Introduction

This guide is designed for:

• Social workers across children’s and adult services;
• Care managers and safeguarding leads;
• Professionals involved in Deprivation of Liberty Safeguards (DoLS);
• Staff working in residential care, homecare, and supported living environments.
• People involved in personal budget planning and commissioning,
• And direct care providers and families.

Whether working in local authorities, voluntary organisations, or private care settings, understanding Pathological Demand Avoidance (PDA) is essential for professionals supporting autistic people with a PDA profile. Tailoring communication, expectations, and environments can reduce distress and enable people to access support more safely and consistently.

• An overwhelming need to avoid everyday demands, often due to heightened anxiety.
• Use of social strategies to elude demands, including distraction, negotiation, or flattery.
• Surface sociability, masking deeper social understanding challenges and heightened anxiety.
• Rapid mood changes and impulsivity, with possible swings from compliance to intense avoidance.
• Ease in role-play and pretending, as a means of control or escape.
• Obsessive behaviours, frequently focused on people or relationships.

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 dependant 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.

For example, standard safeguarding processes that require prompt engagement or attendance at multi-agency meetings may be perceived as coercive, triggering avoidance or escalation. Similarly, transitions between placements, reviews of care packages, or personal budget assessments can provoke high anxiety. Without adjustment, these systems risk excluding the very people they are meant to support.

Failure to recognise and accommodate PDA can lead to:

• Breakdown in relationships between professionals and individuals.
• Missed safeguarding opportunities due to avoidance or disengagement.
• Escalation to emergency interventions that could have been avoided.
• Unwarranted assumptions about capacity, compliance, or parenting.

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 theses 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.

In essence, 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 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.