This scoping review examined the available research on the schooling experiences of children and young people (CYP) aged 4–18 who present with a pathological demand avoidance (PDA) profile. It explored barriers to school attendance and engagement, the impact of school experiences on mental health and wellbeing, and the approaches that may contribute to more positive experiences for children and their families.
The authors searched 13 databases and conducted an updated search in September 2026. Nine peer-reviewed articles met the inclusion criteria. The review identified three main themes:
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Barriers within the education system: limited professional understanding of PDA, inappropriate or ineffective approaches, unmet educational needs, difficulties accessing appropriate provision and parental blame. The studies reported school distress, informal and formal exclusion, placement breakdown and disrupted educational experiences.
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Characteristics of the PDA profile that prevent engagement in education: anxiety, sensory differences, a strong need for control and difficulties managing demands, transitions and social expectations. These experiences can make conventional school environments difficult to tolerate and affect attendance, participation and learning.
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Characteristics, approaches and interventions that help improve schooling experiences: flexible, relational and nurturing approaches, educators who understand PDA, reduced or adapted demands, and environments that prioritise trust, autonomy and individual needs. Informal educational settings were also reported as helpful by some families because of their flexibility and child-led approaches.
The review highlights the potential conflict between the demands of formal education and the needs of children with a PDA profile. Behavioural approaches based on rewards, consequences and compliance may be ineffective and can increase distress when they fail to account for anxiety and the need for autonomy. The findings also suggest that difficulties accessing recognition and appropriate support can compound unmet need, contribute to exclusion and negatively affect the mental health of children and their families.
The authors recommend improved training and understanding among education professionals, more appropriate and individualised approaches, and an end to parental blame. They emphasise that responsibility for improving access to education rests with education providers and systems, rather than being placed solely on children and their families.
Significant research gaps remain. The evidence base is small, many studies use self-selecting samples, and the review found that children’s own perspectives were largely absent: only one of the nine included studies incorporated the views of CYP themselves. Educators’ perspectives were also underrepresented. The authors call for further research that includes children’s voices, investigates the relationship between school experiences and mental health, and evaluates which approaches are effective in practice.