PDA (Pathological Demand Avoidance)
What is PDA?
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.
Support a Young Person by Reducing Demands
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’.
Helpful approaches to supporting your child or young person 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 Spotlights
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.
Jenna is a former head of school in a secure mental health unit who has 20 years experience in both mainstream and specialist settings from primary through to adult education. She in the research phase of a Doctorate degree where she is focusing on the impact of having a hidden disability upon education. She looks at how students may feel, how they may be judged by peers and school and the way in which this affects their learning journey. Jenna believes in thinking outside the box and being brave enough to go against the status quo if it is in the best interest of the students.
Jenna’s experience working with children with PDA:
“I have worked with students with PDA in busy classrooms, small groups and 1:1 and have had to modify my approach on a daily basis! Currently, I tutor three students whose PDA has meant that they are unable to access full time education and I am working with them to ensure that they reach their academic potential.
Prior to this, I worked in a large, urban secondary school supporting staff and students to provide the best support to students with PDA. This included helping teachers and school professionals to really understand what they are ‘seeing’ and experiencing, as PDA can often present as poor behaviour and students can get into trouble unnecessarily.
Understanding it is an anxiety response can really help in modifying approaches and make necessary adjustments.”
Jenna’s approach for working with children with PDA:
“Sit back and listen. Often as teachers we talk too much and presume a lot! Students with PDA may be driven by a need to exert control over certain situations and observing when this happens allows me to be a better judge of what to say and how to say it.
Each student will require a different approach and setting boundaries has to be an incredibly careful process as this can be a ‘flash point’ for some or an anxiety inducing event for others. People don’t realise that a slight alterations to your attitude or words can make a massive difference for a student with PDA. I often have to explain to people the ‘method behind my madness’, for example, it may seem as though I have let a student shout or be rude when in fact I am listening to what they have to say and will address the manner in which it was said at a later date when they are ready to listen and comprehend their actions.
It may seem like we are ‘only’ doing Maths when in actual fact we agreed before the session that it was a Maths day and next week will be English, because this made them feel less anxious about learning with me that session. We may abandon the objective for the session and do something different if that is what is needed at the time.”
Jenna’s top tips for parents/carers with children with PDA:
- Try not to ‘take on’ your child. You may have to change your pre conceptions of what successful parenting is.
- Try to think about the demands that your child is facing or believes they are facing, for example – going to bed, eating particular foods, having to speak about a particular topic.
- Pick your battles! What is the most important issue/what is the issue you can consider this week? Ask your children – can I say this differently? How does this make you feel? You may feel like you are ‘giving in’ but if you know what you want the end result to be then allowing your child to choose the route is often the best way
Rachel is a highly experienced and academically published SEND teacher having taught for over 18 years in both Primary and Secondary settings. She also has 20 years’ experience in Private Practice, covering Specialist SEND settings, County Council Intervention teams, mainstream, PRU and Secure Children’s Educational settings teaching English, Maths and Sciences. She teaches children and young adults ranging from 2.5-21 with ASC, ADHD, PDA, Executive Function/study skills, FAS, Dyslexia & Dyscalculia, CP, Complex Trauma, Dyspraxia, Developmental Delay and Self-esteem challenges. Rachel is a positive role model and mentor to my students being an empathetic and supportive educator.
Rachel’s experience working with children with PDA:
“In my teaching role, I currently have the privilege to work with several children diagnosed with Pathological Demand Avoidance (PDA), a trend that has persisted throughout my career. My instructional approach centres on crafting individualised strategies that provide these students with a sense of control, employing subtle methods that involve asking without explicitly asking. This tactic aims to limit the range of choices available, thereby mitigating the potential for intense emotions, anxiety, and a sense of panic to develop.
My teaching expectations are consistently flexible and carefully presented, using a reassuring and calm tone in collaborative discussions to avoid emotional overload. Recognising the positive qualities inherent in my students with PDA, such as resilience, creativity, and determination, I incorporate these attributes into my lessons. By leveraging these strengths, I aim to support their development of coping skills and foster a heightened sense of self-awareness in the learning process.”
Rachel’s approach for working with children with PDA:
“Working with children with Pathological Demand Avoidance (PDA) requires a nuanced and highly individualised approach due to the unique nature of this autism spectrum condition. PDA is characterised by an extreme anxiety-driven need to resist and avoid demands and requests, leading to challenges in various aspects of daily life.
When working with this condition, I prioritise flexibility and adaptability in communication and expectations. Building a trusting and supportive relationship with my student is key, as these children often struggle with traditional methods of authority and control.
I employ strategies that involve negotiation, collaboration, and creativity to engage the student while minimising anxiety and stress. Clear and concise communication, along with the use of visual supports and routines, provide a sense of predictability and security. Recognising and respecting the student’s need for autonomy and control, I gently introduce tasks which helps strike a balance between meeting essential demands and accommodating their unique needs.
Collaborating closely with parents, other educators, and therapists I develop a consistent and coordinated approach which ensures that the student receives comprehensive support across various settings. Patience, empathy, and ongoing observation are essential components of successfully working with students with PDA, allowing for the tailoring of my interventions to suit the specific challenges and strengths of each individual.”
Rachel’s top tips for parents/carers with children with PDA:
As a professional tutor working with students experiencing Pathological Demand Avoidance (PDA), my key suggestions for parents are centred on fostering understanding and flexibility. First and foremost, focus on cultivating a strong, trusting relationship with your child. Given that PDA often involves heightened anxiety, establishing a secure connection becomes fundamental for effective communication.
Secondly, adopt flexibility in your approach to tasks and routines. Recognise that demands might need to be presented in a manner that allows your child to feel a sense of control. Make use of visual supports and offer choices whenever possible to empower decision-making.
Additionally, effective communication between yourself, educators and therapists will ensure consistency across various environments. Share insights with them about what proves most effective for your child and seek their input for tailored strategies. Cultivate a positive environment with your child that acknowledges small victories and progress, reinforcing a sense of achievement.
Lastly, maintain patience and adaptability, as PDA is dynamic, and what proves successful one day may require adjustments the next. Upholding an open and supportive mindset will help you navigate the challenges associated with PDA while nurturing your child’s overall growth and development.