{"id":14866,"date":"2025-06-15T11:37:56","date_gmt":"2025-06-15T10:37:56","guid":{"rendered":"https:\/\/www.pdasociety.org.uk\/?page_id=14866"},"modified":"2026-02-04T17:44:18","modified_gmt":"2026-02-04T17:44:18","slug":"what-pda-can-look-like-in-clinic","status":"publish","type":"page","link":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/research-professional-practice\/health-and-social-care\/what-pda-can-look-like-in-clinic\/","title":{"rendered":"What PDA can look like in clinic"},"content":{"rendered":"\n[et_pb_section fb_built=”1″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_row _builder_version=”4.27.4″ _module_preset=”default” custom_padding_phone=”||24px||false|false” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”What PDA can look like in clinic” _builder_version=”4.27.4″ _module_preset=”default” title_text_align=”left” custom_margin=”0px|0px|0px|0px|false|false” custom_padding=”0px|0px|16px|0px|false|false” title_text_align_tablet=”left” title_text_align_phone=”left” title_text_align_last_edited=”on|desktop” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” custom_margin=”0px|0px|0px|0px|false|false” custom_padding=”0px|0px|16px|0px|false|false” custom_padding_tablet=”32px|0px||0px|false|false” custom_padding_phone=”0px||16px||false|false” custom_padding_last_edited=”on|phone” hover_enabled=”0″ text_orientation_tablet=”” text_orientation_phone=”left” text_orientation_last_edited=”on|phone” locked=”off” global_colors_info=”{}” sticky_enabled=”0″]Variability in Engagement<\/strong>\n\nOne of the most striking features of PDA in a clinical setting is the unpredictability<\/em> of the child\u2019s presentation. On some days, the child may refuse to attend the appointment altogether. If they do arrive, they might be unable or unwilling to get out of the car or enter the building. Even when physically present in the room, they may:<\/span>\n
    \n\t
  • Refuse to leave their parent or carer\u2019s side<\/li>\n\t
  • Be silent, withdrawn, or unable to engage with questions or activities<\/li>\n\t
  • Alternatively, they may be highly articulate and eager to engage, leading wide-ranging conversations or even initiating philosophical discussions<\/li>\n<\/ul>\nThis variability should not be interpreted as manipulative or oppositional behaviour. As Raelene Dundon, educational and developmental psychologist, points out, \u201cWhat may look like non-compliance is more often a panic-driven attempt to preserve a sense of autonomy and safety.\u201d Recognising this helps to reframe the child\u2019s behaviour in compassionate and constructive terms.<\/span>\n\nControl and Avoidance Dynamics<\/span><\/strong>\n\nPDAer may attempt to control the therapeutic environment to reduce their anxiety. This can manifest in many ways:<\/span>\n
      \n\t
    • Directing the clinician on what they should be doing<\/li>\n\t
    • Interrupting or preventing parents from discussing challenges<\/li>\n\t
    • Refusing to engage unless allowed to choose the location or context-for example, working only under a table or in a specific part of the room<\/li>\n<\/ul>\nThey may also use a variety of avoidance strategies, often framed as plausible excuses:<\/span>\n\n\u201cI\u2019m too tired,\u201d \u201cI am doing this now, but we can do yours next time\u2026\u201d<\/span><\/em>\n\nLibby Hill, speech and language therapist, highlights the importance of flexibility in her work with children: \u201cWorking with PDA children means needing to leave your ego at the door. Go with the flow, focus on the big picture, and be uber-flexible.\u201d<\/span>[\/et_pb_text][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” background_color=”RGBA(255,255,255,0)” height=”100%” custom_padding=”0px|0px|0px|0px|false|false” custom_css_free_form=”selector ul li strong {|| font-weight: 900;||}||selector ul li {|| font-weight: 400 !important;|| position: relative;|| padding-left: 37px;|| margin-bottom: 15px;||}||||selector ul {|| list-style-type: none;|| padding: 0 !important;||}||selector ul li::before{|| content: %22%22;|| position: absolute;|| width: 24px;|| height: 24px;|| background-image: url(%22data:image\/svg+xml;base64,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%22);|| background-size: contain;|| background-repeat: no-repeat;|| top: 4px;|| left: 0;||}||” locked=”off” global_colors_info=”{}”]
        \n\t
      • P \u2013 Prioritise and Compromise<\/li>\n\t
      • A \u2013 Anxiety Management<\/li>\n\t
      • N \u2013 Negotiation and Collaboration<\/li>\n\t
      • D \u2013 Disguise and Manage Demands<\/li>\n\t
      • A \u2013 Adaptation<\/li>\n<\/ul>[\/et_pb_text][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” custom_margin=”0px|0px|0px|0px|false|false” custom_padding=”0px|0px|16px|0px|false|false” custom_padding_tablet=”32px|0px||0px|false|false” custom_padding_phone=”0px||16px||false|false” custom_padding_last_edited=”on|phone” text_orientation_tablet=”” text_orientation_phone=”left” text_orientation_last_edited=”on|phone” locked=”off” global_colors_info=”{}”]It\u2019s helpful to think of PANDA not as a checklist, but as a gentle guide \u2013 especially helpful if you\u2019re new to PDA support. The real work happens through connection, curiosity and trial and error.\n\n\u201cHaving a big toolkit means you can be more adaptable in the moment.\u201d\n\nYou can find our guide to PDA approaches for everyone here. It covers the fundamentals that will help you support PDAers you come across. The rest of the information in this guide is healthcare specific.[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"

        Variability in Engagement One of the most striking features of PDA in a clinical setting is the unpredictability of the child\u2019s presentation. On some days, the child may refuse to attend the appointment altogether. If they do arrive, they might be unable or unwilling to get out of the car or enter the building. Even when physically present in the room, they may: Refuse to leave their parent or carer\u2019s side Be silent, withdrawn, or unable to engage with questions or activities Alternatively, they may be highly articulate and eager to engage, leading wide-ranging conversations or even initiating philosophical discussions This variability should not be interpreted as manipulative or oppositional behaviour. As Raelene Dundon, educational and developmental psychologist, points out, \u201cWhat may look like non-compliance is more often a panic-driven attempt to preserve a sense of autonomy and safety.\u201d Recognising this helps to reframe the child\u2019s behaviour in compassionate and constructive terms. Control and Avoidance Dynamics PDAer may attempt to control the therapeutic environment to reduce their anxiety. This can manifest in many ways: Directing the clinician on what they should be doing Interrupting or preventing parents from discussing challenges Refusing to engage unless allowed to choose the location or […]<\/p>\n","protected":false},"author":19,"featured_media":0,"parent":11126,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"course_tag":[352,356,355],"class_list":["post-14866","page","type-page","status-publish","hentry","course_tag-cpd-for-professionals","course_tag-healthcare","course_tag-healthcare-professionals"],"_links":{"self":[{"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/pages\/14866","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/users\/19"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/comments?post=14866"}],"version-history":[{"count":0,"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/pages\/14866\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/pages\/11126"}],"wp:attachment":[{"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/media?parent=14866"}],"wp:term":[{"taxonomy":"course_tag","embeddable":true,"href":"https:\/\/www.pdasociety.org.uk\/pda2025staging\/wp-json\/wp\/v2\/course_tag?post=14866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}