, they will avoid answering. When food is in front of them and they are expected to eat, rather than being invited to eat, or a bill is expected to be paid, they can freeze up and avoid. Excuses may become part of the resistance and in children this can be quite fanciful, arguing that a toy made them do it or they can't because their legs are broken.

When individuals are demand avoidant, they may offer distraction or diversion (Nawaz & Speer, 2025). They might change the subject, make noises that make further discussion difficult such as refusing to turn down the television, or they may give affection or compliments, even joke to avoid what is being asked of them. They may even create another situation in which those needs are more important in the immediate moment, so that the new scenario gets the attention and not the matter they were previously being demanded. This may even look like crying about another memory entirely and not focusing on the issue at hand.

Sometimes these individuals offer point blank refusal, yell no, and refuse to negotiate (Nawaz & Speer, 2025). They may even physically resist. Other times they may be more passive and try to withdrawal, become floppy, curl up into a ball, not respond, walk or run away, or live in their fantasy world. As a last resort, some individuals will become aggressive. They may push someone or throw something away, hit or kick, even bite. Aggression may also look like resistance, but it may also be a panic response to overwhelming anxiety - of realizing that a demand cannot be avoided, or that these forms of resistance have been exhausted. This may result in meltdowns or panic, potentially including aggression. These states are usually out of the person's control.

Just today I was scrolling through social media and a video of a grown woman, on the floor of an airport, screaming and crying came through my feed. The text said her luggage was too heavy so she was absolutely losing it. The comments were harsh, asking what zoo she came from. Security were present and absolutely befuddled. I have strong suspicion this was an autistic woman in absolute overwhelm, consumed by anxiety, and unable to regulate. Compassion isn't that hard when we recognize this isn't "childish" behavior, weakness, or cause for shame, but system overload. It's not desired by the individual in crisis either. Helping this woman work through resources, offering her tools, assisting her in regulating is the support needed in this scenario but sadly, most of us overpower and isolate which typically only escalates these scenarios.

What is perceived as a demand is unique to each individual, and can range from direct demands, such as requests made by other people, to indirect demands, such as transitions, expectations, and receiving praise (Curtis & Izett, 2025). My husband feels great threat when his schedule is changed, even if that means asking him to lunch in the middle of his work day. It has to be his idea or he completely spins out of balance.

There is often a degree of sociability in these little ones, even grown adults, because they do use distractions, procrastination, negotiation, and social manipulation to some degree to avoid demands (Curtis & Izett, 2025). They may make excuses or engage in fantasy and role play to avoid demands, or they may have drastic mood changes, aggression, violence, and threats. Further, they have a different social understanding; they don't recognize hierarchies, so they are not easily intimidated and will challenge authority. This enforces the perception this behavior is defiance and it sends many vice principals and police officers over the brink.

As a mother of not-so-little ones on the spectrum, who each had a very strong sense of autonomy, I believe this "diagnosis" can be helpful in recognizing that our children aren't being defiant, even hateful, but rather that they have a neurological wiring that leans them into being a very strong advocate for their own rights and freedoms. On the other hand, there are those, specifically in the world of academia, who criticize this diagnosis as undermining the agency and self-advocacy of individuals with autism (Kildahl et al., 2021). The primary concern is that the literature has not done well at trying to understand the perspective of the individual or even their underlying anxiety in the development of demand avoidance.

The single most important thing to an individual with Pathologic Demand Avoidance is their autonomy - to decide things for themselves and be in complete control of what they do and where they are going is paramount. They require equality and fairness. In fact, inequality is beyond their comprehension, or even injustice, which is why they challenge authority.

Experts in the field argue that from the perspective of the individual, their demand avoidant behavior is well rationalized. I am sure this is not so dissimilar from those who choose to birth at home, delay or decline vaccines, and home educate. Homesteaders may even fit in here too. We opt to gain control in these scenarios to ease our anxieties. Maybe this is the result of autism, maybe this is related to a history of being violated, having been victim of unequal power, a history of trauma. These individuals see the world differently and from their perspective, these threats are very valid.

