Clearing Up PDA Theory

Beyond High Demand and Low Demand: A Flexible Approach to PDA

By Michaela Gordon, OTR/L

Over the past year, conversations about PDA (Pathological Demand Avoidance) have grown louder — and sometimes more divided.

Some voices emphasize nervous system safety above all else.

Others emphasize skill-building and resilience.

Many parents are left wondering where they fit in that spectrum.

This post isn’t here to take sides. It’s here to widen the lens.

Because children are complex. Development is complex. And no single explanation captures every child fully.

 


What Is PDA?

PDA was first described in the 1980s by psychologist Elizabeth Newson in the United Kingdom. It is not currently listed as a separate diagnosis in the DSM-5 or ICD-11.

Today, PDA is generally described as a profile seen in some autistic children. Common characteristics include:

  • Intense resistance to everyday demands

  • High anxiety

  • Strong need for autonomy

  • Emotional reactivity

  • Periods of shutdown or escalation

Many children described as having PDA traits also meet criteria for autism. Whether it is a subtype, profile, or overlapping presentation is still debated in research.

What is clear is this: the children described under this profile often experience demands as disproportionately stressful.


The Nervous System Explanation

In some communities, PDA is described primarily as an autonomic nervous system response — meaning everyday demands are perceived as threats, triggering fight, flight, or freeze.

From this perspective, reducing demands (often called a “low-demand approach”) is seen as protective and supportive. Many families report that lowering pressure reduces conflict and improves connection.

That makes sense. When stress decreases, capacity increases.

But regulation is influenced by more than one system.

A child’s ability to handle demands may be shaped by:

  • Autonomic nervous system state

  • Sensory processing patterns

  • Executive functioning skills

  • Cognitive flexibility

  • Motor planning abilities

  • Interoception (body awareness)

  • Environmental stress load

No nervous system exists in a permanently fixed state. Capacity shifts day to day.

When a child struggles more than usual, that is not regression. It is responsiveness to stress.


Regulation First — But Not Regulation Only

You may hear the phrase: “Regulate first, then proceed.”

This is important. Children cannot learn new skills when they are overwhelmed.

But it’s also important to remember something else:

Learning always involves some stress. Trying something new, losing a game, making a mistake, or shifting plans. Discomfort is part of growth. The goal is not to eliminate stress completely.

The goal is to keep stress in a manageable range. Too much stress leads to shutdown. Too little stress can prevent growth. Supported stress builds resilience.

When a child shows intense avoidance, it signals that their stress system activates quickly. In those moments, the adult’s role is to stay regulated, stay connected, and calibrate the level of challenge carefully. We do not abandon expectations. We adjust the path toward them.

Safety means we do not push a child past their limit for the sake of compliance. It does not mean eliminating all discomfort. Children need safety from overwhelm. They also need experiences that build mastery.


The Risk of Over-Reduction

When PDA is explained solely as chronic nervous system flooding, there are potential risks:

  • Assuming dysregulation is permanent

  • Removing developmental challenges entirely

  • Reinforcing avoidance instead of building skills

  • Overlooking executive or motor skill gaps

In the short term, reducing demands can bring real relief. Stress lowers. Conflict decreases. Relationships stabilize. That matters!

But children described as having PDA traits also have goals.

They want friendships, competence, and  independence. They want to grow.

The struggle is rarely a lack of desire. It is often an internal conflict between overwhelm and expansion.

Too little challenge can quietly narrow a child’s world.

This does not mean children need more pressure.

It means they need calibrated support. The goal is not high demand and it’s also not no demand. The goal is thoughtful demand — challenge matched to capacity, inside connection.


From Low Demand to Flexible Demand

 

Rather than eliminating demands indefinitely, I propose a concept I call Flexible Demand — adjusting expectations to match a child’s current regulation bandwidth. 

 

Within this framework, I conceptualize support in bands — reflecting a child’s regulation bandwidth — rather than fixed, progressive levels. 

 

Children move fluidly between support bands, as internal and external factors continually shift their window of tolerance. This movement is not necessarily regression —it is responsiveness to changing demands and environments.

 

Band A – Stabilization Mode

Reduce performance pressure. Increase predictability. Simplify tasks.

Band B – Scaffolding Mode

Introduce just-right challenges. Use collaboration. Gently expose to manageable discomfort.

