PDA in the Therapy Room  ## Metadata - Author: [[Raelene Dundon]] | [[3. Resources/Authors/Raelene Dundon|Raelene Dundon]] - Full Title: PDA in the Therapy Room - Category: #books - Kindle: [Open in Kindle](https://www.amazon.com/dp/B08MJ43KLN) - Document Tags: [[Parenting]] ## Document Notes ## Highlights - Pathological Demand Avoidance (PDA) is considered by the National Autistic Society1 in the UK to be a subtype of Autism Spectrum Disorder characterized by extremely high levels of anxiety, which result in an individual constantly trying to control their environment. ([Location 44](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=44)) - This need to be in control and feel safe results in opposition and avoidance of everyday demands, difficulties with emotional regulation, and often severely challenging behaviour. ([Location 46](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=46)) - In an effort to regain control, many individuals with PDA will first try negotiation, distraction and other social means to avoid demands. If these strategies do not work and their anxiety continues to rise, the fight, flight or freeze response is triggered and can result in behaviour such as opposition, resistance, defiance, arguing or aggression. This behaviour is not a conscious choice, but rather an automatic physiological and neurological reaction that is designed to keep the individual safe from the perceived threat. ([Location 49](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=49)) - PDA is not currently recognized as a specific condition in the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) or International Classification of Diseases – 11th Revision (ICD-11), ([Location 67](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=67)) - in PDA demands are considered to be anything that a child has to do that is not their choice or under their control. ([Location 96](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=96)) - A demand can be a request (e.g. ‘Could you please put that book on the bookshelf?’), a suggestion (e.g. ‘It would be great if you put that book on the bookshelf’), an instruction (e.g. ‘Please put the book on the bookshelf’), an expectation (Thought: the book belongs on the bookshelf, so it should be put back when I finish with it), or even praise (e.g. ‘It was great that you put the book back on the bookshelf when you finished with it’). ([Location 97](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=97)) - Demands are further complicated by the fact that they can be direct, indirect or implied, a consequence or even self-imposed. ([Location 100](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=100)) - An indirect demand is something that an individual feels expected or compelled to do due to messages they receive from their body or the environment they are in. ([Location 103](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=103)) - an individual with PDA will typically do anything they can to avoid carrying out a demand, even if it is something they want to do. ([Location 126](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=126)) - It is not that they ‘won’t’ adhere to a demand; it is that they ‘can’t’. ([Location 133](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=133)) - a child’s level of resistance depends on their level of anxiety at any given time. ([Location 134](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=134)) - individuals with PDA tend not to understand or acknowledge the social hierarchy attributed to individuals in society, leading them to treat all others as being of equal standing to them. ([Location 147](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=147)) - Given that individuals with PDA are in an almost constant state of anxiety and hypervigilance to threat, it makes sense that it would be more difficult for them to regulate their emotions and reactions. ([Location 157](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=157)) - individuals with PDA are prone to rapid and extreme changes in mood, which may appear to occur as a result of obvious triggers, but at other times may seem unpredictable and unrelated to what is happening around them. ([Location 160](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=160)) - Individuals may act automatically to reduce the perceived threat to their safety without being able to think about the appropriateness of their actions or what the consequences might be. ([Location 168](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=168)) - In PDA, it is common for the focus of a restricted interest to be a person rather than an object or topic, resulting in challenges with friendships and difficulties with separation from carers. ([Location 196](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=196)) - PDAers are more susceptible to being adversely impacted by negative life events, and consequently may be prone to experience trauma in their lives. ([Location 238](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=238)) - For an individual with PDA, all demands are met with a sense of loss of control and an increase in anxiety. In this case, demand avoidance doesn’t only occur when the individual doesn’t want to do something, but also when they want to do something but are not in control of it because it has been suggested by someone else. ([Location 248](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=248)) - The main difference between PDA and ODD is the underlying cause or reason for the behaviour. In ODD it is a need to go against authority or rules, whereas for PDA it is an anxiety-driven need to be in control. ([Location 260](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=260)) - individuals with PDA are oppositional in an effort to reduce their anxiety and maintain control of their environment so they feel safe. ([Location 264](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=264)) - The standard tools used by parents and educators to support Autistic individuals such as visual schedules, consistent rules and boundaries and positive reinforcement (e.g. rewards) often prove ineffective for individuals with PDA as they are anxiety provoking due to the implicit demands contained within them. ([Location 271](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=271)) - these individuals need a more flexible and collaborative approach to all aspects of their life, with a focus on building safe relationships and a reduction of anxiety, rather than insistence on routine and compliance. ([Location 274](https://readwise.io/to_kindle?action=open&asin=B08MJ43KLN&location=274))