Help for Psychology Child with PDA

Help for PDA - Children

The concept of Pathological Demand Avoidance (PDA), as a separate diagnostic category, was first proposed by Elizabeth Newson some twenty years ago, and since then a large number of children have been assessed and found to fit the clinical picture she described. The National Autistic Society now views PDA as part of the broader Autistic Spectrum.

Children with PDA have an inability to tolerate demands imposed upon them and an overwhelming need to control their environment.

This need for control is fuelled by huge levels of anxiety, leading to the child engaging in increasingly challenging and often outrageous behaviour in order to avoid demands.

There is little available research evidence about what kind of long-term outcome is likely for children with PDA.  However, without appropriate diagnosis and support, both for the child and his or her family, this has the potential to be very poor.

We have extensive experience in the recognition, assessment and diagnosis of PDA. The assessment process we use is very similar to that used in our assessment of Autism, in that we follow the NICE guidelines and involve a variety of professionals in our assessment. We can also offer follow-up support to both school and families, as although PDA is considered as part of the broader Autistic Spectrum, the management strategies which tend to be more effective with children with PDA are very different. Currently PDA is not included in either DSM V or ICD 10 as a separate diagnostic category. However, we strongly feel that this distinction is important.

PDA COURSES for Parents and Schools

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An amazing team with a shared vision and goal. To improve lives. Had an assessment for my 7 year old son who was finally diagnosed with PDA. The assessment was very thorough and covered everything (including the required guidelines.) These people have changed my life and I can not repay my debt of gratitude. With so many thanks.

Laura Touray (shared with Laura’s permission)

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These children may exhibit superficial sociability but tend to lack responsibility and awareness of acceptable boundaries (social or otherwise). They also tend to be extremely impulsive and demonstrate lability of mood with frequent temper tantrums and ‘meltdowns’. These difficulties often become more apparent when the child begins to attend school, when demands on them tend to become greater. Behaviour can deteriorate quickly and the child may resort to manipulation, or even violence to avoid demands.  More often the child will resort to this type of behaviour across all settings, causing huge disruption within the classroom. However, it is not uncommon for children to ‘hold it together’ and remain compliant whilst they are at school, and then display challenging and distressed behaviour when out of school. Avoidance tactics can include repetitive questioning, ignoring, changing the subject, talking over people, extreme behaviour such as removing clothing, and their behaviour can be humiliating and distressing to parents. They can find it difficult to negotiate with peers, and can become bossy and domineering during play.

Thank you ever so much for the way in which you adapted to fit in with my daughter’s obsessive role-playing during the assessment, you were both extremely patient, caring and understanding, and made us feel comfortable under very difficult circumstances.

A comment from the mother of a girl we diagnosed with PDA (Permission given to share)

Children with PDA can appear controlling and dominating. However, this is usually when they feel anxious and are not in charge. Many parents describe their child with PDA as a 'Jekyll and Hyde'. It is important to recognise that these children have a hidden disability and often appear 'normal' to others. Many parents of children with PDA are accused of poor parenting through lack of understanding about the condition. These parents will need a lot of support, as their children can often present severe behavioural challenges.

Help for PDA – Adolescents and adults

There is very little research available which looks at the long-term outcome for children with PDA who are either not diagnosed, or whose families do not receive appropriate help and support. However, our many years’ of experience in assessment and diagnosis, and working in inpatient and forensic settings, suggest that both adolescents and young adults with undiagnosed PDA may be at significant risk of mental health problems including depression and anxiety. They may self-harm or present with significant behaviour challenges.  Some may be wrongly diagnosed with Personality Disorders.

We have extensive experience in diagnosing and working with both adolescents and young adults, and have developed expertise at ‘unpicking’ PDA from other disorders (e.g. Attachment Disorders) and mental health problems. If you require any further details, please email us at