Why is understanding PDA in healthcare settings important?

• Avoidance of appointments: High levels of anticipatory anxiety can lead to cancelled visits or refusal to attend.
• Challenges sticking to treatment plans: Structured regimens can feel too demanding, triggering avoidance or distress.
• Communication barriers: A PDAer may appear sociable or compliant but struggle to express underlying anxiety or physical symptoms. Conventional question-and-answer formats may increase their stress…
• Exacerbated anxiety. Venues may be noisy, smelly, or have very bright lighting triggering sensory difficulties. Treatment plans may differ offer time creating uncertainty and stress.
• Consent challenges. Complex or urgent decisions may be experienced as demands causing PDA-related anxiety.

Potential Impact: A lack of adjustments around a PDAers access needs can mean that they are unable to affectively access healthcare when they become unwell. This can mean that health conditions worsen, and they experience discomfort unnecessarily. If a PDAer’s needs are not recognised or adequately met, this can result in:

• Worsening mental health. Anxiety around services can contribute to depression, burnout, or crisis. This is a risk especially if demands continually exceed an individual’s window of tolerance.
• Avoidance of critical support. Disengaging altogether, missing essential interventions for potentially life-threatening conditions.
• Greater strain on systems. Delayed treatments place pressure on acute care, emergency services, and social work teams. (autistic people with a PDA profile) can find experiences with healthcare distressing.

Recognising and adjusting for PDA in healthcare settings can be lifesaving.

A person is considered disabled if:

“They have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.”

If a person’s condition meets these criteria above, they are considered disabled -regardless of whether they have a medical label. This means that people without a diagnosis still qualify for reasonable adjustments.

The law obliges health and social care providers to evaluate and reduce barriers to access. It encourages earlier, more effective intervention-without the need to wait for a diagnosis. It also means whether your service recognises PDA or not, the needs presented to you by a PDAer warrant you considering how to make reasonable adjustments.

In some cases, there is a risk of diagnostic overshadowing. This describes when everything someone is experiencing is attributed to one cause, when in fact there are more. For example, a PDAer might also be experiencing:

• Undiagnosed depression or anxiety. A person’s reluctance to engage may be partly driven by underlying low mood, panic attacks, or intrusive thoughts.
• Trauma responses. Previous adverse life events could still be having an impact. PTSD symptoms might intensify the urge to evade demands.
• Socioeconomic pressures. Things like unemployment, housing insecurity, or social isolation can create additional barriers. This can make it difficult to access treatment or support.

Remembering that PDA characteristics exist alongside other challenges helps professionals tailor their approach. Recognising overlapping challenges increases the likelihood of your support being effective