PDA, Anxiety, or “Oppositional”? Making Sense of Demand Avoidance

If someone you love seems to shut down, explode, joke, or disappear the moment a request is made, you’re not alone. Parents, partners, and even clinicians often reach first for labels like “oppositional,” “defiant,” or “noncompliant.” But for many kids and adults - especially those who are neurodivergent - what looks like defiance is actually a nervous system in threat mode.

Pathological demand avoidance (PDA) is one way some autistic people describe a pattern of extreme, anxiety-driven resistance to everyday demands. At the same time, demand avoidance can also be fueled by performance anxiety, social anxiety, trauma, perfectionism, or burnout. And sometimes a true oppositional defiant disorder (ODD) picture is part of the story.

This article walks through how to tell these patterns apart, where they overlap, and how a neurodivergence-informed approach at ScienceWorks Behavioral Healthcare can support you without coercion or shame.

💡 Key takeaway: When someone’s brain reads a request as “danger,” their reaction is about survival—not disrespect.

Pathological Demand Avoidance vs “Oppositional” Labels

Oppositional Defiant Disorder (ODD) is a diagnosis used when a child or teen shows a long-standing pattern of angry, irritable mood and argumentative or vindictive behavior toward authority figures, lasting at least six months and showing up across settings (home, school, peers). (5,6) It’s often conceptualized as a behavior disorder.

PDA, on the other hand, is not a formal diagnosis in the DSM-5 or ICD-11. Instead, it’s a descriptive profile used mostly in the UK and among autistic communities to capture an intense, pervasive avoidance of everyday demands - often in people who also meet criteria for autism. (1,3,4)

Research on pathological demand avoidance suggests:

• PDA features extreme avoidance of ordinary demands, even those the person genuinely wants to meet. (1,2,3)

• Avoidance is often driven by intense anxiety and a need for control, not a desire to annoy or undermine adults. (1,3,4)

• Many individuals show a mix of autistic traits, sensory sensitivities, and social creativity, including role-play or humor used to dodge demands. (1,4,7)

  
  

In other words, PDA-style demand avoidance is better understood as a threat response in a neurodivergent nervous system, not a moral failing or simple misbehavior.

The emotional cost of “oppositional” labels

When a child or adult’s demand avoidance is repeatedly seen as a character flaw, the impact can be significant:

• Shame ("Why can’t I just do the thing like everyone else?")

• Strained family and school relationships

• Escalating power struggles that actually intensify anxiety and avoidance

• Less willingness to ask for help or share internal experiences

🧡 Key takeaway: Labeling a nervous system response as “defiance” can delay the right help and erode trust, especially for autistic and otherwise neurodivergent people.

At ScienceWorks, we work hard to differentiate behavior driven by threat and overload from behavior driven by deliberate rule-breaking, so that treatment plans are compassionate and targeted.

Anxiety-Driven Demand Avoidance

Not all demand avoidance is PDA. For many people, avoiding tasks is mainly about anxiety in specific situations, rather than a pervasive pattern across nearly every demand.

Common anxiety-based drivers of demand avoidance include:

• Performance anxiety – “If I try and fail, I’ll feel humiliated.”

• Social anxiety – “If I join this group, people will judge me.”

• Trauma reminders – School, medical care, or family interactions that echo past painful experiences.

• Perfectionism – “If I can’t do it perfectly, I don’t want to start.”

In these cases, you might see patterns like:

• Avoidance that’s tied to certain tasks or contexts (tests, phone calls, social events) rather than everything.

• Distress focused on fear of evaluation or harm, more than a global sense that any demand feels threatening.

• Some capacity to move toward the task when anxiety is reduced, paced, or supported.

For example:

• A teen with social anxiety might resist going to a therapy group, but once in the room, they participate and even enjoy it.

• An adult with trauma may avoid emails from work because they associate them with previous toxic job experiences.

In these situations, therapy often focuses on treating the underlying anxiety and trauma—for instance, using approaches like CBT, EMDR, or values-based exposure—rather than on behavior charts or consequences. (5)

If this description fits you or your child, you may benefit from targeted anxiety or trauma care, such as our Understanding Trauma services or specialized OCD treatment when intrusive thoughts and compulsions are part of the picture.

