The standard intake form was built to catch the diagnoses everyone agrees on. It asks about sleep, appetite, mood, family history of anxiety, prior hospitalizations. It rarely asks anything that would surface a demand-sensitive nervous system. So the profile gets missed at the front door, the working diagnosis goes the wrong direction, and by week six of treatment you are running interventions that do not match the mechanism you are looking at.
This is not a theoretical concern. We have watched it. A client arrives with a working hypothesis of treatment-resistant anxiety, the form gets filled out, and six weeks into a CBT protocol the anxiety is unchanged because the anxiety was never the load-bearing thing. A parent shows up describing a child as oppositional and difficult, the child gets a behavior plan, and the plan does the opposite of what the nervous system needs. The intake set the trajectory. Catching demand sensitivity at the front door changes the trajectory.
This post is about what to ask, how to ask it, and what to do with the answers. It assumes you are doing a clinical intake with an adult, or with a parent reporting on a child. Most of the questions adapt cleanly across both. None of them are formal assessment instruments. They are screening prompts. If the screening lights up, the formal assessment is a different conversation.
Most intake forms ask about behavior. They do not ask about the conditions under which behavior changes. PDA, or Pervasive Drive for Autonomy, is a context-dependent presentation. The same client can complete a complex task one hour and be unable to make a sandwich the next, and the difference is not motivation. The difference is whether the task carries demand character at the moment.
That mechanism is invisible to a form that asks "do you have trouble completing daily tasks?" The honest PDA client says "sometimes" or "it depends" and the clinician moves on. The form was not built to catch sometimes-and-it-depends. PDA lives in the it-depends.
The other thing standard intakes miss: the client may not have language for what is happening. Many adults arriving for assessment have spent years organizing their life around an experience they cannot name. They know they cannot start things. They know they collapse when scheduled. They know they have a strange relationship with their own preferences. They do not know that any of this is a recognized pattern. So they describe surface behaviors (procrastination, anxiety, low motivation) that send the intake the wrong direction.
The screening questions below are designed to surface the underlying mechanism, not the surface behavior. You are listening for context-dependence, demand-character, and nervous system reactivity.
The RELATE framework organizes assessment around eight domains. Each of them has a screening version that fits inside an intake without burning a whole session.
The standard sensory question ("are you sensitive to noise, light, textures?") catches sensory differences but misses the demand-character that colors sensory experience for many PDA clients. Two questions go further:
A yes to either of these tells you the sensory system is not the only thing in play. The sensory experience is being modulated by perceived control.
This is the core of the screening. The diagnostic question is not "do you avoid demands." Everyone says no, because the word "demand" sounds like something only an unreasonable person would react to. The questions are about what happens with things the client wants to do.
A pattern of yeses here, particularly the internal-demand and self-imposed-demand patterns, is one of the cleanest signals you will get. Standard avoidance does not do this. Demand sensitivity does.
You want to map both the width of the window and the recovery curve.
PDA clients often have a narrow baseline window (40 percent, 30 percent, sometimes lower in self-report) and a long tail on the recovery curve. A two-day recovery from a thirty-minute conversation is meaningful data.
These get collected on standard intake but are not used the way the data could be used. For demand-sensitivity screening, the question is not just what the interests are. It is what happens to the interests.
Loss of regulating interests through demand-contamination is a near-universal experience for PDA adults and often the saddest single thing they report. Hearing it told as a clear pattern is diagnostic.
The intake itself is a communication event. How the client experiences your questions is data.
If the client describes a strong preference for declarative over imperative language ("the door is open" vs "go through the door"), or a recurring pattern of shutting down with direct face-to-face requests, the demand-character of communication itself is in play. This shapes how you will run sessions.
Safety in PDA is conditional and revocable in ways that are not always visible from the outside. Mapping the conditions matters.
This is not pathological. It is mechanistic. Safety registers in the nervous system through autonomy. When autonomy is threatened, the safety reading changes, regardless of what the relationship is otherwise. The screening question tells you whether the client has insight into this pattern, which has implications for the pace at which therapy can move.
PDA almost never travels alone. The screening question is what else is in the picture and how it interacts.
