I was lucky enough to attend the Asia Pacific Autism Conference in Singapore last month, and had the opportunity to hear from professionals working in the Autism field and Autistic individuals themselves about topics relating to support, interventions, lived experiences and hopes for the future.
I also had the opportunity to present my ideas about supporting children with PDA in therapy, and was encouraged by the interest of the parents, educators and therapists that attended in wanting to find better ways to engage and support the children with PDA in their lives.
Since my blog last year about using trauma informed practice to support children with PDA, and my more recent workshops on the topic, I have heard from many parents and professionals who said that these ideas resonated with them, and that they could see the benefits of working in this way. However, the focus of most information available about PDA has continued to be around managing behaviours at home and school, leaving a big gap in information and knowledge where therapy is concerned.
I am hoping that I can begin to fill that gap.
To that end, I am excited to be writing a new book for Jessica Kingsley Publishers which will be a clinicians guide for working with children with PDA in therapy. However, it is still a work in progress and won’t be released for a while yet.
In the mean time, I wanted to share my tips for supporting and engaging children with PDA in therapy. It is not an exhaustive list, but highlights some of the essential elements I think are necessary to engage in effective therapy.
RELATE: Developing a strong and trusting relationship with a child with PDA takes time, but I believe it is ultimately the key to their support. As a clinician, it is understood that the therapeutic relationship is extremely important in supporting clients to make progress, but for children with PDA it will make the difference between a child being willing to come to sessions and engage on their terms, or refusing to even attend. A therapist must genuinely care for the child and accept them without judgement, or the child will see through their pretence and be threatened by their words and actions, making the therapeutic process ineffective.
PLAY: Play provides a way to allow a child with PDA to take control of their environment and process feelings, thoughts and experiences in a safe and non-threatening way. Whether it is formalised non-directive play therapy, client-led pretend play, or playfully engaging in games and activities in the therapy room, play is by definition an enjoyable experience, and through enjoyment and engagement, children can learn and develop at their own pace.
CREATE: Creative activities such as drawing, painting, colouring, and craft have been found to be therapeutically beneficial for many children and adults, and can be used in therapy settings to support the engagement of children with PDA and also to be used as a tool for relaxation.
PRETEND: Many children with PDA are comfortable in drama and role-play, so incorporating elements of this into therapy sessions, or simply taking the child’s lead and joining them in their role-play, can be an effective way to connect with them and support them to explore concepts and experiences.
REGULATE: Children with PDA are wired to detect threat and as such are often dysregulated. I have found that it is essential to have activities available for children to help them regulate their arousal level and feel safe when they come to therapy. Without the opportunity to regulate, children cannot engage. Sensory activities such as making slime, playing with playdough, water, rice and sand, bouncing on a trampoline or rocking on a swing, can be very effective in supporting a child to feel calm, safe and focussed.
ADAPT: When working with children with PDA, it can be difficult to predict what they might do or say, or how they might react to situations or activities at any given moment. Something they loved to do one session might be anxiety provoking the next, so being prepared for different possibilities, knowing when you need to step back, and being able to take the child’s lead rather than pushing your own agenda are extremely important.
LAUGH: Humour and novelty have been found to be helpful in supporting children with PDA in school, and this certainly also applies to the therapy room. In my experience, children with PDA often have a fantastic sense of humour, and tapping in to their silly side can make therapy more enjoyable and certainly helps to reduce a child’s anxiety in session. Showing that you can laugh at yourself and ‘think outside the box’ also makes clinicians more relatable and activities more interesting, which enhances the therapeutic experience for the child.
COLLABORATE: Children with PDA need to feel that they are an equal partner in any interactions, rather than there being a power imbalance where an adult has authority. It is important to allow the child to take the lead, and for the clinician to cooperate and collaborate with them when engaging in activities, to avoid a power struggle which will increase demand avoidance and anxiety.
UNDERSTAND: The thing that children with PDA need most from the adults in their lives is acceptance and understanding. Understanding that their behaviour is not a deliberate act to be difficult or a choice to be ‘naughty,’ but is a response to feeling anxious and unsafe that requires unconditional love and support. Children need to know we understand them and are on their side so they not only feel accepted by others, but also learn to accept and understand themselves.
I am hopeful that with increased awareness of the PDA profile and a better understanding of the needs of children with PDA in therapy, more clinicians will be in a position to support children to manage their anxiety effectively, and improve the outcomes and quality of life of children with PDA in the community.
- Christie, P. et al (2011) Understanding Pathological demand Avoidance Syndrome in Children, JKP Essentials
- Christie, P. et al (2018) Collaborative Approaches to Learning for Pupils with PDA : Strategies for Education Professionals, Jessica Kingsley Publishers
- The PDA Society (2016). Pathological Demand Avoidance Syndrome: A Reference Booklet for Health, Education and Social Care Practitioners.