Demand Avoidance and 10 Strategies to Address Avoidant Behaviours

What is Demand Avoidance?

Demand Avoidance is a pre-disposition to resist doing something that is requested or expected.  Demand Avoidance is a natural human trait that everyone of us has experienced and all of us display this to some degree in our day-to-day lives.  It is a human attribute to seek autonomy over one’s own circumstances so as to be in control of one’s situation.  Demand Avoidance can be seen across all ages. And avoidance is even a feature of “terrible twos.”  Almost every parent has experienced terrible twos which are a normal developmental phase where toddlers around the age of two start asserting their independence leading to challenging behaviours and displaying tantrums and defiance.  Terrible two’s are a result of children learning to express their own desires and opinions while still lacking the full ability to control their emotions or to communicate their needs effectively.  This then results in frustration and outbursts when things do not go their way.

Demand Avoidance varies in intensity and its presentation.  Moreover, Demand Avoidance occurs in children with varying degrees of cognitive abilities, social interaction ability and communication ability.  For example, Demand Avoidance has been noted in children with IQs of less than 60 and also in children with IQ of 140+.  Moreover, Demand Avoidance is a feature in various neurodevelopmental conditions and is a well-known feature of a ‘neurodivergence’ profile.

What causes Demand Avoidance?

Demand Avoidance remains an under-researched aspect of neurodivergence, with conflicting views on its causes, terminology, and classification. The term “Pathological Demand Avoidance” (PDA) itself is debated, with some preferring to view it as a persistent drive for autonomy rather than a pathological condition. Avoiding demands can stem from anxiety, a need for control, or sensory processing challenges common in neurodivergent individuals. While everyone experiences some level of Demand Avoidance, it becomes problematic when it significantly disrupts daily life. Some professionals argue that PDA is an unhelpful label and that avoidant behaviours can be better understood through a child’s social, sensory, and cognitive profile. Despite differing perspectives, there is broad agreement that further research is needed to fully understand the condition.

Conditions associated with Demand Avoidance?

Demand Avoidance is a common feature in children with neurodivergent profile and it has been noted as a significant feature in children with following neurodevelopmental conditions:

• Autism Spectrum Disorder (ASD)
• Attention Deficit Hyperactivity Disorder (ADHD)
• Oppositional Defiance Disorder (ODD)
• Anxiety/Generalised Anxiety Disorder (GAD)
• Post Traumatic Stress Disorder (PTSD), etc

As one can imagine, any disruption to routine, or transitioning between activities can be anxiety provoking to children with neurodivergent profiles.  Typically, developing children learn social hierarchy, such as teacher and student, parents and children.  However, children with ASD have a strong desire for equality and fairness and they find it hard to understand why everything is not on the same level.  Hence, children with DA/PDA resist, or avoid demands being placed on them by teachers and parents.  Children with ASD need to know what is going to happen in order to feel calm and in control.  Hence, Demand Avoidance may be driven by factors such as anxiety and intolerance of uncertainty. Understandably, a strong desire for independence with increased sensitivity to demands is seen as a prominent profile in a subset of children with Autism Spectrum Disorder (ASD).  Pathological Demand Avoidance (PDA) is considered as a subtype/profile among children and young people with ASD.

What are the types of Demand Avoidance?

 As one can appreciate, it is essential to know the types of demands that can trigger avoidance in a child if one were to manage these Demand Avoidant behaviours successfully.  Demands can be broadly categorised into the following categories:

• Implicit demands. Implicit demands are unspoken or unexpressed expectations.  There are several unsaid and implied social norms and routines that children are expected to adhere to without being told.
• Explicit demands. These are clearly expressed and easily understood direct requests or demands such as “brush your teeth,” “tidy your room,” or “finish your homework.”
• Internal demands: These are self-imposed things or personal goals, that the child or young adult desires and sets for themselves.

 

What are forms of Resistance?

Resistance to demands can take various forms, depending on the individual child’s communication ability, coping mechanisms, parenting styles, environment, etc.  Thus, Demand Avoidance or resistance to demands can be of the following forms:

• The fight-or-flight response, triggered by the sympathetic nervous system, prepares the body to confront or escape perceived danger by increasing heart rate, breathing, and muscle tension. In response to demands, this can manifest as anxiety, anger, or distress, leading to reactive behaviours like hitting or running away.
• Active Resistance: This form of demand resistance takes the form of becoming argumentative, point-blank refusal, using distracting and diversionary techniques, making excuses, using negotiation or manipulation etc.
• Passive resistance: This form of Demand Avoidance could be in the form of ignoring the request, procrastination, withdrawal, physically slumping to the ground, pretending not to hear etc.

 

When to seek help?

 Every human being is different.  Just being different does not make one deficient or one’s behaviour problematic. To diagnose any neurodiverse conditions such as ASD or ADHD require that the difficulties and features associated with these conditions are pervasive i.e., occur in more than one situation and by definition have a significant impact on the child’s day-to-day functioning both at home and at school.  As discussed above, Demand Avoidance can be displayed by all of us at some point in time.  However, if persistence and significant resistance to demands start having an impact on the child, peers, siblings, parents and/or teachers then that can become problematic, and this requires attention and interventions.

