Low-Demand Parenting, PDA, and the Boundaries Kids Are Asking For

More and more families coming to us at Crossbridge tell us that their child may have PDA. One mother told me her nine-year-old will not shower, will not come to the table, will not shut off technology when asked, and will not leave for school unless it is entirely on her own terms. A therapist told her that her daughter's nervous system was flooded, and that she needed to lower the demands until her daughter felt safe.

This approach isn’t helping her, and the research tells us why.

What is PDA?

Pathological demand avoidance, sometimes called extreme demand avoidance, describes children who resist ordinary expectations: getting dressed, starting schoolwork, doing a chore, anything that reads as a demand coming from someone else (Newson et al., 2003; O'Nions et al., 2014). Many of these kids melt down, shut down, or turn combative.

PDA was first described as a subtype of autism. That has shifted. A growing body of work finds the same pattern in children with ADHD, oppositional defiant disorder, and other externalizing conditions (Egan et al., 2020; Rai et al., 2026). It is not a formal diagnosis in the DSM-5, and it is not a recognized neurological disorder. Clinical psychologist Cynthia Martin at Child Mind Institute in New York City, says that there is no empirical evidence that PDA is a distinct neurological condition (Child Mind Institute, 2024).

Does anxiety cause pda?

So, is a child resistant to demands because their anxiety is in overdrive? It may seem that anxiety is the engine driving the avoidance, so removing the demand relieves the anxiety. Dr. Paul Sunseri, a family psychologist who has worked with demand-avoidant children for more than forty years, looked hard at the evidence for that claim and found it thin (Sunseri, 2026a).

Anxiety and demand avoidance do coincide. However, their coinciding does not prove that one causes the other, and no study shows that anxiety causes PDA. Children with ADHD and ODD carry high rates of anxiety too, and the rage, panic, and refusal now labeled PDA look a lot like patterns clinicians have seen in those conditions (Stein et al., 2015). Sunseri reads anxiety as a byproduct of years of demand battles rather than their source. "Anxiety is the exhaust, not the engine" (Sunseri, 2026a).

His alternative is that PDA is better understood as a temperament profile: high emotional reactivity, low agreeableness, and low follow-through (Egan et al., 2019; Sunseri, 2026b). That framing is important as it moves us off the picture of a fragile, fixed nervous system and to an a personality trait that can change with age and intervention.

Lowering Demands Doesn’t Fix The Problem

A parent removes whatever triggers the distress, and the child settles down. However, the next time they are faced with a similar demand, the resistance is a little stronger, because avoidance taught the brain that the thing was dangerous and that escape was the way out. So the parent accommodates a little more. The child's world shrinks, and the pattern sets and solidifies. This accommodation-avoidance loop is one of the better-documented mechanisms in childhood anxiety and oppositionality (Bertelsen et al., 2023; Kitt et al., 2022).

So far, there is only one published study on low-demand parenting for PDA. It concluded that after a twelve-week course of low demand parenting, the children's behavior scores barely budged. The changes did not reach statistical significance and were clinically meaningless. The only improvement was a small drop in parent strain (Carlozzi et al., 2025).

I spent my graduate practicum at the Yale Child Study Center's anxiety program, working with families whose kids could not tolerate ordinary demands because of their elevated anxiety. Lowering the bar never helped. What helped was the parent encouraging and supporting the child to do the anxiety-provoking hard things, moving through the discomfort, and getting to the other side.

Dr. Paul Sunseri is also the author of “Gentle Parenting Reimagined”

We recommend this, and encourage you to purchase here. We donate a portion of the proceeds to increase access to therapeutic care via The Sky’s The Limit Fund.

The Friend Trap

Parents today often want to be their child's friend. As a parent of two young adults, I’ve been there and I understand. A lot of us were raised with more control and less warmth than felt good, and the correction has run toward closeness, negotiation, and sparing our kids discomfort. Most of the accommodating parents I meet are acting out of love.

With that said, a child cannot lean on a friend the way they lean on a parent. When the adult hands over the decisions to their child, the child does not feel empowered, they feel unheld - they feel no one is in control, so they need to be. The meltdown at the boundary is often a child checking whether the boundary is real and discovering it isn't.

Most kids who run the house are not asking for more control. They are asking whether an adult will hold the line so they don't have to.

What are firm boundaries?

Firm boundaries are not harsh. Sunseri is clear that the goal is never blind compliance, and that steamrolling a child's autonomy backfires (Sunseri, 2026b). A boundary holds when it is both warm and consistent. You name how hard the moment feels for your child, you tell them you believe they can handle it, and you maintain the expectation.

