Anxiety Doesn't Always Look Afraid

A child may argue, insist on a particular plan, or avoid a task without saying they feel worried. Anxiety is one possible explanation. The behavior alone does not tell us what is happening.

PDA is a contested descriptive term, not a universally accepted diagnosis. A systematic review found major methodological limitations in the literature. Anxiety may be relevant to demand avoidance, but refusal does not establish anxiety, a loss-of-autonomy mechanism, or PDA. Kildahl et al. (2021)

That uncertainty matters. Becoming firmer may intensify an already difficult interaction, but so can missing pain, communication difficulty, bullying, or another unmet need. Rather than deciding in advance that this is boundary testing or fear, assess what is happening and what keeps everyone safe.

Look at what is happening

Look at the specific interaction. Is the child trying to slow things down, make the plan clearer, avoid discomfort, or communicate something else?

For example, a child might reject several shirts before school. Check the clothing’s feel, the time available, and whether something about school is worrying them. This is an illustration, not an account of a particular child.

This does not mean abandoning every limit. A safety boundary can remain clear while the route is negotiated. Offering genuine choices, allowing a pause, or beginning alongside the child are options to try, not techniques established to lower a measurable “autonomy threat.” Their value depends on what happens for this person.

The tone can be a demand, too

The same words can feel different depending on timing, repetition, posture, and whether there is a genuine option to pause. “Whenever you’re ready” may not feel optional when everyone is watching. This is an interpretation of an interaction, not a way to read someone’s nervous system.

Keep anxiety among the possibilities without assuming every refusal is fear.