Pathological Demand Avoidance (PDA) Care in Pennsylvania

What Is Pathological Demand Avoidance (PDA)?

Pathological Demand Avoidance (often shortened to PDA) is a term used to describe a neurodivergent profile characterized by extreme, anxiety-driven avoidance of everyday demands and expectations. These “demands” can be obvious (homework, chores, getting ready for school) or subtle (being asked how their day went, following a routine, or even doing something they actually want to do if it’s framed as an expectation).

PDA was first described in the 1980s by British developmental psychologist Professor Elizabeth Newson, who noticed a subset of children who looked “atypically autistic” yet very similar to one another. They showed an obsessional avoidance of ordinary demands and a high need for control in daily life.

Today, PDA is often conceptualized as a profile within the broader autism spectrum or as an extreme anxiety-based demand-avoidant pattern. It is increasingly recognized in clinical and neurodiversity-affirming communities, but there is still ongoing debate and research surrounding its exact classification.

PDA and the DSM-5: Why You Don’t See It Listed

Although PDA is widely discussed in the autism and neurodivergent communities, it is important to know that:

• PDA is not currently a stand-alone diagnosis in the DSM-5 (the main diagnostic manual used in the United States).
• It also does not have a specific ICD-10/ICD-11 billing code at this time.
• Many professionals view PDA as a behavioral and neurobiological profile that can occur within or alongside existing diagnoses such as Autism Spectrum Disorder (ASD), ADHD, anxiety disorders, mood disorders, and others.

In our practice, we do not treat PDA as a label that replaces existing diagnoses. Instead, we use it as a lens to better understand:

• Why traditional behavioral approaches may have failed or backfired
• Why “oppositional” behavior escalates when pressure or demands increase
• How to build trust, autonomy, and safety so that functioning can improve

Common Signs and Symptoms of a PDA Profile

Every individual is unique, but many people with a PDA profile share a recognizable pattern. Some common features can include:

• Intense avoidance of everyday demands, even simple ones like getting dressed, brushing teeth, or starting schoolwork.
• Anxiety-driven need for control over situations, routines, and interactions.
• “Surface sociability” – someone who can appear socially skilled or talkative but struggles with deeper reciprocity, flexibility, or tolerance of demands.
• Big reactions to feeling controlled, including meltdowns, shutdowns, or what can look like “explosive” behavior when demands pile up.
• Use of creative or strategic avoidance – humor, distraction, negotiation, deflection, or sudden fatigue/illness when asked to do something.
• High sensitivity to perceived expectations, including internal expectations (“I should do this”) that can lead to self-sabotage or avoidance of things they actually enjoy.
• Emotional lability – rapid shifts from calm to overwhelmed, often described as walking on eggshells.
• Masking & burnout – some children and teens may “hold it together” at school and then fall apart at home, or vice versa.

These patterns are often misunderstood as “defiance,” “manipulation,” or “attention-seeking.” At NOVITSKY MD, we approach them instead as nervous system survival strategies, not character flaws.

Experience with PDA-Like Profiles

Over years of practice, Drs. Danielle Scholze and Dr. Mark has met a significant number of children, teens, and young adults who:

• Carry a diagnosis of Autism Spectrum Disorder (ASD), but don’t fit the “classic” presentation.
• Have been labeled with ADHD, ODD, anxiety, or mood disorders, yet standard treatment approaches haven’t fully helped.
• Are clearly neurodivergent, but don’t check all the boxes for any single diagnosis in our current classification system.

For some of these individuals, a Pathological Demand Avoidance–type profile helps make sense of the seemingly confusing mix of:

• High intelligence and creativity
• Strong sense of justice or autonomy
• Extreme distress when feeling controlled, trapped, or put on the spot

Our work at NOVITSKY MD Boutique Mind Doctors is to translate that understanding into practical, compassionate strategies that reduce conflict and help families reconnect.

Neurobiology, Polyvagal Theory & PDA: Why “Demand Avoidance” Is a Survival Response

At NOVITSKY MD, we ground our approach to PDA in modern neuroscience and polyvagal theory. Rather than viewing PDA as willful defiance, we conceptualize it as a nervous system pattern shaped by genetics, environment, and lived experiences.

Polyvagal theory helps us understand how the autonomic nervous system toggles between:

• Fight – arguing, yelling, pushing back when demands feel threatening
• Flight – avoidance, escape, distraction, “forgetting,” or leaving the situation
• Fawn – people-pleasing, masking, over-compliance that eventually leads to burnout
• Freeze – shutdown, collapse, “I can’t,” zoning out, or feeling paralyzed

For individuals with a PDA profile, demands can be perceived as threats to safety, autonomy, or identity. Their demand avoidance is not laziness; it is often a protective reflex from a nervous system that is hyper-tuned to danger.

Our goal is to help that nervous system:

• Spend more time in a regulated, grounded state
• Feel safer in connection with caregivers, educators, and clinicians
• Experience demands as collaborative invitations, not threats

Genetic Susceptibilities and PDA-Like Profiles

Many families we work with are curious about the role of genetics in neurodivergence and PDA-like presentations. While genetics never tell the whole story, certain patterns can help explain why some nervous systems are more sensitive, reactive, or easily overwhelmed.

