In a traditional school environment, there are many demands: read your book, eat your lunch, sit quietly. But for children with traits of pathological demand avoidance (PDA), it can be extremely difficult to meet them. 

Children with PDA have an anxiety-driven need to be in control of the environment and everyone in it. This is often exacerbated by unrealistic expectations that they hold for themselves and others, and can manifest as intense emotions and mood swings.

So what do teachers need to know about PDA? And how can they support those who present with it in their classrooms?

The origins of PDA

The first thing to understand is that the term PDA is relatively new and not universally accepted. 

It was introduced in the 1980s by Professor Elizabeth Newson as part of her clinical work with children at the Child Development Research Unit at Nottingham University. She identified a group of children who shared some features typical of autism, such as differences in social interaction, communication and the ability to think flexibly, but also shared other atypical features, including anxiety-driven demand avoidance. 

Young people affected may experience a constant, underlying anxiety about real, perceived or possible demands that may be made of them. They may also struggle to make or maintain positive relationships and experience low self-esteem as well as negative emotions around feelings of being let down by others.

Newson labelled this group of characteristics “pathological demand avoidance” and called for it to be given a separate identity within the pervasive developmental category of the World Health Organisation diagnostic manual. 

However, according to the neuroscientist and autism expert, Professor Uta Frith, PDA is “a controversial category”. 

“It is not clear whether/how it relates to autism,” she explains. “Because there is a lack of basic research in the condition, it’s very hard to know what is actually going on in these perplexing children.” 

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The category itself might be controversial but, regardless of the label given to them, children who are displaying anxiety-driven demand avoidance can find school a real challenge - and in the absence of more definitive research, special schools such as ours have to find ways to meet these children’s needs as best we can.

Demand for specialist provision in this area is on the increase. In fact, where we are based, in Sutton, 33 per cent of our consultations from neighbouring local authorities now represent learners with what we would consider to be a PDA profile. 

That’s why, this academic year, we opened The Link School satellite site - a new flagship provision for children with PDA. This is the first of its kind and we hope it ignites the conversation around PDA for other schools.

PDA: How to support children

So, what strategies have worked for us in supporting these children that could be replicated in mainstream schools? Here are some ideas, drawn from the experiences of our staff.

• Make building a relationship with the child a priority above task completion. Learn about the child’s interests so you can communicate about them and with them.
   
• Take the word “no” or “don’t” out of your vocabulary and instead offer choices within the task to give the child some control.
   
• Be careful of the way you use praise as this can become a subtle demand. Instead, build esteem by giving regular opportunities for the child to demonstrate skills they are good at or by speaking positively about the young person within their hearing but without doing this directly.
   
• Allow the child to sit outside the usual reward systems as these are usually ineffective, and instead use a variety of spontaneous rewards.
   
• Be prepared to have honest dialogue when the child disagrees with adult decisions. Show empathy and sympathy, learning to speak as an equal. When applying necessary school rules, learn to depersonalise these, so that the child is aware who made the original decision - for example the headteacher, government or health and safety policymaker. This helps to maintain relationships with the person that works with the student on a regular basis.
   
• Reduce anxieties related to direct environmental demands. For example, ensure any schedules used in the classroom are not drawn to the attention of the child, or placed in their eye line.
   
• Allow the child to have their own learning area or safe space to retreat to in the classroom rather than having to adhere to set seating patterns.

There will be times when such actions alone aren’t enough. In these situations, we need to put the child’s emotional regulation needs above curriculum learning. A flexible system, such as the Tolerance/Demand Synchronisation Scale (see below) can be helpful here. 

This works by observing a child closely over time to recognise how they behave when their anxieties are low, medium or high. Staff can then watch for any changes in emotional regulation through the day, matching the level of demand they give to the child’s tolerance level.

Finally, for awareness around PDA to become embedded in any school, everyone needs to understand the role they have to play.

If you are part of a wider trust that contains special schools, it’s important to draw on their expertise, and adapt the school environment and teaching practice in response.

Sandy Turner is the principal at The Link School, part of Orchard Hill College and Academy Trust