PDA, Pathological Demand Avoidance

PDA, Pathological Demand Avoidance, is a stupid name but a useful label. It helps identify this mostly Autistic Trait where a person refuses to do a thing that is asked of them. Primarily it is a response to adrenaline, which itself is a response to change. PDA can be solved.

Case Example: Watching New Media

Understanding PDA

Everything that we do takes effort. That effort is made up of a combination of neurotransmitters , glucose and adrenaline. When we are doing a task, we get into a rhythm and our brain is configured nicely to do this particular task. If we run low on glucose or adrenaline, we may snack or use mood to boost our adrenaline; often that mood is anger or anxiety.

Our mood and adrenaline are bi directionally linked. We can induce a release of adrenaline by thinking angry, anxious, or anticipatory thoughts. We can release adrenaline for a range of reasons, which will prompt a mood: anger, anxious or anticipation. The difference between expectant problems and expectant enjoyment / possibility, is just a dash of endorphins. We can trigger those endorphins with music, good company, or by thinking about the gains we are going to get from doing this. We can block endorphins with pain, or anticipation of discomfort.

PDA most often occurs because someone asks us to do something different to what we were doing. The more unexpected the different thing is, the more this derails us from what we were doing or planning, which triggers a bigger adrenaline surge to help us in making a change.

Understanding Change and Autism – the Biology

Imagine this experiment. A series of people are asked to go through a door. They are to look at the information on a table in front of them, then turn right and go to the next table that they see and answer the questions on that table, then turn right again and exit.

This exact same experiment is run twice, but in one group the tables are in the same big room. In the other group, construction workers have put in a fake wall and open door in the middle of the big room, making it look like two different rooms. All other details are the same.

The first group of people answered the questionnaire fairly well. They retained the information nicely. The second group of people answered the questionnaire noticeably less well. Somehow, walking through a doorway meant that people tended to forget information.

The common explanation for this is referring back to our ancestors, who would walk from one biome into another. In this biome, we need to worry about tigers. In that biome, we need to worry about alligators. We drop the biome survival knowledge from the first biome and load up the biome survival knowledge for the second one as we transition from one area to another. This can happen in literally a couple of steps.

For simplicity, let us think of brains having two major components. The first bit is the general processor, which can do most things okay, but not cheaply. The second bit is various specialised brain components, each can do a specific thing very well and cheaply. Neurotypical Brains have a moderate general processor and lots of specialised brain components. This is why eye contact is cheap for them, they have a brain section that specialises in doing this quickly and efficiently, informing them about who they are looking at. To switch tasks is relatively easy, they just need to dump the general processor brain of the current task and reload.

Autistic brains often have fewer specialised brain components (remember this is a simplification). Another way to look at this is that Autistic Folk have more general processing available as less of their brain has specialised. To do those mini tasks that don’t have a dedicated specialised brain component like the neurotypicals have, they dedicate some of the general processor brain to run those tasks. This means that these things are a bit slower to run than the neurotypical (although we can get quick at it) and quite resource hungry (though practice does make it cheaper). This often means that Autistic folk are better at focusing on a single task than multitasking, such as hearing someone or looking them in the eyes, but not both, as doing both is very expensive (hard).

For Autistic folk, hyper focussing on a single task / category is very efficient. We dump the expensive tasks from our brains and streamline things to do the thing in front of us. Given some time, we can get very good at that thing, even if it involves many intricate steps. We have maximised our working memory and brain functions to make this particular thing easy.

To change biomes, or tasks, we need to halt what we are doing, dump the system of this task, and then load up the new brain routines.

Halting what we are doing means trying to get the thing to a point where we might be able to pick it up again. Modularising the task parts makes that easier, and having a system for how we do the thing means we can restart that system. Even so, the task needs to be put into a safe state to resume – we can’t just walk away and come back to it if it is in mid-process. Often we will just start again, and that is horribly expensive. That’s where modularising the task helps, we can rewind to the last module end rather than the very beginning.

Dumping the system for this task means purging our general brain of a number of things that made this task work well. These mini systems likely aren’t compatible with the next task, so dump them. We may load up a new task that seems similar, but it often is specifically different thus not really compatible.

– if we can find a more generic base task routine that just has minor tweaks for different settings, this can optimise how we do this bit, making it cheaper to run, more adaptable and take less time to switch tasks.

Loading the new system takes some time and some energy. The harder the new task is, the longer it takes and the more energy it requires. Our body supplies us with a release of adrenaline to empower these changes. If our next task involves something costly, we get more adrenaline. Costly for me is often something that requires complex preparation or lots of people. What is costly for you may be different.

Mostly Adrenaline, both neuronal and body, was present in minor amounts during the previous task. It’s sudden presence is cognitively unexpected. The emotion centre in our brain, generally the Amygdala, but may include the Thalamus and HypoThalamus, try to figure out a reason for the adrenaline. The emotion centre conveys the a reason to the frontal lobes in terms of a feeling via the fundamental 6 biological feelings: joy, fear, anger, sadness, disgust or surprise. Adrenaline is most often interpreted as fear (anxiety) or anger (aggression).

