Charlotte Maskrey on PDA, and helping people to get through their anxiety.
Pathological demand avoidance, a lesser known behavioural profile associated with Autism, is sometimes dismissed as defiance, when in reality it is deeply rooted in anxiety. The demand avoidance in PDA can be driven by anxiety, loss of control, fear of failure, and overwhelm.
Fight or flight is associated with anxiety responses, but there are three other responses which are also recognised: freeze, fawn and flop. Flop is a common response to anxiety and demand avoidance. When an individual flops, they enter a state of emotional and physical shut down or collapse. The flop response may manifest as sudden lethargy or fatigue, with complete disengagement, emotional withdrawal, unresponsiveness and reduced processing. For people with PDA, the flop response occurs when it feels as though shutting down is the only option to escape anxiety.
These behaviours are further complicated by the fact that many PDAers already have a high baseline level of anxiety, meaning that demands such as getting dressed, completing homework, or brushing teeth can easily push them over the edge and into their anxiety flop response. The demands can cause them to feel overwhelmed, as if they have lost control, which triggers internal panic. In PDA the avoidance is not about defiance or rebellion, it is rooted in overwhelming anxiety and a need to regain control and cope.
For non-PDAers, a demand is a simple two-step scenario: I am given a demand and I either choose to do the demand or not. When a PDAer is given a demand, the word simple doesn’t apply. The scenario is far more complex. I am given a demand and now I feel out of control. I have lost my autonomy. When I have no control I feel scared, I feel internal panic, intense anxiety, and my thoughts begin to spiral, I can’t move past the anxiety to respond. I begin to shut down and enter the flop response. After a spike of adrenaline, and fear pulsing through my body so suddenly, I am now exhausted. I struggle to move or speak, and I withdraw from my surroundings.
This naturally high baseline of anxiety means that PDAers are often more susceptible to developing anxiety disorders. Many anxiety disorders, such as generalised anxiety disorder, obsessive compulsive disorder and panic disorder, share many characteristics with PDA, such as: avoidance behaviours in order to maintain control and reduce anxiety, emotional dysregulation which can lead to emotional shutdowns and meltdowns, and hypervigilance – being constantly on the lookout for threats and demands in their surroundings.
One of the most prominent shared characteristics of anxiety disorders and PDA is the demand-avoidance cycle. An individual avoids a demand or anxiety-provoking situation in order to gain short term relief, but in avoiding that demand they solidify the anxiety related to the demand and perpetuate a cycle that exacerbates their anxiety response, leading to more avoidance.
The anxiety that fuels PDA can feel relentless, and the demand-avoidance cycle can seem impossible to break, but there are strategies which can help to slowly break down the cycle, while still retaining enough autonomy and control for the individual to reduce anxiety.
One way to support an individual experiencing PDA and anxiety is to reduce the pressure and demands you are placing on them. Creating a low demand environment, reducing rigid expectations and using indirect language can help the individual to still feel a sense of control and autonomy and reduce the risk of a flop response. Low demand environments will be different to each person, but one of the most important things is to ensure the space is predictable and calm. Sudden changes or unpredictability can fuel anxiety. Indirect language can be as simple as changing the structure of a sentence from Go and clean your room to Would you like to clean your room now or later? Offering choices and phrasing it as a question instead of an imperative, allows the person to retain a sense of control over the situation, and to see that they have choice in the demand. One of the most important strategies to support a PDAer is to make sure their feelings are validated. Acknowledge the distress they are feeling, recognise the panic and overwhelm they are experiencing and make sure they know that their emotions and responses are valid. Just because one individual reacts differently to a demand compared to another doesn’t mean one reaction is ‘incorrect’ or ‘overreacting’. People experience different internal responses and levels of anxiety to the demand.
The main thing to remember is that PDA is not defiance or rebellion, it is fear and anxiety. Individuals with PDA need support, kindness, patience and compassion to help them through their anxiety.