Teachers Guide to Understanding PDA

 

What is PDA?


Pathological Demand Avoidance (PDA) is now widely recognised as a distinct profile of autism which presents in some children on the spectrum. Children with a PDA profile will share similar difficulties to others on the autism spectrum in the following areas.
  • Social Communication Difficulties
  • Social Interaction Difficulties
  • Restrictive and Repetitive patterns of behaviour (including sensory seeking or sensory avoiding behaviour)
Children with PDA can appear to have better social understanding and communication skills than others on the autism spectrum, which means that some of their difficulties may be less obvious at first. But their understanding of such matters may not be as good as it seems and may be due to the child imitating, copying and therefore role playing what they perceive to be the correct social responses. Consequently their autism may often be missed with the focus instead being placed on a child's external presentation 'only' which can lead to misunderstandings regarding the underlying cause for these difficulties.

You can read more about PDA and how this profile of an Autism Spectrum Disorder (ASD) can overlap and differ from other presentations of ASD on our website.

The child as a learner

 
This information has been adapted from The National Autism Trust's paper - The Distinctive Clinical and Educational Needs of Children with Pathological Demand Avoidance Syndrome: Guidelines for Good Practice  (taken from the Good Autism Practice Journal, BILD, Phil Christie, 2007)

The overriding state of the child’s approach to school and learning is one of anxiety, which for a number of children impacts on their willingness to come to school in the first place (the ultimate avoidance). Some of the other key characteristics impacting on the child’s learning, emphasised by staff who have worked with children with PDA, are described below, most of which relate to their demand avoidance, others to different criteria. Not all of these characteristics are present in every child.

  • A very poor sense of self-esteem, which often results in children expressing that they can’t do something or won’t like it as a ‘first response’
  • Lack of confidence in crossing the threshold necessary to engage in an activity (what has been described as ‘can’t help won’t’).
  • An expressed desire to be on a par with or better than others, but not seeing it as necessary to put in the effort required.
  • An ambivalence about succeeding and enjoying an experience or activity, typified by the child who destroys their work on completion when it is commented on / praised by the teacher. 
  • A lack of permanence and transfer of learning and experience, which means that there can be very sudden and dramatic set backs for the child after relatively prolonged periods of settled behaviour and progress.​
  • Very poor emotional regulation means the child is prone to mood swings and phases which can be both short-lived or last for longer periods of time.
  • ​A desire to have friendships and relationships with other children but inadvertently sabotaging this through the need to be in control, manipulating and mediating or refereeing others’ interactions.
  • ​As well as the disruption caused by the explosive behaviour or aggression that may be used in response to pressure (which should be viewed as a panic attack). 
  • ​Extensive involvement in fantasy and role play in a way that isolates the child and leads to some of them taking on the features of those they mimic or identify with.
These difficulties can lead to increasingly challenging behaviour and severe ‘meltdowns’. It is not uncommon for children with PDA to experience multiple exclusions from an early age.
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Masking?

However, it is also important to note that the behaviour of a child with a PDA profile of ASD can vary between settings or at different times and with different people e.g. a child can be anxious at home, but appear calm at school. This may be a coping strategy for the child and, as with other children on the spectrum, some children with the PDA profile are able to ‘mask’ i.e. hold in their anxieties.

When a child masks their difficulties and anxieties it may sometimes result in parents feeling isolated and misunderstood when they discuss their concerns and experiences (at home) to professionals. Therefore, it is important for teachers to be aware that the child’s behaviour in school may not be indicative of the difficulties that parents face at home or indeed how the child feels on the inside.

Also, children who mask in school may, at some point experience a rapid deterioration in their tolerance and ability to cope at school, which can sometimes lead to school refusal. This further underlines the importance of a collaborative relationship between parents and school.
 

What can I do to support parents who feel their child may have PDA?


Due to their child’s complex and challenging behaviour the parent's may be exhausted and very concerned. They may have already done a lot of research into what may be contributing to their child’s difficulties. Parents may also be feeling isolated and unfairly judged if they have previously expressed concerns only to be told that the issue is a parenting problem. The difficulties and lack of understanding that parents often face are detailed by Dr Judy Eaton in Autism, anxiety and the impact on parents.


