5 Best Strategies for Supporting Children with Pathological Demand Avoidance (PDA)
Updated: Feb 10
PDA (Pathological Demand Avoidance) is widely understood to be a profile on the autism spectrum. Whilst recognised by the National Autistic Society, there are some regions where PDA does not have official diagnostic status. PDA individuals share characteristics with others on the spectrum and also have a distinct cluster of additional traits.
The distinctive features of a demand avoidant profile include:
resists and avoids the ordinary demands of life
uses social strategies as part of avoidance, for example, distracting, giving excuses, being superficially charming
experiences excessive mood swings and impulsivity
displays obsessive behaviour that is often focused on other people.
Children will often respond by saying ‘No’ to what they’re asked or told to do, even if it’s something they actually enjoy.
It can be more difficult for teachers to understand how best to support pupils with a demand avoidant profile. This is due to traditional classroom or behaviour management techniques such as structure, routine and rewards that often work for pupils with other autism profiles are generally ineffective for those with a demand avoidant profile.
This article will help you understand what PDA is, what we actually mean by demands and how you can support children who display PDA type behaviours.
What are Demands?
We all experience demands every day, and most of us don't even realise they're being put on us. Sometimes, demands appear out of nowhere, like the sudden needs to wear masks or socially distance during COVID-19. We all experience a certain amount of distain when we have to do something we don't want to do, but for a child with PDA, demands can be overly destabilising.
Let's look at 2 types of demand. First, we have direct demands. These demands are requests or instructions made by others and we hear them all the time in school settings; "Sit down," "Be quiet", "Line up".
Additionally, we have indirect and internal demands that are a little more difficult to define.
Questions - the expectation that you may be called on to answer a question at any time.
Decisions - you will need to make decisions throughout the day which makes this a demand.
Internal bodily demands - feelings of hunger and thirst.
Uncertainty - research has shown that an intolerance to uncertainty is common in PDA, with children needing to know and feel like they are in control.
Praise - this carries the implication that that action will be carried out again, but may not achieve the same level of praise in the future.
Transitions - the demand to stop one activity and start another, as well as uncertainty around what may come next.
Expectations - from yourself and others.
Then, in Inception style, you can have demands within demands. For example, when you go to the library, you're expected to sit down, read a book, be quiet etc.
Additionally, there are many "I ought to's" throughout the day; getting up, having a shower, eating, learning, doing homework, going to bed etc.
You may like: The PDA Paradox: The Highs and Lows of My Life on a Little-Known Part of the Autism Spectrum
Once you begin to look at life's demands, you can see how pervasive they are throughout the day and how overwhelming this could be for a child with PDA.
Avoidance of ordinary demands is the primary and most debilitating characteristic of PDA. It’s driven by the child’s uncontrolled anxiety which can feel like a panic attack, and their response is to refuse or avoid demands so they can remain in control of what is happening to them.
What Demand Avoidance Approaches Might You See in a Child with PDA?
Each child with PDA will respond to different demands in a different way - some may flat out refuse to cooperate, shutdown, or withdraw. However, recent research has shown that some children may try more social approaches at first before things escalate to challenging behaviour and shutdowns.
In the calm and able stage, children are able to engage with their given activity, their arousal levels are low and they appear ready to learn.
Initial avoidance strategies may involve distraction, such as changing the subject, procrastination, excusing themselves (e.g. giving reasons as to why they can't engage with the thing they've been asked to do).
If these strategies do not work for the child and they are still being demanded to do something, things can escalate quite quickly and can lead to meltdown. This is due to the child realising they are running out of potential distraction and avoidance methods and panic can set in. This isn't a deliberate choice in escalation, it is a result of their natural fight/flight/freeze response to challenging situations. Meltdowns in children with PDA vs other presentations of autism can be similar to panic attacks.
You may have noticed that several of these avoidance techniques require adequate social and language skills. Children with PDA may appear to be verbally competent, but may understand less than we think. Although they may be highly sociable, they usually struggle to understand where they fit in the social hierarchy (e.g. that adults have more authority than children), and their need to be in control can mean that their peer relationships run into trouble.
You may like: PDA by PDAers: From Anxiety to Avoidance and Masking to Meltdowns
5 Golden Rules for Supporting a Child with PDA
Strategies that can be used to support children with other presentations of autism may also be beneficial for children with PDA.
