History of Understanding PDA 

The term “Pathological Demand Avoidance” (PDA) was coined by Elizabeth Newson in the 1980s¹ and was defined as “obsessional avoidance of the ordinary demands of life coupled with a degree of sociability that allowed social manipulation as a major skill.”² It was originally conceptualized not as part of – but rather adjacent to – Autism Spectrum Disorder (ASD).³

 

However, in 2013 the Diagnostic Statistical Manual (DSM) expanded the definition of ASD to include Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS),⁴ which was where PDA was previously “housed” in clinical circles and diagnoses.⁵ There is now debate in the academic and peer-reviewed literature as to whether PDA is part of the Autism spectrum,⁶ a stand-alone diagnosis,⁷ or exists at all,⁸ with some scholars arguing that PDA simply captures component pieces of other existing diagnoses like ADHD, OCD, Autism, etc., and should not be classified as its own neurotype.⁹ 

 

Regardless of these debates, at At Peace Parents, there is no debate as to whether PDA exists. We have worked with parents in thousands of families whose children and teens fit this profile AND we have pioneered a framework and set of skills that has consistently supported PDA children and teens. We have also worked with therapists, teachers, clinics, school districts, and therapy practices so they can help PDA children and teens and find peace and purpose while doing so. 

 

If you're trying to determine if your child or teen fits the PDA profile, we have developed a questionnaire to help you. (It's short enough that most parents complete it in about six minutes.)

 

Definitions of PDA

Larger non-profits working in this space have slightly different definitions of PDA. PDA North America defines PDA as “an autistic profile” and “demand avoidance as a symptom of a need for autonomy.” They also use the term “Pervasive Drive for Autonomy” to capture the need for autonomy as a driver for demand avoidance.¹⁰ Meanwhile, PDA Society in the UK states PDA is “widely known as part of the Autism spectrum.” Their definition includes aspects of Autism as well as “a need for control which is anxiety-related” and describes PDA individuals as “driven to avoid everyday demands and expectations (including things that they want to do or enjoy) to an extreme extent.”¹¹

 

I believe most PDA children and teens are also Autistic – but this may be very hard to observe behind “masking,”^{12 13 14} interest in socializing, and a consistently heightened threat response. As parents start to accommodate, they often notice more “Autistic traits,” such as monotropism¹⁵ (or “special interests”), gestalt language processing,¹⁶ sensory differences,^{17 18} and stimming.¹⁹ Additionally, I believe that some PDA children fit more in the ADHD neurotype.

 

Regardless, the approach to supporting the nervous system through accommodations does not change based on “diagnosis” or neurotype. For the work we do with parents, therapists, and teachers of PDA children and teens, we use an original conceptualization of Pathological Demand Avoidance that is somewhat distinct from existing conceptualizations in both the literature and the field.

 

Here is how I define Pathological Demand Avoidance (or “Pervasive Drive for Autonomy”): A survival drive for autonomy and equality that consistently overrides other survival instincts such as eating, sleeping, hygiene, toileting and/or safety. This can either be in the moment or over time as nervous system activation accumulates.

 

I believe this definition to be most accurate for two reasons: First, this definition helps us distinguish between other neurotypes like non-PDA Autism, non-PDA ADHD, Obsessive Compulsive Disorder, Bipolar Disorder, and Oppositional Defiant Disorder (ODD) while also recognizing that these neurotypes and diagnoses often come with a strong drive for autonomy and rational demand avoidance (e.g., school is loud and I have auditory sensitivity, so of course I will avoid school!). However, these desires or drives for autonomy do not consistently override basic needs in the same way they do for a PDA child or teen. Additionally, the drive for autonomy in PDA is not always rational: a PDA child or teen’s Thinking Brain^{20 21} may like and enjoy someone or something (e.g., a grandparent, a karate class, or a friend group) and yet *still* the Survival Brain^{22 23} is subconsciously perceiving threat based on repeated losses of autonomy and equality.