Individuals with Pathologic Demand Avoidance think for themselves and don't simply fall in line when authority so demands. To the autistic individual who perceives any particular scenario as stressful, their neurologic response is to avoid, to not comply simply to maintain harmony. Pathologic Demand Avoidance may even be renamed Extreme Demand Avoidance (EDA) rather than pathological.

E/PDA is associated or maybe better explained as a subtype of autism spectrum disorder largely because these individuals are particularly vulnerable to disorders related to stress and anxiety (Hollocks et al., 2019, Kerns et al., 2018, & Rosen et al., 2018). This is not exclusively the case however. The challenge is that mental health disorders are especially challenging to identify in those with autism, because communication is at the core of their diagnosis. Conveying information about their emotional states or levels of anxiety can be exceedingly challenging (Hollocks et al., 2019). Further, mental health problems can present in more atypical or unusual ways in those with autism (Kerns et al., 2020) and it may not be easily observed in families, caregivers or clinicians. The triggering events causing anxiety for individuals with autism are often unique as well compared to the general population.

Extreme or pathologic demand avoidance is a significant problem that parents do increasingly report, as well as educators and social care professionals. E/PDA is not referenced in diagnostic manuals though and there is considerable debate regarding use of the term, whether it constitutes a subtype or profile of autism, a separate diagnostic entity, or an expression of another diagnosable condition such as anxiety, oppositional defiance disorder or attachment disorder (Nawaz & Speer, 2025). In spite of no formal diagnosis in the DSM-5, this distinct entity is recognized among autism research and among advocacy groups such as the National Autistic Society. There are also practice guidelines to assist clinicians in managing those with E/PDA (Curtis & Izett, 2025), so E/PDA is considered a "profile" within the autism diagnosis.

When Extreme Demand Avoidant children are pushed to comply with demands, their behavior tends to become more oppositional and extreme. This is likely to create significant difficulties for their parents, who have described the pervasiveness of their child's demand avoidance in every aspect of daily life.

We know that the implications of autism for the mental health and wellbeing of children and their parents are significant, and that caregivers of autistic children are amongst the most stressed when compared to caregivers of individuals with other disabilities (Nawaz & Speer, 2025). However, the Royal College of Psychiatrists (2020) notes that E/PDA individuals and their families' are likely to be under unusual levels of stress. It's not an exaggeration to say that in some cases, this stress is paralyzing, all-consuming, devastatingly destructive, and can lead to catastrophic outcomes.

Without appropriately tailored support, outcomes can be very poor, and I mean very, very poor (Nawaz & Speer, 2025). Children with PDA behaviors may be neglected and even discriminated against. Police and Child Protective Services may not support the parents or may over power children, even charging them or detaining them, not understanding these scenarios as a mental health crisis.

These individuals as well, aren't typically offered beneficial therapeutic input (Nawaz & Speer, 2025). They aren't offered education, resources, or tools but rather detained in inappropriate settings, with significant impacts on their mental health. It's frustrating for me, for example, that what is often a component of autism is seen by the school system as defiance, even in a child with known autism and an IEP, because teachers and school principles are not educated in how these disorders present. We can not discipline the autism out of children. Studies have demonstrated that the educational experiences of children with E/PDA is overwhelmingly negative, which parents contribute to lack of understanding of PDA and the need for equitable access to multidisciplinary individualized assessment and support delivered by professionals with knowledge of PDA who listen to and assess the child without judgment, facilitating access to services and support.

Parents having knowledge of Extreme Demand Avoidance and comprehension of how this shows up in behavior is critical; however, ignorance is absolutely everywhere, not just in the schools and among mental health professionals, but also among parents themselves.

