13 Pathological Demand Avoidance Strategies

13 Pathological Demand Avoidance Strategies
Dr. Roseann Capanna-Hodge

Dr. Roseann Capanna-Hodge

PDA is a complex condition characterized by demand avoidance, extreme anxiety, and difficulties in social interaction. As parents and caregivers, understanding and navigating these challenges can be both demanding and rewarding. 

When you have a neurodivergent child, you need resources and strategies to help foster positive behaviors and in the case of PDA, motivation. 

These essential strategies are designed to empower parents and caregivers, offering practical insights grounded in empathy and understanding. They are tailored to create a supportive environment that recognizes the distinctive needs of children with PDA. 

Strategies for Supporting Individuals with PDA Profile

Parenting a child with Pathological Demand Avoidance requires a unique set of skills and strategies that address the distinctive challenges posed by this condition. Here are practical tips grounded in empathy and understanding, designed to empower parents and caregivers in creating a supportive environment for kids with PDA.

1. Recognize Sensory Issues

Understanding and acknowledging the sensory processing challenges inherent in PDA is the first step. Recognize that seemingly simple demands may trigger anxiety due to sensory overload. Create a sensory-friendly environment by minimizing sensory stimuli and providing comforting sensory experiences.

2. Person-Centered Communication

Tailor communication to the individual's preferences and needs. Use clear and concise language and allow time for processing. Emphasize visual supports, such as visual schedules and cues, to enhance understanding. Adopting a person-centered communication style can bridge the gap and create a more supportive interaction.

  • Clear and Concise Language: When giving instructions or explanations, use simple and straightforward language. Instead of saying, “It's time to get ready for bed; please go to your room, brush your teeth, and put on your pajamas,” you might say, “Bedtime. Room. Teeth. Pajamas.” This minimizes confusion and makes it easier for the child to understand.
  • Allowing Processing Time: After making a request or asking a question, give the child extra time to process and respond. For instance, if you ask, “Would you like to play with your toys now?” wait patiently for their response, even if it takes a bit longer than expected. Avoid rushing or repeating the question immediately.

Visual Supports:

PDA Parent Tip


For instance, you can use pictures or icons to represent different tasks or activities, such as a toothbrush for brushing teeth or a bed for bedtime. Having a visual schedule posted in their room can provide a clear and predictable structure. 

  • Choice-making: Offer choices to empower the child and allow them to feel in control. For example, instead of saying, “Put on your shoes,” you can present options like, “Which shoes would you like to wear today, the red ones or the blue ones?” This encourages decision-making and reduces the perception of demands.
  • Non-verbal Communication: Pay attention to non-verbal cues and signals. Some children with PDA may struggle with verbal communication but express themselves effectively through gestures or facial expressions. Tune in to their non-verbal cues to better understand their feelings and needs. 
  • Use Positive Reinforcement: Reinforce positive behavior with specific and immediate feedback. For example, if the child completes a task without resistance, say, “You did a great job getting dressed by yourself!” Positive reinforcement can motivate them to cooperate more readily. 
  • Listening Actively: Actively listen to the child's concerns, fears, or preferences without judgment. If they express discomfort or anxiety about a specific task, acknowledge their feelings and ask how you can make it easier for them. This demonstrates empathy and validates their emotions.

3. Implement Predictability and Routine

Kids with PDA often find comfort in predictability. Establish clear routines and communicate any changes well in advance. This not only reduces anxiety associated with unexpected demands but also provides a sense of security and control over their environment.

4. Provide Coping Strategies

Equip kids with PDA with practical coping strategies. Work collaboratively with therapists to identify and develop personalized techniques for managing anxiety, such as deep breathing exercises, mindfulness, or self-regulation tools. Empowering them with tools to cope fosters a sense of independence in handling demands.

5. Encourage Social Skills Development

Recognize the importance of social skills development. Encourage and facilitate positive social interactions through playdates, structured social activities, or social skills groups. By providing opportunities for social engagement, kids with PDA can build confidence and enhance their ability to navigate relationships (O’Nions et al., 2015).

6. Flexibility in Demands

While routine is crucial, be flexible in your expectations. Recognize when adjustments are needed and allow for breaks when demands become overwhelming. Balancing structure with flexibility acknowledges the individuality of each child with PDA and fosters a more adaptive approach.

7. Promote Independence

Encourage and celebrate independence in daily tasks.

PDA Parent Tip 2

This not only fosters a sense of accomplishment but also empowers them to handle demands with a growing sense of self-assurance.

8. Build a Supportive Network

Create a collaborative network involving educators, therapists, and peers. Ensure that those interacting with your child are informed about PDA and its unique challenges. Open lines of communication, share strategies, and work together to provide consistent support across different settings.

