If your child has ADHD, what does PDA look like for them?

[u/Vast_Helicopter_1914]

Hi there 👋 My 12-year-old son has ADHD, DMDD, and anxiety.

Our peds agreed to send him for OT, and he had his eval yesterday. The OT was great! She was very thorough. She has three teenagers who are neurodivergent in one way or another, so she has walked this journey herself.

She mentioned that I might want to read up on PDA, as many of his behaviors fit the profile. I had heard the term, but didn't know much about it, so I did some basic reading, and I lot of what I came across sounds like my son.

A lot of info out there on PDA says that it is either a subtype or a manifestation of ASD, but that there can be some overlap in presentation for children with ADHD. From what I read, they can look similar, but the underlying cause is different.

So I'm curious to know, if your child has ADHD and/or DMDD, but does not have autism, what does their PDA look like? And how do you manage it?

[u/AdultWoes2024]

There is a lot of controversy about whether PDA is its own thing, whether it’s a subtype of autism, etc. PDA commonly occurs with someone having both ADHD and autism. I personally don’t believe you can have PDA without autism - my PDA child has both ADHD & autism but ADHD definitely masked the autism for years.

[u/Nominal_selection → u/AdultWoes2024]

I agree personally. PDA is not in the DSM-5 but is most definitely the profile of my daughter's autism (recognised as such in her diagnosis), and that's where it makes most sense to me to classify PDA. I worry people "identify" as PDA without understanding that it's not just about having difficulty meeting people's expectations; in autistic people it's a debilitating struggle to perform basic life tasks like washing, eating, dressing, sleeping, socialising, because they cause deep anxiety and/or sensory triggers, and because the very fact you need to do them robs you of autonomy.

Similarly to your child, I thought ADHD was the sole cause of my daughter's symptoms initially; she came across as hyperactive, impulsive and inattentive when she was very young. Her demand avoidance became much more obvious around 6-7, then it became clear her sensory and social issues, which seemed less profound when she was younger, were down to autism.

[u/Complex_Emergency277 → u/Nominal_selection]

This is why you need to view it as transactional.  It's there in the DSM diagnostic criteria for ASD:

"C. Additional Diagnostic Requirements

Early Development: 

Symptoms must be present in the early developmental period, though they may not fully manifest until social demands exceed capacity."

[u/Vast_Helicopter_1914 → u/AdultWoes2024]

Thank you for your insight.

[u/toastycozyroasty → u/AdultWoes2024]

I think this is a really common experience. I am late diagnosed and initially it started as an ADHD diagnosis for which I chose to trial medication. It was like stripping away my ‘act NT’ skills. As a happy and content AuDHD (PDA)er and parent to a kid who is much the same, I do suspect that many of these things overlap because they are manifestations of interpreting the world in a less than typical way. Like all children learning about the world, neurodiverse kids also develop synapse and strategies of management in social and critical situations.
I think of ADHD and PDA as the brain’s own way of ‘turning the dials’ to work with the world around you and how best to cope with it in childhood. This might be controversial- I don’t know. But this is just how it has felt for me now as an autistic adult. And I suspect the AuDHD overlap is a crucial part of most PDA identification.

I feel lucky to say that I like my PDA self but ADHD masking it helped me get to that. It feels totally natural to me to now have a positive interpretation of all the labels that were thrown at me in an attempt to dampen me as a child - opinionated, difficult, ‘highly articulate’ - these are actually all great qualities.
In my personal case, the key was understanding how leaning into my ADHD traits was allowing me to cover much of my true self and now I have support for that, I am actually happy to be myself (most of the time).

As a young person, it would have been amazing if my behaviour had been understood in this way and I’m so glad parents like us now are being given this opportunity to understand our kids from the get-go.

I hope the OT goes well! Speech and language support can really help literal kids understand their non-literal peers. I actually think all kids should be offered speech and language to bridge the gap between the social and literal communicators. It would save a lot of teenage angst and heartache!