Anger can be heightened when a task is left unfinished or not in a safe state. Anger can be heightened when the next task is not friendly, such as too sensory stimulating, too boring, too many people, too much expectation etc. Anger can be heightened when there was insufficient warning of change. Anger can be heightened when the task switching is rushed.

Managing PDA

Prevention is better than cure

There are a few things we can do to minimise the disruption of task switching.

Knowing the Plan

Surprise is lovely for some, but generally very unpleasant for Autistic Folk.

With some notice of what is coming, we can begin preloading routines to manage what we expect will come. With too much warning, we can get anxious about it. Finding that fine line is sometimes tricky, but generally knowing sooner rather than later is best.

When the plan changes, it is important to know that it is changing. If the options coming are too many, that too can overwhelm, at which point it is better to be told “the plan has changed, but we don’t know what to yet – I’ll let you know as soon as I can” than frequent updates of change, each of which require loading and unloading routines. It doesn’t take long for PDA to kick in and state “stuff that, I’m not doing anything now”.

Having a default plan is very good. Such as “if we don’t get a better option, we’ll do this [the plan]”. Having a few branches is fine, but not too many. In programming speak “if then that” clauses. For example “If Sam gets back to me by 5pm, we’ll go to the restaurant. If Sam doesn’t, we’ll go home.” Then let them know that Sam did respond, or that 5 pm has happened and so we are on to Plan B.

Warning of Change

I like to have a few minutes notice of when I need to put a task down and put it into a safe state before halting. I find that with many Autistic Folk, a 5 minute warning, a 1 minute warning and then a 10 second countdown are generally sufficient – especially for kids. If the task is more complex / fiddly, then more time may be needed.

Snackrifice aka Food Bribes

Low neurotransmitters and blood sugar can heighten a PDA response. We can prevent this by a small discrete snack at about 5 minutes prior to the change.

We want the snack to contain a bit of sugar and fat, and be a safe food for the person (where safe is something they can generally eat re ARFID, and not likely to trigger a food intolerance, eg chocolate and gluten are bad for me). If appropriate, a more nutritious mini meal can be done once this task is finished.

During the Task Change

Hopefully we have put the first task to bed. Before starting the next task, some things may need to happen.

Tea Break and Enteroception

It is often important to have a bit of time between letting the prior task go and loading up a new task. We’ll call this a tea break.

This is a good time to practice enteroception – the self diagnostic body check. Meds, food, drink, toilet and mood.

Is medication due to be taken? A good time to do so. Generally much better than when you are in the middle of something.

This may involve restocking the body with some food. This may be an opportunity to have a bit of caffeine (if appropriate), and or a more substantial and likely nutritious snack, than the end of task ‘bribe’/lubricant.

This is also a good time to have a toilet break as many folk hyper focus through bodily needs to get things done.

Managing Mood – The ‘Nope’ Response

How is your mood? If you are struggling with mood, have a drink of water, have some food and go and wash your hands (washing your hands often symbolises renewal, making it easier to let things go and start a new thing, a reason why it can be OCD addictive, so don’t over do it).

Now recheck – how is your mood?

If you are having a strong “Nope” response to the next task, go back and check to if you need to take medication, have some food or go to the toilet if you missed one of those steps. If you didn’t miss any of those steps, give yourself a few more minutes for your adrenaline to reduce. It can take up to 15 minutes for your body to return your Adrenaline back to normal values. This can be hindered by focusing on how much you don’t want to do a thing, or on other urgent fear / anger thoughts. It can be sped up by doing some of your calm down exercises – mostly breathing exercises, singing/ listening to music and distraction from the worry / anger thoughts.

Once this has settled, then you can start thinking again and making rational decisions.

Reorientation, Checking the Plan

Once you’ve had your Tea Break / Enteroception Self Management, it is time to review the future.

Is what you expected to happen next what is still needing to be done? Do any modifications to that plan need to happen? To you need to grab any items to help you?

If you are supporting someone else, this is a good time to talk to them about what is going to he happening next and when it needs to start. This can also be an opportunity to prompt someone to get a fidget toy or comfort item if they are struggling.

Limited Choice

There are two important aspects to this section. The first is to recognise that too many choices can lead to decision paralysis. Try to limit choices to 2.5. “Do you want an apple, a sandwich or something else?” If the person is managing this okay, then all good.

If the person is not managing this, then simplify to binary choices “Do you want an apple? No? How about a sandwich? No? Do you know what you want? No. Do you want to not eat right now? Yes. Okay. Would you like some comfort? Yes? A hug? Okay then, come here.”

The second is to give a person some limited choice on how to get to the next task. For example, “We are leaving for our appointment in 5 minutes. Do you want to listen to some music in the car, or do you want to read a book?” The bit that isn’t a choice is what has to happen, the bit that is a choice is how that is going to happen.

Get on With It

The last thing to do is start on the new task. You may be uncomfortable with it for a few minutes, and that is okay. If you are still uncomfortable in 30 minutes, then it is time to re-evaluate if this is the thing you should be doing. Sometimes we have no choice, but often we do. This is more true for adults than children, who rarely get much of a choice – check out Limited Choices above.

Hopefully that gives you some understanding about what PDA is, what drives it, and what you can do about your own or someone else’s PDA.