A persistent and marked resistance to demands is a characteristic experienced by and observed in some autistic people. It can impact essential needs like eating and sleeping, and expectations such as going to school or work, and has implications for diagnosis and support. People with lived experience have suggested strategies for self-management and support.

What is demand avoidance?

Everyone experiences ‘demand avoidance’ (resistance to doing something that is requested or expected of you) sometimes. However, here we use demand avoidance to mean the characteristic of a persistent and marked resistance to 'the demands of everyday life’, which may include essential demands such as eating and sleeping as well as expected demands such as going to school or work.

Although demand avoidance is widely acknowledged as a characteristic experienced by and observed in some autistic people (and potentially other neurodivergent, but not autistic, people), there is very little research into it and the research that does exist is generally of a low quality.

Because of this, many aspects of demand avoidance – including how it is best defined and identified; how common it is; why it happens; and support strategies for someone experiencing it – are under-researched and often contested. On this page we aim to present a range of views and the best available information gathered from lived experience, research and professional practice (you can read more about how these pages are developed on our Advice and guidance content process page).

Types of demand

Below are some examples of the ‘demands of everyday life’ that a person experiencing demand avoidance may resist (note that the demand does not need to be something unpleasant to trigger distress):

• a direct demand (an instruction, such as ‘brush your teeth’, ‘put your coat on’ or ‘complete your tax return’)
• an internal demand (for example willing yourself to do something, or bodily needs such as hunger or needing the toilet)
• an indirect or implied demand (including any expectation, such as a question that requires an answer, food in front of you that you are expected to eat, or a bill arriving that needs to be paid).

Forms of resistance

Noted forms of resistance include:

• giving excuses (which may be fanciful – for example, 'I can't because I am a tractor and tractors don't have hands' or 'I can't because my legs are broken' (though they aren't))
• distraction or diversion (such as giving affection or compliments; changing the subject; making noise that makes further discussion difficult; or creating a situation that needs more immediate attention, for example, by knocking something over)
• point blank refusal (saying "No" and not entering into negotiation; physically resisting)
• passivity/withdrawal (becoming floppy; curling up into a ball; not responding; walking/running away; withdrawing into fantasy)
• aggression (usually as a last resort, when other forms of resistance have failed. For example, pushing someone or throwing something away; hitting or kicking; biting. Aggression may be a form of resistance, but it may also be a panic response to overwhelming anxiety.) 

The overwhelming anxiety of realising that a demand cannot be avoided, or that these forms of resistance have been exhausted, may result in meltdown or panic, potentially including aggression. These states are usually out of the person's control.

Examples of demand avoidance from lived experience

Because everyone experiences demand avoidance sometimes, it can be difficult to understand what is meant by a marked and persistent resistance to demands. The following real-life examples are from people’s lived experience and give a good illustration of the meaning and impact this characteristic can have.

Please note that many of the quoted people identify with the proposed condition Pathological Demand Avoidance (PDA), of which demand avoidance is the central characteristic. This is discussed in more detail further down the page.

The history of and debate about the PDA label

The history of PDA

Pathological Demand Avoidance (PDA) is a term originally developed by the British psychologist Elisabeth Newson in the 1980s and first used in a published research paper by Newson in 2003. It was used to describe a group of children who did not fit into the stereotypical presentation of autism recognised at that time but who shared certain characteristics with each other, the key one being a persistent and marked resistance to demands.

Newson believed this presentation justified a distinct identification (rather than being described generically as ‘Atypical autism’ or ‘Pervasive Developmental Disorder – Not Otherwise Specified’ (PDD-NOS), which were diagnostic labels used at that time) and a list of key features for PDA was created. Some variations of this list have been suggested by researchers and practitioners, though the descriptions have remained broadly the same.

Please note that the following proposed characteristics have historically been described using language associated with the deficit model (of autism), which many people consider inaccurate and offensive; the language below represents a sanitised version, but this should not be considered an endorsement.