 

Second, this nervous-system based definition helps us see a bigger picture beyond the in-the-moment behavior (which is often extraordinarily challenging and confusing for parents, therapists, and teachers) and look holistically at how a survival drive for autonomy is impacting all aspects of life for the PDA child or teen.

 

Without intentional accommodations in their environment, these children and teens constantly perceive threat on a subconscious level, which continually activates the survival responses of the nervous system (fight/flight,²⁴ freeze,²⁵ fawn/appeasement,²⁶ or shutdown/collapse²⁷). These repeated experiences build in accumulation; eventually, they reach a Threshold of Tolerance,²⁸ which is where we start to see violent behavior, selective mutism, toileting regressions, non-24-hour sleep cycles, the need to co-sleep with parents well past the age of 6, restricted eating, constant eating for regulation and control, and children and teens not able to access things like bathing, teeth brushing, and/or grooming – not just for a day, but for months on end.

 

I also believe that PDA intersects with and often causes medical issues such as encopresis, ARFID, repeated UTIs, Reflex Anoxic Seizures, self-harm, suicidal ideation, and chronic illness. However, the conventional wisdom – and what you as a parent, teacher or therapist may have already experienced – is that these challenges are viewed as separate medical issues, rather than the outcome of a nervous system that is *repeatedly* activated and under stress without accommodations – which eventually results in trauma, burnout, and disability.

 

To reiterate, PDA is not a behavioral disorder. It is a nervous system disability that – although fluctuating and often invisible from the outside until burnout hits – disables our children and teens from the things they need to stay alive and healthy: eating, sleeping, toileting, hygiene and safety – as well as the things they often want to do when they are not in the fear part of their brain: learn, engage socially, leave the house, and access movement.

 

If that doesn’t qualify as a disability, I’m not sure what does.

 

Want to dive deeper into understanding PDA? We offer a free masterclass on the subject.

 

Five Key Observable Characteristics of a PDA Child or Teen

While no two PDA children or teens are the same, parents often describe the following five characteristics in their PDAers:

• Survival drive for autonomy that consistently overrides other survival instincts (eating, sleeping, hygiene, safety, toileting) in the moment or cumulatively (burnout)
• Equalizing behavior (looks like controlling or defiant behavior & why PDA is often mistaken for ODD or OCD)
• High Masking (often appears like two versions of oneself in different contexts at one point in life)
• Constant need for nervous system coregulation (looks like constant need for undivided attention)
• Cumulative nature of nervous system activation (this is why many parents learn about PDA when their child reaches burnout and why dysregulation is unpredictable).

 

What is happening in the brain of a PDA child or teen?

Often when we think of a nervous system having a response to perceived danger or life threat, we are thinking about things we can observe from the outside looking in: a car crash, a natural disaster, neglect and abuse, and/or being held up in a dark alley. Although these are “extreme” examples, they illustrate the logic of looking for an outside stimulus that we can see as the “reason” for things that seem totally rational in those moments – screaming, physically fighting for your life, swearing, collapsing, dissociating, or avoiding something at all costs.

 

What makes it hard for parents, therapists, and teachers to grasp that this same nervous system reaction is happening internally for a PDA child or teen is that they can’t “see” the threat from the outside looking in. Even in the case of a child with Sensory Processing Disorder (SPD), we can often locate the “loud sound” or “bright fluorescent lights” with our own senses and observations, and it starts to make sense to us. We can “believe” that they perceived threat and nervous system activation through the sensory system.

