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Natalie Menagh provides useful advice on how to identify and support children with pathological demand avoidance 

I still remember the first child with PDA I worked with. At the time, I only knew that he had a “tentative” diagnosis of Asperger’s, but I now know he had pathological demand avoidance (PDA). 

He came smiling into my classroom – a speech and language unit for pupils who had statements of SEN (now EHC plans). He was probably placed there as the local authority struggled to identify his specific needs and may have felt that any small, more specialist placement would help. From my first meeting with this articulate, exceptionally bright young man, I knew he’d definitely come to the wrong place. All my other pupils were well below age-related expectations and most struggled to speak clearly.  

Even during our initial honeymoon period, I felt wrong-footed by his ability to charm, manipulate and take the lead in my class. It wasn’t long before we got into our first official stand-off. He refused to go into a PE lesson. I’d never actually encountered a pupil who calmly and resolutely refused to do anything a teacher instructed. I think what bothered me most was his confidence in refusing to do what I asked; it both incensed and panicked me at the same time. I literally had no plan B for this.

Fighting for control

Things went from bad to worse after that and we began to see each other as foes in an ongoing battle for control of the classroom. I did absolutely everything wrong in terms of strategies. I tried the positive approach – with reward charts, visuals, incentives and positive praise – and I tried using his special interests to engage him. When that failed, I tried warnings, consequences, regular talks with his mum and stricter, firmer boundaries. The results were volcanic. He shouted that I was stupid, disrupted every lesson I tried to deliver, mimicked children with stammers and speech impediments and shouted at them, telling them to speak properly. He chastised others when they attempted to answer questions; this seemed cruel and unkind, but then he would follow up these “corrections” with a kindly sort of explanation of how to do things right, as though he were the teacher. 

The more I tried to get control, the more he would sabotage my efforts. He’d provide the best apologies, but moments later it would happen again. He frequently tried to adopt the role of the leader in the classroom and I was at a complete loss. As a new SENCO, I felt that I was truly failing in my role but I also couldn’t see the special needs underlying his behaviour; I couldn’t see the anxiety at all. I felt bullied and completely ridiculed by him and would spend my evenings racking my brains for more strategies. I asked for help from every professional I could, and frequently spoke with his mum who also couldn’t explain or understand his behaviour. 

The educational psychologist said he was intelligent and needed a different provision, that perhaps his behaviour was frustration, so we moved him into a mainstream class. Things were the same but now more children were impacted. Expert services who were invited in to observe him were shocked by what they saw. They seemed baffled as to why he seemed to behave in the way he did towards other children and also felt his behaviour seemed very unlike how a child with autism may behave in a classroom. They provided some advice and support but nothing improved in the classroom.

Old-fashioned approach

This pupil had always said he liked teachers who were strict and old fashioned; it was this approach which finally won him over. One of the most experienced and senior teachers taught him in his next class and she was very old-school in her approach. Looking back, he was role-playing with her, as when she had a day when she felt less able to uphold the approach his behaviour escalated significantly. He wanted her to play her role and it gave him some sort of security. I never saw him again after leaving that school, but I think of him often and I always remember him so fondly, despite all the worry. Somehow his unique personality and charm just won us over.

As my career went on, I came across other children who I now know had PDA (often undiagnosed). They were the ones who kept me awake at night and worried me more than anyone else, and for whom I had no answers. What they taught me was to be a very reflective practitioner and that you have to dig very deep sometimes for the right solutions.

My understanding of PDA has developed very significantly now. Having my own child with PDA and living with PDA has been the most useful training of my career. Having managed provision for a number of children with PDA profiles, I’ve learned many strategies and approaches which have had varying degrees of success. 

Different presentations

There is no clearly defined way in which children with PDA present in a classroom. I’ve known children who have been half-wrestled into classrooms by parents and have then been completely unresponsive whilst repeatedly kicking the door and demanding to be let go. I have known others who mask their difficulties and anxieties so effectively that it is a shock when their resistance comes to the surface, and how determined it is when it does. 

Some children with PDA are extroverts and speak very much like they are in charge and we, the teachers, should learn from them. Let’s face it, they are not that far from the truth! I am, indeed, constantly learning from them. Regardless of how they present, they will usually be the child who challenges you most, confuses you most and who you think of more than any other. They are also the ones who, despite the additional stress, you look back on and miss for their exceptional characters.

If you work in a school which is committed to inclusion and child-centred approaches, you will probably be reading this and thinking: yes, we can do this; this is useful information. If, however, your school sees no purpose in helping a child who appears not to want to be taught, then I challenge you to try and read this again and change your school’s ethos. 

Things to consider 

If you have a child you know, or suspect, has PDA then reflect on the following:

Induction
Do you think that, despite failing at other schools, having behaviour problems or exclusions, they will just learn to fit into your regime? Or are you going to use that history to really plan for an effective transition into school?

Training
Consider whole-school approaches such as providing quiet and enclosed spaces, use of a shared dialogue to discuss emotions such as a social cognition or growth mindset approach, non-confrontational language, therapeutic interventions and time for children to engage with special interests.

Family support
Providing support for the family is key to reducing overall anxiety for a child with PDA. Support parents with effective strategies to help their child make the transition into school each morning. Children with PDA cannot cope with demands when they are anxious, so will avoid school which is full of additional demands from adults. How can you counteract this?

Support for self-esteem
Children with PDA usually know they struggle with things and often have low self-esteem. It’s important to find ways to boost esteem without creating additional demands. For instance, share examples of success between home and school, keep visual records of what they do and participate in (use scrapbooks or an early years learning journal, regardless of their school year). 

Remember that children with PDA only tend to respond positively to genuine praise, and praise which relates to something they wanted to achieve rather than something you wanted them to achieve. Those with PDA are often perfectionists who don’t like anyone to question their thoughts or the way in which they respond. It can be therapeutic for them if you make a point of praising their way of viewing something when it is genuinely logical or sensible, despite appearing obstructive to what you are doing.

Interventions
Additional support is tricky for demand avoidant children if mishandled and can feel like an additional demand. Is the intervention fun and interesting whilst also helping their skills? Well-received interventions in my experience tend to include one-to-one working, art therapy, pet therapy and yoga. It depends on a child’s interests and needs. I supported a child with PDA to learn to read by including the school dog in his one-to-one sessions with a reading specialist teacher.

The most effective approaches for children with PDA are relaxing, home-like surroundings with staff who are calm and genuinely interested in child-centred practices. The way in which staff communicate is so important. Staff need to be able to oscillate between humour for distraction and carefully phrased demands. The school ethos makes a massive difference and all staffing groups need to be involved in training for responses to emotional difficulties.

I hope that my journey with PDA and the insights I’ve gleaned along the way are helpful for those of you who may be struggling to understand a child’s behaviour. Research conducted recently by the PDA Society showed, worryingly, that 70 per cent of children with a PDA profile are unable or regularly struggle to attend school. I can easily see how this is the case, but I also feel strongly that we can and should do more to accommodate their needs.

Further information

Natalie Menagh, who has a child with PDA, is SENCO and Inclusion Manager at Whitefield Primary School in Liverpool:
www.whitefieldprimaryschool.co.uk

For more information and about PDA and useful resources for teachers, parents and clinicians, visit the PDA Society’s website:
www.pdasociety.org.uk

N.B. The people pictured are not those mentioned in the article. 


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