What is the connection between ADHD and pathological demand avoidance?

Insane Demand Although avoidance is typically linked to autism; it can also impact those with ADHD.

One feature linked to autism and ADHD is Pathological Demand Avoidance (PDA).

Even if you want to, it could be difficult for you to comply with expectations if you have PDA. You may do everything it takes to avoid giving in to demands of any type. Another name for PDA is Extreme Demand Avoidance.

Others may see someone with PDA as purposefully confrontational or rebellious, although there is little data on PDA to determine whether or not this is the case. In most cases, treatment is required to control demand avoidance tendencies.


Pathological demand avoidance: what is it?

Professor Elizabeth Newson first used the phrase “pathological demand avoidance” in the 1980s. Although it is thought to be a subtype of autism spectrum disorder (ASD), individuals with ADHD can also exhibit it. In addition, both adults and toddlers may exhibit this behavior.

Neither the 10th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) nor the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), recognize PDA as a condition.

Some believe it to be a profile on the autism spectrum, according to the PDA Society. However, a 2018 study claims that there is disagreement about whether PDA and autism are connected conditions or if PDA is a distinct illness.

Individuals who suffer from PDA may go to great measures to resist fulfilling requests. There is a strong correlation between this demand avoidance and anxiety.

These requests may be:

  • External: enforced by third parties, such as a teacher’s directive or a deadline.

  • Internal: imposed from within, such as a schedule you have chosen to stick to.

  • Explicit: like a demand made directly.

  • Implicit: a kind request or an unspoken expectation.

In addition to rejecting activities they do not find fascinating, people with PDA may also steer clear of their favorite pastimes and activities.

While some may find this annoying, it is crucial to keep in mind that PDA is not a decision.


ADHD and pathological demand avoidance: a connection

Anecdotal accounts suggest that many PDA sufferers also fit the diagnostic criteria for attention deficit hyperactivity disorder (ADHD), but more research is required to determine whether a connection exists, according to PDA Society.

In general, there may be similarities between the characteristics linked to PDA and ASD. The correlation between PDA and ADHD may stem from the fact that the two conditions frequently co-occur.

Some people may confuse PDA for ADHD and vice versa. Executive dysfunction can be brought on by PDA or ADHD, both of which can make it difficult to start, finish, and regulate impulses.

However, with PDA, many refuse to comply just because it is a demand. While some people with ADHD may occasionally evade demands, severe demand avoidance is not a common sign of the disorder.

According to a 2020 study, PDA was more accurately predicted by ADHD than by autism. Put differently, it is possible that PDA and ADHD are more closely related than autism. However, further investigation into this relationship is required.


Symptoms of pathological demand avoidance

Diagnostic manuals do not recognize PDA; nonetheless, the PDA Society has identified some essential PDA traits.

The following are PDA symptoms:

  • bucking and dodging customary demands

  • employing social techniques to evade expectations obsessive conduct

  • frequently centered on other individuals 

  • being outwardly kind but shallowly comprehending 

  • impulsivity 

  • extreme mood swings

The PDA Society points out that various people’s experience PDA in different ways. Since each person with PDA is unique, some may find it easier to meet some expectations than others. Furthermore, some persons may experience PDA to a greater extent than others.


Symptoms of ADHD

In addition to the previously listed PDA characteristics, an individual may also exhibit signs of ADHD.

Three primary categories of symptoms exist for ADHD:


  • coupled inattention

  • hyperactivity

  • impulsivity

The following are some signs of inattentive ADHD:


  • challenge focusing intently on details 

  • struggling to stay with or complete jobs

  • memory issues

  • trouble managing time

  • trouble remaining organized

  • trouble following directions

  • prone to distraction

Hyperactive-impulsive ADHD symptoms include:

  • agitated and restless

  • Impulsivity frequently disturbing others

  • inability to wait or remain quietly

  • constant need to move

Combinations of all the aforementioned symptoms may be present in combined ADHD.


Does pathological demand avoidance have a connection to autism?

Since PDA is frequently seen as a profile on the autistic spectrum, some individuals who fit the diagnostic criteria for ASD may also exhibit PDA characteristics.

People with PDA may have an ASD diagnosis that “does not quite fit,” according to the PDA Society. Alternatively, they may be nearly meeting the diagnostic criteria for ASD but not quite.

While the majority of PDA sufferers fit the diagnostic criteria for autism, the PDA association observes that PDA sufferers frequently have:

  • superficially more socially adept than the majority of autistic persons, including feeling more at ease making eye contact

  • less evident routines and repetitive behaviors than the majority of persons with autism

  • interests that, while strong, are not as enduring as the “special interests” that many people with autism have

It is crucial to remember that not all people with PDA have autism, and not all people with autism fit the PDA profile.


Autism symptoms in PDA

According to the PDA Society, individuals with an autistic PDA profile include:

  • Have ongoing social interaction challenges

  • Participate in limited, recurring hobbies or pursuits that hinder day-to-day functioning

  • Perceptive to feelings in the senses

  • Have a control-driven urge stemming from anxiousness

  • To escape expectations and demands, particularly those for things they want to undertake, go to extremes

  • Usually do not react well to traditional methods of instruction or parenting


How can one diagnose pathological demand avoidance?

As PDA is not included in the DSM-5-TR or ICD-10, there are no common diagnostic standards.

The “Extreme Demand Avoidance Questionnaire” (EDA-Q), created in 2013 by PDA researchers, is a tool used to assess the behavior of adolescents with autism.

Parental reports of their children’s behavior serve as the basis for the research questionnaire. The EDA-Q is not a diagnostic tool as a result.


Treatment for pathological demand avoidance

PDA has no known “cure,” however its symptoms can be controlled.

Knowing what PDA is and how to deal with its demands will assist you manage daily life if you meet the PDA profile. Understanding PDA can improve your ability to support someone who fits the PDA description, whether you are a loved one or a teacher.

Both the National Autistic Society and the PDA Society advise adopting a personalized strategy. As not all individuals that meet the PDA profile are created equal, it is vital to try and comprehend your unique circumstances.

This may consist of:

  • identifying triggers (such as observing the demands that frequently cause avoidance and discomfort)

  • determining what kinds of demands are reasonable 

  • locating techniques for stress and anxiety relief

You could gain from:

  • Attempting to lessen stress and worry, as they might exacerbate demand avoidance

  • Changing the wording of requests to make them sound less triggering (if indirect requests are effective, for instance)

  • Reducing the number of needless regulations

  • Attempting to make demands less individualized

  • Together, you and your loved one with PDA can establish limits and unchangeable rules that will help you both feel more in control.

  • Giving plenty of notice before an event or impending demand 

  • being adaptable and establishing alternate plans when demand avoidance kicks in

If you have ADHD or any co-occurring disease, you may want to talk to your doctor about trying an ADHD medication. This could assist you in controlling your ADHD symptoms, which would enhance your wellbeing and executive function.

PDA Society-affiliated researchers observe that many individuals who meet the PDA description develop successful lives for themselves by managing their demand avoidance, frequently through self-employment and independent labor.


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