Parents and teachers should seek help if a child’s Demand Avoidant behaviours are being displayed in public or in group situations as a display in these situations can lead to isolation for both the caregiver and the individual.  One should seek help if significantly more time and effort and energies are being required to navigate abovementioned Demand Avoidance behaviours. Since Demand Avoidance behaviours stem from a significant amount of anxiety, stress and emotional difficulties, help should be sought if Demand Avoidance behaviours are impacting on the child’s emotional wellbeing, social functioning, and or academic learning.  Demand Avoidance behaviours are known to cause feelings of frustration, helplessness or guilt in the child.  Early interventions and appropriate behaviour management can prevent not only the establishment of these problematic behaviours but could also avoid loss of life chances, educational or employment opportunities.

Assessment of Demand Avoidance may include obtaining reports from parents and teachers.  A detailed history to help in identifying when, how and why these avoidance behaviours occur, becomes necessary.  A Clinical Psychologist or a Behavioural Therapist would be able to undertake such a comprehensive assessment, using techniques such as ABC Model (Antecedence, Behaviour and Consequences Model) along with discussing feelings and thoughts about certain demands, with the child and his/her parents, separately.

An assessment could also involve evaluation of a child’s social interaction abilities, communication abilities, identifying any learning issues, reviewing a child’s activity levels and impulse control.  A comprehensive assessment would also identify any external and environmental factors that may be causing or contributing to Demand Avoidant behaviours.  A thorough assessment would help tailor management plan with support strategies to play to child’s strengths, address their difficulties and prevent trigger situations.

 

What strategies can effectively reduce Demand Avoidance Behaviours?

