Helping all children become happy learners
Pathological Demand Avoidance (PDA)
Pathological Demand Avoidance (PDA) is an anxiety disorder closely related to autism first described by Professor Elizabeth Newson in the 1980's. It is also and less commonly known as Newson's Syndrome. There is still considerable debate over whether PDA is a separate condition from autism or a sub-type within the umbrella term of Autistic Spectrum Disorder (ASD). However, the diagnostic criteria for PDA does identify a group of children who appear to have distinct characteristics from ASD. and this can be very useful for parents and professional staff supporting the child.
At present there is no officially agreed diagnosis of PDA. It does not appear in either the Diagnostic and Statistical Manual of Mental Disorder (DSM-V) or International Classification of Diseases (ICD 10). This makes it difficult for professionals involved in diagnosing behavioural disorders to give a PDA diagnosis. As a sub-type of autism it is sometimes diagnosed as ASD with a demand-avoidant profile.
Presentation of PDA
PDA children are very adept at avoiding demands made of them. They will do this for all demands including trivial everyday demands and often for things that they like and enjoy. They achieve this using a variety of demand avoidance strategies:
PDA children are the masters of deflection and can effortlessly manipulate others into forgetting their demands through changing subject, asking a question, or drawing attention to something else. Often they achieve this with charm and guile.
It is this socially manipulative skill that distinguishes PDA children from ASD children.
PDA children are quick to provide an excuse as to why they can't do something asked of them. The child may often appear absorbed in their excuse activity and avoid eye-contact at this point.
'I just need to do..." or "...finish this.'
'My pencil's broken.'
'My hand's not working.'
Withdrawing into fantasy
PDA children often enjoy imaginative play and will retreat into their own fantasy worlds when threatened by a demand. They will then 'invent' excuses based around their fantasy:
'Robots don't eat lunch.'
'I need to brush my unicorn's hair.'
May use toys to resist demand
This is related to the withdrawing into fantasy where the child personifies toys and sometimes other object to enlist their support is resisting the demand.
'My teddy doesn't want me to do this.'
'Dolly wants me to stay and play with her.'
Older PDA children will continually provide counter arguments as to why they can't follow the request given to them. Being very socially manipulative they try to turn the argument away from them by for example pointing out someone else not doing the request.
'You only want me to do this because you don't want to do it yourself.'
'It's so unfair, why aren't they doing it.'
When avoidance strategies fail the child can become instantly angry and this can lead to aggressive outbursts. A PDA child is capable of 'trashing' a room when angry and often has little compassion about what they damage or break.
It is extremely difficult to debrief such incidents with a PDA child. Attempts are met with further avoidance or re-escalation to another meltdown. Restorative approaches tend not to work.
PDA children are very controlling as a way of minimising demands made on them. This can lead to conflict with peers as they try to dominate the play interactions. This can be seen in the way they tend to always take on dominant roles in play and games with other children:
'I'm the queen and you are my servants.'
'I'm the captain.'
'I'll be the teacher and you are in my class.'
Little interest in children own age
PDA children are more likely to play with children either younger or older than them. Younger children are often happy to be directed in their play by the older PDA child. Equally, older children can be very supportive of younger children and happy to be bossed about by the PDA child. When the PDA tries to control their peers this is less likely to succeed and often leads to:
Complaints from other children of unfairness over game choices and roles
Anger and aggression towards other children during play negotiations
Other features of PDA children
PDA children are usually outwardly sociable and want to engage with others. Their social language skills are age approriate though there is frequently a history of late speech development and delayed language.
PDA children are often described by parents as having been placid and passive babies
Children with PDA are subject to rapid mood swings moving from calm to rage and back to calm in an instant
Children may display some obsessive behaviours as they try to control their world
It is also quite common for children with PDA to have co-morbid learning diagnoses such as dyslexia or dyspraxia.
As discussed above, PDA does not have a national or internationally agreed criteria for diagnosis and professionals maybe unwilling or unable to give PDA as a formal diagnosis. Children presented at clinic are most likely to be given a diagnosis of ASD and possibly Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). Less frequently the child may get a diagnosis of Reactive Attachment Disorder (RAD). Sometimes 'Demand Avoidance' is listed as a co-morbid problem alongside the diagnosis that is given.
Five-Minute Guide to PDA
This is a printable resource that folds to create a handy A5 sized leaflet giving basic information about PDA. It is designed to read in few minutes and is useful for explaining the condition to new people.
PDA Behaviour Frequency Matrix
This is an informal assessment tool. It enables parents and/or teachers to map when the behaviours associated with PDA are exhibited and their frequency. This can help inform decisions about making referrals to outside agencies for a formal assessment of needs.
PDA Presentation 1 - What is PDA?
Presentation 1 focusses on the history of the condition and information about diagnosis.
PDA Presentation 2 - PDA Avoidance Behaviours
Presentation 2 focusses on behaviours that PDA children use to avoid demands made of them.
PDA Presentation 3 - PDA and School
Presentation 3 examines how PDA children struggle in school and how school's struggle with PDA children. This is also available in a printable version.
PDA Presentation 4 - PDA Management Strategies
Presentation 4 explores ten strategies for managing PDA children.
Advice and strategies are also available on the Managing PDA page