Why “Just Be Firmer” Doesn't Work:Understanding PDA
Pathological Demand Avoidance (PDA) is a neurodevelopmental profile most commonly associated with autism. Many professionals and advocates now prefer to call it a
“Pervasive Drive for Autonomy,” which better captures what's actually happening: a deep, often involuntary need to maintain control in order to feel safe. In the world at large, it’s just called PDA, including by PDAers themselves. Like me.
People with PDA experience an intense need to avoid everyday demands and expectations. This isn't laziness or willfulness. It's because those demands trigger anxiety that feels overwhelming or even threatening.
Here's what makes PDA particularly confusing: the avoidance can apply not just to unwanted tasks, but even to things the person enjoys or has chosen themselves. The moment something becomes a “demand” – an expectation with a time or a structure attached – it can become impossible to follow through on.
At its core, PDA is anxiety-driven. The key word is anxiety. This is about a nervous system that perceives demands, even small ones, even enjoyable ones, as threats.
Understanding Neurodiversity-Affirming and Trauma-Informed Care: A Different Path to Healing
Neurodiversity-affirming care doesn't see autism, ADHD, or other forms of neurodivergence as disorders that need to be cured. Instead, it recognizes that different brains have different needs, different strengths, and different ways of navigating the world. The focus shifts from trying to make someone “normal” to helping them thrive as their authentic selves.
Seasonal Transitions and Neurodivergence
Over the past 8 years of work with neurodivergent children and adults, I’ve noticed an intriguing phenomenon. Every spring and fall, as well as at other times of the year where there are major changes in weather patterns, the neurodivergent people with whom I’m involved seem to experience a significant increase in dysregulation. When I was still a school-based therapist, this would show up as meltdowns, shut-downs, school avoidance, anxiety, and difficulty focusing and maintaining behavioral expectations in class.
Now that I work primarily with adults, I see more issues with increased difficulty in basic functioning, volatile moods, depression, anxiety, and sensory overload. It has seemed to me, the more I’ve thought about this and observed this phenomenon, that neurodivergent people of all ages experience major changes in weather patterns and circadian rhythms as stress, with all the impacts that stress has on vulnerable nervous systems…
Resources for Neurodiverse Couples
Given that I specialize in working with neurodivergent people and their loved ones, I often come across situations where a client is in a relationship with someone of a different neurotype, which is a common source of conflict, communication problems, and distress. I’ve also experienced this personally, as an autistic person who has had an active romantic life for 40 years and has been married twice. Autistic people, ADHDers, and neurotypical folks communicate and relate in very different ways, with very different expectations. Dr. Damian Milton pinpointed the core issue in his “double empathy problem” concept, introduced in 2012, which at its core can be summarized thusly: people of the same neurotype (autistic to autistic, ADHD to ADHD, neurotypical to neurotypical) generally communicate and understand one another quite well. It’s when we cross neurotypes (autistic to ADHD, for example) that we run into problems. It isn’t, as conventional “wisdom” might tell us, that autistic people have poor social skills or don’t know how to communicate. It’s that our patterns and expectations and interpretations and modes of communicating are just different. From a neurotypical normative perspective, that’s viewed as a “deficit” or “deficiency.” But watch autistics interact with each other, and you’ll see we generally do just fine.
Ask an autistic like me to communicate with an ADHDer, however, and hoo boy, do we have problems. Before I’ve even begun to formulate my thought, they’re on to the next topic, and their constant interruptions (as their brains are exploding with ideas and associations and new topics) feel to me like repeated train derailments. And to the ADHDer, my droning on and on about all the nuances of a topic they (believe they) got within the first 15 seconds after I started speaking sound like the Peanuts teacher, and all they hear is “wah wah wah.”
The complicated question of diagnosis and disclosure
Within my home, there has been frequent debate about whether or not the whole concept of autism – and diagnosis of any kind, whether it be autism, depression, anxiety, or whatever – is relevant or helpful.
My wife, who is a psychotherapist herself with 20 years of experience, was the one who first started calling attention to the possibility that I might be autistic. At the time, I dismissed the idea. I’d been working with autistic children and their families for years and thought I knew what autism looks like. (I did – in children who are heavily impacted, non-verbal or only marginally verbal, mostly boys and mostly under 10 years old.) I was not yet educated on the full range of neurodivergence, like most therapists – indeed, like most people, including all too many professionals who specialize in autism. I wrote off my autistic features as the legacy of complex trauma and chronic toxic stress.
It was only when I went into private practice and started working with a broader range of autistic adults that I started taking the idea more seriously. Especially when my clients started calling me out (gently, and with great kindness and humor) on my “tisms.”
Eventually, as my practice became increasingly focused on neurodivergence-affirming therapy, it started to feel increasingly inauthentic to answer the most common question potential clients would ask – “Are you autistic yourself?” – by saying “I don’t know, my wife thinks so.” How could I truly support people who were newly diagnosed, on the path of discovery, or wrestling with the complex questions around autistic identity when I had avoided walking this path myself?
Relational Neuropsychology: How It Shapes My Therapy Approach
Over the years, both personally and professionally, I have sought to understand the ways in which relationships—both early and ongoing—shape our emotional and nervous system responses. My lived experience, combined with extensive study and clinical practice, has led me to develop a therapy approach grounded, in part, in relational neuropsychology.
Relational neuropsychology has its roots in attachment theory and neuroscience, with key contributions from researchers such as John Bowlby and Mary Ainsworth, who pioneered attachment theory, Allan Schore, who explored the role of early attachment in right-brain development and affect regulation, and Stephen Porges, who developed Polyvagal Theory to explain how the nervous system responds to social engagement and threat. Daniel Siegel and Louis Cozolinoexpanded this work by integrating neuroscience with psychotherapy, emphasizing the importance of interpersonal neurobiology. Jaak Panksepp, a pioneer in affective neuroscience, identified core emotional circuits in the brain that underlie our relational and emotional responses.