Symptom Tests for Children

Is Your Child Showing Signs of Pathological Demand Avoidance?

Could your child’s extreme defiance point to pathological demand avoidance? Learn more about PDA symptoms in children and take this free self-test to see if your child’s behaviors align with this behavioral profile.

By ADDitude Editors Updated on September 8, 2025
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Pathological demand avoidance (PDA), also known as pervasive or persistent drive for autonomy, is a behavioral profile characterized by intense and extreme resistance to, and avoidance of, everyday demands.

In the context of PDA, what counts as a demand extends beyond direct instructions like “clean your room.” The common, trivial requirements and expectations of daily living — from getting dressed for school and responding to a greeting, to following the body’s internal cues to eat and sleep — are often perceived as demands. Casual suggestions can also be interpreted as demands. For children with PDA, even engaging in activities they enjoy can become difficult if it feels like it was someone else’s idea or even a self-imposed demand.

Children with PDA might go to extreme or unusual lengths to avoid complying with a demand. When pressured to comply, they’ll often melt down or react explosively.

PDA is a little-explored behavioral profile, and it is not recognized as a distinct diagnosis. There is debate over how it should be conceptualized. Some view PDA as a profile of autism, while others view it as a cluster of behaviors that can be exhibited by both adults and children, whether they are autistic or not, though it is often associated with neurodivergence.

PDA is thought to arise from intense anxiety, intolerance of uncertainty, and a strong need for autonomy; PDA individuals, stress-prone and with sensitive nervous systems, view demands as inherently threatening to their sense of safety and control. Strategies for supporting PDA children include low-demand, collaborative parenting; reducing or rephrasing demands; and offering autonomy.

Take this self-test to see if your child may be showing signs of PDA and share the results with a licensed medical professional. Find a PDA-affirming provider through PDA North America, a non-profit organization.

My child often avoids or refuses to do most things that are asked of them, whether it’s everyday instructions (e.g., “Put on your shoes”) or typical steps in their routine (e.g., “Brush your teeth”).

My child often seems to perceive even the smallest, most reasonable questions or comments (e.g., “What are you up to today?” “Shall we get dessert?” “Watch this funny video!” “Are you reading that book this summer?”) as demands.

My child often avoids or refuses to do things they enjoy (e.g., playing video games, watching a TV show) or that come easily to them if those things feel like demands or expectations.

My child often resists acting on normal bodily functions, like cues to use the bathroom, eat when they’re hungry, or sleep when they’re tired.

My child often resists doing things that are ordinarily expected and within their capacity, like making eye contact in conversation, leaving the home on time for appointments, or eating at the dinner table with the family.

My child often has difficulty complying with requests made by their teachers, family members, friends, and others.

My child often has a strong need for autonomy and control. They almost always want to be in charge and do things on their terms.

My child often has meltdowns, tantrums, and intense reactions when pressured to comply with demands or expectations.

My child often appears dominant, stubborn, and controlling.

My child’s mood often changes suddenly when a demand is placed on them. They’ll go from cheerful to quiet or angry in a flash.

My child often goes to great lengths to avoid complying with demands—through deployment of distractions, elaborate excuses, jokes, withdrawal, negotiation, storytelling, and other strategies.

My child often doesn’t respond well to rewards and praise; they seem to interpret them as demands.

Can’t see the self-test questions above? Click here to open this test in a new window.

The questions in this self-test were informed by resources from PDA North America and PDA Society (UK), ADDitude articles on PDA (see next steps below), and published research on PDA. This resource is for personal use only; it is not intended as a diagnostic tool.

Pathological Demand Avoidance: Next Steps

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1 O’Nions, E., Eaton, J. (2020). Extreme/‘pathological’ demand avoidance: an overview. Paediatrics and Child Health, 30(12), 411-415. https://doi.org/10.1016/j.paed.2020.09.002

2 Kildahl, A. N., Helverschou, S. B., Rysstad, A. L., Wigaard, E., Hellerud, J. M., Ludvigsen, L. B., & Howlin, P. (2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism, 25(8), 2162-2176. https://doi.org/10.1177/13623613211034382

3 Nawaz, S., Speer, S. (2025). What are the experiences and support needs of families of autistic children with extreme (or ‘pathological’) demand avoidance (E/PDA) behaviours? Research in Autism Spectrum Disorders, 119, 102515. https://doi.org/10.1016/j.rasd.2024.102515

4 O’Nions, E., Happé, F., Viding, E. et al. (2021). Extreme demand avoidance in children with autism spectrum disorder: refinement of a caregiver-report measure. Advances in Neurodevelopmental Disorders, 5, 269-281. https://doi.org/10.1007/s41252-021-00203-z

5 Stuart, L., Grahame, V., Honey, E., & Freeston, M. (2020). Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents. Child and Adolescent Mental Health, 25(2), 59–67. https://doi.org/10.1111/camh.12336

6 White, R., Livingston, L. A., Taylor, E. C., Close, S. A. D., Shah, P., & Callan, M. J. (2023). Understanding the contributions of trait autism and anxiety to extreme demand avoidance in the adult general population. Journal of Autism and Developmental Disorders, 53(7), 2680–2688. https://doi.org/10.1007/s10803-022-05469-3