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Pathological demand avoidance

We provide an extensive range of assessments, intervention and consultation services in relation to pathological demand avoidance (PDA).

Pathological demand avoidance is a behaviour profile within the autistic spectrum condition (ASC).

The main characteristic of PDA is that children and young people strongly avoid and resist demands and instructions. Resistance is related to anxiety and a need for predictability. Resistance can lead to meltdowns. Avoidance is usually caused by feeling a need to be in control and anxiety when the child or young person feels that they are out of control.

Can HSR Psychology diagnose PDA?

PDA does not have recognised diagnostic criteria so at HSR Psychology, our team of psychologists cannot make a diagnosis, but they can identify aspects, traits or profiles. Some services or professionals may provide a diagnosis based on their own criteria, here at HSR Psychology we only diagnose conditions with recognised diagnostic criteria.

Features of pathological demand avoidance:

Pathological demand avoidance may look different depending on the individual experiencing it. Features of PDA can include the following in addition to other features of ASC:

Signs of PDA may seem to get better or worsen in different contexts. For example, a child or young person with PDA may present very anxiously at home but more calm and well behaved at school. It is thought that this can be part of a coping strategy the child or young person develops to cope with these situations or due to the variety in predictability and structure.

Children and young people with PDA often need lots of support to make sure they feel safe and in control. Early intervention allows appropriate support to be arranged from an early age and improves outcomes later on in life.

Our process

At HSR Psychology we ensure that we meet the needs of children and young people. To achieve this we ensure that any specific assessments, intervention, or direct work, is only carried out following an initial discussion.

An initial discussion allows us to understand the background and your expectations of our involvement. Having an initial discussion ensures any services we provide appropriately identify or address needs.

Our process for any specific assessments, intervention, or direct work is as follows:

Step 1: Contact us

We will usually be contacted by the child or young person, parent or carer, or another professional (eg education or health).

You can contact us or complete a referral

Step 2: Arrange an initial discussion

An initial discussion allows us to understand the background and your expectations of our involvement. Arrange an initial discussion

Step 3: Review our recommendations

Following an initial discussion we will send you an email that includes:

  • Next steps recommendations - to provide a bespoke package of support. For example:
    • Assessments
    • Reports
    • Information gathering
    • Meeting
    • Interventions
    • Consultancy
    • Reviews
  • Costing - we will provide costings for any services recommended.

Step 4: Let's get started

On receipt of the next steps recommendations and costing you can decide how to proceed. Once you have decided contact us to arrange the chosen services.

How is pathological demand avoidance assessed?

As pathological demand avoidance is a behaviour profile within ASC, it is useful to know if the child or young person has an existing ASC diagnosis. Read more about how we support children and young people with ASC.

If a diagnosis of ASC has not yet been made, then PDA could also be assessed during that assessment process. Where a diagnosis of ASC has already been made, then specific assessments for needs related to PDA can be assessed through the following ways:

Play-based assessment

Play-based assessments are useful for engaging the child in an assessment which can be completed alone or through joint play with the HSR Psychology team member.


Observations can take place at home or school and are helpful in observing a child or young person’s needs from a distance and in a natural environment. If a child or young person’s behaviour is better in one setting then it is best to observe the child in two settings to compare the difference. This allows an insight into what may trigger the behaviour and what may help.

Developmental history

A developmental history and having a look at previous assessments or reports, could help identify the consistency or any changes of the child or young person’s behaviours.

Psychometric assessments

Psychometric assessments can include the child or young person answering some questions, completing some puzzles or trying to identify a solution to some tasks. Psychometric assessments can identify a broad range of needs from educational to social, emotional and mental health (SEMH) needs.

What happens after an assessment?

After an assessment, information about a child or young person’s strengths, triggers and coping mechanisms will have been highlighted in order to best support them. Following an assessment, information will be shared with the adults around the child or young person so they have an increased understanding of need and how they can help to reduce the child or young person’s anxieties which may be underpinning the PDA behaviours. A report is recommended following an assessment.

What interventions are available for pathological demand avoidance?

Here at HSR Psychology we provide a broad range of interventions which would be suitable for a child or young person experiencing PDA and a number of interventions may be recommended to create a bespoke package of support. Interventions we provide include:

The above is a selection of interventions HSR Psychology can provide for PDA, interventions which are not on the above list may be recommended, but these would be talked through with you during or following an initial discussion

Arrange an Initial Discussion

Arrange an Initial Discussion to find out how we can help. The initial discussion lasts 1-1.5 hours, comes with a written recommendation summary and is a starting point to identify needs. The cost is £180.

  • No waiting lists
  • Experienced psychologists
  • Includes recommendation summary

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What makes us different

Access to a named psychologist

Focus on mental health and wellbeing

Joined-up approach

Bespoke services to meet needs

Multidisciplinary team

Holistic approach

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Flexible, consistent, and competitively priced

We provide bespoke solutions to suit all budgets and requirements for children and young people aged 0-25 in homes, education settings and the community. Our clinical, educational and child psychology services are cost effective.

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Make a referral

To make a referral and arrange an initial discussion please complete our referral form.

Make a referral

Contact us

Ready to get started? The next step is to speak to our team to find out more about the services we provide and how we can help. Call us on 0161 820 9229 or email

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