9. Emphasize Natural Solutions for Brain Health

Explore natural solutions for brain health, such as nutritional support, regular exercise, and mindfulness practices. These holistic approaches contribute to overall well-being, supporting attention, mood, stress, and behavior in a manner that aligns with the individual's needs (Shanmugam et al., 2021)

10. Celebrate Small Victories

Recognize and celebrate achievements, no matter how small. Building a positive and encouraging environment fosters resilience and a sense of self-worth. By acknowledging and celebrating progress, you reinforce the idea that effort and growth are valued.

11. Role Play and Social Strategies

Role-playing scenarios can be an effective way to teach children with PDA how to navigate social interactions and demands. Create role-play situations that mimic real-life encounters, allowing them to practice appropriate responses in a safe and controlled environment. This can significantly improve their social skills and confidence, as well as reduce their irritation when you try to support them. 

12. Long-Term Planning for Future Success

It's crucial to consider the long-term well-being and success of children with PDA with and without additional issues such as ASD, mood disorder, etc. . While immediate strategies are essential, thinking ahead is equally vital. Here are some long-term planning considerations:

  • Individualized Education Plan (IEP): Collaborate with educators to create a comprehensive IEP tailored to the child's unique needs. Address academic accommodations, social skills development, and transition planning.
  • Transition Planning: Plan for transitions between school levels or life stages. Ensure that there is continuity in support as the child progresses from elementary to middle school or from high school to adulthood.
  • Post-School Goals: Identify post-school goals and aspirations. Discuss potential career paths, vocational training, or higher education options that align with the child's interests and strengths.

13.  Addressing School Challenges Effectively

Supporting a child with PDA within the school environment can be challenging. Here's a comprehensive approach to address school-related challenges:

  • Effective Communication: Maintain open and regular communication with teachers and school staff. Share information about PDA and its impact on the child's learning and behavior.
  • Requesting Classroom Accommodations: Advocate for classroom accommodations tailored to the child's needs. This may include preferential seating, extended time for assignments, or sensory breaks.
  • Individualized Behavior Plans: Collaborate with the school to develop an individualized behavior plan (IBP) that outlines strategies for managing challenging behaviors and reducing demands.
  • Regular Progress Monitoring: Ensure that the child's progress is regularly monitored. Adjust strategies and accommodations based on their evolving needs.

Involvement of Mental Health Professionals

The involvement of mental health professionals is crucial in providing holistic support for children with PDA. Here's how to incorporate mental health professionals into the support network:

  • Child Psychologists or Counselors: Consider consulting with child psychologists or counselors who specialize in autism spectrum disorders and anxiety management. They can offer valuable insights and therapeutic interventions.
  • Regular Counseling Sessions: Schedule regular counseling or therapy sessions to address emotional regulation, mood swings, and anxiety. These sessions can equip the child with coping strategies and emotional resilience.
  • Collaboration with School Counselors: Ensure that school counselors are aware of the child's needs and challenges. Collaborate with them to provide in-school support and implement strategies that promote emotional well-being.

PDA Success Stories

As challenging as PDA can be, with the right PDA strategies, behaviors can improve and that means a whole lot less friction. Emilio was a 12 year-old with PDA in our BrainBehaviorReset Program™ when his mom Celeste came to me. As you can imagine Emilio was resistant to most things and tough to parent. 

When she learned how to help Emilio to build stress tolerance through gaining coping skills, he became less avoidant. She also learned that consistency was key in order for Emilio to learn new skills. 

By incorporating these strategies along with holistic methods, they can provide a comprehensive approach for parents and caregivers of children with Pathological Demand Avoidance, offering a holistic approach to supporting their unique needs and challenges at home and in school.

Parent Action Steps 

☐ Establish clear routines and communicate changes in advance of using strategies. 
☐ Tailor your communication and use visual supports and clear instructions 
☐ Foster autonomy by offering choices and responsibilities.
☐ Use our Solutions Matcher to get personalized treatment for your child.


O’Nions, E., Gould, J., Christie, P., Gillberg, C., Viding, E., & Happé, F. (2015). Identifying features of “pathological demand avoidance” using the Diagnostic Interview for Social and Communication Disorders (DISCO). European Child & Adolescent Psychiatry, 25(4), 407–419. https://doi.org/10.1007/s00787-015-0740-2

Shanmugam, H., Ganguly, S., & Priya, B. (2021). Plant food bioactives and its effects on gut microbiota profile modulation for better brain health and functioning in Autism Spectrum Disorder individuals: A review. Food Frontiers. https://doi.org/10.1002/fft2.125

Yasinski, C., Hayes, A. M., Ready, C. B., Abel, A., Görg, N., & Kuyken, W. (2019). Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing. Psychotherapy Research, 30(8), 1–15. https://doi.org/10.1080/10503307.2019.1699972

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Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.

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She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health. 

Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches. 

She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain. 

Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.

She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF).

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