PDA and ADHD: When Demand Avoidance Shows Up in an ADHD Brain
- Kiesa Kelly
- 2 hours ago
- 7 min read
🧠 Key takeaway: ADHD-related “I can’t get started” and PDA-style “I feel trapped when asked” can both produce demand avoidance - but the underlying drivers differ, so support should too.
It’s not laziness—it’s overwhelm. If you (or your child) have ADHD and find yourself freezing, negotiating, or melting down when asked to do “simple” things, you’re not alone. Demand avoidance can show up in many neurotypes, including ADHD and autism. This post clarifies PDA and ADHD—where they overlap, where they don’t, and how to respond in ways that protect autonomy and reduce anxiety. Along the way we’ll point to options at ScienceWorks, from specialized therapy to psychological assessments and Executive Function Coaching.
Quick Definition: What Is PDA / Demand Avoidance?
Pathological (also called Extreme) Demand Avoidance (PDA) is a profile first described in the UK to capture anxiety‑driven, pervasive avoidance of everyday demands coupled with a strong need for autonomy and control. PDA is not a stand‑alone diagnosis in DSM‑5 or ICD‑11; it’s a debated construct most often studied in autistic children, with tools like the EDA‑Q used to measure traits. (1–4)
⚖️ Key takeaway: PDA behaviors are typically threat‑response patterns (fight/flight/freeze/fawn) around loss of autonomy—not willful misbehavior. (1–4)
Because the term is contested, some clinicians use “demand‑avoidant profile” or “PDA‑style demand avoidance.” Whatever the label, the goal is the same: understand the function (what problem the behavior solves) so we can tailor support.
“It’s not laziness, it’s overwhelm”: A Familiar ADHD Story
A bright, caring teen with ADHD wants to finish homework but locks up when reminded. An adult with ADHD loves their job yet spirals when a manager says, “Can you get me that report?” From the outside it can look like refusal. Inside, it often feels like time blindness, task initiation paralysis, and a sudden sense of pressure or loss of agency. (5–7)
⏱️ Key takeaway: ADHD commonly involves differences in time perception and executive functioning that make starting tasks under pressure uniquely hard. (5,7)
Labeling this as “won’t” instead of “can’t” adds shame and conflict—and tends to make avoidance worse.
What Does PDA Look Like?
Core features often reported in PDA:
Anxiety‑driven avoidance of everyday demands (even preferred ones)
Intense need for autonomy/control; demands feel like threats
Social strategies to avoid (humor, negotiation, distraction); if those fail, panic‑like reactions can occur
Demand avoidance across settings (home, school/work, community) (1–4)
Where does it “sit”? PDA has mostly been described as autism‑adjacent in UK research, but debates continue about how best to conceptualize it. What’s agreed: the experience of threat and loss of agency is central, and support should lower perceived threat—regardless of labels. (2–4)
PDA and ADHD: Overlap—and Crucial Differences
Shared Stuff (Why They Look Alike)
Executive function load: planning, sequencing, working memory
Time blindness & temporal foresight: underestimating how long things take
Task initiation difficulties: especially when demands are externally imposed (5–7)
Meaningful Distinctions (Why Support Must Differ)
ADHD flavor: “I mean to do it, but I forget, drift, lose track of time, or can’t get traction.”
PDA flavor: “When I’m asked (even for things I like), I feel trapped or panicky and must escape, control, or avoid the demand.” (1–4)
From the inside:
Kids may say, “I can’t—my legs won’t move,” or turn everything into a game to regain agency.
Adults might over‑negotiate, delay replying to emails, or avoid appointments—even when they want the outcome—because the ask itself spikes threat and loss of autonomy. (1–4)
🧩 Key takeaway: If demand avoidance is mainly executive friction (ADHD), coaching, structure, and scaffolds help. If it’s threat‑driven (PDA‑style), lowering perceived control loss and collaborating on how to do things is essential. (1–4,8–11)
Everyday Patterns Across Settings
Home
Routines: Morning/evening transitions spark protests; playful, low‑demand approaches work better than countdowns.
Homework/chores: “I was going to… then three hours disappeared.” (ADHD) vs. “As soon as you said it, my chest tightened.” (PDA‑style)
Bedtime: Body wants rest; brain says “no” to being told to sleep.
School / Work
Following instructions: “simple” directives trigger freeze or power struggles.
Transitions: Stopping a preferred activity feels like demand + loss of control.
Email pings & ‘quick asks’: Micro‑demands stack up and can feel overwhelming.
Relational costs: Families and partners often feel confused or rejected; the person feels misunderstood or ashamed. Reframing from “won’t” to “can’t (yet)” opens the door to skill‑building and safety. (8–11)
Support That Actually Helps (and Why)
1) Start Low‑Demand and Collaborate
Name the goal together; use Plan B / CPS‑style problem solving: “What’s hard about this? What would make it doable?” Evidence shows Collaborative & Proactive Solutions performs as well as gold‑standard parent management training for oppositional behavior and improves parent–child interactions. (10)
Offer choices on how/when to meet the expectation; avoid yes/no ultimatums. Autonomy‑supportive approaches increase engagement and reduce defiance across settings. (11)
2) Reduce Perceived Threat
Externalize the demand: “The checklist says…,” “Timer says 10 minutes,” “Calendar says report by Friday.” Shifting from you vs. me to us vs. the plan lowers control battles.
Make it playful (with kids): Role‑play, races, or silliness restore agency and bypass threat; then fade to typical routines.
Negotiate autonomy for adults: Co‑author deadlines, pick the starting point, break tasks into two‑minute ‘entry ramps.’
