Adopting a PDA - friendly mindset

For autistic people with a PDA profile, traditional support approaches can often cause more harm than good. Things like firm routines and hierarchical relationships can increase anxiety and reduce trust. For professionals, the right mindset is an important first step in helping manage the anxiety and resistance demands can create. Focusing on understanding, compassion, and co-regulation rather than control or compliance is important. It’s about more than tactics; it’s a philosophy that will help you choose the right approach at the right time. Understanding that stress caused by demands can impact on every area of a PDAers life is a good start. As is knowing that this anxiety gets in the way of being able to do things to keep themselves safe and happy – and that this is not a choice. As a professional working within a system, there may be limitations in the changes you can influence about how your service runs. But anyone can work to build values into the relationships they have with people they support. These are three fundamental values that will help you work effectively with PDAers: 1. Trust Consistency, warmth, and honesty are key. Treating anxious behaviour as communication (rather than defiance) builds security. When PDAers trust that they’re safe, anxiety subsides, and daily tasks become more manageable. 2. Equity Relationships grounded in shared power reduce anxiety. It’s about letting go of control, listening deeply, and negotiating decisions. This approach reassures individuals that you respect their autonomy, reducing tension and the urge to avoid. 3. Compassion Recognize distressed behaviour as an anxiety response. This mindset shift can be difficult, but viewing meltdowns or refusal through a compassionate lens fosters more effective engagement. PDA Society’s PANDA mnemonic outlines ways to introduce the kinds of flexible approaches that tend to help. These aren’t separate strategies to apply one by one but overlapping ideas that support each other. The letters stand for:

• P – Prioritise and Compromise
• A – Anxiety Management
• N – Negotiation and Collaboration
• D – Disguise and Manage Demands
• A – Adaptation

It’s helpful to think of PANDA not as a checklist, but as a gentle guide – especially helpful if you’re new to PDA support. The real work happens through connection, curiosity and trial and error. “Having a big toolkit means you can be more adaptable in the moment.” You 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.

Moving away from traditional methods-where authority figures give orders and expect compliance-can be hard in health and social care. Staff shortages, strict protocols, and a culture of deferring to professional expertise can send a message that people must “do as they’re told.” This can be especially difficult for individuals with PDA, who feel high anxiety about demands.

Reasons mindset change could be difficult include:

• Resource pressures and strict protocols. Many services have rigid schedules and standardized treatment plans. Staff may feel they must push ahead without flexibility. But when a PDAer is anxious or uncertain about giving consent, rigid protocols can worsen resistance and harm trust. Spending time building rapport and adjusting approaches may seem costly at first. In the long run, it prevents missed appointments, stops crises from growing, and improves outcomes.
• Assumed compliance. Many services assume that people needing help will obey instructions. There is also an expectation that parents or carers will enforce this compliance. Yet for PDAers, forcing them to comply fails to ease the anxiety driving their avoidance. It can also damage the therapeutic relationship. In social care, it can confirm fears that professionals use power without listening or empathy.
• Shifting perspectives on parenting. Families of PDAers are often blamed for being “lax” or “permissive” when they choose gentle, cooperative approaches. But Luke Clements warns that parent-blame can hide problems in the system. He points out that professionals sometimes underestimate how hard things are for families. As a result, they judge parents and weaken the partnership needed for effective support. With a PDA profile, less rigid and more inventive parenting is not just a choice; it helps lower anxiety and keep connections strong.

“When professionals assume poor parenting rather than acknowledging systemic limitations, the real needs of the child are overlooked, and families can be unjustly blamed.” -Adapted from Luke Clements’ discussions on institutional bias For PDAers, “good parenting” might look very different from the usual. Parents may use unusual routines, negotiate boundaries, and offer a lot of freedom. While this can clash with older ideas about “firm authority,” it often reduces stress and supports the child’s wellbeing.

Practical suggestions for changing mindsets include:

• Reflecting on authority. Encouraging team discussions about who holds power and why. Ask if your protocols can allow more flexibility.
• Acknowledging pressures. Recognising that staff and resources are limited. Brainstorm creative ways-like shorter appointment slots or remote options-to meet PDAers’ needs.
• Promoting empathy. See anxiety, not defiance. Collaborative approaches reduce stress for both individuals and systems.
• Respect parental expertise. Parents adjusting their style for a PDA child’s needs are not “failing.” Invite their insights to shape support plans instead of blaming them.

Moving to a mindset which centers a respect for each person’s anxiety, autonomy, and lived experience can take time. Yet this shift fosters true engagement, lessens stress for everyone, and honours shared decision-making in health and social care.