When Demands Feel Like Land Mines: ADHD, Pathological Demand Avoidance, and the Art of Staying Married Anyway
Monday, July 7, 2025. This is for my new client. Welcome aboard!
(Expanded from my 2023 presentation at the American Family Therapy Academy, now updated with 2025 research and speculative treatments for couples therapists working with neurodivergent couples)
Some people are allergic to peanuts. Others, to bee stings.
And then there are those who flinch at the mere suggestion that it’s time to empty the dishwasher.
For partners living with Pathological Demand Avoidance (PDA) or ADHD, the everyday expectations of life—polite requests, chore lists, dinner invitations—can feel like psychological land mines.
They may deeply love their spouses. They may want to comply. They are not, in fact, pathological.
But the moment a request hardens into a “should,” something ancient and involuntary lights up the threat circuits of their nervous system.
In 2023, I presented on this topic at the American Family Therapy Academy, making the argument that demand avoidance is not a moral failure, not laziness, and not oppositional defiance dressed up as neurodivergence.
It is, in many cases, a form of autonomic defensiveness—a state-triggered protection against perceived coercion, especially in folks whose nervous systems have learned to equate structure with danger.
Now meet BetteSue and Danny.
He has ADHD with a side order of what looks an awful lot like PDA.
She’s neurotypical, raised on checklist culture and the gospel of follow-through.
They love each other. They laugh, touch toes under the table, and enjoy binge-watching documentaries about endangered birds.
But somewhere between “Can you grab the laundry?” and “It’s time to call your mom,” Danny’s brain treats her requests like a Red Alert.
His heartrate spikes. He snaps. Or he disappears into her phone. BetteSue, confused and increasingly resentful, interprets this not as neurobiology, but as ambivalence—or worse, sabotage.
This post is for couples like BetteSue and Danny. And also for therapists working in the increasingly tangled intersection of ADHD, demand avoidance, and relational rupture.
I also include anyone who has ever sat at the edge of the bed wondering why asking your partner to schedule a dental appointment just launched a Cold War.
The Many Faces of Demand Avoidance
Pathological Demand Avoidance, originally coined by UK researcher Elizabeth Newson in the 1980s, was first observed in children who exhibited extreme resistance to everyday demands (Newson et al., 2003).
These weren’t kids throwing tantrums over screen time—they were highly strategic, capable of using charm, distraction, negotiation, or outright meltdown to avoid any perceived expectation.
In the UK, PDA has been folded into autism spectrum profiles, but elsewhere (including the U.S.), it remains a controversial and somewhat vague construct.
What’s now emerging in the literature is a compelling overlap between PDA and ADHD, especially in partners with high emotional sensitivity and executive function struggles (Stuart et al., 2019).
A 2024 scoping review in Frontiers in Psychology found that many ADHDers exhibit effort-based avoidance—the subjective experience that certain tasks, even simple ones, require an unbearable cognitive cost (Frontiers in Psychology, 2024).
It’s not that they won’t do the task.
It’s that their internal economy of energy, stress, and autonomy has decided the exchange rate is unacceptable.
This is especially true when tasks are externally imposed. In both PDA and ADHD, it’s the loss of agency—not the task itself—that triggers avoidance.
The dishes aren’t threatening. Being told to do the dishes feels like being frog-marched into a sensory courtroom where compliance equals self-abandonment.
Not Just “Difficult”: Demand Avoidance as a Nervous System Reflex
Here’s where polyvagal theory crashes the party.
Stephen Porges’ model of the autonomic nervous system offers a powerful lens through which to understand demand avoidance—not as a character flaw but as neuroception of threat (Porges, 2011).
In PDA, demands are experienced as threats to autonomy and identity, activating sympathetic arousal (“fight or flight”) or dorsal vagal shutdown (“freeze or faint”).
Even benign requests like “Can we talk later?” can be misread by a dysregulated nervous system as “You’re about to be controlled.”
Danny doesn’t dislike BetteSue. But his nervous system may misinterpret her gentle requests as subtle intrusions, leading him to withdraw, lash out, or derail the conversation entirely. He’s not being manipulative.
