Have you heard of PDA in children? Although some might believe it simply relates to a child that says 'no' a lot, there's actually a lot more to it. Here's what it actually is, and expert tips for supporting children who have it.
From understanding why autistic children play differently, to supporting kids with ADHD, raising a neurodiverse child presents a unique set of challenges. Not just children, women are being diagnosed late in life, with the sensory demands of parenting proving difficult for autistic mothers.
Pathological Demand Avoidance (PDA), falls under the umbrella of neurodiversity as it's largely seen in those with autism. It's also nuanced and difficult to pinpoint, because all children are fond of using the word 'no' and PDA can be misinterpreted as a child not doing as they're told. However, kids with PDA will go to extremes to ignore or resist anything they deem to be a demand, and struggle to attend school or undertake activities other children do easily.
For a clinical opinion on the condition, we spoke to Educational Psychologist and resident GoodtoKnow expert, Dr Patricia Britto. She tells us "PDA (Pathological Demand Avoidance) is suggested to be a profile on the autism spectrum; however, it is essential to note that research on this condition is in its infancy stage. The understanding of the complexity of PDA and the autism spectrum is still evolving, as well as the overlapping pattern of strengths and differences that each individual who is diagnosed with the condition can present differently to one another.
Each individual with autism and PDA may have a cluster of traits that is entirely different to another and which can be presented differently in varied environments. For example, some children and young people with autism present differently at home than they do at school, depending on their level of comfort with being their authentic selves in a given environment."
What is PDA?
According to the PDA society, PDA involves an inability to do certain things at certain times, either for yourself or others. It also encompasses behaviours relating to avoiding demands. Although it's considered a natural human trait, demand avoidance can become a problem when it becomes significant and affects physical or mental health.
Dr Britto shares "PDA is not recognised in the Diagnostic and Statistical Manual Fifth Edition [DSM-V] (a diagnostic manual), and therefore, not all professionals agree with this profile. Some services and professionals can choose to use PDA as a descriptive diagnosis alongside another, such as autism, and this is growing increasingly in the UK. Nevertheless, there is a growing use of the terminology of PDA, and some parents have reported worries about their children’s needs not being completely understood, misdiagnosed or missed altogether, even though exercising caution in using the term is still advised."
The PDA Society adds that parents concerned about the condition need to know that it could relate to a developmental or personality condition, and underlying causes can be hard to pinpoint. It’s also important to remember that extreme demand avoidance is the most predominant, but not the only trait in a PDA profile, which is why the definition and diagnosis is so nuanced among experts. Typical traits to look for include children that:
- Resists and avoids the ordinary demands of life.
- Uses social strategies as part of the avoidance.
- Appears sociable on the surface, but lacking depth in understanding.
- Experiences excessive mood swings and impulsivity.
- Obsessive’ behaviour, often focused on other people.
- Appears comfortable in role play and pretend, sometimes to an extreme extent.
How to support a child with PDA
We spoke to Families in Focus, to help us understand how to support children with PDA a little better. Based in Hertfordshire, the community interest company has researched evidence-based therapeutic ways to support parents of children who fit the Pathological demand avoidance (PDA) profile.
They tell us "There is help available to support the enormous anxiety that lies behind children avoiding everyday demands. Helping parents to see beneath the behaviours and understand what is triggering it and build an empathic honest trusting relationship with their child so they can feel safe enough to talk about concerns without judgements.
Finding ways to try to help parents keep calm and avoiding last minute changes with planning and preparation and always having a backup plan and thinking ahead. Meeting other parents with children with PDA traits will help lessen the enormous sense of isolation and build up parental confidence that is often so low with the challenges faced every day and refusal to do things such as putting shoes on to go to school."
Dr Britto adds "Those who have been opportune to have a diagnosis of PDA are likely to experience challenges with not being able to follow demands and may describe that this is because they have a genuine struggle rather than they are simply refusing. A flexible, collaborative and use of careful language is likely to help children and young people with PDA cope with daily demands in some cases but not all. The PDA society often advises the use of the following acronym 'PANDA.'"
- Pick battles
- Anxiety management
- Negotiation and collaboration
- Disguise and manage demands
- Adaptation
Dr Britto concludes "While keeping an open mind, I believe further research into the specific symptoms of PDA should be completed and explored by parents to exercise caution and to ensure the term is accurately used."
For more of Dr Britto's expert insight, she shares everything you need to know about school readiness - and it's not just about having a full toilet trained child. She also offers tips for what to do if you disagree with how a teacher disciplines your child. The Educational Psychologist also weighs in on five things kids never have to do - including not being forced to hug family members if they don't want to.
