PDA
What is PDA?
PDA originally stood for Pathological Demand Avoidance, but has since been suggested to stand for Pervasive or Persistent Drive for Autonomy.
PDA is not a stand-alone diagnosis. It is recognized as a theorized “profile” within the autism spectrum, characterized by an extreme avoidance of demands and a need for autonomy and control, which may extend to food and eating habits.
Dr. Taylor Day, a licensed psychologist specializing in autism and PDA, conceptualizes PDA as a nervous system disability. Individuals with this profile often experience fight or flight or intense anxiety (freeze or fawn) in response to a perceived loss of autonomy.
These behaviors can appear oppositional or defiant but are instead a behavioral response to extreme nervous system dysregulation.
Common signs of PDA include:
Resistance to ordinary demands
Strong preferences to be in charge
Extreme emotions that change rapidly
Anxiety, freezing, and/or avoidance
Aggression
Correcting others’ actions
Remember, PDA is not a diagnosis, which means we still don’t have clear criteria. More research on PDA is needed. However, it can be a helpful conceptualization in knowing how to support your autistic child, especially when traditional behavioral strategies aren’t working.
Learn more about PDA here:
Episode 110 of EVOLVE with Dr. Tay | the podcast for parents of autistic kids - listen on Apple and Spotify
Download this free guide
PDA, Autism, and Eating
Pathological Demand Avoidance (PDA) is a theorized profile part of the autism spectrum that is characterized by an extreme avoidance or resistance to everyday demands and expectations due to high nervous system dysregulation. While PDA is not universally recognized in diagnostic manuals, increasing awareness and research suggest that a significant subset of autistic individuals exhibit PDA traits. Studies indicate that PDA may be present in about 5-10% of autistic individuals, though exact prevalence rates can vary. Further research is needed to understand PDA, its prevalence, and what exactly it is. The unique challenges faced by individuals with PDA, such as intense need for control, heightened anxiety, and intense emotion dysregulation / meltdowns, may distinguish their experiences from those non-PDA autistic individuals.
PDA can significantly impact eating habits, making picky eating a particularly challenging issue. Children with PDA often experience heightened anxiety around mealtimes and food-related demands, leading to extreme food aversions and refusals. Their need for control can result in rigid eating patterns, where they may only accept specific foods prepared in particular ways. Additionally, sensory sensitivities common in PDA can amplify aversions to certain textures, tastes, and smells, further limiting dietary variety.
Eating is often filled with a lot of demands, including external prompts from adults (e.g., what, where, when, how to eat) and internal biological cues (e.g., interpreting feelings of hunger as a demand). Additionally, nervous system activation and demand avoidance can result in overriding basic needs because the body does not feel safe and is in a panic state (i.e., fight or flight). Safety must be achieved to access eating.
These factors combined make addressing selective eating in children with PDA a complex task, requiring a sensitive, flexible approach that respects their need for autonomy while gently encouraging the exploration of new foods. Creating a predictable and non-demanding mealtime environment can be helpful to reduce anxiety and improve eating habits for kids with PDA. [2]
BOTTOM LINE:
PDA can significantly impact eating behaviors due to the individual's need to control their environment and avoid demands. This can lead to irregular eating patterns, food refusal, and challenges in maintaining a balanced diet. Creating a predictable and non-demanding mealtime environment can be helpful to reduce anxiety and improve eating habits for autistic kids with PDA.
Next Steps
Diet
Create a Relaxed Environment: Ensure mealtimes are stress-free and pressure-free. Allow the child to explore food without any expectations or demands.
Use Indirect Approaches: Instead of directly asking them to try a new food, use indirect methods such as placing the food near them without any commentary, or incorporating it into a game or story.
Offer Choices: Provide a variety of food options and let the child choose what they want to try. This is called strewing and gives them a sense of control and autonomy. Additionally, one choice could be “[child’s name]’s choice”, which may even be a choice to not eat the food then. Allowing your child to make this choice can develop the relationship and therefore a sense of safety in eating environments for you and your child.
Incorporate Sensory-Friendly Foods: Focus on the sensory properties of the foods the child already enjoys and find new foods with similar textures, colors, or tastes. Allowing them to brainstorm with you may be a way to increase autonomy.
Role Modeling: Let the child see you and other family members enjoying a variety of foods without making a big deal about it. Often, seeing others eat can spark curiosity. It is essential that you model without expectation, meaning you are not subconscious hoping they will try that. Autistic children can often sense this energy and it makes it less likely to want to explore.
Positive Reinforcement: Praise any interaction with new foods, even if they don’t eat them. Positive reinforcement may help reduce anxiety around new foods and encourage them to explore again in the future. For kids with the PDA profile, it will be important to experiment with this one, as some view positive reinforcement as an implied demand or loss of autonomy (there is a natural hierarchy as typically people in power praise those with less power). Try to share your excitement from a genuine place and not because you are a parent that should tell their child good job. You may even experiment with praising yourself as well as other adults and kids.
