Pathological demand avoidance (PDA) is a profile of autism spectrum disorder and a proposed sub-type. Characteristics ascribed to the condition include greater refusal to do what is asked of the person, even to activities the person would normally like, due to extreme levels of anxiety and lack of autonomy. Although PDA has its own traits that are separate from autism, they generally meet the diagnostic criteria by having significant impairments in social interaction and communication and presenting restricted and repetitive behaviors. Some notable differences in PDA compared to classic autism spectrum disorders are that individuals appear to be more sociable, have far better social skills and social understanding, tend to be more interested in people than objects, are more comfortable with pretend play, and tend to be more imaginative. It is not recognized by either the DSM-5 or the ICD-10 and is unlikely to be separated out now that the umbrella diagnosis of ASD has been adopted. In 2011, it was suggested that these symptoms could represent the condition oppositional defiant disorder (ODD). Elizabeth ONions and others argue that unlike ASD, “children with PDA are said to use socially manipulative avoidance strategies”; and unlike ODD, they “resort to extreme, embarrassing or age-inappropriate behaviour”.The term was proposed in 1980 by the UK child psychologist Elizabeth Ann Newson. Recognition
Pathological demand avoidance is not recognized by the DSM-5 or ICD-10, the two main classification systems for mental disorders.
To be recognized, a sufficient amount of consensus and clinical history needs to be present, and as a newly proposed condition, PDA had not met the standard of evidence required at the time of recent revisions. However, DSM-5 also moved from sub-type classification to the use of ‘Autistic Spectrum Disorder’, which allows for the behavioural traits of different profiles to be described. In 2011, the National Institute for Health and Care Excellence commented on the fact that PDA has been proposed as part of the autism spectrum but did not include further discussion within the guideline. NICE guidance also expects an ‘ASD’ diagnosis be accompanied by a diagnostic assessment, providing a profile of key strengths and difficulties. Demand Avoidance is listed as a ‘sign or symptom of ASD’ (Appendix 3).Christopher Gillberg wrote a commentary article in 2014 that reviewed recent research and stated, “Experienced clinicians throughout child psychiatry, child neurology and paediatrics testify to its existence and the very major problems encountered when it comes to intervention and treatment.”

Proposed diagnostic criteria
As of 2014 there are no recognized diagnostic criteria.