Written by: Lindsay Brown, MS, BCBA, LBA Behavior Analyst
Individuals with Autism Spectrum Disorder (ASD) often present with comorbid disorders; some in the physical realm, such as gastrointestinal issues or hypermobility, and some in the mental realm, such as Attention-Deficit Hyperactivity Disorder (ADHD) or complex Post-Traumatic Stress Disorder (cPTSD). One diagnosis that frequently appears alongside Autism is Oppositional Defiant Disorder, also known as ODD.
A profile of ASD that is similar to ODD and yet is distinctly separate condition is known as Pathological Demand Avoidance (PDA). PDA cannot be diagnosed like ODD because it is not in the Diagnostic and Statistical Manual – Fifth Edition (DSM-5); and the specific symptoms align with ASD symptoms, just in different ways than other individuals with ASD.
Despite these differences, both diagnoses share something in common – they describe how the observer feels in the interaction, not what the child or individual is feeling. While there is a trend for ODD to seem more anger-based and PDA more fear-based (every individual is different!), both can indicate that the child/individual is experiencing a combination of extreme anxiety/stress over a perceived loss of control and a lack of trust toward others, especially those in positions of authority. While individual differences are present, it’s helpful to remember that when feeling threatened (and for this population, any instruction or even talking to them can be perceived as a threat), children may engage in fight-or-flight behaviors, which may seem aggressive or avoidant to the observer who is unaware.
To address this misunderstanding, autism advocates have started using the term ‘Pervasive Drive for Autonomy’ to relabel PDA. To many, this is a more accurate representation to how the child feels – the drive to avoid stress and anxiety (especially anxiety that manifests in the body), and to feel in-control takes over their whole life. Individuals with the PDA profile even describe that even if they want to do something, their body may perceive it as a threat and they can’t even do things that they have the desire to do.
To better understand each condition, here’s a closer look at how they compare.
ODD vs PDA: Similarities and Differences
Oppositional Defiant Disorder (ODD) is a behavioral condition that is typically diagnosed in early childhood or in teenage years. Typical symptoms of ODD include angry demeanor, irritable mood, argumentative and defiant behavior, vindictiveness, resulting behaviors cause distress to self or others, and negative impacts on independent functioning.¹
Pathological Demand Avoidance (PDA) is a non-diagnosable profile of ASD that describes the specific combination of ASD symptoms. Typical symptoms of a PDA autism profile include resistance to everyday demands (even simple routines), an overwhelming need to be in control, frequent mood swings, socially manipulative behavior, obsessive behavior, and more comfortable pretending than being present in the moment. Lack of personal hygiene, staying up late at night, and excluding one’s self from social situations are often common. One study on PDA individuals suggests that approximately 20% of autistic individuals demonstrate some combination of PDA traits in childhood, while only 4% of the study’s sample population displayed the full profile of associated traits²; indicating that the understanding of PDA and its presentation in the general population is still evolving.
Both ODD and PDA share similar risk factors, including familial neurodiversity (specifically ADHD), sensory processing difficulties, presence of anxiety disorders in the person or close relatives, high levels of stress, emotional and/or physical dysregulation (the inability to process or manage sensations/feelings), and are associated with authoritarian parenting.³
Treatment for ODD/PDA
When exploring treatment for ODD or PDA, it is important to consult a behavior analyst that is experienced in modifying ABA protocols to meet individual client needs. The specific interventions for ODD vary from PDA interventions, but there are some general tips that can be used for both:
Build a trusting relationship
Spend time doing things that your child likes to do. Model positive self-talk and encourage your child to use positive self-talk. Congratulate your child on both their accomplishments and the awesome parts of their personality. Cultivate the parts of them that you would like to see grow.
Explain decisions when possible
Children with these conditions are often highly intelligent and insisting on compliance (“Because I said so!”) just frames you as untrustworthy. Understanding the ‘why’ goes a long way for most kids. If you can’t explain the why, try to frame how it will be beneficial to the child.
