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Neurodivergent clients are more likely to be labeled as oppositional, due to struggles navigating the world.

Motivational interviewing emphasizes the client's expertise and autonomy—vital for those with ODD or PDA.

Motivational interviewing fosters self-driven change and deeper client engagement.

“Noah,” an older autistic teen, presented for his intake appointment. His referral for treatment included concerns of self-harm and the term “pathological demand avoidance.” I asked him to tell me briefly what he knew about his referral, and he responded, “Dad wanted me to come. Therapy doesn’t work for me, but I was curious about seeing an autistic therapist. I know I’m here for self-harm. I hit myself when I’m upset. I don’t hurt anyone else, so there isn’t a problem. ‘My body, my choice.’”

During trainings and consultations, I often get questions about treatment strategies for clients with oppositional defiant disorder (ODD) and pathological demand avoidance (PDA). (Note: PDA is not an official diagnosis, but is often used as a label attached to autistic people. The autism community has relabeled this as “persistent drive for autonomy.”) When this question is asked, I can almost feel the distress behind it. As a therapist who specializes in neurodivergent clients, who are more likely to be labeled as oppositional, I can definitely empathize, as supporting oppositional clients is challenging.

Why Are ODD and PDA More Common in This Population?

A simple reason for this frequent co-occurrence is that neurodivergent individuals are trying to navigate life in........

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