In 1980, the British psychologist Elizabeth Ann Newson proposed a new sub-type of autism spectrum disorder in children. These children, who had been diagnosed with autism, refused to do what was asked of them, even if it involved activities they ordinarily liked. They manipulated their parents and other adults and acted in extremely age-inappropriate ways so as not to comply with what was expected of them.
Dr. Newson termed this behavior pathological demand avoidance (PDA) and suggested it was present in a particular group of children who appeared to have autism but in this specific way were not typical of autism. She later suggested they were more appropriately grouped into the Pervasive Developmental Disorder-Not Otherwise Specified.
If we are to accept the possibility of PDA in children, it should not be surprising to assume this condition also exists in adults since, after all, children grow up. This sort of behavior isn’t likely to disappear once that happens. Based on my experience with adults on the spectrum, PDA is not uncommon, especially in men. The signs of demand avoidance include:
- Habitual refusal to carry out reasonable expectations at work, home, and other social settings.
- Passive non-compliance with ordinary expectations.
- Attempts to manipulate others in the service of avoiding requested, expected behavior.
- Using tantrums, hysterics, outbursts, and other inappropriate, embarrassing behavior to achieve their goals.
Characteristics of Pathological Demand Avoidance
Adults with PDA seem to have an extreme need to avoid the ordinary demands of life. They hate routine and the ordinariness this implies. They thrive on novelty and change, often creating chaos to avoid doing what is expected of them. They can at times be adversarial, even antagonistic, to escape demands on their freedom to do what they please.
Characteristically, they have a degree of friendliness and sociability, seeking companionship and engaging in social activities, which makes them good at avoiding demands. This sociability is the main reason why they are considered atypically autistic.
Prognosis
Can autistic adults with PDA change? The data so far is sparse. What I can say is that two factors are likely to influence whether someone with PDA can change. The underlying cause of PDA appears to be significant anxiety about not being in control of one’s environment and one’s actions. Avoiding ordinary demands is a strategy then to cope with the feeling of not being in control. If a person can recognize the feeling of not being in control and understand that avoiding demands is a way to handle that feeling, it is quite possible to change it.
The other factor is the fact that motivation is a highly significant source of change in both neurodiverse and neurotypical people. If someone wants to change and is willing to put in the work to make it happen, no matter who they are and what the condition is, the possibility of change is always present,
Dr. Kenneth Roberson is an ASD psychologist in San Francisco with over 30 years of experience. To ask a question or schedule an appointment, please call 415-922-1122.