The proposed core characteristics most commonly cited are:

• resisting and avoiding the ‘ordinary demands of life’
• using social strategies as forms of resistance – for example, distraction, giving excuses

Other proposed characteristics cited include:

• appearing sociable, but experiencing differences in social understanding (such as recognising hierarchies)
• experiencing intense mood swings and impulsivity
• appearing comfortable in role play and pretence
• displaying dedicated and focused interests, often focused on other people.

Although demand avoidance, including the use of social strategies to avoid demands, is widely acknowledged as a characteristic reported by and observed in some people, no research has found strong evidence for the group of traits proposed for PDA or tested the validity or usefulness of Newson’s theory in clinical practice (the work of healthcare professionals).

PDA is not clinically recognised (it does not appear in the international medical manual, the ICD, nor in the American medical manual, the DSM), which means you cannot receive a standalone diagnosis of PDA. There is debate around how the characteristic of a persistent and marked resistance to demands relates to autism (and other conditions) and whether its grouping with other traits as ‘PDA’ is helpful. For more information about this, see the following subsection ‘Debate about PDA’.

Although it is not possible to receive a diagnosis of PDA, some people have a diagnosis of autism with a 'demand avoidant profile’ or a ‘PDA profile’ noted, and others self-identify with the PDA label. ‘PDAer’ is how many of these people prefer to be referred to. Some object to the use of the word ‘pathological’ in the term ‘Pathological Demand Avoidance’ and have suggested ‘Persistent Drive for Autonomy’ as an alternative. Others think the use of the word ‘pathological’ is appropriate because they find these characteristics ‘all-consuming’.

Debate about PDA

There are stark disagreements within the autism community (which includes autistic people, their families and allies, autism researchers, health care professionals, education professionals and more) about the validity and usefulness of the concept of PDA. One point on which there is broad agreement is that more and better research is required.

Criticism

Some critics note that there is not enough research evidence to confirm PDA as a separate condition to autism and argue that:

• the complex characteristics can instead be understood by considering the individual’s social, sensory and cognitive sensitivities, any co-occurring conditions and whether their environment is suited to their needs
• the label is unhelpful as it implies the issues are within the person and not created by the above factors, which can be addressed.

It has also been argued that the PDA label represents an unnecessary pathologising of differences in autistic people when:

• they act outside of social norms in attempt to gain autonomy (control over their lives)
• they adopt coping mechanisms or attempt to reduce anxiety associated with social norms or assert self-agency (their desire to make their own decisions.)

It has further been argued that PDA-related products, such as training and conferences, have been promoted to parents and that this creates a looping effect where parents or individuals unintentionally consider behaviour selectively to conform to the proposed traits, re-enforcing their belief in the proposed condition.

Counter-criticism

Some of the criticisms listed above have been counter-criticised by people who identify with PDA. They argue that the critics do not have lived experience of these issues and that the views of people with lived experience are being invalidated, or that they are being othered and/or patronised, by these arguments.

National Autistic Society involvement

The National Autistic Society has historically engaged with the concept of PDA through website content, training, conference events and other activities. This has created a belief that the National Autistic Society accepts the concept of PDA, and its relationship to autism, to an extent that goes beyond the evidence, which has been referenced in the debate about PDA. We have reviewed our content and approach to be in line with the evidence.

Identification and assessment of demand avoidance

It is best practice for an autism assessment to identify and record a person’s unique strengths and challenges and so demand-avoidant characteristics or a strong need for personal autonomy must be recorded, with or without the use of any particular terminology such as PDA.

A thorough autism assessment should cover a person's full neurodevelopmental profile, including:

• gathering information about all characteristics, including demand avoidance
• observation of environmental influence on a person’s characteristics.

To support all autistic (or neurodivergent) people, whatever their strengths and challenges may be, there must be:

• good understanding/recognition of neurodivergence (including of complex needs) by health care professionals
• a comprehensive assessment (including external/environmental factors)
• support personalised to align with the person’s strengths and needs.

