PDA (Pathological Demand Avoidance)
Working with children and young people with behavioural challenges
No matter what your child’s special needs might be, they may be anxious and present with behavioural challenges that go alongside their condition. And if you stop for a moment and imagine what it is like to be a young person with SEN, it’s easy to see why.
On one hand, emotional and behavioural difficulties can be an intrinsic part of some neurological conditions. People with autism, for instance, often have trouble understanding social expectations and other people’s behaviour, which means they sometimes get things ‘wrong’ when interacting with other people. This, in turn, increases their own anxiety levels which can lead to anger.
Similarly, kids with ADHD notoriously find it difficult to concentrate or sit still, while many children with all kinds of special needs also have sensory issues. This means that certain lights, sounds, smells and textures, for example, can cause them to feel overwhelmed and panicky as they battle to avoid difficult sensations.
Living with a physical, emotional or neurological condition
On the other hand, some behavioural difficulties stem from the stress a child feels as they try to ‘fit in’ at school or cope with their particular challenges. A youngster with hearing problems, say, may struggle to follow conversations and feel sad and isolated as a result. Someone with dyslexia might mistakenly believe themselves to be ‘thick’ because reading and writing is hard for them and so become despondent.
Unsurprisingly, the frustration young people can feel, with themselves and with the pressures of school and daily life, can exacerbate anxiety levels and lead to angry outbursts or depression. For some children, perhaps those who are non-verbal, a meltdown may be the only way they can let carers know that they are worried or unhappy.
Because of this, it’s essential for parents to seek professional guidance to pinpoint exactly what their child finds difficult. Identifying their challenges means families, schools and health professionals can work together to find solutions – which then reduces the pressure on the young person and helps them to remain calm.
In addition, most educationalists believe it’s crucial to boost a child’s self-esteem before they can make any progress with life skills or academic work. Teachers often speak about the need to build rapport and trust with SEN students, tailoring lessons around the youngster’s interests, working at their pace and offering praise.
What about PDA (Pathological Demand Avoidance)?
Some students, however, are so sensitive to being ‘pushed’ that even praise or encouragement can feel like pressure. Pathological Demand Avoidance (PDA) is a pattern of responses which means a child resists even the simplest requests – to brush their teeth, for example, or to put on a coat to leave the house. Older children might refuse to go to school, complete homework or sit exams.
PDA’ers do not ‘choose’ their behaviour. It is therefore not a behavioural condition but a neurological difference. Furthermore, experts are divided on whether PDA is a condition in its own right or just a facet of autism. The PDA society mentions that more research is required to make a firm decisin. One thing is certain, however – it’s a complex topic and children who display this kind of behaviour need sensitive handling.
According to the PDA Society, a charity which offers advice, support and training to families and professionals, every child with PDA will have different ‘triggers’. They recommend that parents and teachers take the time to understand the young person and identify strategies that work. The most important thing, they point out, is to realise that extreme anxiety is behind most avoidant behaviour.
Helpful Approaches for families with children with PDA
The PDAS website offers lots of suggestions on approaches and support such as allowing plenty of time for a child to complete a task, diffusing stress with humour, using indirect language and giving a youngster a choice wherever possible. Parents and teachers should aim to be flexible with a PDA child, they say, and to focus on the long-term aim of helping them to cope with adult life.
Tutors who have experience working with students with SEN often report that they work very slowly with children with PDA, persuading them to complete academic tasks little-by-little and never saying they ‘have to’ do something. This, they maintain, reduces anxiety and enables the young person to feel in control.
Useful PDA contacts
The Council for Disabled Children offers a free information sheet on their website on ways to cope with challenging behaviour in children with special needs – www.councilfordisabledchildren.org.uk/sites/default/files/uploads/files/earlysupportbehaviourfinal.pdf
Family Lives is a charity that offers advice and support to parents – www.familylives.org.uk
The PDA Society – www.pdasociety.org.uk
PDA Tutor Spotlight
Hannah is a qualified SEND teacher and tutor in South London with eight years’ teaching experience in both the state and independent sectors. She is experienced in working with children with ASC, PDA, ADHD, speech and language needs, anxiety, profound and multiple learning difficulties, global developmental delay, complex medical needs and physical and developmental disabilities such as cerebral palsy and Down syndrome. Hannah specialises in teaching students who are developmentally working within an early years or primary level.
Hannah’s experience working with children with PDA:
My experience working with children with PDA has enabled me to learn and apply a range of strategies to support anxiety, however it is important to remember that not all of these will work consistently. An approach which works for the learner one day may be ineffective the next day, so it is vital to be flexible according to the needs of the child and have a Plan B as well as a C, D and E.
As children with PDA can become very anxious and find changes difficult to manage, it is important to prepare them and involve them in any way possible, which could include showing visuals, drawing pictures, signing or using now and next timetables. These approaches may also need to be broken down further; e.g. if there are changes to the lunch menu at school or if you are not going to be teaching them at a certain time, it’s imperative to think ahead and pre-empt any difficulties the child could face due to these changes.
Additionally, my experience has led me to consider PDA in a variety of situations, not solely based on the demands of school and work. If a child is given praise, this can also be difficult as it may manifest as a demand to accept the praise, potentially causing the child distress.
When you have built a strong relationship with the child, you will be more likely to spot any probable triggers and de-escalate them e.g. instead of offering direct praise, you could write down a compliment and leave it in a nominated tray for the child to read at their own discretion, pass praise to the child’s favourite toy instead of them directly, or the child could nominate a toy or a friend to receive their certificate on their behalf.
Hannah’s approach for working with children with PDA:
When working with pupils with PDA, it is crucial to build a gradual rapport through learning about their interests and intertwining these within highly personalised learning opportunities. A basis for forming a relationship with the child can begin through the use of minimal language, tailored vocabulary and choices, which can be offered with or without verbalising e.g. having options of toys or games available in the room but not directly asking the child to play.
By taking some time to carefully consider and eliminate anything the child may perceive as a potential demand, a relationship can begin to build, as the child is able to have some autonomy and feel more in control of the given situation. Some helpful strategies based around language involve the use of indirect comments; for example, talking to yourself within the child’s earshot can help to alleviate anxiety as it reduces the demands on the child to respond.
Involving some of the child’s favourite toys or characters when modelling activities can also really help, as role play is a place where many children with PDA feel safe to explore their feelings and test out a situation.
As a lot of the behaviour challenges linked with PDA stem from a high level of anxiety and avoidance, it is important to establish a safe space involving some of the child’s favourite items in order to help diffuse any potential escalations. Once these foundations have been ascertained, teaching and learning can begin to develop at a pace which is appropriate for the teacher and the student.
Hannah’s top tips for parents/carers with children with PDA:
- If you have a child with PDA, it can be really helpful to spend some time carefully thinking how questions or instructions can be phrased before expecting your child to complete a task.
- Choices enable children with PDA to feel more empowered as well as reducing the level of demand. An example of this is if your child needs to get ready for school, you could offer a choice of whether they want to brush their teeth before or after getting dressed, or even breaking it down further to which item of clothing they would like to put on first.
- If your child is still not keen on accepting either choice, it can help to make the situation more light-hearted by using humour or distractions, such as assisting with an activity you know they enjoy before returning to the original task.
- Children with PDA can also benefit from a calming area at home and a safe space where they can remove demands completely, e.g. a special box or bin where they can discard work if they are becoming distressed and then choose to return to it at a point which suits them.