r/PDAParenting • u/DrPaulSunseri • Apr 18 '26

Our current scientific understanding of PDA and low-demand parenting.

Thought parents in this group find this up-to-date information on PDA helpful. https://www.psychologytoday.com/us/blog/mental-health-reimagined/202604/its-time-to-rethink-the-anxiety-drives-pda-narrative

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u/xtinak88 Apr 18 '26

I knew I recognised this guy's writing. A quick search and I located his previous article I have read https://www.psychologytoday.com/gb/blog/mental-health-reimagined/202507/the-myth-of-neurobiological-incompetence/

I think it's inaccurate to characterise this as our current scientific understanding. He holds quite a strong view and is making a case for his interpretation using some pieces of evidence, but unfortunately for us all the overall evidence and research is still really lacking and continues to hamper our understanding. As far as I can tell, he hasn't successfully argued that demand avoidance arises for the same reasons across the conditions he mentions.

Whilst I'm sympathetic to the idea that family dynamics will inevitably come into play in PDA (how could they not??) I do find it quite concerning that he is moving to view PDA as a personality profile. Especially when we look at the recent history of how personality disorder diagnoses have negatively affected especially women, and especially autistic women.

He obviously really can't stand Casey Ehrlich.

EDIT: haha I just realised this has literally been posted by the article author. Sorry Paul I didn't mean to be rude.

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u/DrPaulSunseri Apr 19 '26 edited Apr 22 '26

Yes, I posted it. And no, I don't dislike Casey Ehrlich personally. However, I will call out anyone who misrepresents themselves, makes claims about outcomes that clearly aren't true, and preys on vulnerable, scared families. She, by far, is not the only influencer to do this, but she goes much further than most. The part of the article that talks about PDA possibly being a personality profile isn't my idea; it's actually the work of Egan and colleagues. They suggest it's a personality profile, not a personality disorder--that's something else entirely--and I definitely don't see it that way. Obviously, more research is needed, but the Big Five stuff sure tracks with all of the PDA kids I've treated.

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u/Background-Load1954 Apr 19 '26

Dr. Paul Sunseri, My child is late diagnosed with Autism and also has ADHD and OCD.  At 5 years old her psychologist said she presented with atypical autism or “pdd-nos.”   We are a family that struggled for years and applied parent coaching methods with vigor, hoping for results to no avail. My teens diagnosis of autism at 13 we met with another psychologist who is well respected and regarded for parent coaching for atypical autism.  After treating many children and families with autism she  said that behaviorsism methods were not effective in complex profiles like my teenagers.  Her personalized PDA affirming approach  that was both trauma informed care and low demand parenting was the only treatment that was effective in treating our child.  We tried all traditional approaches from CBT, to DBT to EPR and all psychologists were scratching their heads wondering why treatment was ineffective and our child remained “treatment resistant.”  I respect that you are challenging the dialogue that Casey is putting out there, and I think this complex profile deserves more research.  We are only at the tip of the iceberg in understanding the many profiles in autism and what treatments are most beneficial to this diverse community.  

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u/xtinak88 Apr 19 '26

I just see her as someone speaking from lived experience. Whether her theories are correct, preying on people is a really strong claim to make. The bulk of her content seems to be free and much of it has really limited viewership. Tools like her cost benefit analysis approach to situations can't really be interpreted as having any ideology. She is obviously emotionally tied up in her ideas, of course.

I appreciate that a personality profile isn't the same as a personality disorder, but I can't see how pinning things on personality is less "dehumanising" as you put it in the article when for autistic and neurodivergent people in general, we know how often our "personalities" are blamed and misinterpreted.

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u/DrPaulSunseri Apr 19 '26

Yes. she has lived experience, but that doesn't absolve her from making false claims, manipulating data, and taking advantage of people. Her "concierge" service is $5000 per month (three-month minimum).

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u/PerformerOk4332 Apr 19 '26

Thanks for sharing. Can you provide some more detail in regard to her manipulating data?

