PDA - Pathological Demand Avoidance
- Brittany Avera
- Dec 31, 2024
- 4 min read
PDA: A Speech-Language Pathologist’s Guide to Connection and Collaboration
Pathological Demand Avoidance (PDA) may sound complex, but at its heart, it offers an opportunity to deepen our understanding of children who process the world differently. These children invite us to approach therapy with creativity, empathy, and a commitment to building genuine connections.
If you’re a therapist, teacher, or parent working with a child with PDA, you might sometimes feel uncertain about how to support them best. With patience and the right strategies, creating an environment where they feel safe and empowered to grow is possible. Let’s explore how.
What Is PDA Anyway?
PDA is a profile associated with autism spectrum disorder (ASD), characterized by an intense need to avoid demands and expectations. For children with PDA, demands often trigger overwhelming anxiety, leading to a fight-or-flight response.
Common traits include:
Avoidance of everyday demands (e.g., getting dressed or answering a question).
Socially strategic behavior to sidestep demands (such as negotiating or distracting).
An intense need for control over their environment.
Big emotions and meltdowns when overwhelmed.
The key to understanding PDA is recognizing that it’s rooted in anxiety, not defiance. These children aren’t being oppositional; they’re navigating a world that feels overwhelming and unpredictable.
How Is PDA Different from Autism?
While PDA is considered a profile within autism, there are distinct characteristics that set it apart:
Demand Avoidance Rooted in Anxiety: While children with autism may resist certain demands due to sensory sensitivities or rigidity in routines, children with PDA avoid demands primarily because of the anxiety these demands trigger.
Social Strategies: Many children with autism struggle with social communication, but those with PDA often use advanced social strategies like charm, negotiation, or distraction to avoid demands.
Need for Control: While a need for routine or sameness is common in autism, children with PDA specifically seek control over their environment to manage their anxiety.
Highly Variable Presentation: PDA behaviors can vary significantly from one moment to the next, depending on the child’s anxiety levels, making it less predictable than typical autism profiles.
Understanding these differences is essential for tailoring approaches to meet the unique needs of children with PDA.
Mini Book Review: PDA in the Therapy Room by Raelene Dundon
For anyone seeking practical insights into PDA, PDA in the Therapy Room is an invaluable resource. Raelene Dundon writes with compassion and clarity, offering a framework for understanding PDA and its impact on therapy. The book includes:
Clear explanations of PDA and how it manifests.
Real-life examples that illustrate common challenges.
Practical strategies to build trust and reduce anxiety.
Dundon’s approach is thoughtful and grounded, emphasizing the importance of meeting children where they are. Her guidance helps clinicians create a space where children with PDA can feel truly seen and supported.
Working with Children with PDA: Strategies and Examples
1. Reframe Demands as Invitations
Children with PDA thrive when given choices and autonomy. Reframing demands as opportunities or collaborative efforts can reduce anxiety and resistance.
Example: Instead of saying, “It’s time for therapy,” try, “Let’s decide together how we want to start today. What feels good to you?”
2. Use Playfulness and Creativity
Engaging children in a way that feels playful can make tasks less daunting. Creativity helps shift the focus away from the pressure of performance.
Example: If a child hesitates to practice a sound, involve a favorite toy: “Let’s see if your stuffed animal can help us with this sound. What do you think they’d say?”
3. Go Low and Slow
Pressure can escalate anxiety for children with PDA. Taking a calm, unhurried approach allows them to feel more in control.
Example: If a child avoids an activity, ask, “What do you feel like doing right now? Let’s take it one step at a time.”
4. Prioritize the Relationship
Building trust is essential. When children feel understood and valued, they are more likely to engage.
Example: Spend time learning about their interests. “What’s something you love to do? I’d really like to hear about it.”
5. Celebrate Small Wins
Recognizing even the smallest progress can boost a child’s confidence and create positive momentum.
Example: If a child participates in a brief activity, acknowledge their effort: “You tried something that felt hard, and that’s amazing. I’m so proud of you.”
Final Thoughts
Working with children with PDA invites us to approach therapy with flexibility and an open heart. It’s not always easy, but the rewards of connecting with these children and supporting their growth are immeasurable.
As Raelene Dundon reminds us, the best outcomes come from building trust, being patient, and celebrating progress, no matter how small. By creating a safe and accepting space, we can help children with PDA feel empowered to navigate the world on their terms.
Take a deep breath, embrace the journey, and remember: every step forward, no matter how small, is a victory worth celebrating.
Practical Speech Therapy sees children and adults with PDA. Reach out on our website: www.practicalspeech.com
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