Helping all children become happy learners
Managing Pathological Demand Avoidance Syndrome (PDA)
When any request is made of a child with PDA they become anxious. At times they may be able to manage this anxiety sufficiently to comply. However, on another occasion the same or similar request can overwhelm them with anxiety and they are unable to comply. There is rarely an understandable pattern to this so predicting when the child will be more or less compliant is difficult to achieve. In managing children with PDA, there is a need to understand that anything that increases the anxiety or fear of the demand will increase the likelihood of demand avoidance behaviour. Strategies that are most effective tend to focus on avoiding the child noticing that a demand has been made.
PDA children usually required a dedicated key worker in school or nursery who can establish a positive relationship. This person needs to have infinite patience and the ability to quickly change plans in order to work with PDA children. Avoiding aggressive and violent behaviour requires a non-confrontational approach where concepts of right and wrongdoing are dealt with indirectly and sparingly. Where there is an established history of violent outbursts towards staff i.e. more than two; then the keyworker should be trained in restrictive physical intervention. PDA children are unlikely to recognise the authority of senior members of staff so they should also avoid confrontational language and behaviour unless totally unavoidable.
It is important to recognise that normal behaviour management strategies are not effective with PDA children. This includes the usual approaches for managing children with autistic behaviours. The following strategies are more effective. However, these children remain highly challenging and many will require highly specialised support.
Stay calm and try to keep your body language neutral
PDA children can be infuriating in their avoidance of demands. It can be a challenge to always remain calm when working with these children. However, PDA children tend to be hypervigilant and can pick up on an adult's frustration. They will then tend to use this to manipulate or escalate the situation and avoid the demand. Getting very angry with a PDA child can sometimes work initially, (usually because of the novelty, see below) but very quickly becomes ineffective and increases the chance of aggression and violence.
Use their interests to distract and maintain attention
PDA children often have specific focussed interests. These can sometimes be used to gain some cooperation and concentration on adult directed tasks. Try to incorporate their interests into their personalised curriculum. For example, a child interested in fairies may be more likely to do activities that are built around the theme of fairies. Writing stories about fairies, drawing or painting fairies and arithmetic based on the number of fairies in each calculation.
Intentionally complicate language in instructions
Processing language requires brain power. When the language is more difficult to understand or follow it necessarily demands more brain power and concentration. When a complex sentence is spoken to a PDA child their brains become wholly focussed on decoding the meaning of the language. The complex language therefore acts as a distraction from the demand hidden within it. For example:
'It's time for reading'
'When we've found your reading book we'll have time to enjoy it together'.
"Please put on your shoes"
"Before we go out let's check if we've all got our shoes on."
Use novelty to distract or calm
PDA children are generally very curious and can often be easily distracted when a new situation, person or interesting object is presented. This strategy can be highly effective even when the child is having a 'meltdown' or being outright defiant. The following anecdote illustrates this point:
I once arrived at a primary school for a meeting. I had only walked a few steps into the school before I was pounced on by the headteacher. "I'm glad you're here, we're having a bit of problem." Leaving my bags and coat behind I was led into the hall. "He is just running around and refusing to stop. You're the behaviour person, can you sort him out?" There was a five year old boy, who I had never seen before, running around with a big smile on his face. With the headteacher watching and my 'expertise' being assessed I had about five seconds to do something! I walked over to the boy and said calmly, "Hello, I'm a stranger to this school. Could you show me where the Year One classroom is?" The boy stopped, said "Yes" and then we both casually walked down to the classroom.
So why did this work? Mainly novelty, the child was probably curious about me as I was someone unknown. Also, my demand was a polite request asking for help and there was no mention of the wrong behaviour.
In order to apply this strategy you need an endless supply of novelties as each thing tried will only work for a short while. Once the novelty has worn off it become ineffective. Use of tablets can be very helpful as images and short videos can be relatively easy to find and used to quickly acquire some level of cooperation from the child.
Be indirect when giving instructions
It is important to try and avoid making direct demands of a PDA child. This tends to trigger avoidance behaviours or outright refusal. Being indirect when giving instructions is a strategy that removes the demand and replaces it with a description of the situation, problem or need that requires their action. For example:
'Close the door'
'The door is open'.
'Tuck in your shirt'
'Your shirt is untucked'
Be flexible and make the most of the situation
Children with PDA are experts in avoiding demands and so things will often not go to plan. Adults need to be able to 'go with the flow' and adapt to changing circumstances. In school, lesson objectives may become unachievable when the child actively avoids them. At these times the adult's focus becomes about managing potentially explosive situations and attempts to pursue the lesson objectives are often necessarily abandoned. When this happens the adult can try to make the most of the situation by using any opportunity to introduce target related learning into the child's activity. It is important that the child has a personalised curriculum with clear individual learning targets. Staff need to continually make attempts to return to the learning focus by trying to make links with the child's interest or activity at that time. This requires a deep knowledge and understanding of the learning intention in order to continually invent new tasks that are more acceptable to the child.
Reduce pressure around demands
Try to make doing a request a very casual, ordinary and unhurried experience. Use reassuring comments such as:
'You have as much time as you need.'
'It doesn't matter how you do it'.
Transfer the demand to them
Encourage the child with PDA to come up with the next step themselves. For example:
Now you need to put your coat on'
'What do you think we need to do now?'
'Line up for assembly'
'What's next on the timetable?'
Directing the demand at no one in particular
This strategy works best with younger children and should be used sparingly. It involves 'thinking out loud' a problem or need. Take care to avoid any implication that you mean the child and is best delivered facing away from the child.
'I can't imagine how we'll get this Lego tidied away into its box.'
'If only there was someone who could help me do this?'
Create silly challenges
PDA children often respond well to demands hidden within novel and creatively complex language. Adding a bit of fun and humour makes these demands even more likely to be complied with. For example:
'Bet you can't finish before I say "Hibbily Dibbily Do" three times'
'I don't think there is anyone in the whole universe who can do this sum'.
Silly or even absurb challenges require brain power as the child processes the language and ideas involved and this helps to distract them from the demand. However, this can sometimes lead to avoidance manipulation by the child with challenges of their own. It is usually best to avoid or at least be cautious when trying to get the child to compete with others as this may increase anxiety.
PDA children avoid demands because of a severe performance anxiety. This tends to be experienced more when there is a real person making the demand. They are much more likely to comply with requests that are established as coming from a higher authority. They often want to comply with official rules and can sometimes get quite anxious when they or others do not obey these rules. The strategy involves prefixing instructions with reference to this higher authority. 'This is a school rule' or 'It is the law'.
Providing controlled choices
PDA children need to feel that they are in control. They are more likely to follow an adult directed task if 'their control' is maintained by given them choice.
'It is entirely up to you whether you write the date first or the learning objective.'
Use indirect praise
PDA children can be sensitive to individual praise as this can trigger emotions which they are not in control of. Instead it is often better to 'dilute' the praise by making it less personal.
'We did a good job of this.'
'Everyone has done well in this lesson.'
Learning Task Choice Board
Use this resource to help a PDA child access the curriculum by providing a choice of tasks to achieve the learning objective. Each task should ideally be equal in helping to consolidate and develop the lesson learning. Once complete there is space for a choice of two reward activities. This should be completed with the child. Introduce by encouraging the child to record the activities they want to do. Only when comfortably using this way should you begin to encourage other adult directed activities to be included starting with just one. Build up very slowly.
Ten Things To Do to support PDA
This resource folds to make a handy A5 leaflet listing ten PDA strategies