Demand Avoidance

What is demand avoidance?

Demand avoidance is when someone resists / avoids the ordinary demands of life, even when it is in their best interest to comply.  It typically manifests early in life and can be associated with high levels of anxiety. Other characteristics that may encompass demand avoidance are a superficial ability to manage social interaction, extreme impulsivity, an obsessive need for control, being comfortable in role playing and pretending, and possibly a language delay.  The individual may make excuses and withdraw into their own world as a way of avoiding conversations or activities that could lead to a meltdown or panic attack.

How can you identify demand avoidance?

Demand avoidance is a fairly rare condition, and it can be easy to miss because each presentation can be slightly different and/or autistic people may mask their differences.*  Demand avoidance can be misunderstood because it is typically characterized by a series of unusual behaviors.  The underlying cause of those behaviors may not be immediately obvious.  For example, someone with demand avoidance may procrastinate on specific types of assignments, cancel social engagements at the last minute, and be so invested in on-line role-playing games that they neglect other aspects of their life.  If a doctor looked at those behaviors individually, they may have difficulty identifying demand avoidance.  However, if the doctor looked at those behaviors in the context of a patient with anxiety, demand avoidance would seem more likely because each behavior could be seen as a way of managing anxiety.  Demand avoidance can also be misdiagnosed because its presentation may also overlap with Oppositional Defiant Disorder, Conduct Disorder, Reactive Attachment Disorder, Personality Disorders, or Developmental Trauma.

For a formal assessment for demand avoidance, contact your general practitioner to receive a referral to a team that conducts neurodevelopmental assessments (including autism).  These teams usually include pediatricians, clinical and educational psychologists, psychiatrists, and speech and language therapists. Although demand avoidance is not its own diagnosis, getting a specific profile of your child will aid you in providing the best support for your child.

*Masking is when and autistic person hides their difficulties.  Masking is usually specific to a particular environment or certain groups of people.

How is demand avoidance related to autism?

Demand avoidance is not considered to be a separate diagnosis, and it may or may not be associated with a diagnosis of autism.  Demand avoidance and autism share characteristics, which is why some researchers consider demand avoidance to be a subtype of autism, but this is not widely accepted by all researchers. Similar features include lack of cooperation, changes in mood, anxiety, blaming others, and making embarrassing comments in public.

While similar, people who have a demand avoidance profile are considered to have a slightly better social understanding, which they can use to their advantage to resist tasks asked of them.  Other characteristics that differentiate demand avoidance and autism include manipulative behavior, difficulties with other people, harassment of others, fantasizing, lying, cheating, stealing, and socially shocking behavior.

It is important to keep in mind that individuals with autism may be more likely to display demand avoidance than a neurotypical person, and they may need different management approaches.  Those with autism respond very well to structure and having a predictable routine.   Alternatively, a typically developing person with demand avoidance may best respond to novelty, humor, and flexibility.

How can you encourage a child with demand avoidance to be compliant?

The PDA Society suggests using the PANDA approach which stands for pick your battles, anxiety management, negotiation and collaboration, disguise and manage demands, and adaptation.

1. Picking your battles encompasses minimizing rules, enabling some choices, explaining your reasoning, and accepting that some things cannot be done at that moment.
2. Anxiety management includes thinking and planning ahead, treating meltdowns as panic attacks, reducing uncertainty, and acknowledging underlying anxiety and overwhelming sensory concerns.
3. Negotiation and collaboration involves keeping calm when solving challenges and prioritizing fairness and trust.
4. Disguising and managing demands aids in indirectly wording requests, monitoring their tolerance, and doing tasks as a team.
5. Adaptation involves using humor, role playing, being flexible, creating subsequent plans, allowing plenty of time for the task, and balancing the “give and take” in your relationship.

What are some ways people avoid demands?

People with demand avoidance can employ a range of strategies to avoid demands, including: changing the subject to distract others, giving explanations as to why they cannot execute the task, procrastinating, withdrawing into a fantasy work, reducing meaningful conversation, or incapacitating themselves.  When these tactics are not used, the emotions related to being asked to perform a task become bottled up and will lead to a meltdown that resembles a panic attack.  This can involve being agitated or upset, self-harming, shutting down, running away, or being aggressive.

What are some strategies that an individual with demand avoidance can use?

According to the Pathological Demand Avoidance Society, here are many self-help strategies that those with demand avoidance can utilize such as:

• Be aware of your triggers and what methods you use to avoid demands
• Accept yourself and understand how you may “mask” in social situations
• Manage or disguise how demands are given and create a demand-free time for yourself
• Inform others and ask for the necessary accommodations
• Consider counseling, mindfulness, or meditation

It is important to understand that having no demands is not practical, so adapt how demands are given and be flexible.

Why is it labeled “pathological”?

While avoiding demands can be a natural human trait, it becomes pathological when it is all-encompassing and has an irrational quality.  This mean that affected people can have dramatic and/or irrational responses to small requests.  Just like autism, pathological demand avoidance is considered lifelong and is not a choice.  Some researchers consider the term “pathological” to be controversial, so “extreme demand avoidance” has emerged as an alternative term.

Article by: Nicole Steel and The Autism ToolKit

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820467/

https://www.pdasociety.org.uk/

https://www.pdasociety.org.uk/wp-content/uploads/2021/04/What-is-PDA-booklet-website-v2.1.pdf

https://www.spectrumnews.org/news/pathological-demand-avoidance-in-autism-explained/