ADHD, Autistic Inertia, and PDA — What Sets Them Apart?

Photo by Sally Cat PDA

All three of these conditions seem similar on the surface, but here’s a breakdown of their differences.

ADHD

ADHD is a neurodevelopmental condition characterized by difficulty focusing, disorganization, distraction, and forgetfulness. Many people with ADHD also struggle with emotional regulation, rejection sensitive dysphoria, low frustration tolerance, and time management issues.

Autistic Inertia

Autistic inertia is a phenomenon in which some autistic people find it hard to change and transition between states. It includes difficulties with starting and stopping tasks. The monotropism theory of autism relates to this — it posits that autistic people have a tendency to maintain one state. For example, when I need to start a new task, I feel an inability to get up and start it, even though I have every intention of doing it. I feel stuck. It takes a long time to cross that threshold and motivate myself enough. I also often hyper-focus on one thing and want to continue doing it, especially in regard to special interests. I can’t break myself out of that state.

PDA (Pathological Demand Avoidance)

PDA is a proposed sub-type and presentation of autism that is characterized by extreme avoidance of everyday demands (even activities the person enjoys). The PDA nervous system perceives demands and requests as a loss of autonomy, and an extreme threat response is activated. PDA is often confused with and misdiagnosed as oppositional defiant disorder. Other characteristics of PDA include:

• using social strategies to avoid demands
• having more subtle social differences; appearing sociable on the surface but lacking deeper understanding
• needing control
• using fantasy as escape
• experiencing extreme mood swings and impulsivity
• appearing comfortable in role play and pretense
• displaying obsessive behavior that is often focused on other people (National Autistic Society).

Their Similarities & Differences

ADHD and PDA seem really similar and can definitely co-occur if a person with ADHD is also autistic. PDA and ADHD both include difficulty regulating emotions. While PDA is a type of autism and anxiety-driven, ADHD can also occur in allistic people and is more about regulating and wielding attention. Anxiety can also occur in people with ADHD, but they might make careless mistakes and forget obligations; PDA people, on the contrary, intentionally avoid demands.

ADHD and autistic inertia also seem similar because they both include executive dysfunction. While people with ADHD might forget about tasks, autistic people experiencing inertia know what they need to do but can’t get themselves to do it. Autistic inertia is very similar to ADHD task paralysis, though, so it’s hard to identify what sets them apart. People with ADHD seek dopamine from their activities, so they may not have enough motivation to complete a low-dopamine task. Autistic people, by contrast, might have a hard time starting and stopping tasks due to preferring sameness and routine or feeling anxious about not knowing what to expect from new tasks. It’s important to note that autism and ADHD do have extremely high rates of co-occurrence.

Autistic inertia and PDA can be confused because they both are traits/types of autism. It is certainly possible for a PDA person to experience autistic inertia, but it is also possible for a non-PDA autistic person to experience it. There certainly needs to be more research into how these overlap and differ.