Clinicians Take Note: PDA Is Autism Not ADHD
- Amy Duffy-Barnes
- 7 days ago
- 3 min read
Pathological Demand Avoidance (PDA) is understood by many clinicians and researchers as a behavioral profile within the autism spectrum, rather than a distinct diagnosis or a subtype of ADHD. As an autistic clinician I am saddened by the amount of misdiagnosis we see on the records of clients coming into Heartstone Guidance Center. It is important for clinicians especially those involved in diagnostics to understand what PDA is and what it is not. PDAers are a vulnerable population. They deserve better than they are currently getting from us. This is Heartstone Guidance Center's best explanation of why PDA aligns with autism spectrum disorder (ASD), not ADHD. Also maybe we could discuss not labeling neurotypes as disorders.
1. Neurodevelopmental Classification Context
Both ASD and ADHD are neurodevelopmental disorders as classified under the DSM-5-TR. However, PDA fits within autistic profiles due to its underlying cognitive-affective traits, particularly in social communication, emotional regulation, and demand processing, which are not characteristic of ADHD.
2. Core Characteristics of PDA and ASD Overlap
PDA is characterized by:
Extreme avoidance of everyday demands, including those perceived as non-threatening or routine.
Surface-level social communication skills that can mask underlying social processing differences.
High levels of anxiety-driven control behaviors.
Intense emotional dysregulation, often manifesting in outbursts or shutdowns when autonomy is threatened.
Comfort with role-play or fantasy, used to exert control or manage social stress.
These features align more with ASD presentations involving social-communication differences, demand sensitivity, and executive function variability, rather than with ADHD.
Notably, PDA is associated with:
Atypical social reciprocity (as seen in ASD), not the impulsive social engagement of ADHD.
Autonomy-based anxiety, which is qualitatively different from the reward-driven task resistance in ADHD.
3. Differentiation from ADHD Symptomatology
ADHD is defined by:
Persistent patterns of inattention and/or hyperactivity-impulsivity.
Executive dysfunction primarily related to task initiation, organization, and sustained attention, often due to dopaminergic reward deficits.
Behavioral disinhibition, often unintentional or externally driven, rather than intentional or anxiety-based.
Children or adults with ADHD may appear to avoid demands, but the avoidance is typically due to:
Boredom
Task difficulty/Overwhelm
Low intrinsic motivation
Delayed reward sensitivity
In contrast, PDA demand avoidance is emotionally charged, perceived as a threat to autonomy, and is anxiety-driven even in the face of enjoyable or familiar tasks.
4. Research and Conceptual Alignment
While PDA is not yet a standalone diagnosis in the DSM-5-TR or ICD-11, it is increasingly recognized within autism research literature (especially in the UK) as a subtype or profile within ASD. Clinicians often observe that individuals with PDA meet full criteria for autism spectrum disorder, often with:
Sensory sensitivities
Theory of mind differences
Monotropic (deep-focus) attention styles
Difficulties with neurotypical social hierarchies and expectations
None of these are central features of ADHD.
5. Clinical Implications
Treatment approaches for PDA align more closely with neurodiversity-affirming autism support than with ADHD interventions. ADHD strategies (e.g., behavioral reinforcement systems, token economies, externally imposed structure) often fail or escalate distress in PDA, whereas low-demand, autonomy-respecting, relational approaches reduce anxiety and build trust.
Conclusion
PDA is most accurately conceptualized as an autism-related profile of demand avoidance, with features that stem from autistic social-emotional processing and demand sensitivity, not from the attentional dysregulation or reward-processing difficulties that define ADHD. As such, PDA is an autism spectrum profile, not an ADHD subtype, and should be assessed and supported accordingly.
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