Autism Spectrum and PDA
We take a neurodivergent affirming stance when it comes to discussing the treatment of autism. We see autism as reflecting a brain type that is hardly “less than.”
Rather, we recognize that autistic individuals are disproportinately responsible for some of the most important innovations that our society enjoys. Autistic individuals bring a capacity to perceive elements that “neurotypicals” might miss, whether related to social justice, patterns in the environment, creativity, or sensory experiences. At the same time, autism is associated with relatively high rates of seeking mental health services. Autism is linked to genuine mental health vulnerabilities. Autistic individuals are suspectible to anxiety, depression, emotion dysregulation, and behavior dysregulation. There are aspects to our environment than can create undue stress for persons with autism.*
Common challenges associate with autism that may warrent mental health support:
Transitions
Inflexibility
Friendship development
Emotion dysregulation
Meltdowns
Sensory overwhelm
Interpersonal conflict
Overreliance on screens to self-regulate
As with most issues that we work with at CATS, we value parent/ caregiver involvement when it comes to building mental health resilience. It’s also common for us to need to address supports at school so that the child or teen is better understood by their education team and can certain accommodations. Many of our evidence-based approaches for addressing issues such as emotion dysregulation and behavior issues have been shown to be applicable and effective when autism is in the picture.
*We intentionally use both identity-first and person-first language because we recognize that people within the autism community vary in their preference of which type of language suits them best.
We get a lot of questions about Pathological Demand Avoidance (PDA). We understand that families are hearing more about PDA and are looking for providers familiar with this profile. Although PDA is not a recognized diagnosis in the United States, we can speak to common questions that come up.
What is the “PDA Profile?”
A theoretical concept and framework
Considered to be a part of the autism spectrum
An anxiety-driven need to be in control and avoid other people’s demands and expectations
Associated with emotional reactivity, meltdowns, and aggressive behaviors
What is The story behind the PDA Movement?
The term “Pathological Demand Avoidance” (PDA) was proposed by the late Elizabeth Newson, a British developmental psychologist. The seminal paper was published in 2003, and was based on Dr. Newson’s observations of a subset of autistic children and adults who demonstrated an “obsessional avoidance of the ordinary demands of life” coupled with skills in “social manipulation.” Many of these children exhibited aggressive behavior, extreme outbursts, or panic. These descriptions were based on 50 children seen between 1987 and 1996. The paper also described 18 young adults who were seen in this time period, 75% of whom became violent when angry. Some of the parents were said to be afraid of their adult children, or feared for them.
The concept of PDA gradually gained traction in the UK. In 1997, the PDA Society UK was founded by a parent of an autistic child. PDA North America was founded in 2020 by a clinical social worker. Most educational events, trainings, and publications are led by advocates, most of whom are parents of autistic children or adults who self-identify as having PDA.
Families drawn to the PDA framework may experience a deep sense of validation and community, especially if previous approaches have felt blaming or ineffective. Caregivers often describe relief in recognizing that their child’s struggles may reflect a distinct neurodevelopmental profile rather than parenting failure. While this sense of connection can be deeply meaningful, it’s important to note that the effectiveness of PDA-informed methods remains untested and controversial. There are no published treatment studies about what’s effective for individuals who are said to fit the PDA profile. Some proponents reject behavioral interventions entirely, favoring approaches such as unschooling, unrestricted screen access, and radical accommodation, even in cases of aggressive behavior. These methods remain largely unstudied, run counter to evidence-basesd approaches to behavior dysregulation, and are debated within clinical and educational communities.
How Do approaches at Child and teen solutions (CATS) overlap with the PDA intervention philosophy?
At the core of our treatment model is the belief that emotionally secure caregiver-child relationships are foundational to mental health. Children with challenging behaviors need adults who remain calm, predictable, and attuned. We prioritize understanding the function of behaviors (what need they’re expressing), so that interventions can be tailored with compassion.
We emphasize:
Flexible, responsive adult behavior
Active listening and troubleshooting
Recognition of each child’s unique profile
Differentiation between demands that are within a child’s capacity and those that require scaffolding
This aligns with many PDA-informed principles, particularly the emphasis on emotional safety, autonomy, and individualized support.
Where does CATS depart from the PDA intervention philosopy?
Some PDA-informed approaches advocate for accommodating aggressive behavior because it is viewed as a signal of perceived threat. While we agree that aggression can reflect dysregulation or fear, we also recognize that it may stem from other causes such as impulsivity, anger, frustration, or learned patterns.
We believe:
Children benefit from learning to inhibit aggressive impulses
Adaptive communication and emotional expression can be taught
Thoughtful use of contingencies can support self-regulation and skill-building
Contingencies, when applied with care, help shape environments that build a child’s resilience and skills. For instance, shifting how adults respond so we don’t accidentally reward challenging behaviors can be helpful. We also want to make sure we notice and encourage when a child tries something new in the direction of more skillful expressions of their needs.
We do not endorse blanket “low-demand” approaches, as they may unintentionally limit growth or reinforce avoidance. Instead, we focus on building trust, flexibility, and coping skills by helping children face challenges with scaffolded support.
A Commitment to Compassion and Rigor
As the PDA movement evolves, families, clinicians, and researchers face a complex task: honoring lived experience while advocating for evidence-based care that supports long-term mental health. We believe this conversation deserves both compassion and rigor.
Summary
At CATS, we take every child’s unique presentation seriously and hold ourselves to high standards of clinical integrity. While we recognize that some children show extreme sensitivity to demands, we approach these patterns through a developmental lens, drawing on well-established research in autism, anxiety, and self-regulation. Our goal is to empower families with strategies that are both compassionate and grounded in science.
Emotion dysregulation and aggressive behavior are transdiagnostic, reflecting a wide range of underlying causes and developmental profiles. As a neurodivergent-affirming clinic, we recognize that these challenges often emerge in the context of complex sensory, cognitive, and relational needs as opposed to deficits. We offer evidence-based interventions that strengthen children’s capacity for self-regulation, impulse control, and social adjustment.
While we agree that generic parenting advice often falls short, especially for our neurodivergent child and teen clients, our clinical experience shows that even children perceived as having the PDA profile can respond meaningfully to established research-backed methods. We encourage caregivers who are interested in our services to explore our parenting blog to help evaluate whether our services may be a fit for their family. We are always happy to answer questions about our approaches and the rationale behind what we offer.