You are not making the diagnoses here. You are mapping the terrain. AuDHD plus PDA looks different from autism plus PDA, which looks different from anxiety-presenting PDA without an autism finding. Each of these requires a different approach. Catching the layering at intake saves you from running an autism-only treatment plan on a client whose ADHD is doing half of the heavy lifting.
This domain often gets skipped at intake because clinicians treat it as background. For PDA, it is decisive. The treatment approach you can offer depends on what the rest of the client's life will tolerate.
The answer here tells you whether you are doing therapy with a client who can apply the approach in their environment, or therapy with a client whose environment is going to fight the approach the moment they try it. Both are doable. They are not the same plan.
You can ask all the right questions and still get nothing useful if the asking has demand character. PDA clients respond to the felt quality of the conversation, not just the content. Three small adjustments to your delivery make a meaningful difference.
Ask declaratively when you can. "Some people experience X. I am wondering if any of that is familiar" is easier to answer than "do you experience X?" The first invites pattern-matching. The second invites a yes/no, which can be threatening when the honest answer is complicated.
Make refusal a real option. "If any of these questions don't fit or you don't want to answer, that is fine. We can come back to it or skip it." Saying this out loud at the start changes the entire posture of the intake. Clients who would have masked their way through a normal intake will sometimes give you the actual data when they know they can stop.
Watch for the shutdown. If the client's affect flattens, their answers get shorter, or they start agreeing with everything you say, the intake has become a demand. Pause, reduce the pressure, name what you are noticing if it feels safe to do so. The data you get from a regulated client in a 45-minute intake is worth more than the data you get from a dysregulated client in a 90-minute intake.
The intake is not a separate event from treatment. It is the first session. For a demand-sensitive client, the way you ran the intake will determine whether the client comes back at all.
A positive screening on these questions is not a diagnosis. PDA is not a standalone DSM-5 or ICD-11 diagnosis, which means you are working with a descriptive profile rather than a code. What the screening gives you is a working hypothesis that should shape three things.
The treatment frame. If the screening lights up, you are not running standard CBT or a behavioral activation protocol as your first move. You are starting with regulation, autonomy, and felt safety. Treatment progress will look different and you should set that expectation now.
The diagnostic next steps. If the screening points toward demand sensitivity but the formal autism or ADHD picture has not been worked up, you need to decide whether further assessment is indicated. Sometimes it is. Sometimes the descriptive understanding is enough for treatment to proceed.
The collaborative formulation. The most useful thing you can do after a screening that lights up is to share the framework with the client. Many PDA adults have never had anyone describe their experience back to them in a way that maps. Naming the pattern is not just diagnostic. It is therapeutic. The client now has language for what has been happening, and a clinician who knows what they are looking at.
If you are doing intake in a residential treatment center, an inpatient unit, or a school-based clinic, the setup is different. You may not have 60 minutes for an intake. You may have a structured form you cannot modify. You may be doing the intake in a moment when the client is dysregulated by the admission itself.
In those settings, you are not going to run all eight domains in the first contact. Pick three: Demand Trigger Profile, Window of Tolerance Baseline, and Communication Preferences. Those three will catch most of the cases that need a different treatment approach. Document what you find in language the rest of the team can read (more on that in our post on PDA documentation). And get the rest of the screening into the second or third contact, when the client has stabilized enough to give you clean data.
The questions in this post are not just data collection. They are the first place a client with a demand-sensitive nervous system gets to feel that someone is asking the right questions in the right way. For many adults arriving for assessment, this experience is itself unusual. The intake becomes the first session of a different kind of clinical relationship, one in which their nervous system is being read accurately rather than pathologized.
You do not have to do this perfectly. You have to do it deliberately. The standard intake is not malicious. It is built for a different population. Adding these screening questions does not require you to abandon your usual structure. It requires you to add a layer that catches what your usual structure was not designed to catch.
The full RELATE Assessment, with structured forms for adults, parents reporting on children, and clinicians, lives in the RELATE Foundational Training Manual. The framework that organizes these eight domains, including the clinical reasoning that connects them, is laid out in detail there. If your screening lights up regularly enough that PDA-informed work is becoming a meaningful share of your caseload, the manual is the next step.