Experiences Shared by Parents

Avoidant behaviors, anxiety, and an intolerance of uncertainty, are thought to be a significant component of many mental health conditions, but especially so with autism (Kildahl et al., 2021). These individuals often have an insistence on sameness. Parents often do not recognize these behaviors in their little ones at younger ages or even high anxiety, nor associate it with autism. After they become aware of this "trait," they blame themselves and have a great deal of remorse for how they handled previous outbursts or even how they perceived their child in these scenarios, as little monsters rather than vulnerable and in need of help. When their child refused to settle, would wake up from their naps and scream, or have absolute melt downs - this was thought to be a feisty or angry child, or just exceedingly difficult, maybe the terrible twos that never goes away - even poor parenting, but almost never recognized as autistic or unregulated, even panic.

Parents share that everything is a challenge... brushing their teeth, getting dressed, going to the bathroom... everything becomes a fight. Some parents report their little ones as being out of control, even reaching crisis for some children, especially when the pressure increased at school. Many of these children will refuse to go to school when it becomes hard, and this might be as young as 5 or 6 years of age.

When you are the one helping your child regulate their feelings, you are their safe place, the one they want to save during an apocalypse, the one they make art for, and even want to cuddle, but you are also the one they shout at and scream they hate when they are dysregulated. This safe place for the child, is at times, unsafe for the parents. I do have parents in my practice who have been physically harmed by their children, even wearing motorcycle jackets and helmets in their home. We can't free ourselves from these relationships as parents.

I've had parents share that they homeschool because their daughter was unable to go to school. They have meltdowns, refuse to get up in the morning, scream and shout. If mom tries to dress them just to get it done, they would get attacked, even at a really young age. The meltdowns are aggressive too, feeling very similar to domestic violence scenarios. And these parents often report sensory issues in their children. Their clothing touching their arms the wrong way would cause them to panic, to rage, or maybe the food is intolerable at school. They don't sleep at night or they can't be spoken to or fits of rage occur. Parents share they are always having to walk on eggshells.

Parents with children who have Demand Avoidance often report that everything they try is completely wrong when it comes to parenting. They ultimately give up and just let their child be in control in effort to find some calm moments, and they adapt their environments to accommodate their sensory overload. These parents though are often completely isolated without support, as care takers outside the immediately family do not want involved; they can't comprehend passive parenting where the child is in control. Pediatricians can also be pretty ignorant on this issue, even dismissive of PDA entirely.

Most professionals misunderstand Demand Avoidance behaviors because they have a very narrow view of autism and a very stereotypical idea of what an autism child should look like and how they behave. Professionals are more likely to perceive E/PDA behaviors as defiance, or anything else, but E/PDA.

One of the biggest red flags in the healthcare industry in my mind is when they remove support in "preparation for the real world." In the case of E/PDA, clinicians will discredit low demand approaches because again, they want to equip the child to manage a demand-laden life beyond the home. Even pediatric professionals will argue that "life is demands, so they must learn to deal with it." Parents then look overly permissive, even neglecting their parental responsibility, and this is judged as the cause for the child's behaviors. Simultaneously, parents are overwhelmed with the need to advocate and protect their child.

Parents report in the research that they often realize they know more than the professionals they seek support from or even professionals teaching courses on E/PDA because they are living with the experience (Nawaz & Speer, 2025). They also share that often they receive advice from others sitting on the sidelines as if this is an easy fix, or just a parenting misstep, when in fact, they can't comprehend the challenges of E/PDA. My best friend use to say, "Oh, I would spank him. My child would never behave that way," when I was well aware my son was completely panicking. Parents do share though that when professionals have firsthand experience with children with E/PDA, they are better equipped to offer effective advice. Many parents share they didn't receive support until they video recorded their child in these scenarios and showed them to professionals. This isn't simply a knowledge-deficit. It's altogether a very different, and very complex nervous system dysregulation with its own unique therapeutic approach.

Demand Avoidance and the Educational System

One of the key highlights in studies on parent's experiences with E/PDA is that they feel judged by others or dismissed. Others have shared they were further traumatized by healthcare providers and professionals, even police and child protective services. There is commonly a sense that professionals assume parents are simply ill-equipped, overreacting, or catastrophizing their circumstances, or even abusive. The educational system further enforces this culture of parental blame (Nawaz & Speer, 2025). Teachers judge the challengers seen in school, or the "poor choices" as a "home problem." There is never accountability that the problem might be the environment at school.

