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 a facet of autism. The PDA Society – a charity which offers advice, support and training to families and professionals – mentions that more research is required to make a firm decision. One thing is certain, however – it’s a complex topic and children who display this kind of behaviour need sensitive handling.
Experts agree that every PDA child will have different ‘triggers’. Most 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.
Professionals have identified two different kinds of ‘demand’, both of which can be equally stressful for someone with PDA.
Here are just a few examples –
Timetables, questions, laws, instructions, rules, orders.
Feeling hungry or thirsty or needing to use the toilet, desires, family days out, having to do things because of the weather or the time of day, wanting to do something but not being able to start.
Reducing some of these expectations where possible – often referred to as ‘low demand parenting’ – many people agree, can go a long way to reducing a young person’s anxiety and calming their behaviour. But we all have to eat, sleep, keep ourselves clean and go to work or school so how can family life operate in such a way?
Firstly, a collaborative attitude, where you work with a child to find ways to complete tasks rather than telling them what they need to do can help establish an atmosphere of peace and trust. Would it matter, for example, if your PDA child chose to eat cereal for dinner, rather than joining in with what the rest of the family is eating? Would you be willing to negotiate an alternative activity if your child is resisting going to the park?
Naturally, this way of operating goes against traditional methods of parenting where mum and dad are in charge. In reality, although it can reduce a lot of tension in family life, it also requires great quantities of patience and flexibility on the part of adults and any non-PDA siblings.
Specialist tutors will also adopt this cooperative approach to working with a PDA child, helping them to be part of the decision-making process on what and how they will study. Again, this reduces the student’s anxiety.
Using non-confrontational language is crucial, educationalists and health professionals agree, when it comes to creating trust with a PDA-er. Words such as ‘must’, ‘have to,’ ‘should’ and ‘can’t’ might be replaced with gentler phrases like, ‘Would it be OK if…..?’ or ‘How do you feel about….?’
Offering a child a choice between two options – ‘Would you like a bath or a shower?’ – can also allow them to feel a sense of control. With younger children, depersonalising requests using a toy – ‘Teddy says he’d like to go to the park,’ rather than, ‘Put your coat on, we’re going to the park’ – can lessen the perceived pressure they feel to obey instructions.
Strangely, praising a PDA is also best done using indirect language, experts maintain, as the young person might feel pressurised to maintain high standards. Better to comment that a child has worked very hard on a piece of homework, for instance, rather than saying the work itself is ‘excellent’.
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.
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
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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:
"I’m very happy we found this company to help my son with his maths and general homework. He tries everything to get out of doing it and as a very busy single Dad I find it difficult at times. Highly recommended."
Pathological Demand Avoidance, or PDA as it is more commonly known, is a neurological condition. Currently, most professionals work alongside the premise that if a person has a PDA profile
Pathological Demand Avoidance, or PDA as it is widely known, was defined as a neurological condition in the 1980s. It is not easy to know statistics about the numbers of
Coined as a condition in the 1980s, Pathological Demand Avoidance, or PDA as it is more commonly known, has only become more widely recognised since the turn of the century.
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