Supporting Pathological Demand Avoidance (PDA) with Occupational Therapy: A Guide for Parents
Nov 18, 2024
When parenting a child with Pathological Demand Avoidance (PDA), each day can feel like a new challenge. PDA—often linked with autism and sometimes ADHD—can make typical tasks, from brushing teeth to getting dressed, seem monumental. For children with PDA, the need to avoid demands isn’t about defiance or stubbornness; it’s a genuine response to anxiety and a need for control over their environment.
Occupational therapy (OT) can be a valuable resource for children with PDA. OT focuses on helping children develop the skills they need to navigate daily life, and therapists often take a flexible, child-centered approach to address specific sensory, motor, and emotional needs. Below, we’ll explore OT strategies and resources to help you support your child at home.
Why Occupational Therapy for PDA?
Occupational therapists use a holistic approach, working on motor, sensory, and emotional skills that can make demands feel less overwhelming. They consider each child’s unique triggers and sensitivities, aiming to reduce anxiety and create a more manageable daily routine.
In PDA, where demand avoidance is often tied to sensory sensitivities or anxiety, occupational therapy can help your child learn to manage responses, understand their needs, and find self-regulation techniques.
Key OT Strategies for Managing PDA at Home
Here are some strategies from the OT world that can help children with PDA feel more comfortable with everyday demands.
1. Sensory Breaks and “Reset” Activities
Kids with PDA often have intense sensory needs that can make regular demands feel even harder. Try incorporating sensory breaks—activities that allow your child to reset and calm their nervous system throughout the day.
Example: Create a sensory corner or box with calming items like fidget toys, noise-canceling headphones, or a weighted blanket. If your child feels overwhelmed, suggest a “reset break” in the sensory corner.
Benefit: Taking sensory breaks helps regulate their body, reducing stress and making them more open to other activities.
2. Making Demands Fun and Playful
PDA often involves a high level of creativity, so why not turn demands into games? Occupational therapists use play-based strategies to engage kids without triggering demand anxiety. For example:
Example: If getting dressed is a challenge, try a game like “Robot Dress-Up” where you take turns pretending to be robots dressing each other in silly outfits.
Benefit: Playful approaches feel less restrictive, giving your child some control in how they respond to demands.
3. Provide Choices and Visual Schedules
Many OTs recommend using visual schedules and choice boards to support PDA. These tools allow children to see what’s coming next and choose how they’d like to approach tasks.
Example: Use a picture-based daily schedule so your child knows what to expect. Let them pick the order of activities, like “Would you like to brush teeth before or after breakfast?”
Benefit: Visuals and choices reduce anxiety around demands by offering predictability and autonomy.
4. Heavy Work and Body-Based Activities
“Heavy work” activities, which involve pushing, pulling, or lifting, can calm a child’s nervous system, helping them feel more grounded and able to handle demands.
Example: Encourage activities like pushing a laundry basket, carrying books, or building with heavy blocks before tackling a more difficult task like homework or sitting down for a meal.
Benefit: Body-based activities help regulate sensory needs, improve focus, and make demands feel less overwhelming.
5. Collaborative Problem-Solving and Goal Setting
Collaborating with your child in setting goals can be effective. Rather than directing tasks, try working together to create solutions.
Example: If bedtime is a struggle, sit down with your child and ask, “What would make going to bed easier for you?” Let them contribute ideas, and work together to come up with a routine.
Benefit: This approach helps your child feel heard, gives them a role in planning, and allows them to feel in control rather than pressured.
Practical Tips for Using OT Strategies at Home
Implementing OT-inspired strategies at home doesn’t have to be complicated. Here’s how to make these techniques part of your everyday routine:
Create a Calming Toolkit: Assemble a “calm-down” box with sensory-friendly items. Let your child know they can use it whenever they need a break.
Use a “First/Then” Approach: Try saying “First, we’ll do a quick pick-up of toys, then we’ll play outside.” This reduces the feeling of demand by adding a reward or pleasant activity afterward.
Build a Routine, But Keep It Flexible: While consistency helps many kids, children with PDA often need flexibility. Create routines, but don’t hesitate to adapt them if your child shows signs of overwhelm.
Common Challenges and Solutions
Implementing these strategies can take patience. Here are some common challenges you may encounter and ways to work around them:
Resistance to Even Fun Activities: Children with PDA may still avoid activities they enjoy because they feel they must do them.
Solution: Keep the invitation open-ended. Rather than “Let’s read a book now,” try “Would you like to pick a book for us to read together sometime today?”
Struggles with Transitions: Moving from one activity to another is a common hurdle for kids with PDA.
Solution: Use countdowns or visual timers to help your child prepare for transitions. Phrasing like “In five minutes, we’ll start tidying up” can give them a sense of time without feeling pressured.
Additional Resources for Parents
If you’re looking for more support, here are some resources that offer further guidance and understanding of PDA through an OT and sensory lens:
• The PDA Society in the US : This organization provides in-depth information and resources for parents managing PDA. Website link Here.
• Beyond Behaviors by Dr. Mona Delahooke: This book dives into understanding challenging behaviors through a sensory and body-based approach.
• The Explosive Child by Dr. Ross Greene: Offers insight on collaborative problem-solving, especially useful for managing PDA behavior profiles.
Final Thoughts
Understanding and supporting a child with Pathological Demand Avoidance takes patience, empathy, and creativity. Remember, the goal isn’t to “fix” their avoidance; it’s to help them feel safe and understood. Small adjustments, like making demands playful, offering choices, and using sensory-based strategies, can make a huge difference in your child’s experience.
Remember to be kind to yourself, too—parenting through PDA is a journey, and there’s no perfect way to do it. Trying these occupational therapy strategies can open new doors for understanding and connection, and help you and your child navigate the demands of everyday life with a bit more ease and grace.
Parenting Alongside You!
Dr. Emma Hostetter
SUBSCRIBE FOR FREE PARENTING RESOURCES
We know you're busy! So, we'll make sure to only send the IMPORTANT PARENTING stuff!!
We hate SPAM. We will never sell your information, for any reason.