Worse, when educators and professionals dismiss and blame parents, this can worsen their already vulnerable mental stability (Nawaz & Speer, 2025) and destroy the cocoon of support for the child. These parents often feel they are doing a horrible job, which is then reinforced by these judgements and false assumptions. They feel gaslit and start to question their own reality, even sanity. Parents share they want to be heard, to be listened to, and they want help and support. If professionals are unfamiliar, rather than blame the parent, the ethical next step is to refer to a colleague who is familiar. Here is a letter as well, to educators, from the National Autistic Society.

Parents have also been accused of falsifying the autism diagnosis when it presents as E/PDA. Social workers have insinuated Munchausen's even when medical records clearly diagnose autism spectrum disorder (Nawaz & Speer, 2025). Getting these diagnoses can take time, years, so when parents pay for tests themselves, this is viewed as suspicious. These accusations not only fail to offer support to the family in need, but they undermine efforts to safeguard the child by damaging trust in professionals. Fear is instilled in seeking further support for their child, or even for the parents. These families often become very isolated; everyone is more deeply traumatized and further dysregulated.

Impact on the Family Unit

Parents share they've had meltdowns, nervous breakdowns, but they can't admit that because that will be used against them (Nawaz & Speer, 2025). They fake that they are making it, that they are stable and in control. They have no room to be vulnerable and talk about how absolutely devastating these scenarios are and they never ask for help. Add to that, these parent-child relationships can be very taxing because many of these children depend on their parents to accommodate them so they can function in their everyday life.

Adapting their parenting approach to afford their child as much autonomy and control as possible is difficult to navigate, seemingly impossible at times, but it ultimately does help their child to stay emotionally regulated. We second-guess because we were often raised to enforce strict rules and expect compliance as evidence of respect. Giving up power as a parent, seems like failure.

Offering guidance or teaching our littles with Demand Avoidance can be triggers. Here's the thing though, when parents are able to understand their child and meet their emotional needs through affording them autonomy and control, they do describe an intensely close parent-child relationship, and more than they recognized, these children depend on their parents for co-regulation (Nawaz & Speer, 2025). One mother shared about her daughter, "She's unable to independently self-regulate, like she solely relies on me. So, because everything in her world is so intense, she needs to be by my side 24/7" (Nawaz & Speer, 2025). Another mother shared, "I'm like his wheelchair, you know, for a person who's got a physical handicap. I'm like, yes, I'm that for him. So, I know how much he needs me" (Nawaz & Speer, 2025).

Trauma and Demand Avoidance

Trauma, and even stress, are perceived in unique ways for the individual with autism so that events and circumstances aren't always recognized by family as having potential for stress and trauma (Kildahl et al., 2021). The irony is that not only do autistic individuals struggle to understand others, and communicate effectively with them, but the general population also has difficulty understanding autistic people.

Those with autism are mistuned socially and in communication. There are therefore, theories that repeated and reciprocal "mistunements" over time lead to increased divergencies in communication styles and interactions between non-autistic people and autistic people (Davis & Crompton, 2021). The failure to recognize, or respond effectively, when an autistic child is experiencing anxiety, discomfort or distress, may lead to the child feeling misunderstood and alone. To alleviate distress, the child may then engage in behaviors perceived by others as socially inappropriate or disruptive, resulting in negative consequences, even sanctions, socially. An accumulation of such experiences over time leads, in turn, to increased use of these problematic strategies. I can't help but question if this is the root cause of some attachment disorders, most especially for our dismissive avoidant individuals.

Anxiety is the driver of reactivity, and in understanding this, we can come to terms with the child who refuses to comply or conform with the norms. These behaviors could instead be understood as an anxious attempt to increase predictability (Kildahl et al., 2021).

