Supporting Children with Pathological Demand Avoidance (PDA) in School and Social Settings: Occupational Therapy Strategies and Interventions.
Pathological Demand Avoidance (PDA) is a condition that falls under the Autism Spectrum Disorder (ASD) umbrella, characterized by extreme resistance to demands and requests, often leading to highly avoidant behaviour.
Many may wonder about the differences between Oppositional Defiant Disorder (ODD) and Pathological Demand Avoidance (PDA). It’s important to understand that while a person can be diagnosed with ODD without having autism, every person diagnosed with PDA is autistic. One way to differentiate between the two is through the “won’t/can’t” distinction. ODD is often characterized by a deliberate refusal to comply, whereas PDA is marked by extreme difficulty following demands. Children with PDA may experience anxiety and stress when demands are placed on them, leading to behaviours such as meltdowns or shutdowns due to flight/fight response. It is important to remember that this is not about controlling others but rather about needing to control their own experiences.
Children with ODD can respond well to consistent behavioural interventions and positive support plans. In contrast, children with PDA often do not respond to these approaches. Overall, understanding the differences between these two conditions can help inform appropriate interventions and support for individuals who may be struggling.
PDA can have a significant impact on a child’s participation in school. Children with PDA may have difficulty following the demands of the classroom environment, which can result in poor academic performance. In addition, they may struggle to cope with the structure and routine of the school day, leading to anxiety, stress, and meltdowns. As a result, they may avoid attending school, refusing to participate in activities, or engaging in disruptive classroom behaviour.
To support a child with PDA in the school setting, it’s essential to have a collaborative approach involving the school staff, parents, and Occupational Therapist. This can include developing a tailored education plan incorporating the child’s strengths and needs, including sensory accommodations, individualized teaching strategies, and opportunities for choice and flexibility. Occupational Therapists can work with the school staff to develop a sensory diet that helps the child regulate their emotions and behaviours. We can also provide training to teachers and support staff on how to work with children with PDA, including techniques for managing challenging behaviour and promoting positive communication.
PDA can also significantly impact a child’s social skills and engagement with other kids. Children with PDA may struggle with social interactions and may find it difficult to initiate or maintain relationships with their peers. They may also have difficulty understanding social cues, taking turns, or sharing toys and may prefer to play alone or engage in parallel play. This can result in social isolation and difficulties in making and keeping friends, which can significantly impact their emotional well-being.
To support a child with PDA in developing their social skills and engagement with other kids, it’s essential to provide opportunities for social interaction in a supportive and structured environment. Occupational Therapists can work with the child to develop social communication skills, such as initiating conversations, understanding body language and social cues, and recognizing emotions. We can also help the child develop coping strategies to manage social anxiety and stress and build self-esteem through meaningful activities.
As Occupational Therapists, we can help children with PDA by developing a child-centred approach to therapy, building communication and social interaction skills, and promoting resilience and self-esteem through meaningful activities. Using the coach approach, we can help parents better understand and manage their child’s behaviour, guiding them to identify their goals for their child, providing strategies to support their child and helping them identify their child’s strengths and develop strategies that leverage those strengths to address PDA-related challenges. The Occupational Therapy strategies may include creating a structured routine, using visual schedules, breaking tasks into smaller steps, and offering choices.
Pathological Demand Avoidance (PDA) is a relatively new diagnostic category within the autism spectrum disorders. While PDA is not yet officially recognised in many countries, some countries, such as New Zealand and the United Kingdom have included it as a distinct diagnostic category. It is important to note that the recognition and acceptance of PDA as a diagnostic category can vary significantly by country and region, and there is ongoing debate among professionals about the validity of the diagnosis. As such, the approach to diagnosis and treatment of PDA can vary widely depending on the country and individual practitioners involved.
If you have concerns about your child’s behaviour or suspect that they may have PDA or other related conditions, we encourage you to seek the support of a qualified healthcare professional. As Occupational Therapists, we are here to help support children with PDA and their families through individualized therapy plans and evidence-based interventions. Please feel free to contact us if you are seeking intervention.
