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Understanding and working with Pathological Demand Avoidance (PDA)

“Demand avoidance involves not being able to do certain things at certain times, either for yourself or others, and also refers to the things we do in order to avoid demands” (PDA Society, 2021)

http://www.pdasociety.org.uk/

PDA is:

• Avoidance of every day demands including demands placed on self and
demands placed by others
• Types of demands:
– Indirect, such as praise
– Implied, such as remaining seated at school
– Daily should dos, like brushing your teeth
– Internal demands, such as hunger
– Wants, such as seeing friends
• Demands trigger an automatic threat or anxiety response, causing
panic
• ‘Can’t do’ not ‘won’t do’
• Neurological tug of war, because often it is completely irrational even to the person that they cannot carry out the demand at hand
• Part of the Autism Spectrum

We all have a bit of demand avoidance at times, and it can be particularly prevalent during specific developmental periods and noticed primarily as part of neurodevelopmental conditions (ASD/ADHD).

For those with PDA, it is not a choice or on purpose and is due to debilitating anxiety that can feel like a panic attack. Expectations placed upon people with PDA, by themselves or others may cause an overwhelming feeling of loss of control, further perpetuating anxiety, causing a fight/flight/freeze response.

What PDA can look like:

• A desire to be equal or superior to others – a person with PDA may see themselves as equal to everyone and not assume ‘automatic respect’ due to someone’s job title
• A poor sense of self-esteem
• Very poor emotional regulation; extreme/sudden ‘mood swings’
• An ambivalence about success, for example a child may destroys their work on completion especially if praised
• A lack of permanence and transfer of learning and experience; sudden/dramatic setbacks after periods of settled behaviour and
progress
• A desire for friendships, often sabotaged due to a need for control
• Extensive involvement in fantasy/role play
• Meltdowns/shutdowns/behaviour that challenges – or equally a person may mask and internalize

Strategies to support someone with PDA:

• Managing anxiety – people with PDA may engage in behaviour which is underpinned by anxiety. Support someone with PDA through a ‘melt down’ by targeting the underlying anxiety, rather than the presenting behaviour. This can look like:
– Supporting breathing techniques such breathe in for four counts. Model this breathing so it is mirrored.
– Providing distraction, consider what is important to that person in this space
– Being aware of the environment, who is around, is it overly noisy/over stimulating
– Provide one to one support.

• Relationships – people with PDA need to feel safe with those who support them, knowing they are understood and can be themselves.
– Be aware of early warning signs and know when to bring demands down or avoid them all together.
-Allow processing time for the person to respond to you
– Know what calms this person down, be flexible, strengths focused and provide empathy.
– Make sure you take care of you too, so you can show up for this person fully when needed.
– Change our view “what is happening for them” and remember can’t not won’t
– Strengths based approach, focus on what they can do or have done instead.

• Managing the environment
– Allow downtime, especially after demand-dense situations
– Allow time to avoid heightening anxiety
– Support a regulation zone/ space where the person knows they can go. Have the appropriate items in this space which suit the individual to support regulation i.e. music, sensory toys, a fan, soft pillows, food, etc.
– Be aware of sensory preferences.

• “Demands” in a different way
– Suggestions “What do you think about…”
– Wonder out loud “I wonder if…”
– Notice things “here’s a drink” rather “than have a drink please”
– Indirect such as visuals, role play or using a third party such as a toy
– Depersonalize “the café is closing at 2pm” rather then “we have to go now”
– Tone and phrase, be mindful of sounding authoritative, talk about the object rather than the person
– Provide choice “would you like to shower at 8am or 8:30am”
– Model “I am off to bed; I am feeling tired:
– Use humor and make things into a game
– Use interests.
– Focus on adjusting the environment to suit the needs of the person.

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