Global Emphasis on Typical Autism Creates Barriers to Help

Autism in itself is so under appreciated, but when we look specifically at the subtypes, this becomes even more true. Very simply, therapists for children with autism will often utilize sticker charts or rewards for behavior, but again, this approach is ineffective and counter-productive for children with E/PDA. When expectations are placed on performance, this becomes a demand. Many parents share as well, that even in educational systems that claim they work with children with E/PDA, they are using strategies that are not only ineffective, but also exacerbate the situation

(Nawaz & Speer, 2025). This would be like someone having brain cancer, but the radiation is aimed at their knee. Autism is not just autism across the board.

If we want to truly help children, or those with autism, particularly E/PDA, then we must tailor support to the individual's profile of strengths and needs. However, this hasn't demonstrated to be what occurs in practice (Nawaz & Speer, 2025), but when adaptations are unique to the individual, this can significantly improve emotional dysregulation. I will argue too that the vice principal should be involved in all IEPs associated with students with dysregulation, because they are often attempting to punish the child with autism, failing to recognize their behavior as dysregulation rather than defiance. Overpowering and attempting to intimidate these students is quite literally the most damaging approach to all involved.

Sadly, not only is this my own personal experience, but the evidence demonstrates that most parents with children who have E/PDA describe the school system unfavorably (Nawaz & Speer, 2025). By their very nature, educational settings tend to be full of rules and demands which can trigger demand avoidance. Children in these scenarios often experience significant anxiety and attendance difficulties from which it takes a long time to recover. Many suffer trauma. More than half of parents share that their children had to be moved to another school, and many opt for homeschool or alternative provisions in the community. Systems that allow the child to lead, and that are flexible are ideal.

Just obtaining the Health and Care Plan or Individualized Educational Plan can be very exhausting on one's mental health, leading to parental burnout. This can feel like you're knocking your head against the wall. My own personal experience was belittling, dismissive, and even violating. I had to hire an attorney and blew through my retainer quickly. It can be a fight from start to end. Parents are often struggling for any little bit of support, while simultaneously caring for a child with complex needs. It can feel like unbearable torture one can not escape.

Breakdown of Family Structures

One major source of distress reported by parents stems from the breakdown of their family relationships (Nawaz & Speer, 2025). Parents may clash if they disagree with how to approach or respond to the child. In divorce scenarios, co-parenting can be especially difficult when one parent thinks the other is soft and the child needs more structure, rules, and discipline. Siblings may not get the same attention and care, when there are competing needs. Parents often feel they have a limited capacity for meeting all their children's needs, or their partner's needs.

Relationships can also become more distant as it can be confusing and sometimes even chaotic to witness this different approach to parenting (Nawaz & Speer, 2025). Many simply feel more comfort when they are in control, and children with Demand Avoidance, simply don't allow this. They require complete autonomy, which requires a bit more effort.

Worse though, is the impact on the mental health of everyone involved, even physical health, and the relationships within this family which may not prove resilient enough to endure, particularly when there isn't understanding or support. There is grief too, of recognizing they will never have a normal life, or never have a healthy relationship with their child. Complete and utter exhaustion is often prominent (Nawaz & Speer, 2025).

Parents worry that their children will stop loving themselves, that they will not see their value, that they will start to see themselves as difficult, broken, wrong, or a burden (Nawaz & Speer, 2025). They may worry that their child may self-harm, consider suicide, or even be pushed to considering tragedy at school. It's a really scary role, being the parent of a child who not only has E/PDA, but hasn't any real support outside of yourself, and in this role, everyone else wants to bully you as you attempt to protect and advocate for your child.

Admittedly, there is the other side of the coin too, the side where you want to tell your kid to kiss your ass. You do everything for them and they don't appreciate you at all. They scream at you, call you names, and are intentionally cruel. There is no acknowledgement that you do anything for them, and most everyone thinks you are doing it wrong anyway, so yeah, walking away often seems best for everyone. Parents often resent Extreme Demand Avoidance (Nawaz & Speer, 2025); at least with other childhood disabilities, there is empathy and compassion, grace even, and support.

Parents share that they can't think and need breaks, go to work to escape, then feel guilt and shame (Nawaz & Speer, 2025). They don't sleep and hyperfocus on how to help their children, how to understand them, find the magic pill. They isolate and panic.