That is what the research on authoritative parenting and structured parent training keeps finding: warmth paired with limits, practiced consistently, builds cooperation and independence over time (Costin & Chambers, 2007). A skilled collaborative approach fits here too. Martin finds that for many demand-avoidant kids, locating what motivates them and scaffolding the hard task works better than a head-on power struggle, and that heavy reward-and-consequence systems tend to fade (Child Mind Institute, 2024). Holding a boundary and staying in relationship are not opposites; the skill is doing both at the same time.

One distinction is for kiddos needing sensory breaks, extra processing time, or a task broken into smaller steps. Providing those as appropriate is not the same as accommodating avoidance. Erasing the expectation because a child protests is a different thing. The question worth asking is whether you are adjusting the conditions so your child can meet a demand, or removing the demand so they never have to.

Temperament Changes

The good news is that just because your child is demand avoidant today, doesn’t mean they will be demand avoidant as an adult. Personality traits shift with age and with intervention, and the reactivity and resistance that make nine so hard can grow, with support, into sensitivity and healthy assertiveness (Roberts & Wood, 2006; Sunseri, 2026b). Exposure-based work for explosive kids, ADHD-informed structure, and family-based treatment all carry evidence behind them (Naim et al., 2024).

If your family is somewhere in this, and you are trying to sort out what your child needs from what you have been told they need, that is the work we do at Crossbridge.

Jennifer Benson, MSW, is a therapeutic educational consultant and certified parent coach at Crossbridge Consulting. She helps families find the right therapeutic programs and schools for adolescents and young adults who are struggling, drawing on both her clinical training and her own experience as a parent who has placed a child. She visits more than one hundred programs a year. Read Jennifer's full bio.

Related blogs:

What We Can Learn From Anxiety

Understanding your teen’s challenges: Anxiety and ASD

School Avoidance or Refusal: What Parents Can Do

Sources:

Bertelsen, T. B., Himle, J. A., & Håland, Å. T. (2023). Bidirectional relationship between family accommodation and youth anxiety during cognitive-behavioral treatment. Child Psychiatry & Human Development, 54(3), 905–912.

Carlozzi, N. E., Lombard, W. L., Troost, J. P., Graves, C. M., Miner, J. A., Fauser, A. T., & Ehrlich, C. (2025). A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance: The Paradigm Shift Program pilot study. Pediatric Investigation.

Child Mind Institute. (2024). Pathological demand avoidance (PDA) in kids. [Interview with Cynthia Martin, PsyD.]

Costin, J., & Chambers, S. M. (2007). Parent Management Training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clinical Child Psychology and Psychiatry, 12(4), 511–524.

Egan, V., Bull, E., & Trundle, G. (2020). Individual differences, ADHD, adult pathological demand avoidance, and delinquency. Research in Developmental Disabilities, 105, 103733.

Egan, V., Fondacaro, R., & O'Nions, E. (2019). The measurement of adult pathological demand avoidance traits. Journal of Autism and Developmental Disorders, 49(2), 481–494.

Kitt, E. R., Lewis, K. M., Galbraith, J., Abend, R., Smith, A. R., Lebowitz, E. R., Pine, D. S., & Gee, D. G. (2022). Family accommodation in pediatric anxiety: Relations with avoidance and self-efficacy. Behaviour Research and Therapy, 154, 104107.

Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600.

O'Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2014). Development of the Extreme Demand Avoidance Questionnaire (EDA-Q). Journal of Child Psychology and Psychiatry, 55(7), 758–768.

Rai, A. J., Rishworth, B., Gutierrez, R., & Ludlow, A. K. (2026). Sensory reactivity and intolerance to uncertainty: What characterises demand avoidance behaviours in children and adolescents with pathological demand avoidance? Research in Autism, 131, 202816.

Roberts, B. W., & Wood, D. (2006). Personality development in the context of the neo-socioanalytic model of personality. In D. K. Mroczek & T. D. Little (Eds.), Handbook of personality development (pp. 11–39). Lawrence Erlbaum Associates.

Stein, M. A., Kircanski, K., & Gadow, K. D. (2015). Anxiety disorders comorbidity in children and adolescents with attention deficit hyperactivity disorder. Psychiatry Investigation, 12(2), 183–191.

Sunseri, P. (2026a). It's time to rethink the "anxiety drives PDA" narrative. Psychology Today.

Sunseri, P. (2026b). Is pathological demand avoidance a personality profile? Psychology Today.