Diane Gould Therapy

We specialize in PDA and other complex neurodivergent profiles.

What is Pathological Demand Avoidance/Persistent Drive For Autonomy (PDA)

PDA is a complex neurodevelopmental disability that is linked to autism and ADHD and in addition generally includes other co-occurring conditions. It’s recognized as an extreme avoidance of everyday activities due to heightened anxiety. Unlike oppositional behavior, where a person will say “I won’t”, the person with PDA will say “I can’t”. In the United States and Canada, most families and professionals have not even heard of PDA. That leaves parents whose child fits the profile of PDA without understanding support or resources. Parents who have discovered PDA feel isolated and unheard and are often blamed for their children’s struggles. PDA adults struggle with misdiagnosis and confusion about their own challenges. This also leaves teachers and therapists unable to help these individuals and families. 

Although this journey is in its infancy, we are determined to make things happen. Diane Gould founded PDA North America in March 2020, and it became a non-profit organization in 2023. PDA North America is a crucial step in providing individuals and families with the resources they need and in creating a cadre of professionals who will partner with them. And is also working on training educators to educate PDA students. 

A cluster of traits can be called a presentation or a profile – in some cases, this can be quite different from what some people think autism, ADHD, and neurodivergence look like.

This can lead to presentations in some people, including autistic women and girls, marginalized populations, and PDA individuals, being missed altogether, misunderstood, or misdiagnosed, which can in turn lead to poor outcomes.

All research points to early identification and tailored support being the best predictor of positive long-term outcomes. Recognizing these profiles signposts the approaches or support that will be most helpful for each individual.

At Diane Gould Therapy, we offer consultations to parents and professionals concerning PDA. We provide some direct therapy for PDA teens and young adults who are interested in partnering with a professional for better self-understanding and growth.

Those with a  PDA profile share autistic characteristics …“persistent difficulties with social communication and social interaction” and “restricted and repetitive patterns of behavior, activities or interests” present since early childhood to the extent that these “limit and impair everyday functioning” (according to the Diagnostic and Statistical Manual Fifth Edition (DSM-5)) often including a different sensory experience in relation to sight, smell, taste, touch, hearing, vestibular, proprioception and interoception. And as ADHD is most often a co-occurring condition, people experience struggles with executive functioning and related skills.

… and also:

  • have a need for control, which is anxiety-related
  • are driven to avoid everyday demands and expectations (including things that they want to do or enjoy) to an extreme extent
  • tend to use approaches that are ‘social in nature’ to avoid demands
  • present with many of the ‘key features’ of PDA rather than just one or two
  • tend not to respond to conventional parenting, teaching, or support approaches
  • Appearing sociable, but lacking depth in understanding
  • Excessive mood swings and impulsivity
  • Comfortable in role play and pretend, sometimes to an extreme extent
  • Language delay, often with a good degree of catch-up
  • Obsessive behavior, often focused on people, either loving or loathing them
  • Can be domineering and overbearing
  • Parents often describe a “Jekyll and Hyde” personality
  • Bossy and controlling
  • Often more comfortable with adults than children
  • Often hypersensitive to others’ voices, facial expressions, (may absorb others’ emotions)
  • Can be over-familiar with adults and peers
  • May take on the persona of other people, i.e. teachers
  • Can go into role play to comply
  • Have a panic attack or meltdown if highly anxious – these may result in aggression toward others
  • Unconcerned about the impact of behavior on others
  • Can behave very differently at school/college to home
  • Unable to follow routines if set by others
  • Often have sensory issues – noise, touch, brightness, etc

 

Prof Elizabeth Newson (1995) (Revised 1998, Second Revision 2000, Third Revision 2001)