What Distinguishes a PDA-Style Profile?

So when might “plain” anxiety no longer feel like the whole story?

Research on pathological demand avoidance describes a cluster of features that tend to show up together. Not every person will show all of these, and PDA remains a contested construct—but these patterns can still be clinically useful. (1,3,4,8)

Some commonly described PDA-style features include:

• Global, pervasive demand avoidance Everyday asks—"put your shoes on," "log into class," "brush your teeth"—can all trigger the same intense resistance, even if the person wants the outcome.

• Intense need for autonomy and control The person may do much better if they feel they’re in charge, initiating tasks on their own timetable or turning them into a game.

• Social creativity and role-play Humor, storytelling, pretending to be a character, or elaborate negotiation often show up as ways to dodge demands.

• Rapid shifts between engagement and shutdown One moment, they’re deeply connected and playful; the next, they may bolt, hide, or meltdown when they feel “pushed.” (1,3)

• Masking and burnout Many people with PDA-style traits work hard to appear fine in certain settings, then crash at home with explosive or shut-down behavior.

🧠 Key takeaway: In PDA-style presentations, the pattern is the point—demands in general feel threatening, not just specific feared situations.

Because PDA is not an official diagnosis, clinicians at ScienceWorks don’t treat it as a rigid category. Instead, we look at:

• What does this person’s nervous system do when there’s a demand?

• What sensory, executive function, autistic, or trauma-related factors might be shaping that pattern?

• What environments help them feel autonomous, safe, and respected as neurodivergent, rather than pressured to act “typical”?

  
  

Red Flags for Misdiagnosis or Missed Diagnosis

Families often come to us after years of mixed messages:

• “She’s just oppositional.”

• “He’s manipulative.”

• “You just need firmer boundaries.”

  
  

Sometimes those statements are rooted in outdated behavior models that don’t account for neurodivergence, sensory processing, or trauma. Research also shows that families of autistic children with demand-avoidant behaviors frequently encounter disbelief and blame before they receive useful support. (8)

Here are some signs that ODD may not fully explain what’s happening—and that a more nuanced, neurodivergent-informed lens could help.

When ODD doesn’t quite fit

Consider a deeper look beyond ODD when:

• The person is deeply distressed about their own reactions, and says things like “I don’t know why I did that” or “I wanted to do it; I just couldn’t.”

• Behaviors are far more intense around demands than in free-choice situations.

• Rewards, sticker charts, or standard parenting programs make things worse, not better. (1,3,6)

• There are clear autistic traits, ADHD features, learning differences, or sensory sensitivities that haven’t been fully assessed.

ODD frameworks can be useful in some situations—but when they’re applied to a demand-avoidant autistic or anxious nervous system, they can accidentally increase shame and conflict instead of building skills. (5,6)

When “just anxiety” misses the bigger picture

On the flip side, sometimes “it’s just anxiety” doesn’t quite capture the complexity either. You might notice:

• Sensory overwhelm: noise, clothing textures, or visual clutter quickly push the person into overload.

• Executive function challenges: difficulty initiating tasks, shifting between activities, or keeping track of steps—even for things they care about.

• Autistic traits: intense interests, social fatigue, deep need for predictability, or difficulty decoding social cues.

  
  

These are places where a more comprehensive, neuroaffirming psychological assessment can help untangle what’s going on and guide next steps.

🌱 Key takeaway: If the story you’ve been given—“oppositional,” “lazy,” “just anxious”—doesn’t match your lived experience, it’s worth getting a more nuanced, neurodivergent-informed opinion.

Shifting from “How Do I Make Them Comply?” to “How Do We Reduce Threat?”

Traditional behavior plans often start with the question, “How do we get this person to follow directions?” For demand-avoidant nervous systems, that question usually backfires.

A more helpful question is: “How do we reduce threat so that doing the thing feels possible?”

Co-regulation and relationship first

For many people with PDA-style or anxiety-based demand avoidance, nervous systems respond to safety cues, not lectures. Helpful moves can include:

• Staying as calm and grounded as you can, even when the other person is overwhelmed.

• Naming feelings and body signals (“Your shoulders are tight; this feels like a lot right now.”)

