When 'Won't' Is Really 'Can't': Rethinking PDA in Kids

More of the families who come to us arrive with the label already attached to their child: PDA. Recently, 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 most days will not leave the house at all. Getting her out the door for school has become a daily battle, and it is taking a toll on the whole family, her siblings included. A therapist told this mother that her daughter's nervous system was flooded, and that her job now was to lower the demands until her daughter felt safe. She was doing exactly that, and it wasn't helping.

I don't think this approach is serving her daughter, and the research points the same way.

Where the PDA Label Comes From

Pathological demand avoidance, sometimes called extreme demand avoidance, describes children who resist ordinary expectations to a striking degree: 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 the moment they are asked to do something they don’t want to do.

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 puts it plainly: there is no empirical evidence that PDA is a distinct neurological condition (Child Mind Institute, n.d.).

Rethinking the Anxiety Story

Most of what parents hear online rests on one claim. 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 often go together. But going together is not proof 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 recognized in those conditions for years (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). It moves us off the picture of a fragile, fixed nervous system and onto something we know how to work with.

The Problem With Lowering the Demands

A parent removes whatever triggers the distress, and the child settles in the moment. The next time, 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. This accommodation-avoidance loop is one of the better-documented mechanisms in childhood anxiety and oppositionality (Bertelsen et al., 2023; Kitt et al., 2022).

One published study exists so far on a low-demand parenting program for PDA. After a twelve-week course, the children's behavior scores barely moved. 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 things that made them anxious. Removing the stressor, the anxiety-provoking task, demand, expectation, never helped. What helped was supporting the child in moving through their anxiety, actually “doing the thing” with the parents providing validation and encouragement.

ADHD, Autism, and the PDA Label

Most of the kids we work with who get the PDA label are neurodivergent, usually some mix of ADHD and autism. For them the picture is more complicated than defiance, and grouping them with a purely oppositional child is wrong.

Look at what a demand requires of these kids. A child with ADHD struggles to get started, to stay with a task, and to organize behavior when the work is boring or hard (Egan et al., 2020). An autistic child is often rigid, less tuned to the social cues that tell the rest of us what is expected, and thrown by anything that comes at them without warning. Martin describes what an ordinary request can feel like for one of these kids: from a neurobiological standpoint, you may be asking them to climb a mountain (Child Mind Institute, n.d.). The task that looks small from the outside is not small on the inside.

That gap is why these kids get read as lazy or unmotivated. A child who can recite the periodic table but cannot start a five-question worksheet is not choosing to stall. His brain is spending most of its fuel on the parts of the task that come free to other kids: shifting off what he was doing, holding the steps in mind, pushing through the boredom, and managing the frustration when it doesn't go the way they want. By the time the real work starts, he is exhausted and running on empty. What looks like won't is often can't.

This changes what a boundary means for these kids. Holding a demand a child cannot yet meet does not build resilience. It sets up another failure, and these kids have collected enough failures to sadly conclude that something is wrong with them. The work is to tell three things apart: a skill the child has not built, an access need that is reachable, and avoidance that has hardened into habit. You scaffold the skill, you accommodate the access need, and avoidance is where you stop.

Scaffolding is Martin's mountain with steps cut into it. You break the task down, add structure and visual supports, give processing time, and keep the expectation that the child makes the climb with help rather than being carried (Child Mind Institute, n.d.). Accommodating an access need is the sensory break, the warning before a transition, the quieter room, the removal of itchy tags.

Holding the line is not the same as harshness, and it is not about winning a standoff. Sunseri is clear that the goal is never blind compliance, and that steamrolling a child's autonomy backfires (Sunseri, 2026b). It works when it is warm and steady at once: you name how hard the moment feels, you tell your child you believe they can handle it, and you keep the expectation in place. That combination, warmth paired with limits, is what the research on authoritative parenting and structured parent training keeps finding builds cooperation and independence over time (Costin & Chambers, 2007; Furlong et al., 2013).

The danger for these kids runs the other way from defiance. When we do the hard thing for them, again and again, because it is faster and it heads off the storm, they never build the skill, and the dependence solidifies and stays with them. Martin's decades with autistic kids keep returning to the same worry: parents perform tasks their child is capable of long after other kids do them alone, hoping the child grows out of it, and too often the child does not (Child Mind Institute, n.d.). The goal is a child who can make the climb, needing a little less help each year.

Will my child be like this forever?

None of this is fixed. Personality traits shift with age and with intervention, and the reactivity and resistance that they demonstrate now can grow, with support, into sensitivity and healthy assertiveness (Roberts & Wood, 2006). Exposure-based work for explosive kids, ADHD-informed structure, and family-based treatment all carry evidence behind them (Naim et al., 2024). A demand-avoidant child at nine is not sentenced to being a demand-avoidant adult.

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. Get in touch.

Jennifer Benson, MSW, is a therapeutic educational consultant and certified parent coach, and a partner 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.

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