Pathological Demand Avoidance

[Stargrower]

Does anyone have any experience of this in early years? One of my staff suspects that a three-year-old boy is showing traits. I don't have any direct experience of it, and had only heard of it linked to ASD. The traits observed have been:

 

Resists and avoids the ordinary demands of life

Appearing sociable but lacking depth in understanding

Excessing mood swings and impulsiveness

Comfortable in role and pretend play, sometimes to an extreme degree

Language delay, often with a good degree of catch up

 

I'd be interested to hear if anyone has come across it in a child, and how you worked with that child and parents. Thanks!

[Tinahs]

Not had direct experience of a child diagnosed with PDA but I saw a programme a while ago featuring a child with add who had also been diagnosed with PDA & mum was advised to phrase instructions & requests very carefully so that they were not coming directly from her but were imposed on her by some higher body over which she has no control (ie so that she could not be 'blamed' for any demands she made and the child's anger at the demand was not directed at her). The example they gave was if the child said "I don't want to go to school" mum should say matter of factly "I know. I don't want to take you to school either, but the queen says we have to". They showed this example being used with the child & rather than having a massive melt down (which is what he had been doing over going to school) the child said, rather crossly "I don't like the queen!". Mum agreed with him that it was very unfair but out of her control & he got ready for school with no problem.

I have a child this year who (alongside other additional needs) seems to show signs of PDA (although no formal diagnosis, just my opinion). He absolutely will not / cannot comply with any request or instruction, no matter how minor. We now use the technique described above with some success. For example, to get him to put something away I would say "these have to go in the box". He will begin to argue & I will share his disappointment & say "I know but we have to" as though it is not coming from me & is being imposed on me too. We wouldn't normally use phrases such as "we have to..." Or "we've got to ...." but this approach is working (most of the time) with this child. The other approach that works at times is phrasing it carefully so that whatever you wanted him to do was his own fantastic idea(!) Hope this helps & I hope you find someone on here who can offer more experience & advice with this condition. I will follow this with interest for ideas that may be effective with our young man.

[Upsy Daisy]

Asking who is going to do xxx can be a helpful strategy and also giving choices, e.g. would you like to put your coat or your shoes on first?

It's useful to remember that PDA is a trait of Autism and, as a stand alone diagnosis, can be very similar so routine, clear, literal language, visual timetables, care around sensory input, etc are all worth using to see if they are helpful.

Demand avoidance is an anxiety reaction, i.e. the demand makes the child feel anxious. Using rewards can cause the anxiety to peak enormously and the child can feel driven to sabotage the reward in order to remove the demand.

 

Demand avoidance can also increase dramatically when a child's anxiety is high for other reasons so sometimes it's worth looking at other triggers like changes in routine when demand avoidance seems unusually high.