WHAT YOU’LL LEARN

• What Is Pathological Demand Avoidance?
• What Causes Pathological Demand Avoidance?
• Pathological Demand Avoidance Checklist
• How Pathological Demand Avoidance Builds
• How to Navigate Pathological Demand Avoidance Behavior
• Creating a Mindset Shift Around Autonomy and Demands
  

Understanding Pathological Demand Avoidance: What It Is, Why It Happens, and How to Navigate It

If you’ve ever felt like you’re walking on eggshells around your child or locked in constant power struggles, you’re not alone. Parenting can be overwhelming in general—but when your child’s reactions feel atypically extreme, unpredictable, or defiant, it can be downright exhausting.

For some parents, what might look like defiance or misbehavior on the surface could actually be something deeper—Pathological Demand Avoidance (PDA), a nervous system response characterized by extreme resistance to demands or requests and an intense need for autonomy. 

Pathological demand avoidance is commonly associated with autism, but it can also present with ADHD or anxiety disorders–and it is often considered its own neurological difference (although it is not a diagnosis recognized by the DSM-5). 

Parenting a child with PDA is extremely difficult. We have to choose our battles in an entirely different way, be careful about how we say anything, and weigh out what is “enabling” and what is supporting our child as an individual. And without being taught about PDA, most of us are left struggling to figure all of this out. 

This week on The Momwell Podcast, I’m joined by Dr. Casey Ehrlich, founder of At Peace Parents, a platform dedicated to helping parents navigate PDA. We discuss what pathological demand avoidance is and how parents can reduce the battles and reframe their parenting approach. 

What Is Pathological Demand Avoidance?

Pathological Demand Avoidance refers to an extreme avoidance of demands, rooted in a nervous system response that perceives loss of autonomy as a threat. Dr. Casey describes PDA as a survival drive for autonomy and equality that overrides other basic needs like eating, sleeping, or safety.

For example, if a child with PDA is about to touch a hot stove and a parent tells them to “be careful,” their nervous system could feel so threatened by a perceived loss of autonomy that they might touch the hot stove to reclaim it, even at the risk to their own physical safety. 

For children with pathological demand avoidance, the need for autonomy is so strong that even everyday requests like “Put on your shoes” or “Brush your teeth” can trigger a fight-or-flight reaction. 

This can often result in screaming, hitting, or meltdowns. But unlike with behavioral disorders, like ODD, these behaviors and resistance aren’t conscious or willful—they’re a subconscious nervous system response. 

PDA behaviors aren’t willful—they’re about survival in those children’s perception of the world. 

Dr. Casey explained that the resistant behavior can be strong—for example, while a neurotypical child might avoid eating vegetables but eventually give in when hungry, a child with pathological demand avoidance might refuse food altogether if they perceive the act of eating as a demand. 

She said that if we want to learn how to support children with PDA, we have to remember that their behavior isn’t willful—it’s about survival in their perception of the world.

What Causes Pathological Demand Avoidance?

Pathological demand avoidance is a neurobiological condition—it stems from differences in how the brain processes and responds to stress. Children with PDA experience heightened nervous system activation when faced with demands or even requests. 

Our brains are designed to keep us safe, detecting threats around us—a process called neuroception. But for children with PDA, any loss of autonomy triggers a threat warning, just like physical danger would. 

For children with PDA, any loss of autonomy triggers a threat warning.

For children with pathological demand avoidance, a loss of autonomy or a perceived inequality, like being “below” an authority figure, a peer, or even an activity like a board game, are interpreted as threats. They build in the nervous system cumulatively, eventually disabling them from thinking “rationally.”

PDA doesn’t have one specific cause, but it is linked to neurodivergence, particularly autism spectrum disorder and ADHD. 

It’s important to remember that for kids with PDA, autonomy is a true need. Without it, they are forced into fight-or-flight. This can show up differently in different kids. Some might scream, hit, or melt down. Others might exhibit OCD-like behaviors or essentially shut down. 

PDA can create not just tension in the home or “unwanted” behavior, but even health concerns. It’s common for children with PDA to end up trying to regain control through food or body functions. For Dr. Casey’s son, food was a big issue—at one point he was down to just eating three processed foods. 

Pathological Demand Avoidance Checklist

When our children experience meltdowns or show behavior that we might think of as defiant, we might wonder if PDA could be at play. It can be hard to know—especially since not all pediatricians are well-versed in PDA. 

Common characteristics of PDA in children include:

• Extreme resistance to demands: Avoids or refuses requests, even ones they want to comply with.
• High masking abilities: Behaves differently in public or at school compared to home.
• Meltdowns or explosions: Overwhelmed responses when demands feel insurmountable.
• Rigidity around autonomy: Insists on doing things their way or avoids structured activities.
• Think of themselves as an authority figure: They might have trouble separating themselves from authority figures like teachers or parents. 
• Demand avoidance that impacts daily life: Resistance affects basic needs like eating, sleeping, or hygiene.
• Fluctuating Behavior: Appears to “do well” in some situations but struggles significantly in others.

