No kid in the history of kids has ever been 100% agreeable all the time. Some kids struggle hard with rules, directions, and demands. When a child’s inability to cooperate with parents, teachers, and other adults’ instructions to the point where every day and every interaction feels too hard, there may be a clinically high level of demand avoidance at play.
As a parent, once you start the internet search for what this thing is called, you’re likely to come across two or three common diagnostic terms: ADHD (which I’ll write about more in detail later because it’s so common), ODD or Oppositional Defiant Disorder*, and PDA or Pathological Demand Avoidance.
ADHD and ODD have been around for decades. PDA is “new”, meaning only recently have we given it a name and a set of diagnostic criteria (sort of). Any child who goes to a therapist or medical provider might end up with one or more of these tags. Let’s dive into PDA.
PDA is currently considered to be a sub-type or form of Autism Spectrum Disorder, although there are plenty of experts who think it’s a separate thing. PDA basically means that a child CAN NOT (not WILL NOT, that’s important) comply with adult demands. It’s a developmental disorder, meaning it has been present since birth (although symptoms aren’t obvious until around age 3) and doesn’t typically go away with time. A few distinct features of PDA that differentiate it from other diagnoses are:
- Children with PDA get equally upset about demands from peers, games, daily living activities (bathing, brushing teeth), and options or choices as they do when adults tell them to do something.
- Children with PDA almost always also have high levels of sensory concerns (picky eater, only wears certain materials or colors, very averse to noise or light).
- When the child is feeling safe around an adult, they might do a monologue about a favorite activity or thing for what seems like ages. Common topics might be: dinosaurs, reptiles in general, space/planets, ships, trains, and rocks or minerals. I’m sure there are many others.
- Are often upset about having a birthday party or receiving gifts, even if the gift is something they’ve been asking for.
- Behavior modification tools like behavior charts, tokens, prizes for compliance, etc., only make things worse. These things often set off periods of withdrawal of the child from others in the home.
- They need to be “right” and/or “in charge” when playing with peers or siblings.
- They make unique and sometimes funny excuses for not complying with requests, such as “my arms are too short”, “I can’t, I’m feeling existential today”, “you have reached this number in error”.
- When the adult drops the demand and/or allows for more options, the child becomes calm and appears relaxed.
If this list seems like you could’ve written it about your kid, you might want to learn more about PDA, including how to get an assessment and what to do to support your kid.
Here are a couple of solid websites for that:
https://www.pdasociety.org.uk/
If you’re in or near Asheville, NC, you can also contact me for help.
* I do not use the diagnosis ODD. It is extremely outdated and reflects a judgmental, behaviorist view of children. Nearly every kid I’ve ever treated who qualified for ODD according to the DSM also qualified for the diagnosis of PTSD, which is normally more accurate. ODD really needs to be taken out of the book.
https://drcatherinetucker.com/after-the-tantrum/
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