He’s protecting his sense of self from a perceived loss of control.
This same response is often seen in ADHD, especially in high-stress environments or with folks who’ve faced chronic invalidation or trauma. Executive dysfunction + chronic overstimulation + perceived pressure = avoidance spiral.
Marriage in the Age of Avoidance: What Couples Therapists Need to Know
Let’s revisit BetteSue and Danny.
Every time BetteSue asks for something—“Let’s budget,” “Let’s leave by six,” “Let’s not adopt another parrot”—Danny flinches, jokes, zones out, or fights back. BetteSue experiences this as sabotage. Danny experiences it as survival. Both feel alone.
So what can we, as couples therapists, actually do?
Pace the Ask. Instead of focusing on compliance, help couples understand autonomy-first language. “Would it help if…” lands softer than “You need to…”
Externalize the Pattern. The enemy is not each other. The enemy is demand-induced dysregulation. A simple phrase like, “Do you think your nervous system is overwhelmed right now?” might reframe the dynamic.
Introduce Low-Demand Rituals. Encourage the couple to engage in shared tasks where neither is the boss. Cooking together with music, folding laundry during a favorite show, parallel play—all offer a sense of contribution without hierarchy.
Use Acceptance and Commitment Therapy (ACT). Especially for clients with PDA profiles, ACT’s emphasis on values-based action and defusion from anxious thoughts can be liberating (Francis et al., 2021).
Teach “Co-Regulation” Before Conversation. A few minutes of synchronized breathing or movement before a logistics talk can shift the nervous system toward safety and connection.
Timing is Everything. For ADHD clients on stimulant medication, don’t schedule the hardest conversations for 8 p.m. when executive function has already left the building.
Future Directions: What the Research Is Still Figuring Out
While PDA remains under-researched outside the UK, several critical questions are beginning to guide new inquiry:
Is PDA a subtype of autism, ADHD, or a separate neurotype altogether?
What’s the relationship between demand avoidance and trauma?
Can demand avoidance be mitigated by improving interoceptive awareness and nervous system regulation?
Recent work by Bernacer et al. (2025) suggests that effort discounting—a tendency to undervalue rewards when effort is required—is significantly higher in ADHD adults, correlating with unhealthy habits and avoidance (Bernacer et al., 2025).
Others, like Stuart et al. (2019), argue that intolerance of uncertainty and anxiety are better predictors of extreme avoidance behaviors than defiance or ODD-like traits.
Meanwhile, PDA-focused treatment guidelines increasingly emphasize low-demand environments and collaborative problem-solving over traditional behavioral interventions (National Autistic Society, 2025).
Conclusion: Toward a Compassionate Frame for Avoidance
BetteSue and Danny aren’t doomed. But they will need a therapist who understands that demand avoidance is not the same as resistance.
It’s a language—rooted in nervous system vigilance, shaped by neurodivergence, and often misunderstood as rebellion or selfishness.
For couples therapists, the most healing stance is this: What looks like opposition may actually be protection.
When we treat avoidance with curiosity rather than coercion, we create space for new ways of relating, new neural patterns, and—a reshaping of intimacy.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Bernacer, J., Gambra, L., Rodriguez-Romero, D., et al. (2025). Association between ADHD symptoms, physical effort discounting, and unhealthy lifestyles in adults. Scientific Reports, 15, 17255.
Francis, A., Becker-Haimes, E., & Kendall, P. C. (2021). Acceptance and Commitment Therapy for children and adolescents with anxiety disorders: A pilot study. Behavior Modification, 45(5), 740–763. https://doi.org/10.1177/0145445520982860
Frontiers in Psychology. (2024). The experience of effort in ADHD: A scoping review. Frontiers in Psychology, 15, Article 1349440.
National Autistic Society. (2025). Demand avoidance: Advice and guidance. https://www.autism.org.uk
Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595–600. https://doi.org/10.1136/adc.88.7.595
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton.
Stuart, L., Grahame, V., Honey, E., & Freeston, M. (2019). Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents. Child and Adolescent Mental Health, 24(4), 403–410. https://doi.org/10.1111/camh.12264