In My Shoes: PDA, Rejection Sensitive Dysphoria, and the Confidence We Have to Build Ourselves.

By Andrea Grant - get comfortable people - this is a long one. 

My mother had a phrase she used on me, always with a particular tilt of the eyebrow: "Your confidence is in your shoes." Meaning: it comes and goes with the outfit. It is not real. It is not yours. She was, in fairness, a woman who found approval difficult to dispense and criticism effortless to deliver, and I spent a large chunk of my childhood trying to earn a warmth that was never really on offer. 

I got straight A's. I excelled at university. I have built, thus far, a genuinely wonderful career. None of it moved the needle much. 
That is the thing about a confidence deficit installed early — it doesn't respond to evidence. You can hand it a trophy cabinet and it will still ask to see your shoes.I am telling you this because I want to talk about Rejection Sensitive Dysphoria, or RSD, and its close and troublesome relationship with Pervasive Demand Avoidance, or PDA. 
I want to talk about it as a coach, as a teacher of over twenty years, and as the mother of three wildly different children — because I have now watched this particular thread run through four generations of women and one very tender-hearted son, and I think it's time somebody said it plainly: this is not a personality flaw. It is not "being sensitive." It is a nervous system that has learned, often for very good reason, that criticism is dangerous.

❓ What RSD Actually Is:

RSD isn't a formal diagnosis — you won't find it in the DSM — but it is a well-documented pattern, and the overlap with autism and ADHD is striking. Research increasingly suggests that RSD shows up not as an occasional bruised ego but as something closer to a threat response: the brain registers perceived rejection, criticism or failure the way it might register physical danger, triggering a reaction that is fast, automatic, and entirely disproportionate to whoever is watching from the outside. 

One recent overview put the prevalence starkly, suggesting the overwhelming majority of autistic and ADHD adolescents and adults report RSD symptoms of some kind. After years of working in the Neurodiversity field, I have to say I agree. 💯

For a PDA profile specifically, this gets compounded. PDA is characterised by an intense drive to resist everyday demands and to protect a sense of autonomy, alongside difficulty with the ordinary give-and-take of social interaction. Layer RSD on top of that, and even the gentlest correction can register as a demand and a rejection simultaneously — a double hit. 

A 2026 scoping review of RSD in autistic adults also noted something that will surprise nobody who has lived it: autistic people report markedly more adverse interpersonal experiences than their neurotypical peers, alongside considerably more emotional abuse. 
So the hypersensitivity isn't happening in a vacuum. In many cases, the nervous system has simply learned from an accurate assessment of the evidence.

👄👃👂When the Body Becomes the Target

Here is a part of this conversation that doesn't get said out loud often enough, and I think it should be, because it's one of the cruellest feedback loops PDA kids get caught in.

🦷🛁Self-care tasks — brushing teeth, washing, changing clothes, showering — are, structurally, demands.
They're repetitive, they're imposed by someone else's timetable, and they offer no negotiation. 

For a PDA nervous system that experiences ordinary requests as threats to autonomy, "go and have a shower" can trigger exactly the same avoidance response as "tidy your room" or "do your homework." It doesn't matter that the child logically understands why hygiene matters. Understanding isn't the problem. 

The demand is the problem. So the shower gets skipped, the teeth don't get brushed, the same jersey goes on for the fourth day running — not out of laziness, but because the avoidance response fires before the logic gets a say.And children are not known for their diplomacy. 

A PDA kid who has quietly lost the battle with their own nervous system over a shower is now sitting next to classmates who will, without an ounce of malice or restraint, announce that they smell. I know this because my youngest child was the first to alert my PDAer, Olivia, of their odour when they were having a particularly rough patch. 

Harri too - told a boy once that he should consider washing his face as his skin looked 'off'. 

Liv has been asked many times, loudly, why they keep picking at that scab. Add context blindness to the mix — the very real difficulty many autistic and PDA kids have in reading unwritten social rules, picking up on the fact that everyone else changed their approach to a topic three sentences ago, or noticing that their pants are on inside out (another regular of Livvy's) — and you get a child who is being socially penalised on two fronts at once: for things their body did without their consent, and for things their brain genuinely could not see coming.
This is about as efficient a rejection-manufacturing machine as you could design. 

The child didn't choose the smell, the sore, or the missed social cue. But the rejection lands exactly the same way a chosen mistake would — often harder, because there's an added layer of "I don't even understand what I did wrong," which is its own particular flavour of shame. 

Do this often enough across a childhood, and you get an adult whose RSD isn't only about being criticised. It's about being looked at. About the low-grade, constant bracing for the moment someone notices something about you that you didn't know was showing.

👩‍🎤The Fake-It Persona

I am forty-three now, and I can finally say — genuinely, not performatively — that my self-esteem is no longer in my shoes. And yet. 

There are still days I walk into a workshop or a keynote and consciously put on the extroverted, gregarious, "fake it till you make it" version of Andrea, because the version who wonders whether the room secretly finds her tedious doesn't present terribly well to a hall full of educators or parents, or anyone for that matter. It's a costume I know how to wear convincingly. It has served me well professionally. But I notice I still need it, and I think that's worth being honest about, because RSD doesn't announce itself dramatically in adulthood — it just quietly decides which rooms you enter as your full self and which ones you enter armoured.

Interestingly, the one place I have never needed the armour is a classroom. From Grade 1 to Grade 12, I have never once felt uncomfortable in front of my students. I work hard at the rapport, I insist my lessons are entertaining (for their sake, yes, but honestly also for mine — a bored class is its own small rejection), and something about that particular relationship — teacher and "my kids" — has never triggered the old alarm system. I have theories about why. None of them matter as much as the observation itself: confidence is not one setting. It is contextual, relational, and it can coexist quite happily with the very same brain that still occasionally needs a costume for a room full of adults.

