Parent Question:
My 12-year-old daughter’s opposition and meltdowns is making our family life miserable. She won’t do anything she is told to do. Simple requests, such as coming to the table for dinner, getting dressed, or tidying her room can lead to a full-scale meltdown. We can have big battles to go anywhere as a family at the weekend. It is unfair to her younger brother.

She has been diagnosed as autistic and also is gifted in that she is doing well academically at school, though she is struggling socially. I have been online on the autism support groups and lots of the parents mention their children having Pathological Demand Avoidance (PDA) – this seems to fit my daughter’s personality. What do you think and how can I help her?

Answer:
While not yet an official diagnosis, Pathological Demand Avoidance or PDA is a personality profile that seems to explain many of the challenging behaviours experienced by parents of many autistic (and some non autistic) children that was first coined by Elizabeth Newson in the 1980s.

While some people are unsure about the negative ‘pathological’ label (and I prefer the reframe ‘pervasive drive for autonomy’), PDA can be a helpful way of understanding why some children find it very hard to comply with the demands and pressures of everyday life. They experience requests and demands (even reasonable ones) as intense pressure which causes them great anxiety, leading to opposition and meltdowns when the pressure becomes too much. PDA children have a strong need to be in control, otherwise the world feels unmanageable to them.

When helping your PDA child, the first step is to adopt a positive, compassionate and understanding stance towards them. Though their ‘opposition’ to your demands can be disruptive to your plans, they are not doing this ‘on purpose’ to hurt you. It is helpful to see their behaviour as fuelled by anxiety.

While it might seem easy to you to simply go out on a trip, for a PDA child this might incur a lot of stress and social anxiety. A request to tidy their room can fill them with foreboding at the size of the task, an invitation to sit at the dinner table can interrupt their sense of control.

Even a friendly question about school can feel like pressure to them and they can refuse to answer. Rather than it being a case that your child ‘won’t’ do what are told, it is a case that they are debilitated by anxiety and ‘can’t’ for the moment.

Breaking the increasing demand cycle
When parents experience their child saying no to a reasonable request, they can understandably respond by increasing the pressure on the child, demanding they comply. For a PDA child, this increased pressure can intensify their anxiety and lead to arguments and further resistance. If parents escalate and force the issue, unhelpful standoffs and meltdowns can ensue. In the Parents Plus Programmes we suggest a better approach is to:
1. pause and take a step back to break the cycle of increasing demands,
2. to ‘ tune in’ and understand what your child is feeling, and,
3. to take a moment to choose a more thoughtful calm response.

Adjust expectations
When parenting a PDA child it is important to reflect on all the demands you put on them and to focus on only those that are most important. Sometimes you can adjust your expectations and find alternatives that work for everyone.

One family I worked with used to try and go out for a family meal every weekend, but this was very stressful for their autistic daughter (who found it hard to cope with the social demands of meeting lots of people in a noisy restaurant) leading to meltdowns and point blank refusal to go out.

Over time, the family adjusted their weekend ritual to going for a family walk in nature and having a picnic and also to sometimes dividing up. For example, Mum would take the younger son to an extended family gathering in a restaurant while Dad did something outdoors with the daughter. They also arranged for extended family to visit in smaller groups which ensured their daughter still met extended family in a less pressured way.

Plan in advance
It is best to plan in advance and think through how to make demands easier for a PDA child. Building good daily routines can sometimes help your child cope and reduce the stress of ‘uncertainty’ or spontaneous requests. Make sure to pair rewarding or relaxing activities with stressful ones in the routine so these become easier for your child.

For example, you might give your child their favourite food or listen together to a loved podcast to gain their co-operation on a task they normally resist. It can also be helpful to talk through demands with your child in advance and to explore what could make them easier for them. Negotiating small goals and exit strategies can help – ‘Look let’s just try it for two minutes’ or ‘if you don’t like it after ten minutes, just let me know and we can leave early’.

Use indirect approaches
Often subtle approaches and indirect language can work to get a PDA child on board. For example, rather than saying, ‘Get dressed now, we are going out’ you might say ‘your clothes are on the bed, and I’ve got some nice breakfast downstairs when you are ready’.

Or rather than saying ‘start your homework now’ you can help them choose ‘I see you have Maths and English, I wonder which you are going to do first’. Rather than insisting your child tidies her room, you can join with her doing the job to help her get started, perhaps playing some music in the background if that relaxes her. Alternatively, you can decide that room tidying is not worth the battle and simply close the door as you walk by!

What works with PDA is very individual to the child and you have to be very patient and understanding. There is a growing community of parents reaching out online and lots of great resources now available (start with pdasociety.org.uk) where you can seek further help and support.

John Sharry is founder of the Parents Plus Charity and an adjunct professor at the School of Psychology, University College Dublin. This parenting Q&A was originally published in the Irish Times in May 2023. John writes in the Irish Times Newspaper on Tuesdays. His website is www.solutiontalk.ie.