 

With PDA children and teens, however, the root cause of the threat perception is often completely invisible to outsiders and does not seem to make sense. What activates the nervous system – in the same way that a car crash might – is the *subconscious perception of threat* around Autonomy and Equality. It can be hard to believe that this is, in fact, what sets off the nervous system, but for confirmation we need only look to both the anecdotal and growing empirical evidence²⁹ (the observed behaviors of these children) as well as the lived experiences and testimonies of PDA adults.^{30 31 32 33 34}

 

To give you a simple reference point for changing your behavior in relation to a PDA child or teen we can start to think of two parts of the brain: The Survival Brain and the Thinking Brain. The Survival Brain houses the amygdala and the limbic system, whose job it is to detect threat before the Thinking Brain comes online. Necessarily, the Survival Brain is communicating with the nervous system before there is conscious awareness in the thinking brain.³⁵

 

What is happening in the body of the PDA child or teen?

In order to fully understand PDA and what is going on for our PDA children and teens, the first thing we want to understand is “neuroception,”³⁶ a term coined by Dr. Stephen Porges in 2004. It means, “the neurobiological process that results from the subconscious perception of situations and interactions as safe, dangerous, or life threatening.”³⁷

 

For PDA children and teens, the neuroception of safety, danger or life threat is directly related to their perception of Autonomy and Equality.^{38 39 40 41}

 

When a PDA child or teen’s Survival Brain detects a loss of Autonomy or Equality, it detects danger or life threat. This sets off a reflexive and autonomic reaction within the body that is not under the conscious control of the Thinking Brain.⁴²

 

The Survival Brain tells the body to release cortisol and adrenaline, impact the metabolism,⁴³ dilate the pupils to take in more immediate information, release fluids (vomit or diarrhea), and prepare to run or fight for survival.⁴⁴ This can look like aggression, defiance, opposition, intense avoidance, elopement, and even violence. The body is reacting to a subconscious perception of danger.

 

If the Survival Brain subconsciously perceives that it can’t survive by fighting or fleeing, (for example, in the case of a PDA child or teen at school), the brain will communicate to the body that it has a better chance at survival if it freezes or shuts down.

 

When the PDA child or teen moves towards freeze and shutdown, this slows down the metabolism, releases endorphins (think: “shock state”), slows down the heart and breathing,⁴⁵ and is like a “playing dead” state that can look like selective mutism, lethargy, dissociated look in eyes, being “gone” emotionally, chronic fatigue, and depression.

 

I believe that PDA children and teens subconsciously internalize their threat response as part of how the nervous system operates as a hierarchy^{46 47} – first the nervous system goes into fight/flight, then freezes if the individual is not able to fight or flee the perceived danger. If no options are left, then the nervous system will move to shutdown/collapse.

 

The key logic to understand here is that this is all happening based on neuroception – the subconscious perception of threat in the environment. This builds in the system over time and has a cumulative effect.

 

As you read this, it may feel overwhelming; however, it is important to have an accurate understanding of the brain and nervous system – as well as the conceptualization of PDA as a nervous system disability – to make progress with your PDA child or teen. 

 

I should note – I don’t have brain scans, cortisol spit samples,⁴⁸ or large empirical studies showing that PDA operates like this. I believe it to be true with my heart and soul based on the literature on Trauma and Polyvagal Theory, the testimonies of adults who identify as PDA, my experience with my sons, the professional work I have done with thousands of families, and the research I am conducting with the University of Michigan medical school.

 

But if you need “proof” – I get it. I am a scientifically-minded individual as well. If you are skeptical, I would invite you to view everything I have stated above as a hypothesis (I could be wrong!) that can be tested using my empirical approach. I encourage you to experiment consistently with the skills we teach for a week or two and then collect your own data to determine whether you reject the PDA hypothesis and logic, or whether you think it suits the PDA child or teen.

 

You have full autonomy, always, and can change course at any time. Additionally, I am not a guru who believes she knows more than you. As a researcher, I always hold the possibility that I could be incorrect, and I trust your intuition about your own child more than my frameworks.

 

OK, so now that we have a hypothesis for how the PDA brain and nervous system work, what can we do about it?