Although the concept of PDA is not clinically recognised and so it is not possible to receive a standalone diagnosis of PDA, some people are diagnosed as autistic with a ‘PDA profile’ (or similar). However, the usage of this language in an autism diagnosis is not standardised; there is no standard assessment for PDA and usage of this terminology depends on whether the clinicians, practitioners or commissioners in your local area accept it.

Note that many autistic people use social strategies and can have dedicated and intense interests that may be focused on people (these traits may be more common in autistic women and girls, for example), so the presence of these traits is not a reason to discount an autism diagnosis.

How common is demand avoidance?

We don’t know. Because demand avoidance is currently understood as one characteristic in a person’s neurodevelopmental profile and is neither a diagnosable standalone condition nor is there a standardised assessment for the characteristic, there are no data to reliably indicate how common it may be. It is hard to draw conclusions from the limited and often low-quality research that exists.

Why does demand avoidance happen?

Evidence suggests that persistent and marked demand avoidance demonstrates an intense need for control. However, this is not well understood and more research is needed.

Some (low quality) research highlights a relationship between this characteristic and the presence of both:

• anxiety, and
• intolerance of uncertainty (needing to know what is going to happen in order to feel calm).

Demand avoidance may be driven by these factors, both of which are common in autistic people. Alternatively, some people with lived experience of demand avoidance have suggested anxiety may be the effect (not cause) of perceived threats (demands) to autonomy and control.

Impact

Evidence suggests that demand avoidance can impact those experiencing it in a variety of ways, including:

• difficulty getting to sleep, staying asleep and getting up
• short and long-term effects from anxiety and associated symptoms
• difficulty with self-care tasks such as personal hygiene, eating and household chores
• experiencing panic attacks, intense emotional distress and/or difficulty regulating emotion
• difficulties in friendships or other social relationships
• inability to attend education or employment due to distress and/or burnout, which may result in exclusion or termination.

Impact on parents and carers

The parents/carers of people experiencing demand avoidance may experience impacts including:

• distress from witnessing their child / the person they are caring for in extreme distress
• challenges and exhaustion from trying to find effective ways to reduce, disguise or remove demands and support the person
• stress and frustration from trying to access or implement appropriate support in areas such as diagnosis, education, mental health and social care.

Support strategies

It is important that people experiencing persistent and marked demand avoidance are recognised and supported using strategies and approaches personalised to their specific strengths and needs.

Research suggests that the understanding and acceptance of demand avoidant behaviour is fundamental to accessing the right support.

There is limited research on support strategies; however, general advice from personal accounts and professional resources includes:

• reducing and/or removing demands, where at all possible
• a collaborative approach that flattens hierarchies (for example, between parent and child or manager and employee) to work with them rather than ordering them around
• indirect communication styles (not making demands directly)
• avoid potential stressors such as eye contact, touch and confrontational postures/physical stances
• remove any spectators to a distressing situation (by asking people to give the distressed person space or by moving the person to a quiet space if possible)
• a coordinated approach to support, with the person, family and professionals (i.e., from education, social care, healthcare, etc) involved.

Sources suggests people experiencing demand avoidance may benefit from:

• identifying and understanding their demand avoidance (and its triggers)
• managing, reducing and disguising demands
• sensory regulation and creating a sensory environment that works for them
• therapy, counselling, mindfulness and meditation.

National Autistic Society letter to schools and local authorities

We have prepared a letter for parents and carers of children and young people who experience demand avoidance to send to schools and local authorities in situations where support may be being denied or withdrawn with reference to this characteristic. The letter explains our position on best practice in autism assessments, which must record all of a person’s characteristics, including demand avoidance, and details the school and local authority’s legal duties in providing support that is tailored to an individual’s unique profile and needs.

Read our statement and download the letter.

Insight from lived experience                       

Insight from parents