PDA (Pathological Demand Avoidance Syndrome)

1. PDA(Pathological Demand Avoidance Syndrome)

2. “ We have found that the more routines there are, the worse he is – you need to catch him unawares. We have tried using behavioural approaches with him but they have not worked. He doesn’t seem to understand rewards – he will snatch the reward and then not do the task. He has his set agenda and is always in control of the situation” Class teacher

3. What is PDA? • A pervasive developmental disorder • Increasingly recognised as being part of the Autism Spectrum (but requires different management) • A lifelong disability characterised by obsessively resisting the everyday demands of life – then try to avoid the demands • When in control can be enigmatic and charming, when not they display high levels of anxiety leading to extreme behaviour • The appear to have better social interaction and communication skills than other children on the Autism spectrum • Led by their need to control

4. Who is affected by PDA? • Affects boys and girls equally • Likely that genetics factors are similar to autism • 6% of young people with PDA have a sibling with an autistic spectrum disorder • Affects young people from all backgounds and nationalities

5. What causes PDA? • Still being investigated • Linked to the hard wiring of the brain • Likely to be a combination of factors, genetic and environmental which may account for changes in brain development • It is not caused by young persons upbringing, social circumstances or the fault of the parents or the individual with the condition

6. What is a diagnosis? • Formal recognition of PDA by a paediatrician, psychologist or psychiatrist • Fairly recent recognition, and the young persons good social skills can mask their problems, so often not diagnosed until they are older • Often Asperger’s syndrome or autistic spectrum diagnosis does not quite fit

7. What Can PDA Look Like? ~ Despite their use of niceties their social interaction is often flawed by: - their inability to see the bigger picture - their lack of boundaries - their desire to be in control of the situation - often understand rules but don’t feel they apply to themselves ~ Excessive mood swings, often switching suddenly ~ Comfortable (sometimes to an extreme extent) in role playing and pretending - often engage in a level of pretend play not normally expected in children on autistic spectrum - very good at taking on roles and styles of others e.g. behaving as if they were teachers to other children In extreme cases, they can become so engrossed in role play they may loose touch with reality

9. Implications for managing and teaching children with PDA • The children are not naughty or malicious, they are manipulative in the way they avoid demands • Underneath lies a very fragile and vulnerable ego • Pushing a child to obey demands will lead to anxiety and ‘meltdown’ • Communication is important (home and school)

10. The child as a learner • Anxiety driven need to be in control • Explosive reaction if things go wrong • Poor self esteem • Desires to have friends but then sabotages • Expressed desire to be on par of better • Lack of permanence and transfer of learning • Ambivalent about succeeding and enjoying • Poor regulation of emotions • Variable behaviour • Language issues • Sensory intolerances

11. Environmental considerations AIM • The child feels comfortable enough to tolerate and later engage with learning tasks • The child is kept on task as much as is possible • Ensuring that learning is absorbed • Ensuring there is minimal disruption to others TRY • To have flexible working environments e.g. novelty, choice and safe place • Identify sensory issues • consider how to reduce sensory issues e.g. visual aids, imagery, role-play, depersonalise demands, notice boards • Share responsibility • E.g. staff, other children, parents

12. PDA in the School Context • Keyworker approach – 1 ‘expert’ on the pupil • Novelty is king • Exploit strengths eg role play; enter the child’s world – be prepared to play along • Give time to process; use visual prompts • Do not invest emotionally in a strategy – be ready to change it rapidly • Understand that this is a capacity, not a will issue • Be oblique at all times – never direct; include body language & eye contact in this

13. PDA in School c’td • Give 2 choices – no more, no less • Build goals and positive experiences gradually • Humour, bets/challenges, ask for help • Ignore negative behaviour as far as possible • Reduce eye contact – sit beside or behind • Use novelty as much as possible • 3rd parties, puppets, characters • Use low key praise/rewards • Use a limited number of rules consistently applied, avoid confrontation, disguise expectations, start each day afresh

14. Responses and scripts • Be aware of the child’s behaviour as they become more upset • Use a neutral tone, stay calm, wondering ‘out loud’, use complex language, identify a safe place • Consider how to repair the situation Scripted sentences • How would it be if……..? • Ooh, what happens if….? • Would it be a good idea to……..? • I can’t quite see how to….? • How might we do…….? • Would it be possible to….?

15. More Scripts • I really need some help with this……. • Which was could we…? • What if……………………..? • I wonder where that goes………………………….? • I need to get this cleared up now because I have to ……………………? • Your next ‘mission’ is…? • Where shall we………….? • Shall we work inside or outside the classroom? • Let’s do some thinking about……………………….? • Let’s investigate………..? • Let’s experiment……….? • Let’s explore………….....?

16. Further Reading • The National Autistic Societyhttp://www.autism.org.uk/about-autism/related-conditions/pda-pathological-demand-avoidance-syndrome.aspx • www.pdacontact.org.uk • Hampshire Educational Psychology Service PDA Resource Pack