By Emma Spencer, Clinical Psychologist
Pathological Demand Avoidance (PDA) is a profile on the autism spectrum characterised by an extreme avoidance of everyday demands, where overwhelming anxiety is triggered when the individual's nervous system perceives a threat to their autonomy. PDA clients often experience anxiety as they feel threatened by external demands—whether it's being asked to complete a task or engage in typical therapeutic strategies. For years, traditional therapeutic models have struggled to adequately support clients with a PDA profile, and many of the existing strategies inadvertently escalate their anxiety rather than helping them thrive.
As a clinical psychologist and passionate ally to the neurodivergent community, I have worked with PDA clients across various age groups, from young children to adults. Time and time again, I’ve seen how existing therapy models, which can work well for other neurodivergent clients, often fail to meet the unique needs of those with a PDA profile. This isn't due to a lack of skill or empathy from clinicians, but because the traditional approaches inadvertently impose demands, escalating avoidance behaviours in PDA clients.
The Gap in Support for PDA Clients
To this date, there hasn't existed a framework specifically designed to support PDA clients, which is why creating one was crucial. There is a profound need for a model that honours the specific needs of these individuals without pressuring them into compliance or forcing them into uncomfortable therapeutic processes. PDA clients require a trauma-informed, neuroaffirming approach that acknowledges their heightened sensitivity to perceived demands and their need for control and autonomy.
Traditional therapy models, can often feel directive and demand-heavy for clients with PDA. While these therapies are effective for many neurodivergent clients, they can unintentionally trigger avoidance behaviours and escalate anxiety in individuals with PDA if not applied in a sensitive and appropriate manner. As a result, progress can be slow, and engagement in therapy may break down entirely. This highlights the urgent need for an approach tailored specifically to PDA clients, one that works with their need for autonomy, rather than against it.
Introducing the Low Demand Approach to Therapy
Recognising the need for change, I felt driven to develop a framework that is neuroaffirming, trauma-informed, and specifically designed to support autistic clients with a PDA profile. The Low Demand Approach to Therapy evolved from my years of clinical experience, working closely with clients who exhibited extreme demand avoidance. My approach places autonomy at the heart of the therapeutic process. It’s about removing hierarchy, empowering clients to take control of their therapeutic journey, and fostering a sense of safety and collaboration in the therapy room.
By reducing perceived demands, allowing for flexibility, and working with clients at their own pace, the Low Demand Approach seeks to create a space where clients with a PDA profile can engage in therapy meaningfully, without the overwhelming anxiety that often accompanies traditional models. It ensures that their need for autonomy is respected, making therapy feel less like a demand they need to resist and more like a supportive tool they can utilize.
Why This Framework Matters
This framework is significant because it finally offers clinicians a way to work with PDA clients in a way that honours their unique neurodivergent needs. It moves away from compliance-based therapy models and instead focuses on fostering collaboration, autonomy, and trust. The aim is to empower PDA clients to participate in therapy at their own pace, in a way that feels safe and manageable to them.
The Low Demand Approach doesn’t just help PDA clients engage in therapy; it also helps them build emotional regulation, improve their ability to cope with daily demands, and ultimately live fuller, more empowered lives.
Stay tuned as I’ll be sharing more about the specific principles and applications of the Low Demand Approach to Therapy in upcoming blog posts. It’s an exciting step forward in neurodiversity-affirming therapy, and I can’t wait to continue sharing this journey with you!
Emma Spencer, Clinical Psychologist and passionate ally to the neurodivergent community, is committed to improving therapeutic support for PDA clients through her Low Demand Approach to Therapy. Stay tuned for more updates and training opportunities!