Most children sometimes avoid doing what is asked of them. However, some children take this avoidance to an extreme, resisting almost any request.
Avoidance can be in any form, like making excuses, distraction, focusing on other things rather than the assigned task, escaping, or panic attacks. This extreme avoidance might look like refusing to brush their teeth in the morning, persistent arguments over doing homework, or having a meltdown when asked to get dressed for school. Such behaviors can create challenging situations at home and school, making it important for parents to recognize these signs of PDA, pathological demand avoidance.
The History of Pathological Demand Avoidance
The term was originally developed by the British psychologist Elisabeth Newson in the 1980s to describe a profile of extreme resistance of a child to everyday demands. It was coined to describe children who use social manipulation to avoid demand, but it has since been expanded to include a broader set of behaviors.
This is often linked to anxiety and a need for control. However, the PDA label is in debate as this is not officially recognized in international diagnostic manuals like the DSM-5 or ICD-10.
Why Does Demand Avoidance Happen In Children?
Pathological demand avoidance in children is rooted in intense anxiety and a strong need for control. Avoiding demands is a way to maintain a sense of control over their environment and emotions when they feel overwhelmed.
This is a survival strategy, meaning when they show extreme reactions, such as meltdowns, it is a response to anxiety, not a sign of being difficult or spoiled. The child is not refusing to do something that is asked of them, but they do so out of a feeling of being unsafe.
Some experts suggest that a hyper-sensitive nervous system can be triggered into a fight, flight, or freeze state by the slightest demand.
Even seemingly small requests, like asking about their day, can trigger a strong reaction because the demand itself feels overwhelming.
Demand avoidance may be driven by these factors, both of which are common in autistic people. In contrast, some people with lived experience of demand avoidance have suggested that anxiety can be the effect of perceived threats to autonomy and control.
Characteristics of Pathological Demand Avoidance (PDA)
It is good to understand the different characteristics of PDA. Individuals with this profile respond to requests and expectations differently from others.
There are eight primary characteristics associated with this profile.
- Resistance to Everyday Requests: These individuals habitually resist ordinary demands. They often refuse tasks that others view as unimportant, routine matters.
- An Intense Need for Personal Control: They possess an overwhelming need to feel in charge of their own actions. A fear of control by others drives this need. Intense anxiety over a loss of control often triggers rapid mood shifts.
- Use of Social Strategies to Escape Demands: They use social tactics, especially to avoid requests. They rely on these strategies to escape pressure.
- Surface-Level Social Skills: On the surface, these individuals often appear to possess good communication abilities. However, under this act, they struggle to truly understand social interactions.
- Intense Focus Driven by Anxiety: High levels of anxiety drive their behavior. This often results in an intense focus on specific people. It can also lead to deep worry regarding performance expectations.
- A Preference for Roles Over Reality: They often appear more comfortable in pretending scenarios or adopting a specific role. Reality feels less safe to them than these adopted roles.
7- Tactics for Evasion: This PDA symptom in children comes with specific methods to avoid requests. To outside observers, these tactics may look like manipulation. Common examples include:
- They make excuses.
- They create distractions.
- They linger in starting tasks.
- Some show issues and threats.
- Some PDA people claim physical inability to act (e.g., stating they cannot move their arms).
8- Unpredictable Moods: Their moods shift rapidly. An individual might appear energetic and positive at one moment. Just a few minutes later, they may seem withdrawn or downcast.
Treatment Strategies for Pathological Demand Avoidance (PDA) in Children
Pathological Demand Avoidance (PDA) currently has no known cure. Children with PDA instinctively resist direct requests. This resistance can be dealt with through therapy attempts.
Communication and Interaction Strategies
- The delivery of requests is necessary.
- Direct orders seldom work, so therapists use the indirect command.
- The instructions are brief and clear to ensure effectiveness.
- Therapists expect that there would be resistance. They use specific strategies to turn refusal into acceptance.
- They understand that children require sufficient opportunity to absorb information before they act.
Positive reinforcement is key. Praise successful task completion by highlighting personal strengths. Do not acknowledge failure. Attention to mistakes often causes a repetition of the unwanted action.
Professional Assessment Areas
Professional diagnosis helps identify specific difficulties. These assessments focus on:
- How the child speaks and understands others.
- Social interaction abilities.
- Reactions to sensory input like noise or touch.
- Physical movement control.
- Overall ability to learn.
Collaborative Professional Support
Collaboration among specialists is necessary to deal with pathological demand avoidance. A team of professionals helps address the unique and complex needs of individuals with PDA. A team can consist of:
- Speech and language therapists who help with communication challenges, particularly in understanding and responding to demands in a non-confrontational way.
- Physiotherapists address any skill difficulties or sensory processing issues that may impact a person’s ability to participate in daily activities and manage stress.
- Occupational therapists work on developing strategies for everyday tasks with the focus on independence, self-regulation, and integrating sensory needs into the environment.
Cognitive Behavioral Therapy
Cognitive behavioral therapy for demand avoidance adapts standard techniques to reduce anxiety and challenge unhelpful thought patterns that are related to demand. Key strategies include reframing demands and teaching coping mechanisms, such as relaxation and breathing exercises. They provide strong mechanisms to handle anxiety.
This strategy is effective for young kids and adults. However, CBT helps to reframe thoughts about stressful situations to reduce anxiety and change responses to demands.
There is a need for support for PDA kids’ intellectual abilities and their mental functions. Professionals and parents must understand that what they achieve one day may not be effective the next.
The major goal is to identify the child’s unique strengths and challenges and align them with the professionals who will support their independence and teach them to develop such skills to meet the demands.
Parental involvement and advocacy are needed to support children with PDA by collaborating with therapists and psychiatrists. Parents can help create a positive and nurturing atmosphere that promotes growth and development in a child.
Inland Empire Behavioral Group has expert psychiatrists to provide solutions to different mental health conditions. We provide evidence-based, holistic care with modern techniques that are helpful. Call us to find the support.