Band C – Expansion Mode

Increase autonomy. Reduce scaffolds. Allow natural consequences with emotional availability.

Movement between bands is expected and healthy.


When Behaviors Feel Severe

It is also important to recognize that not all intense avoidance is purely developmental.

If you notice:

  • Sudden regression in skills

  • Extended mutism

  • Prolonged shutdowns

  • Episodes of unresponsiveness

  • Self-injury or dangerous aggression

  • Abrupt changes in baseline functioning

Medical or mental health evaluation may be appropriate.

Conditions such as seizure disorders, mood disorders, catatonia in autism, or other co-occurring challenges can sometimes present in ways that look like extreme avoidance.

Seeking clarity is not a failure. It is advocacy.


We’re Better Together

There are many conversations happening right now about PDA. Some prioritize nervous system safety. Others emphasize skill-building and graded exposure. Some focus strongly on autonomy. Others on structure.

Underneath the different language and models, most parents and professionals share the same goal:

We want children to feel safe, understood, and to grow into capable, confident humans.

We do not have to choose between compassion and challenge.

We do not have to choose between safety and growth.

These ideas do not compete.

They can work together.

If we stay curious instead of defensive…

If we stay collaborative instead of divided…

If we remember that no parent is trying to harm their child…

Then we are already moving in the right direction.

 

If this framework resonates with you, I’ve created a more detailed parent guide that expands on these ideas and offers practical examples of using the Flexible Demand model in everyday situations. 

 

If you’d like a copy, feel free to reach out – I’m happy to share it. 

OT Meets Raising Lions

 

 

    As an OT, I have searched endlessly for an effective behavioral approach for children with sensory processing challenges. I was lucky enough to meet Joe Newman, author of the book Raising Lions. In a short period of time, I was on a trajectory to work with him, adopting his philosophy to address behavioral challenges, and assisting families in the Santa Barbara community with using his approach.

 

 

It is the responsibility of all adults working with children to address behavior. In my opinion, it is important that the child and the adult feel emotionally safe to express themselves and that everyone feels respected. Without these healthy boundaries, deep connections will be difficult to foster and children will struggle to understand the balance between their needs and wants and those of others.

 

 

In my practice I work with many children that have sensory modulation challenges. Sensory modulation refers to the brain’s ability to respond appropriately to incoming sensory stimulation in order to maintain an appropriate level of alertness so that the child’s responses match the situation within a reasonable range.

 

 

 Some children over-respond to sensory stimulation causing strong emotional reactivity, impulsive action, and intense physical responses such as crashing, bumping, excessive touching, excessive movement, and/or loud singing or talking. These children often have poor emotional control and can become oppositional and irrational in their behavior. On the other end of the spectrum are the children that are under-responsive. These children are passive and often miss sensory cues. They have difficulty with keeping up with peer interactions and often need support to complete daily activities. These children are prone to having passive tantrums. Due to their chronic low arousal, they become accustom to others initiating tasks for them or in some cases doing the tasks for them. It can be challenging for adults to recognize these children’s level of ability because they will express they don’t know how to do something or that the task is outside of their abilities even when it’s possible that they could do the task.

 

 

I believe we need to recognize these children’s struggles, but we can’t let this block us from seeing their capabilities. These children need both empathy in regards to the challenges they face, but also good boundaries and effective tools so they can learn needed developmental skills.

 

 

In OT, we work with children with sensory modulation challenges by presenting them with different types of therapeutic sensory activities that have either an excitatory and/or inhibitory properties so the child can learn how to get into and maintain a level of alertness that allows them to interact with their environment in a meaningful and productive way.

 

 

When working with children with sensory modulation challenges, we also have to address the behaviors that arise due to the nature of these challenges. With the Raising Lions approach, I have found success in helping children learn impulse and emotional control because of the opportunities that the method’s 1-minute breaks provide. Here is why I feel the method is effective:

 

 

