Although demand avoidance is typically associated with autism, some research suggests it’s a part of ADHD, too. Approaches like mindfulness-based cognitive therapy can help treat it.

Demand avoidance is a relatively common condition involving a tendency to avoid everyday pressures and demands. When this tendency significantly affects day-to-day life, psychologists may refer to it as pathological demand avoidance (PDA).

Though PDA was traditionally associated with autism spectrum disorder (ASD), recent research has uncovered a link between the condition and attention deficit hyperactivity disorder (ADHD), too. Here’s what to know about the condition — as well as how to get back on track with tackling day-to-day demands.

Although demand avoidance was traditionally associated primarily with ASD, in a 2020 study, researchers concluded that having ADHD was an even greater predictor for having PDA than ASD.

Specifically, researchers found that about 70% of those with ADHD whom they studied had markers of PDA. Meanwhile, scientists reported that the correlation between ASD and PDA was too negligible to draw any conclusions. As the study only included 132 people, more research is needed.

In general, according to 2023 research, PDA is associated with:

  • autism spectrum traits at a rate of about 50%
  • lower agreeableness at a rate of about 42%
  • lower emotional stability at a rate of about 50%
  • higher self-reported delinquency at a rate of about 34%

However, the study didn’t cover the relationship between ADHD and demand avoidance in particular. Researchers also noted that PDA seems to be particularly correlated with generalized personality traits rather than autism-dependent traits specifically.

Keep in mind that both conditions may be commonly associated with PDA since there’s significant comorbidity between autism and ADHD. According to 2022 researchTrusted Source, about 50% to 70% of autistic people also have ADHD.

Furthermore, people with both ASDTrusted Source and ADHD naturally tend to have lower levels of dopamine, which helps control the brain’s reward and pleasure center. As a result, those with either condition may neurochemically have a more challenging time generating sufficient excitement and energy to complete everyday “low dopamine” tasks, such as cleaning or completing a tedious assignment.

Both ADHD and PDA may cause issues with executive dysfunction or decision making, which may make it challenging to:

  • start tasks
  • finish tasks
  • control impulses

Symptoms specific to PDA include:

  • a resistance to the everyday demands of life
  • anxiety that fuels a need to attempt to control the environment
  • social manipulation to avoid demands
  • sociability coupled with a lack of sense of responsibility
  • extreme changes in mood that help reinforce their behaviors
  • obsessive behaviors that revolve around their demand avoidance

Symptoms of ADHD avoidance that may overlap with PDA include:

People with ADHD sometimes fall into an avoidance cycle called “positively valenced cognitive avoidance,” which may overlap with symptoms of PDA. It typically consists ofTrusted Source:

  1. a triggering situation
  2. an initially negative emotional response
  3. an excessively optimistic thought that provides short-term relief
  4. avoidance behaviors that prevent healthy strategies to manage the situation

Researchers explain that since these maladaptive avoidance behaviors provide short-term relief, the cycle may continue. However, in the longer term, these patterns can lead to increased behavioral avoidance that may affect your life in an undesirable way.

A demand-avoidance cycle can seem inescapable when you’re inside it, but there are ways to break out. The best way is to find a mental health professional who has experience working with ADHD clients. They can help you create strategies for your ADHD avoidance, including:

  • Recognize triggers: Being aware of the trigger that provokes the avoidance cycle is key to breaking down the pattern. So, for example, if it’s a looming deadline that triggers you, start noticing your emotions, thoughts, and habits as soon as they happen.
  • Reduce anxiety: Since anxiety seems to fuel the avoidance cycle, experts recommend taking measures to reduce it, including mindfulness techniques like meditation, yoga, breathwork, or other types of exercise. Reducing caffeine intake, getting enough sleep, and maintaining an overall healthy lifestyle also help reduce anxiety. Reduced stress and increased mindfulness can also help you gain greater awareness of your triggers.
  • Minimize unnecessary rules: Since those with ADHD may feel boxed in by strict rules and regulations, which can also perpetuate an anxiety-shame cycle, try to see where you can implement more freedom and flexibility into your routine. For example, consider asking your work if it would be acceptable to set your own hours when possible.
  • Set intentions: Create what researchers call “if-then” strategies to address the trigger, such as a deadline. For example, rather than falling into an overly negative or excessively positive thought-habit loop, set a doable intention such as, “When I feel the compulsion to avoid a task, I’ll work on it for just 5 to 10 minutes.”
  • Reward yourself: Impulse control is key to managing both ADHD avoidance and PDA. So rather than enjoying your snack before you finish your assignment, for instance, consider trying to delay gratification and eat it to celebrate its completion.
  • Restructure your cognitive-behavioral patterns: Mindfulness-based cognitive therapy (MBCT) is a proven way to help people with a variety of conditions, including ADHD and PDA, change harmful patterns and lead more fulfilling lives. Many of these tips, for example, can be implemented very successfully with the specialized support of an expert.
  • Practice nonjudgment: Nonjudgment is a key aspect of MBCT that can help people break free from guilt and shame cycles that may be perpetuating old, unwanted habits. When you observe your situation without harsh or critical judgment, you can act from a place of genuine compassion in order to change your habits.
  • Seek support: Reaching out to ADHD support groups, counselors, or other professionals may help you find the support you need to fully address your day-to-day demands. You may also want to try “body doubling,” or the practice of working alongside someone to increase focus and add an extra layer of accountability.
  • Make environmental modifications: Setting up your environment for success can help you address tasks head-on and avoid distractions. For instance, you may want to clean and organize your workspace, play soothing music, keep your computer charged and ready and your phone on silent and away from your space to encourage increased attention.
  • Build skills: Remember that you’re not alone. Many people struggle with organization and time management. Many people who formerly struggled with time management now excel at it thanks to their ability and willingness to learn and change. To increase your confidence and competence in these areas, consider educating yourself on mental health in your free time.

The organization ADDitude has also compiled a list of ways to help manage ADHD-related procrastination.

What medication is used for pathological demand avoidance?

Though there’s no specific medication to treat PDA, there’s some limited evidence from 2024 that suggests that fluoxetine may be helpful in managing disruptive behaviors associated with the condition.

Specifically, the researchers studied the impact of the medication on children with autism with PDA and found:

  • a significant reduction in most PDA-related behaviors
  • an overall improvement in children’s behaviors, quality of life, and loved ones’ quality of life

Although this study was small (just 13 participants) and conducted on children with autism specifically, it may potentially be a suitable treatment for those with ADHD. Traditional ADHD medications may also benefit PDA-related symptoms.

If you are interested in pursuing psychiatric medication, talk with your primary healthcare professional.

Some evidence suggests that demand avoidance, or the tendency to avoid day-to-day demands, may be a common feature of ADHD as well as autism. Treatments like mindfulness-based cognitive therapy, exercise, and anxiety-reducing techniques like meditation can help combat it.

Education on healthy habit formation can also help you create a life where you excel at meeting the demands of day-to-day life rather than feeling burdened by them.