What We Really Know About PDA: Evidence, Myths, and Support Strategies
Research, evidence, and practical strategies for supporting children and adults with PDA
I had to defend myself this week. I’m not upset about it; it’s a good thing. As a professional working in this field, I have to be ready to explain and defend what I do and be confident that I am correct… or be ready to adapt and learn.
Last week, after advertising my PDA Parents and Carers course on social media, a very nice professional challenged my claim that the course offered “evidence-informed” guidance and practical strategies for supporting children with PDA at home and in education. The interaction was positive and full of learning, and it prompted me to write this article to clarify what we really know about PDA, what research tells us, and how support can be informed by evidence and lived experience.
Buckle up…
Introduction
Pathological Demand Avoidance, or Pervasive Drive for Autonomy (as many individuals with PDA prefer it to be called), is a behavioural profile characterised by an overwhelming need to avoid everyday demands and expectations, often driven by anxiety. While PDA is not officially recognised in diagnostic manuals like the DSM-5 or ICD-11 (I’ll explain these manuals in a mo), it is increasingly acknowledged within the neurodiversity community and among professionals working with neurodivergent individuals.
Research, including the 2024 Frontiers in Education scoping review, highlights that although there is debate about how PDA should be classified (whether as a distinct profile, part of the autism spectrum, or a separate developmental presentation) there is broad consensus that PDA exists as a recognisable profile, with consistent patterns of demand avoidance, anxiety-driven behaviours, and a strong need for control.
Bottom line: Researchers agree PDA exists, they just aren’t yet certain how to classify it. Until a clear classification is agreed, it cannot be included in the DSM-5 or ICD-11. Does this mean an individual does not experience PDA if it isn’t formally recognised? Absolutely not. Saturn existed long before it was officially classified as a planet. Recognition does not create reality.
What are the DSM-5 and the ICD-11?
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition – the manual used by clinicians in the United States to diagnose mental health conditions)
ICD-11 (International Classification of Diseases, 11th Revision – the global diagnostic standard published by the World Health Organisation for health conditions, including mental and developmental disorders)
Okay, now that’s out of the way, let’s work out where we came from, so we know where we’re going…
Origins and Recognition
The term Pathological Demand Avoidance (PDA) was first introduced by Professor Elizabeth Newson (pictured below, source in references) in the 1980s, a pioneering UK-based child psychologist. Newson observed a distinct subgroup of children on the autism spectrum who displayed extreme avoidance of everyday demands, often using socially manipulative strategies, distraction, or anxiety-driven resistance to maintain control.
Her clinical observations highlighted that these children were often sociable, imaginative, and highly motivated to engage with others, but only on their own terms. Newson noted that conventional behaviour management techniques, such as reward systems or insistence, were often ineffective and could increase distress. Over the decades, subsequent studies and scoping reviews have expanded on Newson’s work, building a growing body of literature on PDA characteristics, anxiety, and educational implications.
Research Evidence
There is a misconception that little peer-reviewed research exists on PDA. In reality, several studies have contributed valuable insights, we don’t have all day so I just picked a handful:
O’Nions et al. (2015) identified key PDA behaviours, including obsessive need for control, social manipulation, and avoidance strategies. They highlighted that anxiety is a core driver of these behaviours.
Kildahl et al. (2021) conducted a systematic review of PDA studies, noting the heterogeneity of methods, variable diagnostic criteria, and gaps in evidence on effective support strategies.
Haire et al. (2024) performed a scoping review on research methodologies, emphasising the need for standardised approaches, consistent tools, and longitudinal studies.
Newman et al. (2019) examined psychological profiles of children with PDA, showing heightened social anxiety and emotional dysregulation compared with children on the broader autism spectrum.
Green et al. (2022) explored educational outcomes and strategies for children with PDA, finding conventional interventions often ineffective and advocating for individualised, flexible, trauma-informed approaches.
Photo by 🇸🇮 Janko Ferlič on Unsplash
Lived Experiences
The lived experiences of individuals with PDA and their families offer crucial insights through qualitative research. While these findings do not meet the strict definition of evidence-based treatment, they are rigorously researched and peer-reviewed, offering valuable guidance for practical support. Here are a few I picked out:
Curtis et al. (2025) explored mothers’ experiences of raising children with PDA, highlighting the importance of shared understanding, coping strategies, and tailored support.
Kenny et al. (2024) investigated adults with PDA, emphasising challenges across the lifespan, including access to appropriate services and the need for understanding beyond childhood.
Nawaz et al. (2025) examined the support needs of families, showing significant barriers in accessing recognition and effective support, and calling for more inclusive and responsive systems.
These studies demonstrate that PDA has profound real-world implications and that support strategies must be flexible, informed, and compassionate.
Evidence-Informed Support Strategies
A common question parents ask when exploring support for children with Pathological Demand Avoidance (PDA) is whether there are any evidence-based strategies. This is also the reason we are here reading this article, because the suggestion that my course contained these was called into question.
While there is not yet a single intervention that has been rigorously tested through randomised controlled trials (RCT’s) or meta-analyses specifically for PDA, this does not mean there is no evidence to guide support. Read that again.