      1. It’s relational. As an occupational therapist, we work not only with the whole person, but the dynamical responses within the child’s relationships. Raising Lions is a relational approach. It respects the child’s autonomy, but also works towards interdependency with others.
      2. It’s non-judgmental. Children with sensory modulation issues are usually up against a lot of criticism because their behaviors are typically inappropriate during their daily interactions. Raising Lions approach provides boundaries in a non-judgmental way so the child doesn’t start to take on the image of the villain, class clown, or helpless victim to name a few.
      3. It’s a non-stimulation protocol. Getting stickers, losing tokens,  and long explanations are all excitatory mechanisms for a child with over-responsive modulation issues. These approaches may work short term, but usually become ineffective over time. The child heavily relies on these systems and they often do not correct the actual issue, modulation. The Raising Lions method allows the therapist to stop all activity in a very neutral and natural way.You can then have the child re-enter the activity or therapeutically change the factors to achieve what we call the “just-right challenge” so the child can achieve regulation. Basically, it allows the child an opportunity to harness his/her ability to manage incoming stimuli without adding more stimulation, which prevents over-stimulation.
      4. It gives the parents and the child a blue print and clear options. Children with modulation issues typically don’t respond to standard parenting practices such as timeouts, sticker charts, and long talks about behavior. It’s because these children are responding to impulses and their actions are typically ahead of their thinking. The child’s states of dysregulation can dysregulate the family system, leading parents to strategies such as bribing, threatening, caving in or other desperate attempts to gain control of the situation. Raising Lions helps parents to learn to stay calm and neutral. It helps the parent to regulate and detach from the child’s behavior, which creates an environmental opportunity for the child to learn how to modulate in small durations of time. It helps the parents do the same, and the therapist and…it’s a win-win!

    Examples of how I use the protocol in therapy sessions:

     

        1. I want to get Johnny ready to do some coordination activities, but he’s crashing and rolling on the floor and grabbing everything in sight. His mother tells me he started off his day like this and also reported he had a hard day at school. I’m thinking he is over stimulated and I want to give his sensory system some organizing input. He decides out of a choice of two activities that he wants to bounce and roll on a therapy ball while listening to a song with a steady beat. While doing this, Johnny starts to sing in a loud voice and he begins to slam his hands loudly against the ball. Instead of telling him to stop, lower his voice, or take the ball away, I ask him to take a minute. I turn off the music and wait for him. When he is done, we return to the task. I continue to do this until he shows modulation while on the ball. Johnny is learning to regulate in two ways. One he is taking the small breaks which allows him to make a different choice in how he’s interacting during the task and two, he’s learning how to use offered tools in an effective way to positively influence his neurology.
        2. I have asked Suzie to start practicing her letters in her handwriting book. She has already done some preparatory sensory work to get her ready for this task, but Suzie really dislikes writing and she definitely doesn’t like to use a pencil grip. While writing, I notice her move the pencil grip up the pencil. We have already discussed the purpose of the grip and she knows it is part of the process so I don’t lecture her. I ask her to take a minute. She returns and I then notice that she is writing the letters excessively large and  she is looking at me to see my reaction. I calmly ask her to take another minute and when she returns we redo those letters. Using the Raising Lions approach in this situation is helping Suzie move through the discomfort of using muscles she is not use to activating due to the grip and it is also helping her to learn emotional control during a non-preferred task.
        3. Bobby is playing a game with his sister Katie. He is really competitive, especially when he’s playing his sister. Before starting, we discussed whether his alertness level was high, low or just-right. He tells me his engine feels high and he picks an activity from a choice of 2 things (running and crashing into the bean bag or jumping on the trampoline). I know Bobby has trouble sitting still so I also give him a cushion with texture that gives him a consistent regulating input. However, Bobby starts to lose and I can see a change in his behavior, which is the start of a potential explosion. I ask Bobby to take a minute. His sister then laughs and makes faces at him while he’s taking a minute so I ask Katie to take a minute as well. In this situation, the Raising Lions approach is used to give Bobby a moment to pause before the anger of losing sets in and gives him a chance to make another choice. It also lets him see that there are boundaries for his sister too, which helps him to see his sister also needs minutes to adjust her behavior. I find this a powerful choice especially for children that are frequently in trouble or villainized.

      Raising Lions has been such a wonderful addition to my therapy practice. I am now able to slow down and to make more purposeful decisions in approaching children. Although most of the children I work with are initially upset about taking a minute to reset, they start to recognize the pause instead of the punishment, the choice instead of the demand, and the relationship instead of just themselves.  When this starts to happen, so many other positive changes occur.  Here’s to all the Lions!

      Michaela E. Gordon, OTR/L


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