Demand Avoidance versus Oppositional Defiance Disorder

The main objective for a young person with Pathological Demand Avoidance (PDA) is an anxiety-driven need to be in control. The main objectives for young people with Oppositional Defiance Disorder (ODD) are to get a reaction from others and create power struggles. In both cases what you'll see is:

  • Refusing
  • Giving excuses
  • Distracting or changing the topic of conversation
  • Negotiating or needing to have the last word
  • Bombarding with repetitive questions or noises
  • Withdrawing into a fantasy world
  • Complaining of physical impairment
  • Panic-driven physical outbursts or meltdowns/ shutdowns

Managing Demand Avoidance

It’s helpful to remember that if a child can do something, generally they will. Rather than viewing the child as willful or badly behaved, think of them as a child who is struggling and needs support.

Often strategies helpful for the autistic child don’t work for PDA. It can be helpful to make requests indirect where possible. Other helpful tips include:

  • Pick your battles
  • Acknowledge the anxiety and difficulty the young person is experiencing
  • Ask the young person what would help, to give some control back
illustration showing how to reframe from certain behaviours

Using the PANDA approach for PDA

P - pick battles
A - anxiety managment 
N - negotiation and collaboration
D - disguise and manage demands
A - adaptation

The PANDA approach

Managing ODD

  • Use specific praise to encourage positive behaviour – for example, ‘It was really helpful when you put your plate on the bench’.
  • Look at using a structured reward system like a reward chart. These work especially well for children aged 3-8 years.
  • Give short, clear and specific instructions – for example, ‘Please put the dishes in the sink’.
  • Give choices about when your child can do tasks, not whether your child will do them – for example, ‘Would you like to do your homework now, or after the next TV show?’
  • Follow up on challenging behaviour straight away. For example, if your child doesn’t do what you ask, ask again and say, ‘This is the last time I am going to ask you’. If your child still doesn’t cooperate, you could use a consequence like loss of privilege.
  • Use consequences in the same way and for the same behaviour every time. This means your child knows what to expect. For example, you might always use a time-out for hitting.
  • Acknowledge your child’s strong emotions and let them know you’re there to listen and help. For example, ‘I understand you’re feeling angry. Do you want to talk about it?’
  • For these strategies to help your child, it’s important to use them consistently. But this can take patience and practice, and it can be challenging if your child opposes them. You can ask your child’s psychologist for help or for other strategies you can try.

Puberty

As always preparation is key! Preparing children with ND for puberty prevents them from feeling confused or afraid or that there is something wrong with them as their bodies change. Children will develop at different times but the start of puberty ranges from 8-13 years in girls and 9-14 years in boys.

Strategies to use:

  • Be young person led
  • Start talking about puberty when your young person starts noticing differences in themselves and others.
  • Prerpare your young person before they startbeing fearful of changes they are already experiencing - knowledge is key!
  • Introduce terminology when it is right for you and your child
  • Talk about and use the word 'puberty' before it happens, this will help them become familiar with the word
  • Use explanations such as 'puberty is when a child's body changes into an adult body and this happens to us all'
  • Use photographs of familiar adults at different stages and ages
  • Use visual guides and drawings according to age and level of awareness/readiness

Increasing Expectations

Expectations and responsibilities increase as a young person gets older, despite all these challenging changes:

  • Responsibilities around the house, towards friends, family
  • Learning to understand their role within the family is tricky as additional responsibilities can be confusing (like any change)
  • They may have a job and the responsibilities that entails
  • Expectations all round to do their best in school – including decisions based on what course their future ‘might’ take (options) – exams – some schools push exams ALL the time – what next? College, sixth form, uni, apprenticeships
  • They’re expected to fit in (comply) especially with regard to new activities that are allowed depending on age: 16 – have sex, smoke; 17 drive; 18 drink, vote 

All these happen at a time when they are least sure of who they are, when they are at their most uncertain. 

Social Situations

Neurodivergent children might identify better with younger or older people. Therefore, at school this becomes more difficult as their peer group may start to look after their appearance, express feelings through talking, separate fact from opinion and start to want to choose their own clothes and socialise alone out of the house. Children who are ND may find these things hard and will feel different because they are different.

Challenges – social isolation

Following puberty peers can be less tolerant of someone who is different. Some children are still unable to carry out tasks such as tying shoelaces or riding a bike. Whilst peers are interested in fashion and clothes, ND children may prefer to dress in the same comfortable clothes every day. ND children may feel anxious around interacting with others because they do not understand what their peer group are talking about and are unable to relate to their interests. 

Social media

  • Using the internet to socialise with friends and peers as there is no pressure on understanding body language. The internet also provides a safe and known environment at home at a time that suits the young person
  • However, remember safe internet use and to consider  boundaries around social media
  • Neurodivergent children often like to spend time with either older children or younger children as this reduces peer pressure
  • Having one good friend or a very small group of good friends can help with socialisation skills

Don’t panic!

  • Remember every child is different, so don’t compare!
  • Find out what they are aware of already about their sense and self
  • Make a resource folder about individual topics
  • Look at visual aids such as social stories that can help you to talk to your child
  • Use family and friend support systems
  • Consider values – what does your child value? How do they want to be seen by others? What can they do to achieve this?

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