Pathological Demand Avoidance (PDA)
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How these difficulties might present
PDA (Pathological Demand Avoidance) is seen as a behaviour profile within the Autism spectrum. How might these difficulties present?
There are key indicators:
- Child resists and avoids ordinary demands of life.
- They seem under an extraordinary degree of pressure from ordinary everyday demands and expectations and attempt to avoid these to an ‘obsessive’ extent.
- The overriding state of the child’s approach to school and learning is one of anxiety.
- Child has sufficient social understanding to be socially manipulative in their endeavours and will often adapt strategies to the person making the demand. Strategies may include distraction, giving excuses, delaying, arguing, suggesting alternatives and withdrawing into fantasy.
- Child displays surface sociability, but apparent lack of social identity.
- Child often shows swift changes in mood. Appears to be driven by the need to be in charge and can change in an instant when this isn’t the case.
- Can be comfortable in role play and imaginative play. Unlike the child with Autism the child with PDA will be interested in role play. They can use this as an avoidant tactic. They often like to take the role of the teacher.
- Their use of language may mask their level of understanding.
Strategies to support:
The key to supporting the child is to recognise and reduce their anxiety level, so that they can manage everyday demands.
- The use of structure, routine and behavioural principles of reward need to be adapted and personalised for children with PDA. The key element is to involve the child in developing any strategy, so that they feel that they have some control. For example: for some children, displaying information in a visual format can create a sense of independence and choice which reduces anxiety e.g. visual timetables. It is important that they are created and referred to with the child, and include an element of choice, rather than being done ‘to’ the child and that they are used in a flexible and non-confrontational way.
- Key adults need to build a strong relationships with the child. It is important that they understand the child’s difficulties and keep demands to a minimum. All adults will need to have an understanding of which strategies support the child and to consistently implement these strategies throughout the day.
- Adults need to look at the day ahead and identify and prepare for possible triggers for the child.
- Child and key adults to identify a space in the classroom or school where the child can go to feel calm.
- Because of the challenging nature of PDA in children adults need to keep calm and it is recommended that staff support each other at key points of the day when necessary, in a “tag team” manner.
It can also help if the adults:
- Use INDIRECT language. At all times try and avoid DIRECT requests. Useful sentence starters such as:
- “I wonder if we can…”
- “I can’t see how to make this work…”
- “Maybe we could investigate…”
- Sow seeds of an idea and allow the child time to process the information. Use drama and role play.
- Use humour and distraction to lighten the intensity of the demand.
- Give the child choices, so that they feel that they have some control over what is happening to them: Which shoes do you want to wear? Crocs or trainers?
- Use child’s interests wherever possible to engage them.
- Are prepared:
- Have a range of choices available to the child, and think through how they will be presented to the child.
- Use a flexible approach:
- Are ready to scale back demands or change their approach if the child begins to panic.
- Choose their battles:
- What’s really important for the child, and the adult?
- What should the adult hold firm?
- What can they be flexible about?
Remember that the child’s resistance is based on anxiety and offer a calming approach and environment.
Useful resources, links and further reading:
- PDA Society
- The PDA Resource
- Autistic Education Trust
- National Autistic Society National Autistic Society
- Christie, P., Duncan, M., Fidler, R., & Healy, Z. (2011). Understanding pathological demand avoidance syndrome in children: A guide for parents, teachers and other professionals. London: Jessica Kingsley.