What is Pathological Demand Avoidance?
Individuals with PDA have an obsessive need to avoid the demands, expectations and even suggestions of others. Their need to avoid these demands stems from having intense anxiety. Children with PDA will find it impossible to comply with even simple demands, i.e. playing a game that they usually like if it has been suggested by someone else or managing personal hygiene.
In order to obtain a diagnosis of PDA all of the following criteria must apply:
- Passive early history
- Resists and avoids the ordinary elements of life
- Surface sociability
- Changes of mood
- Comfortable in role play and pretending
- Language delay (possibly result of passivity)
- Obsessive behaviour
- Neurological involvement
These strategies of avoidance that a child may display are essentially socially manipulative.
These strategies can include:
– Distracting adult
– acknowledging demand but excusing self
– Procrastination and negotiation
– Physically incapacitating self
– Withdrawing into fantasy and play
– Physical outbursts and attacks
- Rely on your intuition more than would usually be the case with autism- have an individualised teaching style.
- Use phrases such as….‘I wonder how we might…’ or ‘I can’t quite see how to do…’ rather than ‘Now let’s get on with your work…’
- Allow a feeling of self-control. Give options and allow the child to feel that they are in control of the decision.
- Introduce a key person for the child or a mentor system. This is needed to build up trust. This role could be shared by 2/3 people. Be consistent in your approach.
- Keep calm in the face of challenging situations. A child with PDA may be adept at reading signs of excitement in others as a result of their behaviour.
‘Pulling rabbits out of the hat’:
- Novelty and variety is often effective because a child may exploit routine / predictability
- Variety in the pace of presentation and style can intrigue the child
- Building on a child’s strengths and interests provides opportunities for incidental learning
- Revisit strategies that have worked in the past
- Drama and role play make use of the child’s interest in imaginative play and can be used to depersonalise requests or teach morality
- Visual clarification methods (symbol strips, written messages, cartoon drawings, etc).
- Ground rules need to be as few as possible but then maintained by passing over responsibility, ‘I’m sorry but it’s a health and safety requirement’
- Have a designated safe place that they child can go to
- Allow longer processing time
- Using quite complex language can be effective as the youngster may find it intriguing and more negotiative
- Humour can sometimes be helpful.
- Expectations should be disguised where possible and reduced to a minimum. Confrontation should be avoided where possible. This should be underpinned by an understanding of the condition; the child with PDA doesn’t make a ‘deliberate choice’ not to comply and cannot overcome the situation by ‘an act of will’. He/she may, though, begin to make a series of achievements towards this end as trust and confidence builds.
Collaborative Problem Solving:
- Solve problems together- involve the child in creating a solution