What is Pathological Demand Avoidance

  • Resisting and avoiding the ordinary demands of life this might include getting up, getting dressed, eating a meal or washing. Significantly, it includes things that someone might want to do/enjoy.
  • Using ‘social’ strategies as part of the avoidance – this means not just saying no, withdrawing, shutting down or running away, but a variety of avoidance approaches including distraction, making excuses.
  • Appearing sociable, but lacking some understanding – meaning that individuals may appear more sociably ‘able’ than one might expect.
  • Experiencing intense emotions and mood swings – meaning difficulties with emotional regulation, rapid mood swings, impulsiveness and unpredictability.
  • Comfortable in role play, pretence & fantasy – this can sometimes be to an extreme extent with other personas. The line between fantasy and reality can sometimes become blurred.
  • Displaying obsessive behaviour that is often social in nature – as with other autistic people, repetitive or restrictive interests is common with PDA.

Understanding Behaviours

Anxiety – a PDA child’s behaviours are underpinned by anxiety and a need to feel in control.

Difficulties in processing language – the child with PDA may have good expressive language but may not be able to process verbal communication quickly enough to keep up during a conversation.

Difficulties with social interaction – they may not always understand the unwritten rules of social interaction including body language and tone of voice.

Confusion about emotions – they may not be able to understand or accurately ‘label’ emotions in themselves or other people.

Intolerance of uncertainty – they may struggle with all the ‘what ifs’ of life, not knowing how things might ‘pan out’ or what might be expected of them.

Sensory overload – The PDA Child’s heightened sensory perception can also contribute to anxiety, overload and avoidance.

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Pathological Demand Avoidance card - Stickman Communications
Pathological Demand Avoidance - The Control

Top Tips for staff and parents!

  • PDA can turn “parenting norms” upside down so our own mindset and moods are key factors in developing a toolkit of helpful approaches.
  • Look beyond surface behaviours – outward behaviours are just the tip of the iceberg with many contributory factors lying below the surface.
  • Re-balance your relationship – a more equal relationship between child and adult, based on collaboration and respect, builds trust. Try to aim for win:win solutions.
  • Allow the option of saying no. Avoid using demand words such as: Need, Must/Must not, Will/Will not, Can’t, Now.
  • Make requests instead of demands: Is it OK with you if…, How do you feel about…, Do you mind…, Would/could you…, If you’re happy to…., When you have finished with … could you then…
  • Model desired behaviours.
  • Pick your battles and treat every day as a fresh start.
  • Focus on the long-term objective of building a child’s ability to cope rather than short term compliance.
  • Be flexible – helpful approaches require creativity and adaptability.
  • See the positives – whilst supporting a child’s challenges, try not to lose sight of their many positive qualities.
  • Support and self-care for you – it’s also important to ensure you are caring for yourself as well as possible.
  • Subtle adaptations to language can benefit the child eg: “Your clothes are on the bed” rather than “you need to get dressed now.”
  • Offering choices: the idea is to give the child some control without losing all control as the adult.
  • Ask the child for help – saying that you don’t know or can’t remember how to do something.

Where can I seek help?

REACH School SENCO – Amanda Thomas

Assistant SENCO – Alison Miller

Birmingham City Council SEND Department – www.birmingham.gov.uk/localoffer

www.forwardthinkingbirmingham.org.uk

www.pdasociety.org.uk

www.autismwestmidlands.org.uk

www.autism.org.uk

PDA comes under the umbrella of Autism

• The PDA profile of autism is often missed – either because an assessment for autism is refused or because, following an assessment, no diagnosis is given or because autism is diagnosed but no mention is made of PDA traits.

• This may be because the PDA profile may not always ‘look like’ what many people think autism ‘looks like’.

• In PDA, social interaction and communication skills – including eye contact and conversational timing – can seem more conventional or ‘socially accepted’. Indeed, individuals are often refused autism assessments on these grounds.

What is a Demand?

Direct demands such as: Wake up, get up, get dressed, get your bag etc. Anxiety levels are raised from the moment a child wakes up, one demand compounds the next and it can quickly get to overload point. Sometimes this is described as the “coke can effect” – it’s easy to predict the results if you imagine giving the can a shake every time a demand is made.

Indirect demands such as:

Time – is an additional demand on top of the demand itself. Plans – advance planning may lead to increased anxiety but equally there may be an intolerance of spur of the moment activities. Questions – the expectation of being required to respond to a direct question can be disabling. Decisions – sometimes knowing a decision has to be made makes it a demand. Uncertainty – intolerance of uncertainty has been found to be very significant in PDA. Praise – this carries the implied expectation that the action will be carried out or improved on next time. Socialising and peer pressure – including special occasions such as birthdays, Christmas and trips out. Transitions -the demand to stop and switch what you’re doing and also the uncertainty around what may come next.