Key things that you can do to help are:

  • Consider and have regard to the guidance specified in the special educational needs and disability code of practice: 0 to 25 years, January 2015. (chapter 6 - schools)
  • Listen to their concerns
  • Look at the evidence that parents discuss and present to you
  • Talk to the other professionals who may be able to help such as the school SENCO, Educational Psychologist and / or the autism outreach team
  • Remember that how a child presents at school is not always indicative of how the child is actually coping, signs of anxiety can be subtle and/or masked; and may only be evident at home
  • Develop a collaborative relationship with the parents, working as a team is the most positive and beneficial way to support the child across both settings

Why is it important to identify children who may have PDA?

It is important for teachers to recognise and identify children who may have PDA because early diagnosis, support and intervention is often crucial for the best short and long-term outlooks for the child. The correct support and understanding in school will also reduce time spent on inappropiate behaviour and therefore pressure on teachers and staff.

What are the benefits of identifying children who fit the PDA profile?

  • A diagnosis is helpful in highlighting that the child’s difficulties are primarily due to a developmental disorder rather than a result of parenting issues or solely oppositional behavior.
  • It can help children with PDA, their families and professionals, who work with the child, to understand why they experience certain difficulties and hoe they can support the child more appropriately.
  • Allows parents and proffesionals to access services, support and appropriate advice about strategies.
  • Avoids incorrect assumptions and diagnoses, such as Oppositional Defiance Disorder (ODD), Attention Deficit Hyperactive Disorder (ADHD), Reactive Attachment Disorder (RAD), dyslexia or dyspraxia (although a child might have these as well).
  • Many children will require additional support in school and it is crucial that this support is tailored to their specific needs, which may differ to those that benefit from more typical ASD support. This helps to avoid school exclusion.
  • Informs local authorities and schools about the importance of providing support and using appropriate PDA strategies and interventions.

Implications for education and teaching staff


The strategies that tend to be successful for many children on the spectrum may need considerable adaptations for a child with PDA; an entirely different emphasis is often required.

It can be more difficult for teachers to understand how best to support pupils with a demand avoidant profile. This is because traditional management techniques such as structure, routine and rewards that can work for pupils with other autism profiles are generally ineffective.  They may even cause more anxiety and make situations worse for these pupils. Jilly Davis, teacher at The National Autistic Society’s Robert Ogden School.


Children with PDA can be exceptionally demanding which can create great pressures on individual staff and teams. Working in a creative, flexible and adaptive way can be both physically and emotionally draining.  Therefore, access to PDA specific training, regular opportunities for communication, planning and mutual support is important for teaching staff working with a child with PDA.


Tips for supporting a child in the classroom  

  • A school environment is often filled with demands and triggers for sensory & emotional overload, which often leads to high anxiety levels for a child with PDA.
  • Ground rules need to be as few as possible but then maintained using techniques such as passing over responsibility to a higher power e.g. a health and safety rule, de-personalising your requests (using imaginary characters or visual clarification), giving choice or negotiating.
  • Adjust your demands according to the child’s tolerance level e.g. when anxiety is high, reduce demands and when anxiety is low you may be able to increase demands accordingly.
  • Take pride in your ability to work in collaboration with the child, aiming to prove you are the boss will be counterproductive.
  • It may help to give instructions in an indirect, non-confrontational style – practice ‘asking without asking’ e.g. “I wonder if someone might be able to help me do this……….”
  • Have a safe place or several areas where the child can go to be alone when they are overwhelmed.
  • When a child has a ‘meltdown’ use quiet tones, give them space and reassurance. Try to think of it as a panic attack.
For more detailed information please view Educational and Handling Guidelines for Children with Pathological Demand Avoidance Syndrome.

Further information – education resources


You can find further information, leaflets, websites and webinars in our extensive list of education resources and webinars

Further reading and information about PDA

Further information about PDA can be found in the following areas of our website.

The National Autistic Society also provide an increasing amount of information about PDA.

Please note that the PDA Society are not making any recommendations nor is responsible for the content of sites and links that are external to the PDA Society.

Please contact us if you discover any broken links.