 

A Paradigm Shift

First, I want to outline the paradigm that you are likely currently working within, whether you are aware of it or not. Most of us start our journey as parents of PDA children and teens – or professionals working with PDA children and teens – from a perspective of conventional wisdom and behaviorism (even if we are “gentle” about it). We are putting ourselves in the role of the “decider” and the “authority,” even if we are not authoritarian, because society tells us that is our job. Unfortunately, the “role” of parent, therapist, or teacher sets off the threat response with the PDA child or teen and shuts down their capacity for connection and long-term collaboration.

 

Conventional Paradigm

Conventional wisdom around parenting, education, and many therapeutic practices is premised on the idea that it is our responsibility as adults to explicitly teach children and teens the skills they need to be good humans and eventually be independent in the world. We correct bad behaviors and encourage good ones, and we demonstrate appropriate behavior to our children and teens through the following strategies:

• Incentives (rewarding them for good behavior with our attention, love, tokens, gifts, more screen time, privileges, preferred activities in therapy, etc.) or disincentives (taking away our attention, removing screen time, grounding, consequences, raised voice, disapproval, or even punishments).
• Exposure – If your child or teen is anxious or avoidant, we encourage them to “get used to” whatever is causing that avoidance, like going to school, participating in a new activity, or even socializing with new friends.
• Explicit teaching and correction in the moment of the unwanted or wanted behavior.

 

Additionally, conventional approaches to the behavior of children and teens are based on three fundamental assumptions:

• A child or teen’s behavior is goal-oriented and rational
• A child or teen’s behavior is coming from the Thinking Brain
• A child or teen must be taught to be good (instead of being considered inherently good)

 

This logic is not wrong or flawed. This is a paradigm that works for MANY children and teens. That is partly why it is the “conventional” wisdom.

 

However, to truly support PDA children and teens in their long-term well-being, mental health, and ability to access prosocial behaviors, we must return to – and accept – the logic of PDA as a nervous system disability and not a behavioral disorder.

 

Through the PDA Paradigm – and based on the logic of how a brain and nervous system under threat operate, we make new assumptions.

 

The challenging behavior you see from a PDA child or teen is:

• Not goal-oriented or rational, but rather nervous-system driven
• Not coming from the Thinking Brain, but rather the Survival Brain
• An inability to access their goodness due to their activated threat response. They are already good.

 

The PDA Paradigm

As a parent, therapist, or teacher, we are always activating or accommodating a PDA child or teen. There is no in-between, no gray space, and no yellow zone.

 

Every time a PDA child or teen perceives – on a *subconscious* level – that there is a loss of Autonomy (not truly having freedom and choice) or Equality (they are not equal to or above you, a friend, a sibling, a board game, situation, or teacher, for example) it will drive them into the Survival Brain.

 

I want to pause here and remind everyone that the Survival Brain is the “older,” reptilian part of the brain that functions primarily to tell the human’s nervous system whether they are safe, in danger, or under life threat.⁴⁹

 

From this part of the brain, humans cannot:

• access rational thought and understand cause and effect;
• think creatively and learn new information; or
• access empathy for other humans.

 

When we try to incentivize, disincentivize, expose, teach, or correct PDA children and teens – no matter how gently – it registers as threatening, and moves us further from our goals of helping them learn and connect.

 

These approaches simply put the PDA child or teen into the Survival Brain and make it less likely that they will be in the correct part of the brain for accessing and learning skills, connection, etc.

 

Further, this builds over time; PDA nervous system activation is cumulative.

 

This is why it feels like you are “walking on eggshells” or “all of a sudden” a PDA child or teen went into burnout or had a regression. They have likely been moving invisibly towards their Threshold of Tolerance for weeks, months or even years.

 

Remember, even if they are “complying” in the moment, they are still experiencing the bodily impact of the nervous system going off and moving towards the Threshold of what a human can tolerate.

