Have you ever worked with a child and had a feeling that they may be autistic but didn’t quite fit the profile? Have you implemented strategies with a child, which sometimes were effective but other times were not? You have a feeling there is something underlying but cannot quite put your finger on what it is? As an early years SENDCo, I had a young girl who puzzled me. At some moments her behaviour, play and interactions with other children showed signs that she may be autistic, however she did not display ‘typical’ autistic traits. She also reminded me of my middle child, who almost completely mirrored the girl’s behaviour. 

For weeks, I kept going back and forth, observing both my daughter and the young girl I was working with. I was trying to find the key that would unlock the reasons for their behaviour. I could see both children were having some difficulties in the classroom and at home, but I did not know how to support either of them effectively. It began to play on my mind, that despite all my experience and qualifications working with young children with SEND, I did not work out what was going on for both children and I began to feel like I was failing them. 

Fast forward a few weeks and I happened to stumble across a chapter in a book, which discussed Pathological Demand Avoidance (PDA). This was more than a light-bulb moment, it was one of the brightest illuminating moments in my career. Almost word for word, the text in front of me was describing the two young girls, and for the first time in months, I felt a wave of relief that I had found the missing key, and I jumped out of my chair and shouted, “yes, yes, that is exactly it!”. With this newfound excitement, I began my journey into the world of PDA.

What is PDA?

Pathological Demand Avoidance (PDA) is a developmental condition often characterised by an individuals’s persistent drive to avoid everyday demands. Often people with PDA will utilise a range of social strategies to avoid such demands and, although there is still much more to learn about PDA, it is acknowledged that it is an anxiety-based condition. In many parts of the UK, PDA is not recognised as a separate condition and is often placed under the umbrella of autism. However, from my professional and personal experience of working with and having children both with Autism and PDA, I can say without hesitation that they are both very distinctly different, as are the strategies used to support them. By no means am I an expert in the field of PDA. However, I feel that it is important to share my lived experiences and the knowledge that I have gained so far, as it could just maybe be that illuminating moment for someone else. PDA is not a condition that is commonly known and often missed by many professionals. Therefore, more knowledgeable practitioners can help to narrow the knowledge gap, improve practice, and, importantly, effectively support children. 

How to identify PDA in children

As with many neurodivergent children, a child’s individual profile can vary; some ‘traits’ may be more present than others and can also change in their intensity. This list is not definitive, but intended as a guide for you to start to begin to identify some of the key characteristics of PDA;

• Resistance and avoidance of ordinary, everyday demands – this could be as simple as asking a child to wash their hands or go to the toilet.
• A child may appear to be sociable and play with their peers well, however, on closer observation, you may notice that they ‘copy’ the social interactions of others and lack social understanding. I observed this with the young girl I was working with. When I sat back and watched her play, it was often that she gave each of her friends a role to take on. If they did not take on this role, she would get very frustrated. Other times, she would be on the edge of the play activity and although she appeared to be part of the group, she stood back watching, rather than participating. 
• Children may draw upon social strategies as part of the avoidance of demands and to reduce their anxiety. My daughter would often watch and ‘assess’ the social situation to try and work out what was happening. She was able to get to know an adult and how to use them to avoid a demand or achieve a desired outcome. 
• A child may have difficulties in managing and regulating their emotions and feelings. This can present as excessive mood swings and impulsivity. A child could be sitting happily playing one moment and then have a sudden and intense meltdown the next. Often leaving you thinking 'What happened there?’
• Children will show obsessive behaviour, which is often focused on other people. This focus is often social and can be observed as a ‘love-hate’ relationship with other children and adults. This can sway from one extreme to another.
• Children may show a particular interest and appear very comfortable in role play and pretend play, often to an extreme extent. This feature was very strong in my own child from a young age. She loves role play and taking on the persona. However, this often extends beyond play and she will rename herself to become the character and ‘act them out’ for weeks at a time. She even changes her mannerisms and clothing to match her character. 

From my own experience, a child with PDA can often be ‘mis-labelled’ as having challenging behaviour. Although some of the behaviours that a PDA child presents can be disruptive, you must remember that the behaviour is coming from a place of anxiety and not aggression. A child with PDA needs time, understanding, nurturing and support. 

Supporting strategies

PDA is often anxiety-based, therefore the main aim of any strategy that you implement is to reduce a child’s anxiety. This may take some time for you to identify any potential sites or triggers for a child’s anxiety, so it is important to spend time getting to know them and reflecting on any ‘behaviour’ incidents and potential triggers. In terms of strategies to support children with PDA in your classroom, although one size does not fit all in terms of what works for each child, there are two approaches that I have found particularly useful both at home with my own child and in my practice. These are the ‘low demand’ and the low arousal approaches. Both strategies are designed to reduce a child’s stress, fear, and frustration, and subsequently reduce their anxiety. 

The low-demand approach seeks to reduce the demands and expectations that you place on a child. Managing your expectations of behaviour, knowing when to challenge and direct children in their learning, and stepping back to allow them to initiate activities can all help support a child with PDA. Furthermore, how you present a demand to a child can significantly influence how they perceive it and respond to it. For example, if you want a PDA child to go to the bathroom and wash their hands before lunchtime, a high-demand approach would be to tell them to “go and wash your hands”. This could trigger an anxiety response and they would be less likely to follow the demand. However, by rephrasing the sentence, you take the attention off them and reduce the demand being made. So alternatively, you could say "It is nearly time for lunch, let’s all go and wash our hands”. It is often helpful to take the direct focus/attention off the child as much as possible, which can be done by talking in the third person.

Similarly, the low arousal approach aims to reduce a child’s fear, frustration, stress, and anxiety by reducing any unnecessary sensory input surrounding a child. A classroom can be a hive of activity, with lots of sounds, smells, movement and colour. For a child with PDA, they are likely to experience some sensory processing difficulties and too much sensory input can trigger their flight, fight, or freeze response. Therefore, the low arousal approach uses a collection of different strategies, that aim to reduce any unnecessary sounds, smells, resources, etc. It additionally encourages practitioners to consider their classroom décor and use more natural/neutral tones. For further information on these approaches, have a look at my mini-series about them, which is also on the SEND Network: Children's Mental Health Week: The importance of supporting the social, emotional and mental health and development of young children | SEND Network (send-network.co.uk)

Conclusion 

I think back to some children who I have worked with over the years, and it made me wonder if there could have been other children with PDA, but due to my gap in knowledge surrounding it they had ‘slipped through the net’. Although I cannot go back and change my previous practice, I can move forward and continue to support any child who may present with PDA in the future. Furthermore, I am a strong advocate of raising awareness surrounding PDA and in time, I hope it can be recognised as a distinctive profile in its own right and not kept hidden under the umbrella of autism. I think this is im

Useful websites:

• The PDA society: PDA Society – Pathological Demand Avoidance
• Bridging the neurodivide: Autistic | Tiggertraining/Bridging The Neurodivide | England
• PDA Dad UK: Home | PDA Dad UK

Suggested reading:

The PDA society  has an extensive reading list: Books | PDA Society Resources

Also check out one of the latest podcasts on the SEND Network: Season 3 Episode 5: Unmasking neurodivergence with Duncan Casburn (PDA Dad UK)