🙂Raising Confident Kids, On Purpose

When I decided to have children, I made a deliberate decision that I was not going to hand any of them a pair of shoes they'd spend forty years trying to fill. 

I'm not a parent who tells her kids they're brilliant at everything — that's its own trap, and kids generally know when you're lying. 

But I am scrupulous about naming their actual, specific, true positive attributes, out loud, often. With Liv I have to be a bit more subtle or they misconstrue it as a demand, they did well at something this time, so therefore it will be expected again. I cannot set that bomb off.

It has been genuinely fascinating to watch this land differently across three very different nervous systems though.

My eight-year-old, Georgia, has absorbed it beautifully and without complication. She knows she is funny, clever and beautiful, and she will tell you so with zero prompting. She has a phone with nothing on it but kids' YouTube, on which she records herself doing her makeup, inventing new playdough concoctions, and dressing her dolls with a level of unbothered, accented commentary that is both admirable and, frankly, very funny. 

Georgia is neurotypical, like me, and for her the affirmation-plus-honesty approach seems to have simply worked as advertised: message received, confidence installed, no further intervention required.

Harrison is a different story. He's autistic, has ADHD, and is what's known as a fawner — someone who will accommodate other people to his own detriment, chronically, almost reflexively. 

There's a memory I keep coming back to: Harrison used to visit a friend — I'll call him Norman — and he told me, repeatedly, how much he loved going. I arrived early one day and found Harri sitting on the couch watching Norman play Xbox. When I asked why he wasn't playing too, Norman's mother told me, quite matter-of-factly, that Norman was "having a difficult day." 
It took several very carefully paced conversations to establish what was actually going on: Harrison was never allowed to touch Norman's things without express permission, and he had taken on all the tidying up himself because Norman didn't enjoy it. 

I was horrified. We talked at length about what a real friendship requires — that it only works if both people are having fun, that it was never his job to manage another child's moods in exchange for company. He has come a long way, but the conversation resurfaces periodically, whenever I catch the fawning creeping back in. 

Harrison knows, cognitively, that he is funny and warm and has plenty of friends. But he also misreads ordinary friction as rejection with alarming speed. Any correction from me has to arrive wrapped in an affirmative precursor, or it lands as devastating rather than instructive. 
If a friend falls out with him, he can spiral for days, needing repeated, patient conversations to separate "something went wrong" from "I am the reason everything goes wrong."

🚶‍♀️Then there's Olivia, sixteen, non-binary, autistic with a PDA profile, and walking the RSD road about as visibly as anyone I've met.

 We work on it together, deliberately — practising specific counter-phrases they can reach for to interrupt the internal narrative before it takes hold. And they know, intellectually, that they're funny, sharp, interesting, and remarkably artistic. 
I used to hope RSD was something Olivia would simply outgrow. 

Working professionally with older teens and adults on the spectrum has disabused me of that hope rather thoroughly — this thing runs deep, and it doesn't obligingly age out. 
What Olivia describes, and what I hear echoed constantly in my coaching work with clients across Cape Town, isn't really about any single rejection. 
It's a baseline hum of not being valid. Of being in the way. Of somehow encroaching on someone else's space even from the far side of the room, having done nothing at all.

🏄‍♀️The Cape Town Piece

I'd be doing this topic a disservice if I didn't say something about where I do this work. 

Support for neurodiverse families here has generally improved — Cape Town now has resources like the Neurodiversity Centre,  supporting PDA and Extreme Demand Avoidance in older kids and teens, which simply did not exist when I started this journey with Olivia.

But I see a lot of families and I visit a lot of schools and ours is a system that remains under strain. 

Families here have historically faced diagnostic waits stretching to nine months and waiting lists of up to five years for a place at an autism-specific school. 

Public LSEN schools, while often excellent, routinely carry multi-year waiting lists of their own. 

If you are a parent trying to get your PDA child into an environment that won't manufacture RSD by attrition — one demand, one detention, one "must try harder" comment at a time — you are often doing it without much of a safety net, and frequently while also managing your own nervous system's response to watching your child struggle. That context matters. 

RSD in a South African PDA kid isn't only a neurological story. It's also a story about how long a family had to wait, how many mainstream teachers had no training in what they were looking at, and how many well-meaning "just be confident" pep talks landed as one more demand from a world already asking too much.

Where This Leaves Us

I don't have a tidy resolution, because RSD doesn't offer one. It's not a phase; it's a wiring. 
What I have instead is a practice — the same one I'm teaching my kids and the same one I had to teach myself decades after my mother first told me my confidence lived in a shoebox. 

💫 You name the true, good things about a person, specifically and often, so there's something solid to stand on when the old alarm bells start ringing. 

You separate the story ("I am fundamentally in the way") from the event ("a friend was short with me today"). 

You help a teenager to rehearse kinder sentences to say to themselves, the way you'd rehearse lines for a play, because eventually the rehearsed line becomes the reflex. And you keep showing up in the rooms that still require a costume, because sometimes the only way through is to wear the persona until the day you notice, almost by accident, that you didn't need it.

My mother was wrong about the shoes, as it turns out. Confidence built the way she built it — conditional, performance-based, always one bad day from repossession — never really belonged to me at all. 

The confidence I'm handing my own three children is a different currency entirely: witnessed, specific, and not up for negotiation just because someone had a difficult day on the Xbox, or a bad hygiene week, or their pants on inside out. It's slower to build. It's also, as far as I can tell, the only kind that actually stays on your feet.