• Offering proximity without pressure (“I’m right here with you. We’ll figure it out together.”)

  
  

Choice, autonomy, and collaborative problem-solving

Collaborative approaches are especially important for neurodivergent folks who’ve spent years feeling misunderstood or controlled.

Some practical shifts:

• Offer choices wherever possible: what to do first, how to do it, when to take breaks.

• Turn demands into invitations: “How can we make this work for your brain today?”

• Externalize the problem: “It’s you and me together versus this tricky task,” instead of “you vs. me.”

These are the kinds of strategies our clinicians and coaches weave into specialized therapy and Executive Function Coaching, especially when ADHD, autism, and anxiety overlap.

Environmental tweaks that matter more than you think

Small environmental changes can dramatically lower demand-related distress:

• Sensory loadAdjust lighting, sound, and visual clutter; consider noise-cancelling headphones or predictable routines.

• Clarity of expectationsBreak tasks into smaller steps; use written or visual supports; check for understanding instead of assuming it.

• Pacing and transitionsBuild in warm-up time, transition warnings, and recovery time after demanding tasks.

At ScienceWorks, we often pair therapy with executive function strategies so that neurodivergent brains aren’t asked to “just try harder” without practical, science-based supports.

When and How to Seek Support

You don’t have to figure this out alone. Consider reaching out for professional help if:

• Daily life feels like one long power struggle around routine tasks.

• The person is suffering, not just “acting out”—for example, expressing self-hatred or hopelessness after meltdowns.

• School refusal, shutdowns, or conflicts with peers and family are escalating.

• You’ve tried typical parenting or behavior programs and either nothing has changed or the situation feels worse.

What kind of help can be useful?

Depending on your situation, helpful next steps may include:

• A neurodivergence-informed assessment to explore autism, ADHD, OCD, trauma, or learning differences.

• Therapy that explicitly integrates PDA and demand avoidance research with evidence-based approaches for anxiety, OCD, and trauma. (1–5,8)

• Executive Function Coaching to translate neuropsychological insights into daily routines.

• Neurodivergent-affirming groups for parents or adults, so you’re not doing this in isolation.

At ScienceWorks Behavioral Healthcare, our team includes clinicians and coaches with specialized training in OCD, trauma, insomnia, ADHD, autism, and neuropsychological assessment. We work collaboratively to design care plans that:

• Respect neurodivergent identities and lived experience

• Treat demand avoidance as a signal about threat and overload

• Blend therapies like CBT, I-CBT, ERP, EMDR, ACT, and coaching when appropriate

• Center autonomy, consent, and practical skill-building

If you’d like to explore whether our approach is a good fit, you can get in touch for a free consultation to talk through your situation and options.

🤝 Key takeaway: The goal isn’t to “fix” a demanding person—it’s to understand their nervous system and build a life where demands feel safer and more doable.

References and Citations

(1) O’Nions, E., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2014). Pathological demand avoidance: Exploring the behavioural profile. Autism, 18(5), 538–544. https://doi.org/10.1177/1362361313481861

(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., Helverschou, S. B., Rysstad, A. L., Wigaard, E., Hellerud, J. M., Ludvigsen, L. B., & Howlin, P. (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) Lopez, J. D., Daniels, W., & Joshi, S. V. (2024). Oppositional defiant disorder: Clinical considerations and when to worry. Pediatrics in Review, 45(3), 132–142. https://doi.org/10.1542/pir.2022-005922

(6) Mayo Clinic Staff. (2023). Oppositional defiant disorder (ODD): Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

(7) National Autistic Society. (n.d.). Demand avoidance. National Autistic Society. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance

(8) Nawaz, S., & Speer, S. (2025). What are the experiences and support needs of families of autistic children with Extreme (or Pathological) Demand Avoidance behaviours? Research in Autism Spectrum Disorders. Advance online publication. https://doi.org/10.1016/j.rasd.2024.102515

Disclaimer

This article is for informational and educational purposes only and does not constitute medical, psychological, or legal advice. It is not a substitute for individualized assessment, diagnosis, or treatment. If you have concerns about your own mental health or that of a loved one, please consult with a qualified healthcare professional in your area or contact emergency services in a crisis.