Interactive Food Play: Engage the child in activities that involve food, such as cooking, gardening, or playing with food-themed toys. This can build familiarity and comfort with different foods. A bonus tip is to allow them to tell you what to do during this food play. For example, they could be the chef and you could be their assistant. Interactions that flip the natural hierarchy ( known as equalizing) can be great for building trust and safety.
Gradual Exposure: Introduce new foods slowly and in small amounts. Pair them with familiar favorites to make the experience less overwhelming. One important caveat with this is to not start this until they are regulated. This means both in the moment as well as the broader context of their well being. Many PDA individuals experience autistic burnout and utilizing exposure when their nervous system is in a chronic state of dysregulation is typically ineffective and counterproductive. It is ok if your child is not ready for this step and you need to prioritize other needs than progressing their diet. You can always come back to this at a later date!
Avoid Bribing or Coercion: Avoid using rewards or punishments related to food. This can increase anxiety and resistance. Additionally, in general, use of rewards and punishments are not optimal for many PDA autistic children.
Respect Autonomy: Recognize and respect the child’s need for control and independence. Allow them to have input in meal planning and preparation. This could include food items as well as non-food related decisions.
Consider What Demands Can Be Reduced: Oftentimes when we are working on increasing food variety, that is an increased load on their nervous system. Even if you have figured out how to navigate reducing external demands with food exposures like described above, there are internal demands that can be difficult to control. Consider ways you can drop other demands - for example, if your child is exploring new foods, you may allow them to have their favorite drink even if it is not your preferred selection. Also, it can be helpful to reduce the demands around having to sit at the table, use utensils, eat while others are eating, etc.
Supplements
There is no one-size-fits-all supplement for autistic kids with PDA, and it's essential to approach supplementation with careful consideration. However, some supplements can be beneficial for overall health and potentially help with some challenges associated with PDA such as nervous system dysregulation. Always consult with a healthcare professional before starting any new supplement. Here are a few supplements that might be considered:
Omega-3 Fatty Acids: Known for their benefits on brain health, mood regulation, and inflammation, omega-3s can be found in fish oil supplements. They might help with behavioral and cognitive functions.
Probiotics: These can support gut health, which is increasingly linked to overall mental and physical health. A healthy gut can positively influence mood and behavior.
Vitamin D: Supports overall health, including mood regulation and immune function. Many children, especially those with limited outdoor activity, can benefit from a vitamin D supplement.
Magnesium: This mineral supports muscle and nerve function and has calming effects. It can help with anxiety and sleep issues, which might be beneficial for children with PDA.
B Vitamins: B vitamins, particularly B6 and B12, support energy production and brain function. They can be beneficial in managing stress and improving overall well-being.
Zinc: Zinc is essential for immune function, growth, and development. It can also support cognitive function and mood regulation.
It's important to remember that each child is unique, and their nutritional needs can vary. A healthcare professional, such as a pediatrician or a registered dietitian, can provide personalized advice and ensure that any supplementation is safe and appropriate for the child's specific need
Lifestyle
A low-demand lifestyle is generally best for an autistic child with PDA. This can include:
Making suggestions without expectation for your child or offering choices
Minimizing social demands by reducing the frequency and intensity of social interactions, as these can often be overwhelming and overstimulating to the nervous system
Simplifying daily routines by creating predictable daily schedules
Using declarative language (a great resource for learning more is The Declarative Language Handbook by Linda Murphy)
Focus on activities that can proactively help regulate the nervous system:
Choose physical activities that align with the child's interests and turn them into enjoyable games or challenges, such as scavenger hunts or playful competitions.
Participate in activities as a family, such as walking, biking, or playing games together, to provide support and encouragement.
Select activities that match the child’s sensory preferences, such as swimming, yoga, or trampoline jumping, to ensure they are comfortable and engaged.
Establish a calming bedtime routine and ensure a comfortable sleep environment to promote good sleep hygiene and overall well-being.
Incorporate calming techniques like deep breathing exercises, meditation, or sensory breaks to help the child manage stress and transitions.
Focus on co-regulation and connection with you, as your calm nervous system can help them to regulate
Consider use of screen time as a tool for regulation, as many autistic adults report it can be soothing and help their brains to slow down
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Support guide for your PDA child.. Dr. Taylor Day. Retrieved from https://drtaylorday.com/therapy
O'Nions, E., & Eaton, J. (2020). Extreme/‘pathological’ demand avoidance: an overview. Paediatrics and Child Health, 30, 411-415. https://doi.org/10.1016/j.paed.2020.09.002.
Authors
Written by: Brittyn Coleman, MS, RDN/LD
Co-Written & Reviewed by Taylor N. Day, PhD, Licensed Psychologist
If you need support with navigating PDA, learn more at drtaylorday.com.
