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How is Pathological Demand Avoidance Treated?

There is no cure for PDA. Treatment interventions can be difficult for individuals with PDA as the nature of the disorder means that the individual is obsessively concerned with avoiding any demands placed upon them, including treatment methods. Wording of demands is important; they must be indirect in nature and are often more effective if they are short and not confusing.

Therapists working with individuals with PDA are prepared for avoidance tactics and strategies to overcome avoidance demands. It is important that individuals are provided with plenty of time to enable them to process information. If an individual with PDA performs a task correctly they should be praised to emphasise their personal qualities, failure should not be recognised as this will reinforce this behaviour. Assessments will be used to identify problems or difficulties in the following areas:

  • Communication skills - expressive and receptive language
  • Social skills
  • Sensory processing
  • Motor skills - gross and fine
  • Learning ability

PDA can be treated by a number of professionals within a multi-therapy approach. Professionals who are often involved in the assessment and treatment of individuals with PDA include:

For most individuals with Pathological Demand Avoidance there is a great need for their educational needs to be met. It is vital for these individuals to have 1:1 support normally through a teaching assistant or key worker.

Educational needs for an individual with Pathological Demand Avoidance can be summarised under three main areas:

  • Keeping the child on task for substantial periods throughout the school day
  • Ensuring that what they appear to be learning they are actually absorbing and retaining - many children with this disorder will appear to be learning but may not be processing or absorbing the information. This may occur when the child feels that fewer demands will be made of them if they appear to be attentive
  • Ensuring that there is a minimal degree of disruption to other children - not all children with Pathological Demand Avoidance are disruptive, however, this may occur if they are trying to resist social demands

Whatever the child's intellectual ability they will function at a level below what they could achieve due to the fact they will be active in being passive, often working harder to avoid the demand than they would have done if they had accepted it. It is therefore important that educational support is aimed at helping the child tolerate being educated to allow them to reach as much of their potential as possible.

Support required for children with Pathological Demand Avoidance is extensive. It is important that professional and parents/carers know that what works on one day may not be effective the following day due to the highly variable nature of this disorder.

Health professionals can provide valuable help and strategies for parents/carers of children with Pathological Demand Avoidance enabling them to deal with situations that may arise within a home setting and helping them to meet the child's continuing needs whilst maintaining a happy home environment for everyone.

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