Pathological Demand Avoidance (PDA) and Oppositional Defiant Disorder (ODD) are two conditions that share similarities but are distinct in their nature. Both are characterized by intense resistance to requests or tasks.
However, while PDA is proposed as a subtype of autism spectrum disorder, ODD involves a persistent pattern of defiance, arguing, and refusal to follow directions, particularly with authority figures.
Understanding the differences between PDA vs. ODD is crucial for effective diagnosis and intervention.
Download your FREE guide on
Autism Behavior Interventions
Understanding Pathological Demand Avoidance (PDA)
Pathological demand avoidance (PDA) is generally attributed to autistic individuals. Those with ASD and PDA will often display significant adverse behaviors upon being told to perform what others may attribute as daily tasks or routines
Similarly, it can be triggered when these persons are directed to do something challenging, even if it may be something they wish to do.
Pathological demand avoidance is not considered a formal diagnosis in the United States as it has not been included in the latest edition of the Diagnostic and Statistical Manual (DSM-V). It is considered more of a potential component of ASD.
It should be noted that PDA is not triggered by defiance of being told to do something. Instead, the person avoids the request or demand based on anxiety about everyday tasks or challenging demands.
It is estimated that approximately 10% of those with ASD also may be categorized as having PDA. Further, it is noted that as many as 30% of those with ASD may show some traits of PDA as well.
Understanding Oppositional Defiant Disorder (ODD)
Oppositional defiant disorder (ODD) is a formal DSM V diagnosis that is generally diagnosed during childhood.
ODD is categorized by a chronic pattern of arguing, anger, or irritation towards those who are perceived to be figures in authority. These can include parents, teachers, administrators, coaches, or law enforcement.
Those children with ODD are more apt to:
- argue with others,
- display vengeful behavior when limits are placed upon them,
- have difficulty taking responsibility for their behavior,
- exhibit malicious behavior at least twice in the six months previous to their diagnosis.
It is unknown what the actual cause of ODD may be. However, it is theorized that a complex interplay of genetics and environmental causes may make a child more apt to display these behaviors.
It is estimated that between 1-11% of children fall into the category of oppositional defiant disorder, with the overwhelming proportion of children being male.
PDA vs ODD: The key differences
Initially, it may seem that the behavior of both those with PDA and ODD looks quite similar. That being said, there are some very notable differences between the two issues.
Motivation and emotional responses
The motivations for the aggressive response between ODD and PDA are also very different. Those with PDA are displaying behavior primarily from an anxiety-based reaction to avoid a demand that is placed upon them.
Those individuals with ODD are responding from a place of anger to control the situation that they perceive those in authority are trying to assert over them.
For instance, when you ask a person with PDA to do an assignment, they may respond with excuses or react harshly. This is not because they don’t want to do the homework. Instead, it is because they have anxiety and are overwhelmed about even starting the task.
Like what you’re reading?
UNLOCK FULL ACCESS (50%OFF)
In contrast, a child with ODD may not wish to do the homework and react with anger because it is a figure of authority telling them what to do. They don’t want to follow the rules and constraints they perceive are being placed upon them.
Social skills and defiance patterns
Those with PDA will typically have good surface social skills and utilize them to attempt to avoid demands and routines that they deem anxiety-provoking.
Those with ODD tend to have social skills that are typical for their peer group. However, due to their history of defiant behaviors, they may have challenges in maintaining relationships.
An example of this may be that a child with PDA will try to talk their way out of doing a chore and use their social skills to distract from the task at hand due to anxiety.
Meanwhile, a child with ODD will react with anger and defiance when given an identical chore because they don’t want to release control to a person who they perceive as a figure of authority.
Behavioral and defiance patterns
Those with PDA will generally avoid demands that they perceive as creating anxiety and will respond in this same manner, regardless of whether it is a figure of authority, peer, or parent.
When looking at those with ODD, they tend to be more likely to refuse or become defiant toward those figures they see in authority. They may respond positively to others who make the same demands, depending on their viewpoint of that person.
Download your FREE guide on
Autism Behavior Interventions
PDA is driven by anxiety, causing resistance to demands that feel threatening. Because of that, people with PDA may be rigid in stressful situations but more flexible in others.
Those with ODD tend to display a primary emotion of anger versus anxiety. They will be less apt to be flexible when it comes to their motivations or being asked to follow the rules.
Managing PDA and ODD
Despite some similarities between PDA and ODD, we intervene in both of these conditions in a vastly different manner in most cases.
In the case of PDA, try to lessen direct requests and offer choices whenever possible. Doing so gives the child the ability to feel that they have some control over the situation, and this reduces feelings of anxiety.