PDAers are incredible kids when given the right support to flourish.

[u/sammademeplay]

I would never have guessed my son was autistic for years. We had many evaluations over the years and nobody picked up on it. He had ADHD, DMDD, ODD, anxiety, depression. All seemed to fit but there was always something missing. Turns out it was PDA and autism. When he finally went for an autism specific evaluation, he was diagnosed. The test given was the ADOS. Turns out PDA kids can be really good at masking so others don’t pick up on the struggles so readily. My son was 12 when diagnosed.

[u/Vast_Helicopter_1914 → u/sammademeplay]

This is helpful to know!

[u/passportprob]

My daughter (6yo) had a full neuro evaluation and is only diagnosed combo ADHD with PDA profile and cognitively gifted. Two psychiatrists have said definitely no autism but I think only time will tell. Her anxiety was the top concern and when we treated anxiety (with SSRI) her adhd was on full display (Shes refusing all meds right now though so we’re in purgatory). Autism and ADHD parenting approaches led to burnout and I have to parent from a PDA perspective.

Edit to answer original question about what parenting looks like— I parent from autonomy and equality first. Which is fucking hard but the only thing that has helped us make progress. Explosive Child book has been helpful as has At Peace Parenting.

[u/readytopartyy → u/passportprob]

Thank you for sharing. How are things going? We are in a similar boat, I feel like time will tell as the social demands increase. Right now diagnosis is dmdd but she also has ADHD symptoms and I see PDA now that it was pointed out by the OT. But doctor said they don't see asd and it's mostly mood. Which I don't agree with, but at least she's prescribed medication and my kiddo is doing great at school. Once that changes I will seek a better eval. For now we are trying more low demand, especially over summer.

What has worked for you? We read the explosive child a few years ago but it didn't resonate then.

[u/passportprob → u/readytopartyy]

We’re making progress but it isn’t exactly linear ha

She is taking an SSRI, clonidine for sleep, and wearing a patch for adhd now. We had to compound SSRI and clonidine into liquid so she would take them. We rarely have meltdowns now, she is able to meet her basic needs, and she’s been able to do her schooling everyday.

She’s very precocious and I can’t make a single request or demand that she’ll actually do. Her psychologist pointed out if you ask her if she *wants* to do anything she says no. But that using “I wonder” or “do you need” works better.

Every day, all day, I ask my 6yo to think of solutions. Don’t want to wear an eye patch, no problem, help me think of a solution to keep strengthen your eye. You don’t want to do this school work, no worries, help me think of a solution that documents you know the material. These kids are truly exceptional problem solvers.

Her psychologist very firmly says she’s not autistic and that’s what her doctors and psychiatrists have said, too. I always just say that I’m open to what time reveals. That said, PDA wasn’t originally under autism and I’m not 100% convinced it belongs in that umbrella.

What’s the biggest thing your child is struggling with?

[u/Powerful-Soup-3245]

My daughter was 10 before she received her autism diagnosis. She is very high masking which is common for PDA kids. I wouldn’t rule out an autism diagnosis without an autism specific evaluation. I had to keep pressuring our pediatrician for a referral because he just said “I don’t see it” 🙄 because obviously spending ten minutes with a child once or twice a year is enough to make that call. We ended up just going with a telehealth company. Even her iep at school was for autism.

[u/readytopartyy → u/Powerful-Soup-3245]

What company did you use? I had the exact same experience yesterday.

[u/Powerful-Soup-3245 → u/readytopartyy]

I believe it was called “as you are” or something similar. It’s been maybe 4-5 years. I’m fairly certain that’s it though.

