Health & social care
Introduction
This guide is designed for:
- Primary are clinicians (GPs, practice nurses) in the UK.
- Secondary care clinicians in non-autism-focused fields.
- Allied health professionals (e.g. therapists, dietitians, physiotherapists) who may encounter individuals with PDA characteristics.
- Social workers and support staff who assist with medical appointments and care coordination.
Whether working in primary, secondary, or tertiary care in both NHS or private practice, understanding PDA helps professionals tailor their communication, the clinical environment, and treatment plans to reduce stress and achieve better outcomes for both parties.
This content is best read through in the order above, and navigated in order using arrows at the bottom of pages – but if you want to jump to a particular section you can do so using the buttons above. You can also access a short downloadable resource here which summarises how PDA can present in both children and adults and offers some helpful approaches.
Introduction to pathological demand avoidance (PDA)
Definition and characteristics of PDA
Pathological demand avoidance (PDA) is widely regarded as a profile on the autism spectrum, characterised by:
- An overwhelming need to avoid everyday demands, often due to heightened anxiety.
- Use of social strategies to elude demands, including distraction, negotiation, procrastination, or flattery.
- Surface sociability, masking deeper social understanding challenges and heightened anxiety.
- Rapid mood changes and impulsivity, with swings from compliance to intense avoidance and extreme distressed behaviours.
- Ease in role-play and pretending, as a means of control or escape.
- Obsessive behaviours, frequently focused on people or relationships.
- Need for control as a way of reducing anxiety
- Intolerance of uncertainty, to a greater extent than the general Autistic community
You can find detailed information about the profile and its characteristics here.
PDA is not recognized in major diagnostic manuals like the DSM-5 or ICD-11. However, it is increasingly accepted in UK clinical and academic settings. The National Institute for Health and Care Excellence (NICE) does not provide separate guidelines for PDA. This means identification is dependent on expert clinicians and local pathways (Christie et al., 2022). As a result, many PDAers may have had multiple prior diagnoses or be in the process of reassessment.
Interested in learning more?
If you want to develop your practice in supporting PDAers we can help. Our training for professionals shares practical tools and the theory behind them – presented by people who know what they are talking about. Many of our courses are CPD accredited too. You can find them here.