Dr Rachel Worthington, Affiliation: Senior Lecturer, Manchester Metropolitan University, Email: r.worthington@mmu.ac.uk; Dr Alice Bennett, Affiliation: Honorary Researcher, Manchester Metropolitan University
Introduction
It is well documented that autistic people are more likely to encounter the Criminal Justice System (CJS) as a victim or witness to a crime. However, for those autistic individuals who are alleged perpetrators of offending, research has shown they may experience challenges to all parts of this process from arrest, attending court, through to imprisonment and rehabilitation back into the community. As a result, various legislation and guidance has been developed making recommendations for how autistic people could be better supported in the CJS. For example, in England and Wales the Police and Criminal Evidence Act 1984 Code of Practice was revised to provide further guidance to officers when detaining, cautioning, and interviewing vulnerable suspects, including autistic people (Home Office, 2023). Following recommendations from the Bradley Report (2009), NHS Liaison and Diversion Services have also been introduced to support vulnerable people involved in the CJS. Despite this progress, it is unclear to what extent such guidance and practice is relevant for autistic individuals with Pathological Demand Avoidance (AuPDA).
Autism is a spectrum disorder, and presentations vary widely. While Pathological Demand Avoidance (PDA) is not formally recognized in the DSM-5 as a separate diagnosis, the Royal College of Psychiatrists1 note it as a profile some autistic individuals experience, often causing significant stress for them and their families. Key features include:
- Persistent avoidance of everyday demands
- Use of social strategies to resist demands
- Surface sociability
- Intense mood swings and impulsivity
- Enjoyment of role play
- Socially focused obsessive behaviours
Unlike other avoidance disorders, AuPDA individuals may avoid not only disliked tasks but also activities they enjoy or self-imposed demands. When demands persist, this can lead to severe anxiety, mood instability, aggression, self-harm, and extreme efforts to regain control which may sometimes lead to contact with the CJS. However, no studies have specifically explored the experiences of AuPDA individuals in the UK CJS and the experiences of professionals within the CJS who may be required to support them.
Method
Given the limited research on AuPDA individuals in the CJS, a qualitative design was adopted to capture nuanced insights into lived experiences and professional perspectives.
Two complementary studies were conducted:
- Study 1: In-depth semi-structured interviews were conducted with 18 AuPDA individuals. In some instances, both the family member and their children had AuPDA and had contact with the CJS resulting in the data pertaining to 21 AuPDA people. All had a formal autism diagnosis. Interviews were conducted via Microsoft Teams, lasting 1–2.5 hours, with full ethical approval, safeguards, informed consent, and withdrawal rights. Interview questions and participant facing documents were reviewed for inclusivity and accessibility to minimize demand-related stress.
- Study 2: 32 CJS professionals completed an anonymous online qualitative survey about their experiences with AuPDA individuals. Respondents included prison staff, police officers, barristers, magistrates, and youth justice practitioners. This method was adopted as CJS professionals work in highly regulated environments where expressing views on systemic challenges or gaps may pose reputational risk. Anonymity was therefore critical to encourage participants to share sensitive experiences without fear of identification.
Data was analysed using reflective thematic analysis2 and adhering to a 16-item rigor checklist3.
Results
AuPDA individuals often face unique challenges that are poorly understood by professionals, leading to escalating cycles of fear, conflict, and punitive responses. Three key themes shaped these experiences.
Theme 1: Misinterpreting Resistance
Participants described how some professionals lacked knowledge of the diverse ways in which autism can present. They felt this led to AuPDA behaviours being misunderstood resulting in increased contact with the CJS. These misunderstandings appeared in several interconnected ways.
Although all participants had a formal autism diagnosis, AuPDA individuals reported being told they were “not autistic” during crises because they didn’t fit stereotypes of autism (e.g. “you have eye contact”). Participants described using advanced observational skills to “spot everything,” copying social rules they had observed others use to escape demands (e.g., flattery) or using intellect to “burrow down on an argument”. These anxiety-driven strategies were misinterpreted as “manipulative” being purposefully defiant, a “psychopath” or being “badly behaved”. As a result, instead of empathising with autistic challenges professionals increased demands upon them using more dominant styles (“Grant and Phil Mitchell”) and asserting more authority and control. However, this heightened AuPDA anxiety/fear even more, triggering states of terror and extreme fight-or-flight responses such as “running into cars,” climbing buildings, or becoming “really violent” even toward loved ones or people they liked. Fearing for their own and others safety, professionals responded with more control (e.g., threatening to taser the person), which frightened AuPDA individuals even further thus creating a feedback loop or “battle for control”. This was described as a “tug of war” between AuPDA individuals and professionals whereby “more control equals more fighting against being controlled”. Escalation was described as “very quick,” often leading to physical restraint.
Participants also noted that when arrested, court and probation settings increased fear because these were inherently authoritarian environments with many demands (e.g., where to sit, what time to attend). These triggered feelings of lost autonomy and fear. For some this was combined with autistic “blunt honesty” where individuals would “tell it like it is” and question authority (e.g., asking “why?” when told to remove their hands from their pockets). Seeking autonomy rather than “bowing to authority” was an AuPDA coping strategy, but instead was perceived as them being disrespectful. When professionals couldn’t answer questions logically (e.g. why the person should remove their hands from their pockets), professionals felt angry. Participants believed this led to harsher sentences and breaches of court orders. For others, rigid legal processes intensified anxiety, sometimes prompting guilty pleas simply to avoid returning to court.