1. Understanding triggers and preventing them:  Undertaking evaluation of Demand Avoidance behaviours using the above ABC Model (Antecedence, Behaviours and Consequences) can help identify reasons, triggers, and situations that bring up Demand Avoidance behaviours.  Better understanding of the child’s behaviour would thus help preventing these Demand Avoidance behaviours by thinking ahead, planning, providing advance notice to the child of any upcoming changes, etc.
2. Thinking about environment:  Understanding a given child’s sensory needs and sensory processing difficulties can help in optimising their environment and prevent overwhelming the coping capacity of the child.  Undertaking sensory regulation activities and creating a sensory environment that is conducive to the child’s needs would help minimise Demand Avoidant behaviours.  An Occupational Therapist would be better placed in drawing up a ‘sensory profile’ for your child and help create a ‘sensory diet’ to help regulate a child’s sensory difficulties. An Occupational Therapist would be able to give several sensory modulating activities that would help regulate your child’s auditory, visual, oral, smell, tactile, vestibular (sense of movement and balance), proprioceptive (position of one’s body in space) and interoceptive (internal sensation from body such as hunger, pain, thirst and need to use toilet, etc) strategies.  Some of these strategies may involve offering a child, fidget toys, chewy toys, use of headphones, seamless socks, weighted blankets, wearing tinted glasses, taking packed lunches with preferred food and drinks, opportunities for movement breaks, physical activities to meet proprioceptive needs, etc.
3. Reducing, removing, and or changing the perception of demands:  Using appropriate language and tone of voice can benefit children with Demand Avoidance behaviours massively.  Using appropriate language or starting or ending requests with the word “please” can make good difference.  Re-phrasing demands for the choice of phrases, such as “I wonder whether…” “Let’s see if you..,” “Maybe we could..,” “A possible idea could be..,” can all moderate the perception of demands.  Avoiding trigger words such as “don’t” or “no” or “shouldn’t” can appear as accommodating and helpful.  A Clinical Psychologist or a Behavioural Therapist would be able to give several more ideas to reduce the perception of demands.
4. Having Demand free downtime:  Since the mood and behaviour of children with DA/PDA can change very quickly it is important to notice signs of escalating anxiety and watching the child’s stress levels.  Doing so can help in reducing Demand Avoidance behaviours by decreasing demands.  Having demand free downtimes can help children have a sense of control and can help them to relax and thrive.  Having demand free breaktimes can be very effective in reducing anxiety and stress levels.  Offering children an escape plan in the form of ‘me’ time or ‘short breaks’ can help them to reset their mood and behaviours.
5. Using effective behavioural strategies:  Using child’s toys as distraction, turning things into a game can be a very effective strategy.  Use of humour can be a great way to make everyone feel more relaxed and can thus help reduce the perception of demands.  Offering choices can give the child a sense of control for example, “Would you prefer to brush teeth in 15 minutes or 20 minutes”.  Explaining that the requirement has been made by the other person or the higher authority than you, stating certain law dictates this rule can help depersonalise the situation. Judicious use of negotiation and collaborating with your child to come up with solutions can be very productive and fruitful.  Using ‘indirect’ communication including physical prompts such as tap on the hands to get dressed, use of visual prompts such as visual timetable or visual calendar, written communication in text and messages, writing on post-it notes can all be very fruitful.  Stepping back when your child has lost their cool and giving them extra space and time can help them calm down more quickly and prevent further escalation of the situation.
6. Making adjustments to parenting style:  Demand Avoidance is not a result of poor or ineffective parenting, and it is a misconception to think so.  Neurodivergence and neurodiversity are not the result of parenting.  However, appropriate adjustments to parenting style can help children with Demand Avoidance/PDA.  Parenting a typically developing child would involve parents remaining ‘in control’ of the situation and order of things.  Yet this style of parenting can be unhelpful and would escalate Demand Avoidant behaviours in neurodivergent children. Use of above strategies to make your child feel in control of the situation is a very useful strategy.  It is also useful to appreciate why occasional parenting approaches such as use of rewards, praise or sanctions are not effective in children with Demand Avoidant behaviours.  This is because rewards can create added demand on the top of the demand or environment itself.  Similarly, praise may be perceived as a demand or the need to repeat a given activity or improve on previous performance.  Use of sanctions and consequences may lead to confrontation and escalate the situation.  A Clinical Psychologist or a Behavioural Therapist will be able to show how, and when to use rewards, praise and sanctions appropriately.  An assessment from these professionals would be worthwhile.
7. Managing anxiety and stress levels:  Acknowledging your child’s feelings and emotions can help them feel less anxious.  Teaching them coping mechanisms like deep breathing exercises, counting backwards from 10, can all be helpful.  Encouraging open communication and creating a consistent routine can be valuable.  Encouraging regular exercise to manage stress and undertaking mindfulness activities such as focusing on sensations in the body or engaging in meditation can be valuable.  Do not dismiss your child’s concerns or also avoid minimising their feelings.  Please read the article on anxiety I wrote for more strategies to address anxiety. Parents should seek professional help when symptoms of anxiety are severe or persistent.
8. Supporting social interaction and social communication:  Children with neurodiversity commonly have slower processing ability even when their cognitive abilities are in the average or above average range.  Hence allowing them extra processing time can give them chance to make sense of what is required of them and will help them to think how to respond.  Avoid asking multiple questions in one go.  Instead, ask them to respond to your first request before adding any follow-up questions.  Try and be clear and precise, while being ‘indirect’ by use of phrases such as “I wonder if you could help me with….” The use of role play can help children understand other people’s perspectives.  Use of social stories can be very useful to help your child understand other people’s needs, feelings, and emotions.
9. Managing challenging behaviours:  The abovementioned approaches and strategies can be very helpful in reducing the severity and intensity of distressing and challenging behaviours.  Using simple and easy to understand rules that are consistent across situations can be helpful.  Clearly stating the consequences of not following the rules and always enforcing the consequences for negative behaviours can help reduce the frequency of challenging behaviours for future.  Positive disciplinary methods such as ‘time outs’ can be helpful.  Having access to ‘calming strategies’ and a ‘quiet space’ for a child to retreat to when they become overwhelmed are very useful.  Children with Demand Avoidant behaviours can find it hard to identify and regulate their feelings and emotions.  Creating space in the classroom or school where the child can go to, to feel calm can be helpful.  Doing so would avoid attracting negative attention from others and prevent escalation of challenging behaviours.
10. Enhancing resilience:  Fostering a ‘growth mindset’ by encouraging the belief in the child that abilities to manage anger and regulate emotions can be developed through effort and practice.  Encourage establishing positive relationships with friends and family so that they have support network during challenging times.  One can model resilience by showing children that everyone faces difficulties and can overcome them.  Explaining that mistakes are opportunities to grow and improve, will help them embrace their mistakes and not panic.  Teaching children the importance of taking care of their own physical and mental health through activities such as healthy eating, sleep and relaxation techniques are valuable.  Helping children to identify problems and brainstorming solutions would help them to develop or come up with coping mechanisms. Please read the article on resilience that I wrote, for more strategies.

 

Where to find further information, support and advice?

1. National Autistic Society: https://www.autism.org.uk/advice-and-guidance/topics/behaviour/demand-avoidance.
2. PDA Society. https://www.pdasociety.org.uk/wp-content/uploads/2020/01/positive-pda-booklet.pdf.
3. Neurodisability and Community Child Health, Oxford Specialist Handbook, Dr Srinivas Gada, May 2022. https://www.amazon.co.uk/Neurodisability-Community-Specialist-Handbooks-Paediatrics/dp/019885191X/.
4. NAS Demand Avoidance Support Letter National Autistic Society:
5. Reframing Autism, Australia: https://reframingautism.org.au/pathological-demand-avoidance-pda
6. Helpful approaches with PDA-Children: https://www.pdasociety.org.uk/resources/helpful-approaches-for-children/pathologicaldemandavoidance.