1. Think ahead
Look ahead at your day and week ahead and try to anticipate what may be tricky for your child to manage. Identifying potential triggers allows you to create strategies ahead of time.
Whenever your child is anxious or in crisis, you can use an activity from the list to distract them and make them feel at ease again. For older children, who may have more insight into their anxieties and what can help them in times where they feel distressed, try making an All About Me profile or journal with them. Pupil Passports also work very well for this and you can involve other teachers, carers and parents in the creation of this.
2. Give notice
Anyone who has worked with a child with autism before will know how important routine and planning is to ensure they feel as calm as possible. This is also true for children with PDA. Children with PDA find it very helpful to know what is going to happen as it will give them a sense of being in control of situations and it also allows processing time.
For some children, visual timetables work very well and it gives them a sense of independence when they are able to tick off or remove activities from their timetable themselves. For children with PDA, it can be helpful to be made 'with' the child vs you simply giving a routine 'to' the child.
3. Monitor Stress Levels & Scale Back Demands
You may notice that the moods and behaviours of a child with PDA can change very quickly. You need to be aware of the early signs that a child is getting overly stressed or anxious so that you can either remove them from a situation, distract them or scale back the demands being placed upon them. Speak to the child's parents about early warning signs and be sure that all relevant staff (Teachers, TA's, lunchtime supervisors etc) are aware of what they are.
As the child gets older, it is helpful for TA's or LSA's to help the child understand and recognise their own stress levels, what they need in any given moment and how to communicate this effectively. Try using a feelings board or Zones of Regulation.
You may like: Zones of Regulation: An Overview
4. Give Space
Children with PDA may find it difficult to regulate their emotions. Make sure there is a space in the classroom or in a separate room in the school where a child can go to regulate themselves and calm down. This room or space should be as calming as possible, so do not fill it with too many items that could cause a sensory overload. You may want to have items there that the child likes and that are calming for them, but they mostly need space.
5. Remain Calm
When children with PDA are anxious or panicking, they need the adults around them to provide a sense of calm. We must first be able to regulate ourselves so that we can then help the child come out of their time of crisis. Find a method that works for you. For me, taking a deep breath and counting to 3 before I react or intervene in a situation really helps ground me and prevents me from any knee-jerk reactions that may frighten the child or cause their anxiety to increase.
How to Avoid Demand Avoidance
1. Use Indirect Language
Choosing how you phrase a particular request could be the difference between a child interpreting this as a demand and refusing to participate or seeing it as a new and exciting activity.
Some great sentence starters are;
"Let's see if we can..."
"I wonder if we can..."
"Shall we beat the clock and do X?"
"I can't seem to make this work..." -- this one may entice the child to come and 'help' you with the activity.
Ones to avoid are;
"It's time for you to..."
"You've got to" or "You must"
2. Plant the seed
As with most children with autism, they will need extra time for processing and to understand what is going to happen. Plant the seed of what you would like to happen at the start of each session or activity, but do not expect it to happen straight away.
“If they’re given a task, sometimes what she likes to do is to watch, and then she’s fine, but if you were to, as you would with some children, chivvy them along, she’d become entrenched... Whereas if you go ‘That’s fine, you just watch’, the reality is she’s an interested, bright child, and actually she can’t resist wanting to join in…You let her come round herself.”
- SENCO of a KS2 Child with PDA
3. Use the child's interests
Again, this is why getting to know your child is so, so important. You can use characters or elements of a child's special interest to make activities less demanding, or to depersonalise the demands being made. For example, if your child really liked Peppa Pig, you could say;
"Madame Gazella says these are the rules at school."
This can take a bit of practice and you will need to really get stuck in and find your inner actor or actress, but dramatics and roleplay typically goes down really well with children with PDA.
4. Offer choices
Giving a child simple choices will help the day run much more smoothly. If you give the situation or activity that is going to happen as a given, you can then offer the child a choice about how they approach that activity. This will give them a sense of being in control, so less likely to refuse the demand, but you have directed what is going to take place.
For example, "When walking to swimming, would you like to hold my hand or walk with your friends?" In this case, walking to swimming is happening regardless, but the child has choice about who they walk with to get there.
The Teacher's Introduction to Pathological Demand Avoidance: Essential Strategies for the Classroom
Being Julia - A Personal Account of Living with Pathological Demand Avoidance
PDA in the Therapy Room: A Clinician's Guide to Working with Children with Pathological Demand Avoidance