Have you ever gotten your bills for the month in the mail and the mounting pressure of needing to pay all these bills, to avoid debt and to be a "responsible adult" etc., causes overwhelm and anxiety or stress, so you put off (avoid) paying the bills for a few days or weeks?
That is an example of demand avoidance a neurotypical adult may experience. For kids with ASD, ADHD, or other disabilities, PDA can occur as a result of transitions, interupptions, schedule changes, difficult task demands, sensory overload, or low motivation. PDA goes beyond escape behaviors in that the demands, whether externally or internally placed, cause intense anxiety, making individuals who are already struggling with rigidity and other symptoms unable to cope with complying with the demand. This anxiety may lead the individual to externalize the anxiety (aggression, tantrums, elopement) or internalize the anxiety (rumination, SIB).
ABA strategies to helping an individual with PDA can include priming, visuals, coping skills, predictable routines, and addressing sensory issues like providing noise canceling headphones.
The best website I have found to explain PDA (they even have brochures and PowerPoints) is [https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/](https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/)
It should be noted that, if I recall correctly, PDA is not a recognized diagnosis in the US yet. However, BCBAs and other professionals are beginning to recognize it and work to address it.
This is not an exhaustive explanation or anything but I hope this helps!
I work with a kid who exhibits PDA in a very unique way but I feel like it exemplifies how this works.
Essentially if you give him a beneficial instruction sometimes (let's get ice cream!) he will decline the instruction but then, after declining, immediately request ice cream. Then he will decline it again. This creates a cycle that is incredibly frustrating for him and whoever he is communicating with. It looks like this:
"Let's get ice cream."
"No! No ice cream!"
"Okay."
"I want ice cream."
"Okay, let's get ice cream."
"NO!"
"Do you want ice cream?"
"No!"
"Okay."
"I want ice cream."
Obviously this can be super frustrating for all involved. I've been practicing this with him and this may sound weird but - I'm teaching him chess. This is a highly intelligent lad who loves board games because he is rule centric. Chess is a great game for him because that is a game that you need some direction to learn and you have to be able to change your mind (that's a key aspect of cognitive flexibility).
What often happens is I will tell him "If you use your rook, you can take my knight". He will see this but refuse to do the move - he's already decided he wants something else, and he wants to avoid my "demand".
If I don't move my knight, he will, inevitably, do this move on his next turn. But he can't do it in the moment. To practice this I will give him a lot of time to change his mind but if declines, I will always move my piece so he can no longer get it. This is a natural consequence but obviously, it's just a game. And he's actually a very graceful loser so it isn't a huge deal. But he still wants to succeed so now, every once in a while, he can push back that rigidity and will follow my advice. When this happens, he always gets my piece and I will usually not take a piece from him for several moved (to avoid accidentally punishing the flexibility).
It is a slow process but he has slowly increased flexibility in this way.
It's still called ODD, IF the client actually has that diagnosis. PDA isn't recognized in the US at the moment, so even though BCBAs may be acknowledging it, they ethically should not be moving forward saying a client has such a diagnosis before they do (that goes for every medically diagnosed situation not just PDA). PDA could appear in a future DSM, then people can actually be diagnosed with it in the US too.
I don't think it necessarily needs a diagnostic label. I view it more as an explanatory term for a specific symptom. Like sensory overload or echolalia.
I definitely get where you're coming from, especially when it seems so common place, with that being said you can follow your ethics how you see fit. I'm reading the BCBA ethical code as
> 2.12 Considering Medical Needs
> “Behavior analysts ensure, to the best of their ability, that medical needs are assessed and addressed if there is any reasonable likelihood that a referred behavior is influenced by medical or biological variables. They document referrals made to a medical professional and follow up with the client after making the referral.”
I'd also consider a medical diagnosis as identifying a disease, condition, or injury from it's signs and symptoms.
Similarly we wouldn't (and shouldn't) go around stating a client with ASD has ADHD because they're lacking focus every now and then and we wouldn't treat it's symptoms as assuming they had a diagnosis that they didn't have documented. A client shouldn't receive modifications based off assumptions of diagnoses, we can't diagnosis them ourselves and PDA *doesn't exist* here.
I am doing research on this also. I have a client who seems to march to the beat of a different drum. I have never seen anything quite like it. This client will say no to things he clearly wants and it doesn’t appear to be a lack of understanding. Have a client that is requesting to be changed ( giving me a pull-up) and loves to sit on the toilet so much that I have a DRL in place. But If I tell him let’s go to bathroom and we will sit on the toilet and I’ll change you. I might have asked him if he wants me to do the most horrid thing he can imagine.
A simple rephrase of instruction can be night and day. If I ask him to clean up or give instruction “put in” while holding out a box— asking him to clean up just 1 toy (like 1 piece of train track) I seek incredibly high intensity behavior biting, trying to break windows. If I tell him “I need help with….” He will clean up his entire work space laughing and smiling.
Hello /u/Femole! I regret to inform you that your comment has been removed because your account is too new. This is to help us prevent spam from proliferating on this subreddit. A message has been sent to the moderators, and if this comment is a genuine contribution, then it will be manually approved by the moderators.
In the meantime, please familiarize yourself with /r/ABA's rules, located in the sidebar [or by following this link](https://www.reddit.com/r/ABA/about/rules).