Parents also described how professionals questioning their child’s diagnosis (and responding in a more authoritarian way as a result) escalated the situation resulting in them being “gaslighted” when reporting safety concerns or advocating for their child. Instead, being told they were “too soft” as parents and in some cases, they were threatened with legal action when asking for help. Consequently, they tried to scaffold their child’s difficulties and only contacted CJS professionals when they were desperate such as during significant acts of violence. However, this reinforced CJS professionals’ perceptions of their child being anti-social and “really violent” rather than autistic. Parents desribed this as emotionally exhausting: “not just a battle looking after him, it’s everyone else”. Some AuPDA participants also described being victims of crime but not reporting this to CJS professionals because they felt their “cards were already marked” as being “bad” and they would not be believed.
Theme 2: Knowledge is Power
Participants in both studies wanted training for CJS professionals on AuPDA.
None of the participants across both studies viewed aggression or violence as acceptable; they wanted to learn skills to manage demands, reduce their anxiety and to understand consequences. They did not want others including CJS professionals to “give in” and recognised that demands are a part of daily life. However, all felt that professionals who enabled this through patience and encouraging the person to consider the consequences for themselves (rather than authoritarian control), were more effective at de-escalating situations. Participants stressed the importance of understanding that AuPDA reactions resemble “panic attacks” and professionals “hold their nervous system in their hands” They felt understanding that behaviours stem from terror, not defiance, could help professionals respond with calm, low-arousal techniques rather than shouting or escalating control.
To help CJS professionals empathise with AuPDA needs, participants felt training could be psychoeducational and explain the diverse spectrum of autistic traits and how AuPDA differs from stereotypes of autism (e.g. behaviour that may look anti-authoritarian is rooted in fear not disrespect). Participants felt CJS professionals could also be taught how to explain the logic of requests (demands) in an intellectual way (brain over brawn) stating facts but in a warm manner. They felt this would help to build trust, set clear expectations of behaviour and help them to explain the natural consequences of the AuPDA person’s choices giving them a sense of autonomy. They felt these strategies were more effective than threats or force and knowing this would help professionals as well as the AuPDA individual.
Theme 3: Systems of Care, Not Control
Participants emphasized the need for systemic, integrated approaches to supporting AuPDA individuals. Working together rather than against each other was seen as essential, with a multi-disciplinary approach involving social workers, mental health teams, family, and police considered as crucial. In high-risk cases, participants suggested police could get to know the AuPDA individual when calm to foster trust, rather than only encountering them during high-stress emergencies. Access to mental health support for AuPDA individuals was also highlighted as a priority, with participants stressing the need for autistic trauma-informed, flexible approaches that recognise missed appointments often reflect demand avoidance rather than a lack of motivation. Families were also noted to experience significant strain and mental health challenges due to their child’s difficulties, compounded by limited respite and inadequate follow-up after crises. Participants stressed that families often act as the primary calming influence during incidents, underscoring the need for sustained support to prevent burnout and reduce future criminal justice involvement.
Conclusions:
Autism is a spectrum condition, and presentations vary widely4. Findings suggest AuPDA individuals enter situations with anxiety, a need for control, and heightened observational skills to detect threats. When demands arise, they may first use social skills such as negotiation, debate, or flattery, but if these fail, fear escalates and extreme behaviours—including physical force—can occur. This cycle mirrors criminal justice professionals’ experiences. For example, the police also operate in high-risk environments and have a heightened radar for threats to their safety. When they feel threatened, they too may use negotiation and if this fails physical force.
When CJS professionals interpret AuPDA behaviour as disrespectful and purposeful disobedience this can lead them to conclude warranting a more authoritarian style is justified. However, this escalates the situation resulting in AuPDA individuals and CJS professionals engaging in “battles for control” because they are both seeking the same thing, safety through control. When CJS professionals recognise AuPDA behaviour as being driven by autistic anxiety this can improve empathy, compassion and more helpful responses that could de-escalate the situation.
In summary, AuPDA in the CJS can be exhausting and frightening both for the individual and those around them. It is important to note that many biopsychosocial factors contribute to violence and aggression, and AuPDA alone does not excuse or explain offending behaviour. AuPDA is complex and some individuals may have additional comorbid needs which have different indications for risk and intervention. Determining the specific drivers of aggression or offending requires comprehensive assessments by qualified health professionals with expertise in autism and forensic practice. Hence, findings from this study cannot be used to infer decisions about capacity, culpability or fitness. Such decisions should never be based on research and must only be made by registered health professionals. However, training and multi-systemic support for the AuPDA individual, their family, and CJS professionals could help improve the well-being of everyone involved.
If you would like to read more information about this study and the ways in which AuPDA individuals and CJS professionals could be supported, the link to the full published study4 can be found below.
Bibliography
- Royal College of Psychiatrists. The psychiatric management of autism in adults. London: Royal College of Psychiatrists, CR228. 2022.
- Braun V, Clarke V. Thematic analysis: A practical guide. Sage. 2022. 31.
- Ahmed SK, Mohammed RA, Nashwan AJ, et al. Using thematic analysis in qualitative research. J Med Surg Public Health. 2025;6:100198.
- Worthington R. & Bennett, A. (2025). Role traps and control conflicts: autistic pathological demand avoidance (AuPDA) in the criminal justice system. Journal of Psychology and Clinical Psychiatry. 2025;16(6):251‒262. DOI: 10.15406/jpcpy.2025.16.00842.