Sometimes we have a gut feeling that more than “defiance” is going on. If your child exhibits many of these behaviors and you have that intuitive feeling, it might be worth exploring pathological demand avoidance more deeply. 

At Peace Parents offers a free masterclass that goes through different presentations of PDA and helps you dive deeper to understand your child, along with other resources to help determine if your child might have pathological demand avoidance. 

How Pathological Demand Avoidance Builds

Our children often live in very structured ways. They wake up, and we tell them what to eat for breakfast. They go to school, where they have to follow rules and expectations all day long. And by the time they come home, it’s snack time, homework time, dinner time, bedtime—demand after demand after demand. 

We don’t even mean to set things up this way—we’re just moving our kids through their day. But to PDA children, it’s a series of unending losses of autonomy. 

By the time they come home, they’re ready to explode.

Many kids with PDA are high-masking—they might only exhibit meltdowns and resistant behavior at home. But masking all day long creates ongoing pressure on the nervous system. By the time they come home, they’re ready to explode, leading to extreme after school restraint collapse meltdowns triggered by any loss of autonomy or equality. 

PDA responses can come from activities that they typically love and enjoy, or from an interaction with a parent that they have a wonderful relationship with. It often surfaces at even unexpected moments. 

Dr. Casey also pointed out that the demands can be internal. Our children might agree to something or even come up with a routine that seems great for a while—and then eventually it can start to feel like a requirement or a demand, even if it was self-imposed. 

If we want to support our children with pathological demand avoidance, the key is equalization—allowing our children to regain a sense of autonomy in order to reset their nervous systems and bring them out of fight-or-flight. 

 How to Navigate Pathological Demand Avoidance Behavior

Parenting a child with pathological demand avoidance often requires a complete mindset shift. Traditional approaches like discipline, structured routines, or even rewards can backfire, as they may inadvertently increase the child’s perception of threat.

We can help our child equalize by lowering demands and offering more opportunities for autonomy. Dr. Casey pointed out that this goes against all traditional parenting mindset and behavioral approaches—but you can start small. 

For example, instead of insisting that your child eat dinner at the table, you can allow them to eat in a different spot. Or perhaps if they resist wearing clothes, you can let them take off their clothes at home, avoiding that battle altogether. 

We can help our child equalize by lowering demands.

Dr. Casey said that it’s also helpful to avoid asking questions after school or a long day when our child has had to mask their behavior or adhere to social norms and expectations. Questions can feel like a demand for a response, resulting in a meltdown or resistance. 

We can start with low-stakes situations and release control, allowing our children to have more autonomy in their lives and their decisions. It might feel strange at first, but when our children are allowed to have autonomy throughout the day, they might be less likely to experience meltdowns or become triggered. 

It can be hard to navigate how much autonomy to allow—especially if we have other children. There might be times when we feel like we’re building our entire lives around our PDA child. Dr. Casey said that it’s often helpful to think of situations from a cost-benefit standpoint. 

Sometimes, the cost of a PDA response is necessary, especially when it comes to safety or hygiene. But other times, it’s not worth it. For example, maybe we have an event that we have to attend, and we have to weather the response knowing what’s coming. Or maybe we can be flexible. We have to take moments as they come and consider the entire family in decisions. 

Dr. Casey also pointed out that when we allow our child more autonomy on a regular basis, it defuses the nervous system response—if we can be proactive and provide more autonomy, it can lead to less big meltdown moments.

Creating a Mindset Shift Around Autonomy and Demands

One of the most challenging aspects of parenting a child with PDA is letting go of societal expectations and norms. Our friends, family members, and in-laws might think that children “should” behave in a certain way. 

But we are the advocate for our children. If we want to support them, we have to willing to break away from norms where they don’t matter and figure out what works best for our child and our family. 

Dr. Casey believes that peacefully parenting children with pathological demand avoidance involves unlearning traditional parenting approaches and embracing a mindset rooted in empathy, flexibility, and collaboration.

Instead of viewing behavior as a choice, parents can start to see their child’s actions as a form of communication. 

The goal isn’t to “fix” PDA or force compliance, but to create a safe environment. 

The goal isn’t to “fix” PDA or force compliance, but to create an environment where your child feels safe, supported, and empowered to meet their needs in ways that work for them.

This can feel like a radical shift, especially when faced with outside pressure or judgment. But as Dr. Casey pointed out, the long-term benefits—fewer meltdowns, stronger relationships, and a child who feels understood—outweigh the short-term challenges.

Parenting a child with pathological demand avoidance can be challenging, but it’s also an opportunity to develop a deeper understanding of our children’s needs and strengths and meet them where they’re at, creating a long-term sense of trust, safety, and support. 

If you’re struggling with your child’s behavior or unsure how to navigate parenting challenges, you aren’t alone. Working with a mom therapist can help you reframe your mindset, let go of guilt, and approach parenting in a flexible way. Book a free 15 minute virtual consult today. 

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