Pathological Demand Avoidance ADHD: Understanding the Intersection of Two Neurodevelopmental Disorders

Neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) often coexist in children and adults. One specific subtype of ASD that has recently gained attention is the Pathological Demand Avoidance (PDA), a behavior that is characterized by an obsessive avoidance of everyday demands.

What is Pathological Demand Avoidance (PDA)?

Pathological Demand Avoidance (PDA) is a relatively new term coined by Elizabeth Newson to describe a pattern of behavior exhibited by some individuals with Autism Spectrum Disorder (ASD). Unlike other subtypes of ASD, PDA is not recognized as a standalone disorder but rather falls under the umbrella of ASD. PDA is characterized by an “obsessive resistance to everyday demands” and the individual’s need to remain in control of themselves and their environment.

The PDA profile is distinctive due to a particular pattern of behaviors that distinguishes it from other forms of ASD or related disorders. These symptoms include:

  • Preference for being in control of situations and avoiding routine demands
  • Difficulty following instructions from others
  • Anxiety when exposed to perceived expectations from others
  • Using social manipulation as a means of avoiding demands
  • A high degree of impulsivity and distractibility
  • A disregard for social norms and values

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) affects around five percent of school-aged children globally and is characterized by symptoms of hyperactivity, impulsivity, and difficulties in sustaining attention or concentration. However, ADHD affects people of all ages, including adults. People with ADHD struggle with executive dysfunction, which includes difficulties in organization, time management, and memory. People with ADHD experience many negative effects on their daily lives, including school and work and emotional and social functioning.

ADHD is classified into three subtypes: predominantly inattentive type, predominantly hyperactive-impulsive type, and a combined type that involves a combination of inattention, hyperactivity, and impulsivity. Treatment for ADHD usually includes medication, behavioral therapy, and coaching, depending on the severity and the individual’s specific symptoms.

The Intersection of PDA and ADHD

The overlap between PDA and ADHD remains understudied. However, the limited research that has been undertaken supports the idea that there is a relationship between these two conditions. A 2018 study conducted by Sunderland University in the UK found that of the 67 children being treated for ADHD, more than half had demand avoidance traits, and almost 40% of the children with ADHD scored highly in PDA criterion.

Moreover, a study by Philpot et al. (2018) suggested that individuals with ADHD and PDA have more significant cognitive and behavioral deficits than individuals who have either ADHD or PDA individually. This finding is based on a measure of working memory capacity, where individuals with the two conditions had well-below-average working memory performance compared to individuals with only either condition.

Treating PDA and ADHD

Despite the overlap between these conditions, therapeutic interventions for each condition are still different. While the most effective ADHD intervention is medication, behavioral and educational interventions may be more appropriate for individuals with PDAV. Enhanced communication, low-arousal approaches, and structure are suggested as important components of any approach used in managing this group’s behavior.

The use of medication may have limited utility, and lesser-known medications such as sympathomimetic agents, have shown some benefit in the treatment of PDA in children. However, there is no current pharmacological treatment or medication specifically developed for PDA.

The Importance of Early Diagnosis and Intervention

The overlap between PDA and ADHD highlights the importance of early diagnosis and intervention. Early recognition and diagnosis are critical in ensuring children with neurodevelopmental disorders are provided with the right support, to prevent the potential later onset of long-term complications.

The use of cognitive, behavioral, and social-emotional interventions has shown to be effective in improving the quality of life for individuals with neurodevelopmental disorders. It is crucial to recognize the underlying condition, the symptoms, and the individual’s unique needs for planning the appropriate intervention strategy.

Conclusion

Pathological Demand Avoidance ADHD is relatively new, but recent studies indicate that PDA and ADHD frequently co-occur. Providing a diagnosis of both conditions requires multidisciplinary assessment by clinicians with specialist knowledge of each. Understanding the intersection between PDA and ADHD and following treatment guidelines for each disorder’s specific needs will help ensure successful outcomes for individuals experiencing the complex set of symptoms that characterize these challenging conditions.

FAQs

What is Pathological Demand Avoidance ADHD?

Pathological Demand Avoidance (PDA) is an autism spectrum disorder that results in an overwhelming need to avoid everyday demands, often leading to anxiety, distress and extreme avoidance behaviours. ADHD (Attention Deficit Hyperactivity Disorder) refers to a group of related behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness that can impact on daily life.

What are the treatment options available for Pathological Demand Avoidance ADHD?

Treatment options for PDA ADHD may vary depending on the severity of the condition and the individual’s needs. Therapy and behavioural interventions such as Cognitive Behavioural Therapy (CBT), Speech and Language Therapy, and Occupational Therapy can be helpful in reducing anxiety, improving social communication and interpersonal skills, and managing challenging behaviour. Medications that work to improve mood, attention span or manage anxiety may also be prescribed in conjunction with therapy.

How can someone with Pathological Demand Avoidance ADHD manage their condition?

Individuals with Pathological Demand Avoidance ADHD can benefit from understanding their condition and learning strategies that can help them manage their disorder on a daily basis. It is important for them to establish routines and structure, manage their time effectively and set achievable goals. Developing strong communication skills, building positive relationships and learning self-regulating strategies can also empower individuals with PDA ADHD to take control of their condition and improve their quality of life.


References

1. O’Nions, E. J., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2016). Pathological demand avoidance (PDA): Exploring the behavioural profile. Autism, 20(2), 154-161.

2. Cassell, A. M., Jones, R. S. P., & Holt, G. (2015). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 100(2), 185-188.

3. Gillberg, C. (2014). The essence of PDA: Distractibility, recklessness and a need for control. In Newson, J. T. (Ed.), Minds well met: The challenge of autism (pp. 187-196). Jessica Kingsley Publishers.