In some patients, we may see variations on genetic testing such as:

• SLC6A4 (serotonin transporter) s/s – associated with differences in how the brain moves serotonin, which may contribute to heightened sensitivity to stress and mood/anxiety vulnerability.
• COMT met/met – associated with slower breakdown of dopamine in the prefrontal cortex, which can influence focus, executive functioning, and stress reactivity.
• ANK3 and CACNA1C variants – genes involved in neuronal signaling and calcium channels that have been linked in research to increased susceptibility for certain mood and neurodevelopmental conditions.

These findings do not diagnose PDA, autism, or any condition by themselves, and they do not determine a person’s destiny. However, they can deepen our understanding of:

• Why some individuals are more prone to hypervigilance and demand-related shutdowns
• Which systems (serotonin, dopamine, calcium channels, etc.) might be particularly sensitive
• Where thoughtful, targeted support (including lifestyle, therapy, and sometimes vitamin/OTC supplementation) might help modulate the nervous system

Any discussion of genetic findings and supplements at NOVITSKY MD is done cautiously, collaboratively, and never as a shortcut for the hard work of relationship-building, environmental changes, and skill-building.

Are There FDA-Approved Medications for PDA?

At this time, there are no FDA-approved medications specifically for Pathological Demand Avoidance. PDA is not a formal DSM-5 diagnosis, so there are no medications labeled for this profile.

However, many individuals with a PDA profile also experience:

• Autism spectrum features
• ADHD and executive function challenges
• Anxiety, OCD, or panic symptoms
• Depression or mood instability
• Sleep disturbances

When appropriate, we may consider medications that target these co-occurring symptoms (for example, ADHD treatments, SSRIs for anxiety/OCD, or mood-stabilizing strategies), always weighing:

• The individual’s unique neurobiology and genetics
• The family’s values and goals
• Potential benefits vs. side effects

We also sometimes explore evidence-informed vitamin and over-the-counter (OTC) supplementation as part of a larger plan to support brain and nervous system health. These are never one-size-fits-all and should always be discussed with a licensed medical provider.

How NOVITSKY MD Works with PDA Profiles: Thinking Outside the Box

Because PDA is fundamentally about perceived threat and loss of autonomy, traditional “do what you’re told” approaches often make things worse. At NOVITSKY MD Boutique Mind Doctors, we work closely with families to create outside-the-box, neurodivergent-affirming plans that focus on:

• Collaborative care – listening deeply to the child/teen’s experience and building plans with them, not just for them.
• Polyvagal-informed strategies – supporting co-regulation, sensory needs, and safe ways to discharge stress.
• Family education & coaching – helping caregivers reframe behaviors, reduce demand pressure, and use language that preserves autonomy.
• School collaboration – when appropriate, partnering with schools to adjust expectations, transition plans, and accommodations.
• Genetics- and biology-informed care – using labwork and, when desired, genetic testing to understand vulnerabilities and tailor interventions.

Ultimately, our goal is to modulate the nervous system so the individual is:

• Less hypervigilant and reactive
• More able to tolerate everyday demands without panic or shutdown
• Better able to build trust with a team that understands PDA and knows how to empower them
• More in control of their own life – not by avoiding everything, but by feeling safe enough to engage

FAQ: Pathological Demand Avoidance at NOVITSKY MD

Is PDA “real” if it’s not in the DSM-5?

Many important clinical concepts started as patterns noticed in real people before they had their own diagnostic codes. PDA is an emerging profile that helps explain why some individuals respond very differently to demands and traditional interventions. Whether or not the DSM-5 formally names it, the lived experience is real – and deserves thoughtful support.

How is PDA different from Oppositional Defiant Disorder (ODD)?

ODD is framed as a pattern of angry, defiant, argumentative behavior. PDA, by contrast, is understood as extreme anxiety-driven avoidance of demands, often in neurodivergent individuals, with a strong need for control and safety. Punishment- and compliance-based approaches that are sometimes used in ODD typically backfire with PDA profiles.

Can adults have PDA?

Yes. Although much of the early literature focused on children, many adults describe a PDA-like profile, often after years of misdiagnoses or being told they are “too sensitive,” “lazy,” or “difficult.” We see teens and young adults in our practice who resonate strongly with the PDA lens.

What does working with NOVITSKY MD look like?

We begin with a comprehensive evaluation that explores development, neurodivergent traits, medical history, family patterns, nervous system responses, and genetics where appropriate. From there, we co-create a personalized plan that might include therapy, medication when indicated, family coaching, school collaboration, nervous system-regulation tools, and targeted lifestyle or supplement strategies.

Ready to Explore PDA-Informed Care?

If you see your child, teen, or yourself in this description of Pathological Demand Avoidance, you are not alone—and you are not “doing it wrong.” There is a way to understand these patterns through a compassionate, neuroscience-informed lens and to build a team that truly “gets it.”

NOVITSKY MD Boutique Mind Doctors serves neurodivergent individuals and families throughout Pennsylvania via boutique, high-touch psychiatric care.

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