A note on Pathological Demand Avoidance and social difficulties

Little Miss M can be intensely controlling of people in social interactions (including us and extended family members). The more people she’s with, the more in charge she becomes and the more attention she needs. This makes social interactions really difficult. She’ll direct what should happen and what people can do, giving a constant narration of what is allowed, what isn’t allowed, what she’ll do and what others must do, often repeating herself again and again to ensure things happen in a particular way. We find that accommodating her need for control and doing things according to her particular ideas prevents her anxiety from escalating out of control. Whereas if you don’t and things don’t happen the way she needs them to she becomes overwhelmed and overloaded with anxiety and emotional dysregulation.

This controlling behaviour is a sign of anxiety. The anxiety is caused by several factors which include:

  • fear of uncertainty
  • alertness to demands from others
  • a need for things to be perfect (according to her specific ideas).

It’s also important to take into account that her difficulties with social communication are a contributing factor to her difficulties with social interactions too. These include:

  • not understanding or being aware that the other people have different likes, skills and needs to her
  • finding it very hard to predict what people will say or do
  • not always understanding social language
  • requiring more time to process language and information
  • requiring more time to express herself fully

add to this her need for certainty and these factors which can be confusing and somewhat unpredictable become extra sources of stress and anxiety for her. The more anxious she is, the more controlling of the interaction she’ll be.

Given the fact that her brain perceives there to be a threat of danger when she’s not in control and when faced with uncertainty, this controlling behaviour is easy to understand. Attempting to take charge and control the interaction is her way of trying to feel safe when she has such little control of what other people do and the demands they place upon her. It’s also her way of trying to ensure things happen in the way she imagines they will in order for them to meet her expectations and be perfect.

It’s not easy for her to maintain friendships due to this and the interactions she has with others, including our extended family as well as a lot of her interactions with us at home are affected in this way, making them incredibly difficult for everyone involved, especially her. The anxiety she experiences also has a knock-on effect on her wellbeing. We aim to address this by ensuring social interactions become less anxiety inducing for her.

Here’s what we are doing to try and help with this

1. Helping her develop her social skills and understanding around the areas she has social communication difficulties with. Given the additional confusion and anxiety they cause her, this may help but the level of demand avoidance shown under these circumstances and the intensity of her anxiety around them makes this incredibly difficult to tackle. Interactions with others only seems to be getting harder which causes a cycle of feeling less in control and more vulnerable and anxious.

We contacted the PDA society for their advice with this because we were at a loss as to how best to help her and thanks to their advice we have a plan in place to work on developing her skills and understanding in this area as well as developing alternative ways to manage her anxiety (other than controlling people) so interactions can become more mutually enjoyable.

  • We’ll work on this with her at home when her anxiety is low.
  • It needs to be done indirectly so it’s not seen as a demand so we’ll subtly and creatively incorporate more opportunities to discuss and practice social skills and accommodating people’s different interests and needs as well as understanding language and behaviour into daily life and the activities she enjoys. We’ll use things like stories, films, TV programmes, games, role-play and anything else which appeals to her which covers these areas and we’ll carefully and gradually use some of our own interactions with her to demonstrate how everything relates to us so she eventually feels better equipped to be in social interactions.
  • We’re realistic that it will take some time and a certain amount of maturity will probably be required before the social skills can take effect but our hope is that with time this plan will help Little Miss M feel safer and less anxious in social interactions.
  • We’ll also indirectly help her learn other ways to manage her anxiety around other people. She’s currently not aware of how her behaviour is a reflection of her emotions so we’ll start with helping her make those connections by talking indirectly about this in relation to other people and characters in films and stories. Once she can identify her behaviour as a sign of anxiety, we can encourage her to find other ways to reduce and manage it (taking a break, doing a calming activity, talking about how she feels etc.).


2. Ensuring social opportunities are suitable for her particular abilities and needs at any given time so they are manageable for her. Hopefully this will also make them much more positive experiences and help break the cycle of feeling anxious about them all. It’s important we remember that her abilities and needs will change as she develops skills and will vary from day-to-day (or moment-by-moment) as she goes through varying phases of anxiety. We hope that being aware of this and adapting as necessary will have a positive effect on her view of social interactions and set an example for her to be able to do this herself in the future.

Areas to consider include:

  • Being realistic about who/what/where/when is best for her social interactions at the present time.
  • Keeping the number of people she directly interacts with at any one time to a manageable amount. This is quite low at present because the more people she is around, the more stressed and anxious she becomes.
  • Keeping the length of each interaction to a manageable time. This is quite a short amount of time at present before she needs downtime.
  • Providing the right level of support throughout interactions and being on hand to help with any difficulties or rising anxiety before they become overwhelming.
  • Incorporating enough downtime between interactions where she can do her own activities to relax and de-stress.

People can help by:

  • Giving her extra time to process information so she isn’t under pressure to respond or act quickly.
  • Giving her extra time to express herself effectively.
  • Communicating clearly.
  • Reducing the demands placed on her and being thoughtful with wording in this respect.
  • Recognising when she may be confused or having difficulty – usually when her behaviour changes and help her however necessary.

If she starts attention seeking or becoming more controlling, people can help by:

  • Collaborating with her, being flexible and understanding her need for certainty and the ways in which her anxiety around this displays.
  • Accommodating her need for things to happen in a particular way if possible.


3. Reducing as much uncertainty as possible by discussing the specifics. We’ve found that if we discuss what will happen at the start of something and involve her in deciding elements of what that will be, she is generally less controlling of the actual interaction which is a sign that she is comfortable because she knows what to expect. We need to remember to do this all the time, even with familiar scenarios and hope that by eliminating as much uncertainty as possible, she’ll feel more assured and less anxious. This is also an opportunity to gain insight into any specific ideas she may have already formed in her mind about the interaction and address how/whether or not they can be achieved beforehand which is usually less overwhelming for her than discovering things aren’t as she thought they would be in the moment.


It’s really important to remember that when she behaves in this controlling way, it’s because she is confused and anxious and because demands and uncertainty are scary. She needs to have certainty about her interactions with people and have limited demands placed on her in order to function at her best. It’s so important that this is always at the forefront of people’s minds so the necessary adjustments can be made to help make a difference to how much anxiety she feels.