3) Build ADHD‑Friendly Scaffolds
Time blindness supports: visible clocks, alarms with labels, “timeboxing,” and realistic duration estimates. (5–7)
Task initiation: two‑minute rule, body‑double sessions, and micro‑checklists.
Executive function coaching: translate therapy insights into daily systems for planning, prioritizing, and emotional regulation. (8–9)
4) Use Targeted Therapies When Helpful
CBT for adult ADHD can reduce residual symptoms beyond medication and maintain gains at 6–12 months. (8–9)
For kids with heavy oppositional cycles, CPS‑informed parent work offers a compassionate, evidence‑based alternative to purely consequence‑based models. (10)
🔑 Key takeaway: Combine safety (low demand + autonomy) with skills (EF scaffolds + coaching/CBT). That’s the sweet spot when ADHD and PDA‑style demand avoidance intersect. (8–11)
How ScienceWorks Can Help
Clarify the picture with an assessment. Our psychological assessments sort through ADHD, autism, anxiety, OCD, and demand‑avoidant patterns so your plan fits you.
Therapy for adults & teens. We offer specialized therapy (CBT, ACT, ERP, EMDR, I‑CBT, CBT‑I) that’s neurodivergent‑affirming and paced to your nervous system.
Executive Function Coaching. Our Executive Function Coaching turns insight into daily rituals—scheduling, task initiation, and emotion regulation.
Parent consults & groups. Explore groups and parent supports that blend CPS‑style collaboration with ADHD‑friendly structure.
Ready to get started? Contact us to schedule a free consultation.
FAQ: Fast Answers
Is PDA a diagnosis?
No. PDA (or “PDA‑style demand avoidance”) is not in DSM‑5 or ICD‑11. It’s a debated description of a pattern often seen near autism; the same behaviors can also show up with ADHD and anxiety. (1–4)
Can someone have both ADHD and PDA‑style demand avoidance?
Yes—demand avoidance can ride along with ADHD. The why matters: executive friction vs. threat response. We often address both. (5–11)
What if school or work calls it defiance?
Reframing to skills + safety (CPS, autonomy support) typically lowers conflict and improves follow‑through. (10–11)
About the Author
Kiesa Kelly, PhD, HSP is a licensed clinical psychologist and Chief Clinical Officer at ScienceWorks Behavioral Healthcare. She provides affirming care for OCD, trauma, insomnia, and autistic & ADHD neurotypes, with advanced training in CBT‑I, EMDR, ERP, and I‑CBT. Learn more about Dr. Kiesa Kelly.
Dr. Kelly leads a multidisciplinary team offering integrated assessment, therapy, and coaching for neurodivergent adults and teens. Her work blends scientific rigor with a gentle, collaborative style to help clients build practical systems that fit real life.
References and Citations
(1) Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600. https://doi.org/10.1136/adc.88.7.595
(2) O’Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2014). Development of the ‘Extreme Demand Avoidance Questionnaire’ (EDA‑Q): Preliminary observations on a trait measure for pathological demand avoidance. Journal of Child Psychology and Psychiatry, 55(7), 758–768. https://doi.org/10.1111/jcpp.12149
(3) Kildahl, A. N., Loennecken, M. C., Helverschou, S. B.,& Leif, O. (2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism, 25(8), 2162–2176. https://doi.org/10.1177/13623613211034382
(4) Haire, L., Symonds, J., Senior, J., & D’Urso, G. (2024). Methods of studying pathological demand avoidance in children and adolescents: A scoping review. Frontiers in Education, 9, 1230011. https://doi.org/10.3389/feduc.2024.1230011
(5) Noreika, V., Falter, C. M., & Rubia, K. (2013). Timing deficits in attention‑deficit/hyperactivity disorder (ADHD): Evidence from neurocognitive and neuroimaging studies. Neuropsychologia, 51(2), 235–266. https://doi.org/10.1016/j.neuropsychologia.2012.09.036
(6) Weissenberger, S., et al. (2021). Time perception is a focal symptom of attention‑deficit/hyperactivity disorder in adults. Psychiatry Investigation, 18(7), 618–627. https://doi.org/10.30773/pi.2020.0413(Open access summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293837/)
(7) Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention‑deficit/hyperactivity disorder: A meta‑analytic review. Biological Psychiatry, 57(11), 1336–1346. https://doi.org/10.1016/j.biopsych.2005.02.006
(8) Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005). Cognitive‑behavioral therapy for ADHD in medication‑treated adults with continued symptoms. Behaviour Research and Therapy, 43(7), 831–842. https://doi.org/10.1016/j.brat.2004.07.001
(9) Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication‑treated adults with ADHD and persistent symptoms: A randomized controlled trial. JAMA, 304(8), 875–880. https://doi.org/10.1001/jama.2010.1192
(10) Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. D., Jarrett, M. A., Lewis, K. M., Smith, M. W., Cunningham, N. R., et al. (2016). Parent Management Training and Collaborative & Proactive Solutions: A randomized control trial for oppositional youth. Journal of Clinical Child & Adolescent Psychology, 45(5), 591–604. https://doi.org/10.1080/15374416.2015.1004681
(11) Reeve, J., & Cheon, S. H. (2021). Autonomy‑supportive teaching: Its malleability, benefits, and potential to improve educational practice. Educational Psychologist, 56(1), 54–77. https://doi.org/10.1080/00461520.2020.1862657
Note: Individual results vary. PDA remains a debated construct; recommendations here focus on function‑based supports that are compatible with ADHD and autism best practices. Citations include both clinical trials and high‑quality reviews to reflect the current state of the evidence.
Disclaimer
This article is for informational and educational purposes only and is not a substitute for professional diagnosis, advice, or treatment. If you’re experiencing mental‑health symptoms, consult a qualified clinician. If this is an emergency, call your local emergency number immediately.