 

Theory of Change for PDA Children and Teens

It can feel overwhelming and triggering to lean into this logic. That’s normal! The good news is, there are lots of things we *can* do to support these unique humans. By understanding this logic and taking a long-term approach, we can drop the Conventional Paradigm and exclusively focus on four goals:

1. Help the PDA child or teen develop a Window of Tolerance⁵⁰ so that they aren’t past their threshold of nervous system activation (burnout is essentially a PDA child or teen operating consistently past their Threshold of Tolerance).
2. Help the PDA child or teen create new neural pathways that aren’t only threat oriented and reactive.⁵¹
3. Help the PDA child or teen spend more time in the Thinking Brain than in the Survival Brain.
4. Consistently signal felt safety,⁵² which precedes attachment and emotional connection.⁵³ By doing this we can develop trust and connection, which is the foundation on which all collaboration and mentorship from a parent, therapist, or teacher is built.

 

As we focus on the four goals above, we increase the likelihood that and frequency with which the PDA child or teen will be able to:

• Learn to manage and understand their nervous system
• Access empathy
• Make rational decisions
• Learn new skills and information
• Access skills and information they already have
• Observe your modeling and mentorship with openness

 

But here is where it starts to feel counterintuitive, because we support PDA children and teens to meet the goals outlined above by accommodating them as comprehensively as possible, as this will bring them back into their Thinking Brain (over and over) and reduce cumulative nervous system activation.

 

In practice, this is hard. It might mean watching a child drop a candy wrapper on the ground and picking it up for them and saying nothing (Lowering Demands) or listening to a teen swear at you and choosing not to correct them (Diffusion).

 

By choosing accommodations consistently and over the long term – even when it feels like the “wrong approach” – we reduce cumulative nervous system activation and support a PDA child or teen to operate from below their Threshold of Tolerance and out of burnout. And this enables them to feel safe, connect, learn and grow.

 

The 12 Accommodations we can use to bring cumulative nervous system activation down are the following:

1. Autonomy Accommodations
2. Equality Accommodations
3. Signaling Nervous System Safety Accommodations
4. Communication Accommodations
5. Strewing Accommodations
6. Play Accommodations
7. Humor Accommodations
8. Novelty, Dopamine, and Sensory Intense Experience Accommodations
9. Lowered Demands Accommodations
10. Diffusion Accommodations
11. De-escalation Accommodations
12. Risk Mitigation Accommodations

 

But it also isn’t as simple as just accommodating consistently. To accomplish the four goals outlined above, we must truly let go of the Conventional Paradigm and shift the relationship and energy between ourselves and the PDA child or teen.

 

While this is incredibly challenging in implementation, in real life, and in a household, clinical, or classroom setting, many parents, therapists and teachers make tremendous progress with the PDA children and teens they support.

 

To help them do so, we offer numerous free classes and an educational podcast. Additionally, for parents who need support along the way - and many do - we offer private coaching and the only evidence-based, proven effective live program for parents of PDA children and teens.  

 

¹ Phil Christie et al., in Understanding Pathological Demand Avoidance Syndrome in Children: A Guide for Parents, Teachers and Other Professionals, JKP Essentials (Jessica Kingsley Publishers, 2012), 11.

² E Newson, K Le Maréchal, and C David, “Pathological Demand Avoidance Syndrome: A Necessary Distinction within the Pervasive Developmental Disorders,” Archives of Disease in Childhood 88, no. 7 (July 1, 2003): 596, https://doi.org/10.1136/adc.88.7.595.

³ E Newson, K Le Maréchal, and C David, “Pathological Demand Avoidance Syndrome: A Necessary Distinction within the Pervasive Developmental Disorders,” Archives of Disease in Childhood 88, no. 7 (July 1, 2003): 595–600, https://doi.org/10.1136/adc.88.7.595.

⁴ American Psychiatric Association, ed., Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR, Fifth edition, text revision (Washington, DC: American Psychiatric Association Publishing, 2022).

⁵ Newson, Le Maréchal, and David, “Pathological Demand Avoidance Syndrome,” July 1, 2003.