Research so far is largely qualitative and exploratory, but it is peer-reviewed, robust, and provides valuable insights into effective strategies. These studies, alongside lived experience, highlight approaches that reduce anxiety, respect autonomy, and support emotional regulation, offering parents and practitioners evidence-informed guidance even in the absence of a neatly packaged, fully validated treatment.
Key insights include:
Understanding anxiety-driven demand avoidance – recognising behaviours as coping mechanisms, not defiance (O’Nions et al., 2015).
Relationship-based, low-demand approaches – offering choice, reducing pressure, and respecting autonomy improves engagement and reduces conflict (Kildahl et al., 2021; Haire et al., 2024).
Lived experience – families report that low-demand, flexible strategies prioritising connection reduce distress and improve parent–child relationships (Curtis et al., 2025; Kenny et al., 2024).
Educational strategies – individualised, flexible approaches tailored to the child’s sensory, emotional, and cognitive needs help prevent school exclusions and improve outcomes (Nawaz et al., 2025).
Holistic support – incorporating predictability, sensory regulation, and emotional safety enhances resilience and wellbeing.
These strategies, informed by both research and lived experience, provide practical guidance for parents and practitioners.
What This Means for Parents
Evidence-informed support does not require a single, universal intervention. Children with PDA thrive in environments that:
Prioritise connection and emotional safety
Reduce unnecessary demands and pressure
Offer choice and flexibility to support autonomy
Recognise behaviours as anxiety-driven, not defiance
Incorporate sensory regulation and predictable routines
Parents and practitioners can apply these principles to create trauma-informed, neurodiversity-affirming environments. The SENDinMama PDA Parents and Carers course translates this research into practical strategies, and accessible language, empowering families with tools that blend science and lived experience.
Importantly, my approach is informed not only by research but also by my lived experience as a PDA AuDHD adult raising multiple PDA children and over 15 years of working with SEND, neurodiverse and trauma affected children and teens in education. This combination deepens my understanding and allows me to offer compassionate, realistic strategies that I have tried and tested myself.
Conclusion
While PDA is not yet officially recognised in diagnostic manuals, the growing research and lived experiences confirm it as a distinct behavioural profile. Supporting individuals with PDA requires flexibility, compassion, and evidence-informed strategies that honour each person’s unique experiences. I have worked hard through SENDinMama to ensure that my work represents honesty, accuracy and accountability, and that the support I offer comes from that place.
I am proud to be supporting our community.
With love,
SENDinMama
Want more?
Explore these next:
Resources Hub: Printable, PDA friendly tools and Book Lists for Home Education & School
Blogs: The Ladder and the Lion
References
Curtis, S., et al. (2025) The experience of mothers of autistic children with a pathological demand avoidance profile. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-025-05234-5
Haire, L., et al. (2024) Methods of studying pathological demand avoidance in children and adolescents: a scoping review. Frontiers in Education. https://doi.org/10.3389/feduc.2024.1230011
Kildahl, A. N., et al. (2021) Pathological demand avoidance in children and adolescents: a systematic review. Autism Research. https://doi.org/10.1002/aur.2525
Kenny, N., et al. (2024) A phenomenological exploration of the lived experience of adults with pathological demand avoidance. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-024-05893-3
Nawaz, S., et al. (2025) Families’ experiences and support needs for children with extreme demand avoidance. Child and Family Social Work. https://doi.org/10.1111/cfs.12950
Newman, L., et al. (2019) Psychological profiles and emotional regulation in children with pathological demand avoidance. Autism. https://doi.org/10.1177/1362361319876543
O’Nions, E., et al. (2015) Identifying features of 'pathological demand avoidance' in children with autism spectrum disorder. Autism. https://doi.org/10.1177/1362361314564952
Green, C., et al. (2022) Educational strategies and outcomes for children with PDA. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-022-05512-4
Photo of Elizabeth Newsom: Elizabeth Newson, 1929-2014 | Times Higher Education (THE)
I was formally diagnosed with a PDA profile of Autism late in life and since then I've done a lot of investigation into it and thought deeply about my own experiences and those of my granddaughter who is on the AuDHD diagnosis pathway and whom I strongly believe to be PDA.
As you so rightly observe PDAers *MUST* be involved in the conversation around diagnosis, support and ongoing research. If only because there is so much nonsense talked about PDA and deep misunderstandings about where it comes from.
I personally would always want to point out that what people call 'demand avoidance' is merely a recognition that every human should have a right to self determination. Further, that steeply hierarchical systems of power are harmful to humans and we PDAers care deeply about equity and social justice. I would go so far as to say it's not anxiety driven but is part of our 'sensory profile' in that it is unfairness and methods of control that disregulate us - in the same way as too much noise for example. The product is mistaken for the cause.
As a personal anecdote I'll tell you this: I have been a carer for my granddaughter for 5 years and we never have a problem with 'demand avoidance' but her authoritarian Father has been screamed at, peed on and spat in the face. Enough said I think.
Intervention? Aren’t interventions meant to stop an adverse behavior? Why would anyone suggest an intervention. That would likely lead to further burnout. Great article BTW.