Jilly Davis is a teacher at The National Autistic Society’s Robert Ogden School and has a wealth of experience in working with children with Pathological Demand Avoidance (PDA) on the autism spectrum. She presents some educational guidelines for teaching children with PDA, focusing on how to adapt your teaching style and use visual supports.

Introduction

Children with PDA can be challenging for teachers, as traditional behaviour management techniques such as structure, routine and rewards that can work for children with autism are generally ineffective. They may even cause more anxiety and possibly inflame situations for children with PDA.

O’Nions et al (2013) describe PDA as follows:

"Individuals with PDA have the same level of 'Autistic like Traits' as other individuals with a more typical presentation of Autistic Spectrum Disorder (ASD).

"Individuals with PDA are the only group who have an anxiety driven need to avoid the demands of everyday life regardless of personal consequences.

"Individuals with PDA need to avoid the demands, expectations and suggestions of others so that they feel in control and secure in an unpredictable world."

Starting points

Empathy and understanding of PDA and a child's individual personality and tolerances are crucial in helping children learn in an educational setting.

At Robert Ogden School, we have developed an educational resource called The Inclusive Learning Hub (ILH). Here we offer children with PDA or who have a demand avoidant profile the opportunity to follow a personalised bespoke package of educational and behavioural support. We facilitate a child-led learning environment, which the child feels they have some control over.

This resource gives the children the optimum opportunity to re-engage in learning, as the majority of these children were excluded from a range of educational provision including autism-specific environments. Our starting point is where the child is at and what they want to learn, rather than what we want the child to do.

These children are very complex and it is creating a whole package of measures that makes a difference, rather than isolating just a few key issues. There are no absolute or clear guidelines to working with these children but there is a repertoire of approaches.

One of these approaches is about adapting your teaching style to accommodate each child's capacity to learn at a given time to the pressure and anxiety they may feel at any given time. The abilities to be flexible and adaptable, to facilitate and not dominate are vital. Try to realise there are times when you need to cut back or reduce demands but also recognise when you can add expectations.

Visual Supports

Visual clarification methods such as daily schedules or planners that are so successful for children with autism can also be useful for children with PDA, but often for a slightly different reason. They can be used in a way that de-personalises demands and gives children spontaneity, choice and novelty, which are all approaches that aim to "include the hard to include".

When a child first starts with us in the ILH, we negotiate with the child what lessons they want to learn and the best time to do those lessons, and when to do lessons they are not so interested in. This not only empowers the child but gives them responsibility for their learning and builds up self-esteem. It helps them to feel like they have some control over their day.

We also identify any strengths a child has and their strong interests. These are embedded into their curriculum. For example, a child’s interest in Minecraft can be included throughout the day. This could be in geography, history or English lessons. Their planner will have pictures of the different characters in Minecraft and can be changed regularly in order to capture interest and help a child learn to accept that seeing information on a piece of a paper can be a positive experience. As these children are visual learners it is important for them to tolerate and accept direction from written text.

Using a child's interests to create structure - case study one

We found that a very successful strategy for a child with a strong interest in football was that his Monday planner could have each lesson related to football, however slight the connection. We recognised that Mondays were a difficult transition for him after the weekend and any learning we imposed on him would result in either a major meltdown in which he’d have verbal or physical outbursts, or total noncompliance.

But introducing a different picture of a football player onto his planner meant he would come into school in a positive manner to see if he could identify the player. If he couldn’t, his first lesson would be to Google the player, or if he did, it would be to produce a biography of the player. His next lesson would be a maths lesson and we would have created a worksheet based around the league tables from the weekend. The afternoon included a sports newspaper and a physical activity, which would obviously be football or ball skills.

If his tolerance to learning meant that even his very motivating lesson in the mornings was too difficult for him to comply with, then the visual support became a negotiation tool. We would take responsibility to reduce the child’s anxiety, and change the day around such as bringing the football or ball skills lessons earlier on in the day, and giving a reason, for example "the paper hasn’t arrived" or "the printer is not working so we cannot print off the worksheet".

Case study two

A child who was interested in the games Call of Duty and Grand Theft Auto had to have a more indirect approach as we cannot allow those games to come into school. What was acceptable for us and also motivating for him, was that in his history lesson, he produced timelines of all the different consoles and console games over the years. He produced an encyclopaedia of this information, which many of the other children were interested in.

He also produced a number of PowerPoint presentations about the timeline of consoles and games for his ICT lessons, which we were able to use in lessons for some of the other children who play on console games. One of his strengths was drawing but he refused to participate in Art. However, we allowed him to draw characters from the games, and this flexibility allowed him to re-engage with the lessons. He is incredibly proud of his portfolio of pictures and has many of them up on his bedroom wall.

His planner identified his lessons but then gave more information about the content of the lesson so he was reassured that it would be something he was interested in.

Negotiating and using planners

Another point to remember is to use a planner to check with the child about any negative feelings they may have about their day. You can then put proactive strategies to avoid noncompliance into their planner. For example, the top of a child’s planner could contain a question such as "is your planner ok for you today?" If a child indicates some anxiety about a topic, a lesson or the person they are going to work with, then be prepared to take control to avoid stressful situations and make the necessary changes.

If the child says they are not going to do maths, do not comment initially – do not ask why they don’t want to do the lesson or try to encourage them to do it. At some point prior to the lesson, ask another member of staff to mention that maths has been cancelled today so that it can be crossed off the planner and an alternative lesson can be put in its place.

If for some reason a member of staff is causing anxiety, changes can be made to give the child the choice of another member of staff. However, be careful of over-dependence as one of the diagnostic criteria for PDA is an obsessional interest in people. Generally speaking, children with PDA want to learn but there are times when they "can't help won't". It does not mean that if they misbehave or are noncompliant that they feel they have won and so can do whatever they want.

Helping children choose

Offering choice on visual planners is another effective way to help children access education. It gives them a feeling of being in control – for example, you can ask "do you want to do Maths or English first" and then make changes on the planner. Another technique is to give a choice of tasks with the same objective, making the task you want the child to do easier. Again, identify this request in a visual format so it appears that someone else is making the request.

This technique may help you to negotiate with the child until you reach a compromise. Sometimes you have to move the goal posts but try to finish on a positive note even if you have to blame someone else for the content of the work. If it is possible, give a choice on the planner of where the child can do the lesson, for example, "do you want to do this work in the library or in class?"

Be careful about putting times on the planner, as this can be difficult for some children to comply with. Check with the child if the format of their planner is acceptable, for example, would they prefer it on different coloured paper or in a tablet form?

Conclusion

A good starting point if you are working with children with PDA is to ask yourself:

  • Does a pupil’s curriculum include personal relevance with curriculum choice?
  • Does a pupil’s learning nurture the unique talents and strong interests of each pupil?
  • What strategies can you use to enable pupils to take an active part in their educational experience?  
Visual support is only one small aspect of the different teaching approaches that are effective in teaching children with PDA. Other areas to take into account are the physical environment, a non-confrontational approach to managing behaviours, the presentation of tasks and the philosophy of the whole school in terms of inclusion for all.  

Useful links

Recommended reading

Duncan M, Healy Z, Fidler R & Christie P (2011) Understanding Pathological Demand Avoidance Syndrome in children. London Jessica Kingsley Publishers. 

Fidler R, Christie P (2015) Can I tell you about Pathological Demand Avoidance Syndrome? London Jessica Kingsley Publishers.

Research

Find out more about PDA research and publication on PDA in peer reviewed journals.


Last reviewed: 12 July 2016.