⁶ Damian Milton, “Pathological Demand Avoidance (PDA) and Alternative Explanations: A Critical Overview” (PARC Meeting, London, UK: Unpublished, 2018).

⁷ Elizabeth O’Nions et al., “Development of the ‘Extreme Demand Avoidance Questionnaire’ ( EDA ‐Q): Preliminary Observations on a Trait Measure for Pathological Demand Avoidance,” Journal of Child Psychology and Psychiatry 55, no. 7 (July 2014): 758–68, https://doi.org/10.1111/jcpp.12149.

⁸ R Woods, “Demand Avoidance Phenomena: Circularity, Integrity and Validity - a Commentary on the 2018 National Autistic Society PDA Conference,” Good Autism Practice 20, no. 2 (October 1, 2019): 28–40.

⁹ Jonathan Green et al., “Pathological Demand Avoidance: Symptoms but Not a Syndrome,” The Lancet Child & Adolescent Health 2, no. 6 (June 2018): 455–64, https://doi.org/10.1016/S2352-4642(18)30044-0.

¹⁰ PDA North America. www.pdanorthamerica.org

¹¹ PDA Society. www.pdasociety.org.uk/about-pda/autism-and-pda/

¹² Sally Cat, PDA by PDAers: From Anxiety to Avoidance and Masking to Meltdowns (London: Jessica Kingsley Publishers, 2018). pp 69-87.

¹³ Eilidh Cage and Zoe Troxell-Whitman, “Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults,” Journal of Autism and Developmental Disorders 49, no. 5 (May 2019): 1899–1911, https://doi.org/10.1007/s10803-018-03878-x.

¹⁴ Laura Hull et al., “Development and Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q),” Journal of Autism and Developmental Disorders 49, no. 3 (March 2019): 819–33, https://doi.org/10.1007/s10803-018-3792-6.

¹⁵ Dinah Murray, Mike Lesser, and Wendy Lawson, “Attention, Monotropism and the Diagnostic Criteria for Autism,” Autism 9, no. 2 (May 2005): 139–56, https://doi.org/10.1177/1362361305051398.

¹⁶ Marge Blanc, Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self- Generated Language (Madison, WI: Communication Development Center, 2012).

¹⁷ American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.

¹⁸ Jordan N Grapel, Domenic V Cicchetti, and Fred R Volkmar, “Sensory Features as Diagnostic Criteria for Autism: Sensory Features in Autism,” Yale Journal of Biology and Medicine 88 (2015): 69–71.

¹⁹ Steven K Kapp et al., “‘People Should Be Allowed to Do What They like’: Autistic Adults’ Views and Experiences of Stimming,” Autism 23, no. 7 (October 2019): 1782–92, https://doi.org/10.1177/1362361319829628.

²⁰ Daniel J. Siegel and Tina Payne Bryson, The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind (New York: Delacorte Press, 2011).

²¹ Bessel A. Van der Kolk, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma (New York, NY: Penguin Books, 2015). pp 55.

²² Siegel and Bryson, The Whole-Brain Child.

²³ Van der Kolk, The Body Keeps the Score. pp 56-57.

²⁴ Stephen W. Porges, The Pocket Guide to the Polyvagal Theory, Norton Series on Interpersonal Neurobiology Ser, v. 0 (Erscheinungsort nicht ermittelbar: W. W. Norton & Company, Incorporated, 2017). pp 14.

²⁵ The Polyvagal Institute. www.polyvagalinstitute.org/whatispolyvagaltheory

²⁶ Rebecca Bailey et al., “Appeasement: Replacing Stockholm Syndrome as a Definition of a Survival Strategy,” European Journal of Psychotraumatology 14, no. 1 (December 31, 2023): 2161038, https://doi.org/10.1080/20008066.2022.2161038.

²⁷ Porges, The Pocket Guide to the Polyvagal Theory. pp 10-11

²⁸ I define “Threshold of Tolerance” as the point at which repeated perceptions of danger and concomitant nervous system activation accumulates and reaches and/or surpass a human being’s limit before they begin to either immediately default to full blown panic responses (fight/flight or shutdown) or move towards trauma and/or nervous system burnout.

