Pathological Demand Avoidance

How to spot the signs and support pupils

Pathological Demand Avoidance (PDA) is a term that is becoming more and more familiar across the UK.  You may have children in your class this year who present with PDA, but what exactly is it?

What exactly is PDA?

Elizabeth Newson former head of the Child Development Research Unit at the University of Nottingham, now a consultant in developmental psychology to the Early Years Diagnostic Centre in Ravenshead, coined the term PDA in 2003. The name was used to describe the behaviour of what she called “puzzling” children. Those where the child’s behaviour reminded her of autism but couldn’t be, because various aspects didn’t fit.

What does PDA look like?

Children with PDA will go to extreme lengths to avoid everyday demands due to their intense need to be in control.  It is thought anxiety is the underlying factor behind PDA behaviours. The key word being anxiety

For the children with PDA, they feel they physically cannot do the task at hand; this is more than simply just not wanting to do the task.

Sometimes the child might be aware they’ve done the task before so they know they can complete it.  But, the anxiety inside is shouting “You can’t!”

PDA is now widely accepted by many as being a part of the Autism Spectrum… however, not everyone agrees. Some researchers argue that PDA may be a feature of multiple conditions, not specific to autism (Gore, Langton & Frederickson, 2018). To add to the haziness, PDA is still not recognised within the medical classification manuals such as the DSM-V or the ICD-10, meaning clinicians willingness to diagnose PDA can vary massively… not very helpful!

So to help ease levels of confusion and frustration for the parents and the child in your class, it is essential to be able to spot the signs of PDA and know how best to help.

Key Features of PDA

  • Resisting demands – this is not restricted to just tasks the child doesn’t like. Those with PDA also find it hard to do activities they know they enjoy.
  • Passive early history.
  • May have had a language delay but they have managed to “catch up”
  • Obsessive behaviour may surround other people and fictional characters rather than physical objects (trains/cars).
  • Very comfortable in role play and pretence.
  • Can show a good level of eye-contact.
  • Impulsive.
  • Can appear manipulative or charming.
  • Sensory difficulties.

But remember: no two children are the same!

Avoidance techniques
A child may avoid tasks through very direct methods such as “saying no” or physically dropping to the ground and refusing. However… as always, it is not that straightforward. Some avoidance behaviours are much more discrete. Some children use their good language skills to use techniques such as negotiating, delaying and making excuses.

Speak to a Speech and Language Therapist

Top 10 Tips For Supporting a Child with Pathological Demand Avoidance:

1. Offer choices

Instead of “When you have finished your reading, write a story” try “Would you like to write a story first or read a book?” This way the work is still being completed whilst allowing the child to feel like they are in control of their time and learning.

2. Use their areas of interest to interest them

If he/she enjoys drama you could try using role play activities to engage them in tasks.

3. Don’t bombard them with language

Allow the child to process and regulate their thoughts and emotions in the moment.
Saying things such as “why can’t you do it?” “it’s not that bad” are likely to send anxiety levels rocketing!

4. Indirect praise!

Direct praise may make the child in your class feel pressured and uncomfortable. Instead when the child is nearby try telling another member of staff about how well they did in an activity. This way the child still receives the positive praise but does not have the added pressure of responding to it there and then.

5. Prioritise demands

Is it important that the child sits on a chair, facing the board and write the date before the class begins? Or is it just important they are sat in the correct seat?

6. Know your pupils inside out!

Discover what makes them anxious and their tell-tale signs. Behaviour is not always a sign of naughtiness. E.g. the child in your class who is singing aloud and not appearing to listen? Their singing might be a way they deal with anxiety?  Other behaviours could include rocking, picking, humming, chewing. The list is endless! Ask the child’s parents/carers they know their child better than anyone and will be able to tell you what helps… and what doesn’t!

7. Classroom support

Do they need extra support in class such as a teaching assistant or visuals to help reduce anxiety?

8. Allow the child to feel in control

The child in your class will likely begin to show signs of frustration when they feel out of their depth! You need to be able to present tasks in a way which means the child is still following instructions but in a way which allows them to feel like they have a sense of control (check out my 5 alternative phrases at the bottom of this blog!).

9. Support the child to help themselves

Helping the child how to recognise and regulate their emotions may prevent extreme behaviours. When the child feels they are losing control over a situation techniques such as “deep breaths” and “counting to 10” may help them manage the situation.

10. …… and RELAX!!

Anxious vibes spread! Stay calm. Don’t panic. You’ve got this!

5 phrases to avoid using with a PDA child:

  • It’s time to…
  • We have to…
  • You need to…
  • We must…
  • First… Then…

5 alternative phrases which may be helpful in the classroom:

  • I wonder if we can…
  • Let’s see if we can…
  • I wonder if anyone could help me to do…
  • What do you want to help me with today…
  • Maybe we could

Emily Woodhouse

Speech and Language Therapist

Recently graduated from Newcastle University, Emily is passionate about working with pupils with SEN, especially PMLD. She also strives to raise the profile of lesser known SLCN conditions.

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