Additionally, predictability and routine are equated with safety for those with PDA, so provide them with a routine that can help them understand what to anticipate. Teaching coping skills such as mindfulness and breathing can be very helpful in this regard as well.
Individuals with ODD can benefit from therapy, including cognitive behavioral therapy (CBT), to address negative thought patterns. Parental enrichment programs can also help reinforce positive behaviors consistently.
Teaching these children how to establish assertive conflict resolution skills versus an aggressive and defiant handling of problems can also be highly beneficial.
Similarities between PDA and ODD
At first glance, PDA and ODD have several characteristics that overlap. Both involve refusal or defiance to do a particular activity. In both cases, the parent or authority figure may see anger and defiance toward following a specific direction.
Additionally, in both PDA and ODD, one may see arguing, defiance, and refusal. When asked to do a task, the irritability or sudden behavioral change may even look similar.
The primary contrast is the trigger and reason that lies behind the behavioral response (i.e., anxiety versus anger and defiance).
Supporting your child’s unique needs
Ultimately, you know your child best and what may be behind the motivations for their behavior. Suppose the foundation behind their refusal to follow directions is anxiety. In that case, there are many effective means of dealing with such behavior that will decrease the level of PDA.
Suppose the cause is defiance towards figures of authority, as is the case in ODD. Many effective interventions in anger management and parenting skills also exist to help with this challenging disorder.
Whichever issue you are dealing with, remember it is your patience and perseverance that ultimately will prevail over the challenges of either issue.
FAQs
Q: Is ODD on the spectrum?
A: No, oppositional defiant disorder (ODD) is not a part of the autism spectrum disorders. That being said, a significant portion of children with ASD may exhibit some of the symptoms of ODD at one time or another.
Q: Can you have PDA and not be autistic?
A: Yes, it is possible to exhibit PDA behaviors and not have autism. Many other conditions (such as ADHD) or other anxiety-based disorders can foster PDA in children.
Q: What are the examples of PDA behavior?
A: In looking at PDA, several examples can be found that highlight these behaviors. These include excessive procrastination when asked to do a task that may be deemed challenging, irritability or anger when asked to do a chore or task, difficulty in handling any change in routine, behavior that is obsessive in nature, as well as difficulty with sensory stimuli.
Q: What does PDA look like in an adult?
A: Similar to PDA in children, adults exhibit many parallel symptoms. These include having significant difficulty with change in routine, avoidance of complex or anxiety-provoking tasks, irritability or low frustration tolerance, or obsessive behavior.
References
O’Nions, E., & Eaton, J. (2020). Extreme/‘pathological’ demand avoidance: an overview. Paediatrics and Child Health, 30(12), 411-415.
Petrucciani, S., & Recchia, C. (2014). DSM V. s.n.
What is PDA? – PDA North America. PDA North America -. (2024, November 2). https://pdanorthamerica.org/what-is-pda/
Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., Le Couteur, A., & Baird, G. (2018). Pathological demand avoidance: symptoms but not a syndrome. The Lancet Child & Adolescent Health, 2(6), 455-464.
Burke, J. D., & Romano-Verthelyi, A. M. (2018). Oppositional defiant disorder. In Developmental pathways to disruptive, impulse-control and conduct disorders (pp. 21-52). Academic Press.
Hawes, D. J., Gardner, F., Dadds, M. R., Frick, P. J., Kimonis, E. R., Burke, J. D., & Fairchild, G. (2023). Oppositional defiant disorder. Nature Reviews Disease Primers, 9(1), 31.
Hinze, E., Attwood, T., & Garnett, M. Differentiating Pathological Demand Avoidance in Autism from Oppositional Defiant Disorder.
Woods, R. (2023). ” Pathological Demand-Avoidance”(PDA): A” pathological”/extreme avoidance to its hype. ECHO Autism Summer Pop-up Session: PDA.
Duncan, M., Healy, Z., Fidler, R., & Christie, P. (2011). Understanding pathological demand avoidance syndrome in children: A guide for parents, teachers and other professionals. Jessica Kingsley Publishers.
Hood, B. S., Elrod, M. G., & DeWine, D. B. (2015). Treatment of childhood oppositional defiant disorder. Current Treatment Options in Pediatrics, 1, 155-167.
Frick, P. J., & Nigg, J. T. (2012). Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Annual review of clinical psychology, 8(1), 77-107.
O’Nions, E., & Eaton, J. (2020). Extreme/‘pathological’ demand avoidance: an overview. Pediatrics and Child Health, 30(12), 411-415.