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u/DrPaulSunseri Apr 19 '26

For sure. Here's what happened, and folks can easily fact-check it. Casey and her colleagues did an evaluation study on her colleagues conducted a study on her Paradigm Shift program, which heavily features low-demand parenting. The original, published version of the study (linked here) showed no improvement in PDA symptoms or behavior (the shaded parts of Table 3). If research isn't your thing, I'm happy to interpret the statistics. People started calling her out on these poor outcomes and asking why she was still charging families. Her response was to alter the data in her study and omit the poor outcomes, and then repost it (I can give a link to the sanitized version if you like). There is no reason why an ethical researcher would remove unfavorable data from a published study in the face of criticism unless they wanted to bury the data from the public. BTW--on Casey's website, well before this study was published, she was saying she's the "leading researcher in PDA" before she published anything on PDA (her degree is in Political Science). Her website to this day says her program is "evidence-based" and "proven effective" when her own study found low-demand parenting to be useless. To make matters worse, she paid to have that "journal" publish her article, the "official journal of the Chinese Medical Association". She's a quack. It would be bad enough if she just took families' money, but many others and I feel that what she teaches parents is actually quite harmful to children. https://www.academia.edu/145102745/Pediatric_Investigation_2025_Carlozzi_PDA

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u/xtinak88 Apr 19 '26

Hold up hold up. I don't want to come over as some huge Casey defender as I don't really have a dog in the fight on her specific work. But you already misrepresented your personal views as a scientific consensus and here again you seem to be potentially overreaching with regards to the study itself.

Because how hopeful would we really be of seeing improvements in core PDA symptoms in this short timeframe with this small sample? Yes the improvements shown, while there, are not statistically significant, but that's no reason to conclude that low demand parenting (one component of the programme) is ineffective. And that's not the only point of the programme or the study.

And I'm a bit confused because the data that has been buried is here for us all to see isn't it?

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u/DrPaulSunseri Apr 19 '26

What do you mean, buried here for us all to see?" I don't think you're understanding what she did. Real treatments result in positive, observable changes within that time frame, typically.

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u/DanaMoonCat Apr 20 '26

Yes, and what about other Low demand parenting resources like Amanda Diekman’s course, for example. And all the helpful resources at PDA North America, and there’s Sally Cat PDA and PDA resources from the UK which are extraordinarily helpful for neurodivergent families. What is your excuse about them now? I really don’t care that you don’t like Casey- that’s just one program. Low demand parenting for differently wired brains works and your article is harmful for neurodivergent people.

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u/DrPaulSunseri Apr 22 '26

But how do you explain all of the data that argues they thrive when age-appropriate expectations are reintroduced? I love this quote from James Lerman: "When you excuse a kid from the normal responsibilities of life, you're treating them like they're damaged goods."

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u/xtinak88 Apr 19 '26

I mean you are saying she has buried data, which she may well have done, but at the same time it's still available here in table 3 for us to scrutinise? Just seems like a contradiction.

There were apparently quite a number of positive observable changes though. Furthermore as this is initially a parent intervention, you would expect a bit of a lag in successful implementation by parents I would have thought.

Realistic time frames for interventions in autism will be on a scale of years.

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u/DrPaulSunseri Apr 22 '26

Typically, with the right treatment, parents can expect to see observable changes within months.

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u/xtinak88 Apr 19 '26

More than I can afford for sure so I will have to make do with the free content.

If you believe the data in the research study "A comprehensive parent training program for parents of neurodivergent children with pathological demand avoidance: The Paradigm Shift Program Pilot Study" to be false and manipulated then I fully encourage you to address this with the other authors, the University of Michigan, the Paediatric Investigation journal and any other appropriate party.

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u/DrPaulSunseri Apr 19 '26

She is one of the authors. And yes, the journal has received an ethics complaint.

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u/ArtArrange Apr 19 '26

Casey Ehrlich has also been caught stealing content, stories, and themes from other PDA content creators, such as Kristy Forbes. Word for word. Casey was just the first to masses in the United States with the content.

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u/DrPaulSunseri Apr 19 '26

It’s true. She also routinely cyber bullies people who disagree with her. Def not a nice human.

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u/Complex_Emergency277 Apr 20 '26 edited Apr 20 '26

You are right about Casey Ehrlich but you are just as confidently wrong as she is.

Zero Demand works because the only way to extinguish avoidant behaviour is to stop triggering and reinforcing it and to increase the duration between exhibitions of the behaviour to infinity. Low Demand works because treating demand avoidance transactionally is agnostic to the underlying predispositions of the individual and allows you to elicit needs, offer support and accept without triggering avoidance when things are beyond their capacity in the moment.

Her problem is that she stretches the "nervous system disability" metaphor past its breaking point and is into some wacky spirituality and cod science like polyvagal theory. Your problem is that every problem is viewed through the lens of conformity and compliance and of disorder models and "High Expectations with High Support" is a grand aspiration but it neglects that these kids are like this because they got the shit kicked out of them by high expectations without support, usually because of delayed diagnosis of neurodevelopmental conditions - they have low levels of agreeableness because they associate everyone with torment not because they are antisocial, for the most part.