Children, autism, behaviour problems and therapy

You are probably at your wits end if you are reading this. Your every day feels like a battle of wills and you desperately need help and support for you and your child. Some say he/she may be autistic but others say they are fine and just need to be managed behaviourally. Perhaps they have already been diagnosed. 

It can be exhausting to deal with regular outbursts and meltdowns about school or even doing the smallest thing. You have probably tried everything, reward charts, stickers, bribes, explanations. but if there is demand avoidance (which is part of the autism spectrum) none of these approaches will be consistently successful. Which can lead to a sense of hopelessness. Worse still, family and friends give you advice with the intention of helping but it only makes it worse. You want to say, "Yes don't you think I tried that?!”

Your child may even fulfil the criteria for pathological demand avoidance (PDA) which is unrecognised by some local authorities and CAMHS but is recognised as a condition on the Autistic Spectrum by the National Autistic Society. This is where even the smallest demand can trigger anxiety in the child, who is desperate for a sense of control.  

Children with a PDA profile (in a nutshell) really struggle at school, hate brushing their teeth, make excuses when asked to do something and are very emotionally dysregulated (which means their moods are up and down and extreme). 

I don’t know where your local CAMHS are with provision for autism but there can be real difficulties in accessing the specialist support your family deserve. There are support pages for PDA on Facebook but to be honest, many can add to your sense of stress.

One of the main recommendations of managing behaviour with a PDA profile is to reduce or remove demands. For example, “When will you brush your teeth - before or after breakfast?” or “Shall we do...or not?”. Also, interestingly, children with PDA tend to not like praise, so the best way to compliment them is to tell someone else in front of them and then change the subject.

PDA is somewhat a contradiction to us neurotypicals - on the one hand they seem self-absorbed but on the other they are hyper sensitive to letting people down. 

This is a whistle stop tour to PDA but I urge you - if you suspect your child is autistic with demand avoidance or PDA, make sure you find a therapist who is willing to work in a very person centred way, so the child keeps a sense of control over what they do in therapy, and that little demands are placed on them.

It takes a special kind of therapist to put their agenda aside and really want to get to know how the individual ticks. Who is prepared for refusal and disengagement and willing to hand back the power. Of course, the relationship between therapist and child is key - your child has likely encountered much disapproval, judgement, rejection and misunderstanding right now (mainly at school) and it will take time to establish trust. 

I hope this helps and I wish you compassion, strength and curiosity for your journey.

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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Eastleigh, Hampshire, SO53 5SS

Written by Vicky Mills Duddridge

Eastleigh, Hampshire, SO53 5SS

I have worked as a therapist with children and adults for over 25 years and have a son with PDA. I have published books for young children on autism and am currently researching therapy for PDA children

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