²⁹ PDA Society. 2024. PDA in our words. https://www.pdasociety.org.uk/pda-in-our-words-2024/

³⁰ Cat, PDA by PDAers. pp 36-47.

³¹ Harry Thompson and Felicity Evans, The PDA Paradox: The Highs and Lows of My Life on a Little-Known Part of the Autism Spectrum (London: Jessica Kingsley Publishers, 2019). pp 47.

³² Tomlin Wilding, “Changing the Name PDA,” Wilding Blog (blog), April 4, 2020, http://tomlinwilding.com/changing-the-name-pda/.

³³ Nancy Doyle, “Emerging Neurodivergent Identities: A Lesson On Pathological Demand Avoidance From Kristy Forbes,” Forbes.Com, March 26, 2021, https://www.forbes.com/sites/drnancydoyle/2021/03/26/emerging-neurodivergent-identities-a-lesson-on-pathological-demand-avoidance-from-kristy-forbes/

³⁴ Bachelor Star Demi Burnett on How Her Autism Diagnosis Improved Her Mental Health (Yahoo Life Videos, 2022), https://www.yahoo.com/lifestyle/bachelor-star-demi-burnett-self-191640936.html?guccounter=1.

³⁵ Van der Kolk, The Body Keeps the Score. p 61.

³⁶ Stephen W Porges, “Neuroception: A Subconscious System for Detecting Threats and Safety,” Zero to Three 24, no. 5 (2004): 19–24.

³⁷ Porges.

³⁸ Cat, PDA by PDAers. pp 36-47.

³⁹ Thompson and Evans, The PDA Paradox. pp 47.

⁴⁰ Wilding, “Changing the Name PDA.”

⁴¹ Doyle, “Emerging Neurodivergent Identities: A Lesson On Pathological Demand Avoidance From Kristy Forbes.”

⁴² Porges, The Pocket Guide to the Polyvagal Theory. pp 56, 68.

⁴³ Stephen W. Porges, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation, The Norton Series on Interpersonal Neurobiology (New York: W. W. Norton, 2011). pp 154.

⁴⁴ Van der Kolk, The Body Keeps the Score.

⁴⁵ Porges, The Pocket Guide to the Polyvagal Theory. pp 10.

⁴⁶ Porges, The Polyvagal Theory. pp 165.

⁴⁷ Porges, The Pocket Guide to the Polyvagal Theory. pp 21.

⁴⁸ W. Thomas Boyce, The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive (New York: Knopf, 2019). pp 32-41.

⁴⁹ Van der Kolk, The Body Keeps the Score. pp 56.

⁵⁰ This term is inspired by - but somewhat different from - Dr. Dan Siegel’s conceptualization from his 1999 book: The Developing Mind: How Relationships and the Brain Interact to Shape who we are. It refers to the “optimal state of arousal” and below the threshold you are under-aroused, and above, you are over-aroused. What I mean here is: a window or “room” beneath the Threshold of Tolerance so that even if the PDA child or teen perceives threat and does experience nervous system activation, they can weather it without tipping over into perceiving life threat – and the accompanying nervous system responses – and/or burnout/trauma. This is based on the logic that PDA nervous system stress is cumulative over long time horizons.

⁵¹ This is based on the concept of Neuroplasticity and the idea that “neurons that fire together, wire together.” Pedro Mateos-Aparicio and Antonio Rodríguez-Moreno, “The Impact of Studying Brain Plasticity,” Frontiers in Cellular Neuroscience 13, no. 66 (February 27, 2019): 1–5, https://doi.org/10.3389/fncel.2019.00066.

⁵² Van der Kolk, The Body Keeps the Score. pp 81.

⁵³ Porges, The Pocket Guide to the Polyvagal Theory.