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ABA) if you have any questions or concerns.*
Have you ever gotten your bills for the month in the mail and the mounting pressure of needing to pay all these bills, to avoid debt and to be a "responsible adult" etc., causes overwhelm and anxiety or stress, so you put off (avoid) paying the bills for a few days or weeks? That is an example of demand avoidance a neurotypical adult may experience. For kids with ASD, ADHD, or other disabilities, PDA can occur as a result of transitions, interupptions, schedule changes, difficult task demands, sensory overload, or low motivation. PDA goes beyond escape behaviors in that the demands, whether externally or internally placed, cause intense anxiety, making individuals who are already struggling with rigidity and other symptoms unable to cope with complying with the demand. This anxiety may lead the individual to externalize the anxiety (aggression, tantrums, elopement) or internalize the anxiety (rumination, SIB). ABA strategies to helping an individual with PDA can include priming, visuals, coping skills, predictable routines, and addressing sensory issues like providing noise canceling headphones. The best website I have found to explain PDA (they even have brochures and PowerPoints) is [https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/](https://www.pdasociety.org.uk/what-is-pda-menu/what-is-demand-avoidance/) It should be noted that, if I recall correctly, PDA is not a recognized diagnosis in the US yet. However, BCBAs and other professionals are beginning to recognize it and work to address it. This is not an exhaustive explanation or anything but I hope this helps!
I work with a kid who exhibits PDA in a very unique way but I feel like it exemplifies how this works. Essentially if you give him a beneficial instruction sometimes (let's get ice cream!) he will decline the instruction but then, after declining, immediately request ice cream. Then he will decline it again. This creates a cycle that is incredibly frustrating for him and whoever he is communicating with. It looks like this: "Let's get ice cream." "No! No ice cream!" "Okay." "I want ice cream." "Okay, let's get ice cream." "NO!" "Do you want ice cream?" "No!" "Okay." "I want ice cream." Obviously this can be super frustrating for all involved. I've been practicing this with him and this may sound weird but - I'm teaching him chess. This is a highly intelligent lad who loves board games because he is rule centric. Chess is a great game for him because that is a game that you need some direction to learn and you have to be able to change your mind (that's a key aspect of cognitive flexibility). What often happens is I will tell him "If you use your rook, you can take my knight". He will see this but refuse to do the move - he's already decided he wants something else, and he wants to avoid my "demand". If I don't move my knight, he will, inevitably, do this move on his next turn. But he can't do it in the moment. To practice this I will give him a lot of time to change his mind but if declines, I will always move my piece so he can no longer get it. This is a natural consequence but obviously, it's just a game. And he's actually a very graceful loser so it isn't a huge deal. But he still wants to succeed so now, every once in a while, he can push back that rigidity and will follow my advice. When this happens, he always gets my piece and I will usually not take a piece from him for several moved (to avoid accidentally punishing the flexibility). It is a slow process but he has slowly increased flexibility in this way.
Nice, what an excellent way to provide multiple opportunities to practice a skill during a preferred activity!
Amazing.
Lol! I had this same conversation with a kid over a carrot. I think they used to call it Oppositional Defiant.
It's still called ODD, IF the client actually has that diagnosis. PDA isn't recognized in the US at the moment, so even though BCBAs may be acknowledging it, they ethically should not be moving forward saying a client has such a diagnosis before they do (that goes for every medically diagnosed situation not just PDA). PDA could appear in a future DSM, then people can actually be diagnosed with it in the US too.
I don't think it necessarily needs a diagnostic label. I view it more as an explanatory term for a specific symptom. Like sensory overload or echolalia.
I definitely get where you're coming from, especially when it seems so common place, with that being said you can follow your ethics how you see fit. I'm reading the BCBA ethical code as > 2.12 Considering Medical Needs > “Behavior analysts ensure, to the best of their ability, that medical needs are assessed and addressed if there is any reasonable likelihood that a referred behavior is influenced by medical or biological variables. They document referrals made to a medical professional and follow up with the client after making the referral.” I'd also consider a medical diagnosis as identifying a disease, condition, or injury from it's signs and symptoms. Similarly we wouldn't (and shouldn't) go around stating a client with ASD has ADHD because they're lacking focus every now and then and we wouldn't treat it's symptoms as assuming they had a diagnosis that they didn't have documented. A client shouldn't receive modifications based off assumptions of diagnoses, we can't diagnosis them ourselves and PDA *doesn't exist* here.
This is amazing and so helpful! Thanks for posting OP and thanks for the info in this comment, redditor 🙌🏻
Here's a CEU on it! https://manhattanpsychologygroup.com/news-resources/media/pathological-demand-avoidance-pda-aba-free-webinar/
I am doing research on this also. I have a client who seems to march to the beat of a different drum. I have never seen anything quite like it. This client will say no to things he clearly wants and it doesn’t appear to be a lack of understanding. Have a client that is requesting to be changed ( giving me a pull-up) and loves to sit on the toilet so much that I have a DRL in place. But If I tell him let’s go to bathroom and we will sit on the toilet and I’ll change you. I might have asked him if he wants me to do the most horrid thing he can imagine. A simple rephrase of instruction can be night and day. If I ask him to clean up or give instruction “put in” while holding out a box— asking him to clean up just 1 toy (like 1 piece of train track) I seek incredibly high intensity behavior biting, trying to break windows. If I tell him “I need help with….” He will clean up his entire work space laughing and smiling.
[удалено]
Hello /u/Femole! I regret to inform you that your comment has been removed because your account is too new. This is to help us prevent spam from proliferating on this subreddit. A message has been sent to the moderators, and if this comment is a genuine contribution, then it will be manually approved by the moderators. In the meantime, please familiarize yourself with /r/ABA's rules, located in the sidebar [or by following this link](https://www.reddit.com/r/ABA/about/rules). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ABA) if you have any questions or concerns.*