Don’t shame or blame
Children are still learning to control their emotions and behaviors. They are also trying to figure out who they are. Telling them or others around them how ‘bad’ their behaviors are just teaches them that ‘bad’ is who they are as a person and it will shape their behavior in the wrong direction. Try only talking ‘good’ about them in front of others – it will likely start changing how they see themselves and ultimately their behavior.
Work on the deficits
Both ODD and PDA are linked to working memory impairments, whether due to stress/anxiety or the memories not being stored properly in the brain. It’s helpful to communicate in a way that supports their working memory instead of commenting on their deficits (e.g., “I often see your shoes in the living room when you get home. I wonder if they’re in there or in the kitchen” instead of “Why can you never find your shoes? You always lose them!”. Additionally, a lot of these children struggle with sensory processing, which adds a layer of difficulty to recognizing and stopping extreme emotions from spiraling. Model labeling sensations that go with emotions so that they can start recognizing when they’re becoming upset (e.g., “I’m starting to get a headache and my belly feels like someone’s squeezing it; I must be getting anxious. I better go sit in a quiet room right now until I feel better.”)
Break down big tasks
Complex tasks feel scary and overwhelming and a PDA child is more likely to quit before they ever begin. Transitions in general tend to also be a big issue – all that change is stressful! So break big tasks into smaller pieces (e.g., “Pick up the blue things in your room” or “Pick up the books in your room” vs “Clean your room”).
Give choices
Give the gift of structured choice. Do you need them to sit, but know that asking directly will cause a problem? Ask which color chair that they want – they get a choice but still have to do the action. Instead of telling them that it’s time to shower, ask if they want to listen to Frozen or Trolls in the shower. It makes them feel like they have some control over their situation.
Make the environment the ‘bad guy’
Since there’s a link to lack of trust in others and defiant behavior, you can make demands come from the environment – alarms, signs, or other environmental modifications can lessen the motivation to avoid demands, since they didn’t come from a specific person. A lot of kids with ODD/PDA also struggle with working memory, especially when instructions were presented verbally, so using visuals to signal demands instead of saying them might help.
Encourage autonomy and give preferred responsibility
These kids want to be in control, so work with them on safe and acceptable ways to be in control. Struggling to stick to a workout plan? Tell your child they can ‘punish’ you by fining you a dollar for every day you don’t work out. Your spouse forgot to put the dishes in the dishwasher? Your child can be the dishes police and come up with a solution to remind people to put their dishes away. Give them control in creative ways. It teaches them how to handle responsibility and collaborate with others.
While these tips can help, navigating ODD/PDA by yourself can be very overwhelming. To really address the behaviors and core skill deficits, consult an experienced Board Certified Behavior Analyst (BCBA) who can observe your child and generate a thorough treatment plan. A good treatment plan will focus on ensuring that 1) the child can communicate their needs efficiently, 2) the child can tolerate barriers to access and demands, and 3) the child can understand their own body sensations and ultimately their emotions. Please reach out to Already Autism Health at 866-598-4571 to see if our experienced behavior analysts can help you and your family navigate ODD/PDA.
Here are some additional resources worth checking out:
- The Parent’s Guide to Oppositional Defiance Disorder – Amelia Bowler, BCBA
- Declarative Language Handbook – Linda Murphy, SLP
- Interoception Curriculum – Kelly Mahler, OTD
Citations
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Gillberg, C., Gillberg, I. C., Thompson, L., Biskupsto, R., & Billstedt, E. (2015). Extreme (“pathological”) demand avoidance in autism: A general population study in the Faroe Islands. European Child & Adolescent Psychiatry, 24(9), 979–984. https://doi.org/10.1007/s00787-014-0647-3
- Mayo Clinic Press. (2025, November 4). The 4 types of parenting styles: What style is right for you? https://mcpress.mayoclinic.org/parenting/what-parenting-style-is-right-for-you/