These are some of the more tragic family units in my experience working with families, and we are only on the very cusp of even acknowledging this in the literature which has not quite trickled into clinical practice, and certainly not into the educational system. Connect with me if this resonates.

Strategies for Optimizing Support

There is so little research here. We are still just trying to understand, and there are a few really good qualitative research studies on this, which I've referenced here, but understanding best practices for clinicians is just not understand, not even approaches for families. Certainly, I am not offering all this is out there, and there are experts in this field, but the basics are reducing and removing demands wherever possible. When the child's support team can come together collaboratively, without hierarchies, including the child and parent or manager and employee, then these individuals can be very well integrated and utilized within these relationships and environments. Many of us seek self-employment for this reason!

Indirect communication can be very helpful, and avoiding making demands directly. Eye contact, touch, and confrontational postures or physical stances which may be perceived as aggressive should be avoided. Educators, social care workers, healthcare practitioners, and parents really do need to lean into one other, without judgment and blame, in effort to truly support this individual.

Understanding the triggers unique to this individual is vital. For many that I work with, these triggers present within healthcare, when their patient rights are removed, when they are not educated and informed, but rather prescribed and overpowered. Demands can be disguised as well. Avoid terms like "need, must, have to," and more "may, could, would you, how about?" More of "I wonder if we might be able to..." or "I am not sure how to do this. Could you show me?"

My former husband would call me, which feels very demanding to me, so I'd ask him to text me so I could respond when it works for me, but even this text would often cause me to respond, "Don't boss me." Simply asking me to call him when I am bored, would ease all my anxiety. Of course, now that he is my ex and I appreciate that he well understands this trigger for me, it's become a funny inside joke when he texts me, "call me NOW."

Little tricks too, such as having bills on automatic payments can avoid the demand of having to pay them when they arrive. You can also schedule them right after paydays. Allowing as much demand free time in your schedule is important. Work on the belief that you need to always be productive. When our cup is full, it is much easier to not feel so punched by new demands. And honestly, if your child can only go to school today if they wear crazy mismatching clothes or even their dinosaur pajamas, that's okay! Find creative ways to find your way through.

Sensory regulation is at the core of autism spectrum disorders, attention deficit disorders, and even trauma. Therapy can be profound for improving our skills here, as can EMDR and somatic therapies. Yoga and meditation do work. I am evidence of such. But let me close by saying, when others react poorly to those with E/PDA, to something they have no control over, this can cause damage to their self-esteem, mental health, and emotional wellbeing. Don't punish others for something they have no control over. Who wants to be perceived this way? They are trying to protect themselves from a perceived threat, and that doesn't have to make sense to you to be valid. Compassion doesn't require your understanding.

References

Curtis, S. & Izett, E. (2025). The experience of mothers of autistic children with a pathological demand avoidance profile: an interpretative phenomenological analysis. Discover Mental Health5(5).

Davis, R. & Crompton, C. J. (2021). What do new findings about social interaction in autistic adults mean for neurodevelopmental research? Perspective on psychological Science, 16, 649-653.

Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, E. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological Medicine, 49(4), 559-572.

Kerns, C. M., Winder-Patel, B., Iosif, A. M., Nordahl, C. W., Heath, B., Solomon, M., & Amaral, D. G. (2020). Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. Journal of Clinical Child & Adolescent Psychology.

Kildahl, A., Helverschou, S. B., & Howlin, P. (2021). Pathological demand avoidance in children and adolescence: a systematic review. Sage Journal, 25(8).

Nawaz, S. & Speer, S. (2025). What are the experiences and support needs of families of autistic children with extreme (or pathological) demand avoidance (E/PDA) behaviours? Research in Autism Spectrum Disorders, 119.

Rosen, T. E., Mazefsky, C. A., Vasa, R. A., & Lerner, M. D. (2018). Co-occurring psychiatric conditions in autism spectrum disorder. International Review of Psychiatry, 30(1), 40-61.

Royal College of Psychiatrists. (2020). The psychiatric management of autism in adults.