For counseling or psychotherapy, working with an autistic, neurodivergent, or neurodiversity-affirming provider may be most helpful.Īlthough many autistic folks benefit from structure and routine, structure imposed by others can feel like a demand and threat to autonomy for the person with PDA. Sometimes just talking to a supportive professional who understands can be important. 11īecause PDA has a strong component of anxiety, counseling or therapy can help identify triggers and offer coping strategies. Because preservation of autonomy is crucial for PDA individuals, approaches that support autonomy, agency, and self-advocacy are most helpful. Areas of need include sensory support, help with identifying emotions or managing anxiety, or support with speech and communication. Treatment Options For Pathological Demand AvoidanceĪutism doesn’t necessarily require treatment, but there may be areas of struggle for which an autistic PDA individual may benefit from specific support. Might play pretend or be comfortable with role play.Special interest might be a person, either real or fictionalMay have special interests or seem to have a “one track mind”.Impulsivity or difficulty with self-regulation.Sensory differences, including sensory seeking, sensory sensitivities or even sensory processing disorder (SPD).Difficulty with emotional regulation or mood swings.Might appear interested in socializing but have difficulty interpreting social interactions or situations.Use of fantasy as escape or avoid demands.Might be a passive, watchful observer in the first year.Might even resist preferred activities or activities the person enjoys.Here are common traits and characteristics shared by PDA individuals: 1,2,10,11,12 They may also be adept at masking or camouflaging social differences. Often, PDA autistic individuals may have more subtle social differences. One of the primary characteristics looked for during autism assessment is a difference in or difficulty with social interactions. Many autistic PDA individuals fly under the radar of an autism diagnosis because they don’t match stereotypical autistic traits. 8 As PDA self-advocate Harry Thompson expresses, “ODD is more of an ‘I won’t.’ PDA is more of an ‘I can’t.’” 9 While ODD can have genetic and neurobiological factors, oppositional behavior in those with ODD is thought to stem from thoughts and emotions that may be angry or “negative” in nature, whereas PDA resistance to demands is a result of neurological wiring and brain chemistry. First, PDA is a presentation of autism, and PDA individuals will possess other autistic traits such as sensory issues, difficulty with executive functioning, or social differences. These profiles may look similar but are actually quite different and require different approaches. Oppositional Defiant DisorderĪutistic children who fall under the PDA profile are often misdiagnosed as having oppositional defiant disorder (ODD). Donna Henderson) often describes PDA instead as a “persistent drive for autonomy,” where any perceived threat to autonomy invokes an extreme anxiety response and action in an attempt to preserve it. In a shift away from viewing demand avoidance as purely pathological, PDA autistic adult and educator, Harry Thompson (as cited by Dr. 5,6 Other strengths of PDA individuals include being sensitive, highly empathic and intuitive, determined, compassionate and humorous. PDA autistic individuals can be innovative, independent thinkers and often possess the trait of being autodidactic, preferring to learn on their own. Missed diagnosis or misdiagnosis is especially common for autistic girls and women who fit the PDA profile. 2īecause PDA individuals may not fit certain stereotypes about what autism is thought to “look” like, it isn’t uncommon for them to go undiagnosed/misdiagnosed for longer periods of time. In other cases, they may do the opposite of, or anything but, what would be an expected response. Sometimes they will “freeze” or find themselves in a state of fight or flight. Ordinary tasks, such as eating in response to hunger cues or following directions in class, can invoke a sense of anxiety or dread, preventing the individual from meeting the demand. PDA individuals express that while they may want to meet demands or expectations, they’re unable to do so. All PDA individuals are autistic and can share common traits with members of the autistic population, including differences in communication, social interaction, sensory needs, and special interests or stimming however, PDA also presents with more subtle social differences. Coined in the 1980s by British psychologist Elizabeth Ann Newsom, PDA isn’t a formal diagnosis in the DSM-5, but a subtype of autism that is gaining more recognition.
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