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Penny Rayas, MFT
Penny Rayas, MFT, Therapist
Category: Mental Health
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Experience:  I have 20 years experience in the mental health field
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My 11 year old son has a diagnosis of ASD but due to his

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My 11 year old son has a diagnosis of ASD but due to his extreme anxiety and avoidance behaviour I have researched at length and discovered PDA which fits my son exactly. My local Camhs does not diagnose this but I know other counties do. Is there a major difference in treatment for this condition? My son will avoid at all costs the help that is offered for children diagnosed with ASD and is displaying some incredibly worrying behaviour including attempts at self harming? Can I get him privatly assessed if I am not happy with the outcome after my next meeting at camhs this week?
Hello there I would like to ask a few questions. ASD your mean Autism Spectrum Disorder. What do you mean by PDA? What symptoms do you see?
Customer: replied 5 years ago.
Hi It stands for Pathalogical Demand Avoidance. He Is on the Autistic spectrum but doesn't fit with all the typical behaviours. He is sociable and has friends, he hates to be on his own, he is scared of everything that is new, different and has extreme emotional 'meltdowns' when anxious. This esculates very quickly into fear driven rages where he kicks walls and anything in his way, cries uncontrolably, has almost toddler tantrums and tries to strangle himself. He climbs out of windows and runs up the road, and has picked up a knife and held it to his throat. This behaviour is happening every school morning he has never coped with school and now he has moved up to secondary school it has become worse. The most ironic side of it is that in school he is calm and engages in the lessons and is a model child and no one can believe how bad it is at home he holds it together most of the time at school, but freaks out about school at home.....Help!

The problem is that most therapists do not know how to deal with children with PDA. Because it is a new disorder classes on teaching parents on how to handle children with this disorder are not available. People with PDA can be controlling and dominating, especially when they feel anxious and are not in charge. They can however be enigmatic and charming when they feel secure and in control. Many parents describe their PDA child 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 feel that they have been wrongly accused of poor parenting through lack of understanding about the condition. These parents will need a lot of support themselves, as their children can often present severe behavioural challenges.

I think the way to help your son is to reduce the anxiety that causes these behaviours. I wonder if your son has a therapist who is trained on this disorder. People with PDA become experts at avoiding demands - they seem to feel an extraordinary amount of pressure from ordinary everyday expectations. It is often not the activity itself that is a pressure but the fact that another person is expecting them to do it. The person's threshold or tolerance can vary from day to day, or moment to moment. It is important to realise that the more anxious a person with PDA is, the less they will be able to tolerate demands. As a child, their avoidance of those making demands on them knows no boundaries and usually includes a level of social manipulation. Strategies range from simple refusal, distraction, giving excuses, delaying, arguing, suggesting alternatives and withdrawing into fantasy. They may also resist by becoming physically incapacitated (often accompanied by an explanation such as "my legs dont work" or "my hands are made of lava"). If pushed to comply, they may become verbally or physically aggressive, with severe behavioural outbursts, best described as a 'panic attack'.

So the treatment for PDA is the same as we have for most of the anxiety disorders. First try to stay calm and second maybe try to teach your son how to stay calm. When he is anxious deep breathing exercises will help him stay relax and let go of anxiety.

Exercise 2:
The 4-7-8 (or Relaxing Breath) Exercise

This exercise is utterly simple, takes almost no time, requires no equipment and can be done anywhere. Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.

  • Exhale completely through your mouth, making a whoosh sound.
  • Close your mouth and inhale quietly through your nose to a mental count of four.
  • Hold your breath for a count of seven.
  • Exhale completely through your mouth, making a whoosh sound to a count of eight.
  • This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply.

This exercise is a natural tranquilizer for the nervous system. Unlike tranquilizing drugs, which are often effective when you first take them but then lose their power over time, this exercise is subtle when you first try it but gains in power with repetition and practice. Do it at least twice a day. You cannot do it too frequently. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. If you feel a little lightheaded when you first breathe this way, do not be concerned; it will pass.

People with PDA are likely to need a lot of support into their adult life. Limited evidence so far suggests that the earlier the diagnosis and the better support that they have, the more able and independent they are likely to become.

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