This week we are going to discuss Pathological Demand Avoidance (PDA), a term originally used by Elizabeth Newson and her collaborators in the 1980s to describe children with difficulties in social communication, in establishing relationships and using language accompanied by obsessive and rigid behaviours (The British Psychological Society, 2017). This syndrome is not yet registered with a diagnostic manual (DSM-5) as it is fairly new and more research still needs to be done to support it. For the last three decades however, more and more psychologists and parents talk about PDA which at the moment is seen as a subtype of autism, an atypical profile (though subtypes have been eliminated with the latest diagnostic manual and re-described in three different levels). Nevertheless, PDA should be acknowledged and professionals should make an effort to understand it.
Many psychologists attribute PDA as a syndrome accompanying ASD (Autism Spectrum Disorder), but more and more research suggest key differences between the two, individualising it as a syndrome on its own:
- Though avoidance shows in all children at one time or another, the extreme avoidance is what describes PDA.
- PDA individuals use social strategies to avoid demands while ASD individuals withdraw from it.
- PDA individuals have communication skills but lack depth (Newson et al., 2003)
- Good development of expressive language, but robust receptive language (Christie, 2015).
- Challenging behaviour at times, but masking it intentionally in specific situations.
- Presence of eye contact with intention rather than avoiding it like ASD individuals.
PDA syndrome affects all areas of development in varying ways and to different degrees. The PDA profile is mainly defined by resistance and avoidance to ordinary life demands and excessive mood swings. It may be accompanied by anxiety. Their rigidity specifically shows in the need to control situations; at the surface one will only see impulsivity, variety of emotions, need of control and other unwanted behaviours. Unlike in children with autism though, children with PDA who suffer of language delays in the early years of life, can recover much easier. As for the content of their speech, it may seem disconnected and unusual.
The most important characteristic to remember is the adaptability children with PDA develop using many strategies to avoid demand, becoming comfortable with social manipulation (The Psychologist, 2017). These children do not fit under the traditional ASD diagnosis and at the same time they present common symptoms with attachment disorder.
In a classroom, children with PDA indicate anxiety which directly influences the degree of willingness to participate in the educational process. Teachers who have worked with such children were also able to mention that:
- have a very low self-esteem
- lack confidence in the group
- experience mood swings (tantrums, meltdowns)
- though they want to have friends, they constantly sabotage their relationships
- confused reactions regarding same situation or same completed work
- explosive behaviours accompanied by aggression and/or violence
- difficulties integrating in groups, transitioning and identifying own mistakes
Teachers and parents can support such a child’s learning first of all by understanding his/her condition. As a next step, it is recommended that parents work closely with an occupational therapist who could organize a sensory diet for the child. This step will involve the identification of triggers in daily settings (classroom or home) and the identification of demands (at individual and group level); in specific cases, it is important to know when to adjust demands according to the child’s tolerance. As you already know, families and classrooms have basic rules of coexistence that keep everyone safe; in such cases, it is recommended that these rules be written in simple language, be consistently applied and be in a small number. If difficult situations occur, it is preferred that a non-confrontational approach is used.
In a school, such a child will require specific adaptations and continuous effort. It is important that the child learns how to stay on task in each class, throughout the day. But it is to remember that such a child is not naughty or less intelligent, but he/she is incapable by nature, cannot cope. Simply telling them to stop or how to do something does not solve the problem; they need adapted support, time and space, and trustful relationships in order to build positive experiences.
Next, teachers need to ensure that the knowledge is retained and applied in various contexts. Incidental learning is one style that can be easily used in such cases along with role play. Many times a PDA child will be accompanied by a support staff during parts of the school day, therefore, there are less disruptions in the learning environment when demands are put on the child.
Lastly, but not less important, teachers take into consideration that everyone in the environment is as little as possible disrupted during the school day. Typical peers in the classroom should learn about tolerance and acceptance while the PDA students could learn about compliance. It cannot last for the whole school day (be it 4 hours or 8 hours), but it should be expected of the individual to increase the time of compliance.
In the end, with all the stress and challenges a PDA child brings, teachers could see such cases as challenging and potentially rewarding from a professional point of view.