Understanding co-occurring conditions and diagnostic overshadowing with PDA

When supporting PDAers, it’s important to recognise the impact co-occurring conditions and diagnostic overshadowing can have. Understanding that people can experience more than one condition, and so need support that is personalised to them individually, can lead to better support and outcomes.

Two overlapping pink speech bubbles with a wavy line beneath them appear on a teal square with rough edges, set against a light blue background.communication.

A PDA profile of autism rarely exists in isolation. Many PDAers will have more than one diagnosis. This could be something like Attention Deficit Hyperactivity Disorder (ADHD), or an anxiety disorder, obsessive-compulsive disorder (OCD), or Post Traumatic Stress Disorder (PTSD). They might also be experiencing chronic stress, social isolation, or trauma.

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 everyone tailor their approach. Recognising overlapping challenges increases the likelihood of your support being effective.

What are co-occurring conditions?

Co-occurring conditions (sometimes called comorbidities) refer to additional medical, physical or mental health conditions that can exist alongside a primary condition like PDA. Many PDAers experience other challenges that may affect their behaviour, emotions, and daily life.

Common co-occurring conditions for PDAers include (but are not limited to):

Attention Deficit Hyperactivity Disorder (ADHD): many PDAers have symptoms of ADHD, including difficulties with focus, impulsivity, and managing energy levels.
Anxiety related conditions: anxiety is often a core feature of PDA, but can also be an independent diagnosis such as generalised anxiety disorder (GAD) or social anxiety.
Mood related conditions: depression or mood swings can sometimes accompany PDA, particularly if ongoing challenges lead to feelings of frustration or isolation.
Obsessive-Compulsive Disorder (OCD): some PDAers may develop obsessive behaviours or compulsive routines as a way to manage anxiety or regain a sense of control.
Sensory Processing Disorder (SPD): people might have strong reactions to sensory stimuli and find certain sounds, textures, or environments very distressing.

What is diagnostic overshadowing?

Diagnostic overshadowing happens when the traits of one condition overshadow other potential diagnoses. When professionals or caregivers attribute all behaviours to one thing without considering other explanations it can lead to conditions being overlooked or misunderstood.

What might this look like in real life?

Anxiety mistaken for avoidance: if a PDAer is struggling to leave the house, it might not just be due to demand avoidance. There could also be underlying agoraphobia or social anxiety.
Hyperactivity seen only as demand avoidance: if a PDAer is finding it hard to sit still or focus, this could be related to ADHD rather than simply being avoidance behaviour.
Mood swings labelled as PDA: emotional highs and lows might not only be part of PDA but could also indicate a mood related condition like bipolar disorder.
Reluctance to move or exercise: the pain of hypermobility is underestimated and written off as PDA refusal.

How might this feel for a PDAer?

For a PDAer, diagnostic overshadowing can feel confusing or invalidating. When other conditions are not recognised, the support offered may not address their actual needs.

“It’s hard when people think everything is just PDA. Sometimes, I’m not avoiding, I’m genuinely overwhelmed or scared and the anxiety I’m feeling is huge.”

Fabio*

“Our PDA son had become so used to things being challenging that he didn’t mention his poor eyesight until he was 11. An eye test confirmed he needed glasses.”

Mark*

How can I help?

The important thing is to remember that every PDAer is a unique human being and that while PDA may impact on every part of their life, it won’t be the only thing that does. Their personality, lived experiences and any other conditions they have alongside PDA will contribute to how they feel and behave.

When a PDAer is experiencing something that is having a negative impact on their life that you or they do not believe is wholly attributable to PDA it is always ok to ask for help understanding what is going on, and finding ways to make life easier.

Fancy a challenge that makes a difference?

You might enjoy taking on a community fundraising challenge. Lots of people choose to support PDAers by doing gaming marathons, ultra marathons, cake sales or selling their old stuff at car boots. They make a massive difference and we are so grateful. If you want to join in, we’ve got ideas to get you started.

Fundraise for us