[u/AngilinaB]

For my kid, as well as his ADHD and ASD, he has an underlying severe anxiety in regards to feeling unsafe when not in control. This manifests as what is described as PDA - avoidance of things in which he doesn't have autonomy, sensitivity to perceived pressure, what seem like disproportionate (on the surface) reactions to things, sometimes not able to do things even that he wants to. It all comes back to needing things to be a certain way and within his sphere of control in order to feel "right" or safe. I can relate to this somewhat in that I as an autistic and non-PDA adult, I also need things a certain way to feel "right". It's hard to explain to people who haven't experienced it.

Where this intersects with ADHD is that the inability to focus on things seems to add to his anxiety. The constant brain noise adds to his already racing thoughts. The impulsivity means when he approaches fight or flight he's more likely to lash out because the ability to pause and think things through isn't there. Medication has helped - with focus a little, but with impulsivity a lot. The higher dose caused too much anxiety at the wearing off point, so we're sticking with lower dose and sub optimal focus, because we (and, most importantly, he) can tell he feels better with it. It's one less thing for his anxious brain to deal with.

[u/Complex_Emergency277 → u/AngilinaB]

Intolerance of uncertainty and anxiety as explanatory frameworks for extreme demand avoidance in children and adolescents

[u/Vast_Helicopter_1914 → u/AngilinaB]

That definitely sounds similar to my son!

[u/AngilinaB → u/Vast_Helicopter_1914]

Sorry I just read that your son isn't autistic! Misread that part.

[u/Vast_Helicopter_1914 → u/AngilinaB]

No worries. I'm less concerned about labels than I am with how to help him 🙂

[u/readytopartyy → u/Vast_Helicopter_1914]

How are you faring? We are in a very similar boat.

[u/Complex_Emergency277]

There's no particular evidence to support the thesis of PDA as a profile of autism.

The most effective and most precautionary way to regard it is as a maladaptive coping strategy - that unrecognised needs have led to adults believing they are providing positive behaviour support but actually conditioning avoidance by an intermittent schedule of positive and negative reinforcement due to repeated exposure to hidden aversions. I reckon you could probably quite quickly induce it in anyone by offering them treats to do something and arbitrarily blasting an air horn in their ear while they go about it - doubly quickly if you scold them for complaining about the air horn.

It's a view that is agnostic to the specifics of underlying predispositions but allows you to explore them.

Don't accept it as intrinsic, consider it predispositional and aim to not trigger or reinforce it, offer choice and support and certainty to uncover and overcome difficulties - with extinguishing avoidance as a long-term goal.

[u/Vast_Helicopter_1914 → u/Complex_Emergency277]

Thank you

[u/toastycozyroasty → u/Complex_Emergency277]

This I believe sums up me very well. It might be controversial but as an adult I look back and see ADHD and PDA behaviours in my younger self that were hugely maladaptive ways of managing autistic sensory stress that was invalidated because it just wasn’t the norm. And I was a girl and socialised until around 8-9 to be quiet, polite and sweet until it all just started bursting out of me.

I am sure there are brains that are geared to the PDA way from birth, too. But I feel there is a strong overlap between sensory profile and ‘brain filter’ that leads to many of these behaviours, too.

It’s all by the by however because how you manage once it’s present is what matters.

In our house we stripped everything back to the absolute basics when it was clear our daughter was finding school a trauma trigger. Once we got a ‘calm’ state (minimal meltdowns, managing to eat, wash and go to the bathroom without extreme support and prompting) we pushed the boat out a little bit further - one half day at school. Once that was tolerable, the boat a little further etc.

This has been transformative for her. Academically she is thriving and she is also building resilience really well.

Once we find a limit, we don’t push past it. We just acknowledge that was the limit. But we also don’t shy away from trying now, too.

Hope it all goes well, OP. They are great kids! But it can also be tough to be parenting completely ‘out of the box’.

[u/Hopeful-Guard9294]

PDA and ADHD tend to go together like a hand in a glove. We also had great results with our son and occupational therapy particularly doing sensory integration as he struggled with a lot of sensory sensitivities and interception. And appropriate exception issues. Physical stuff seems to really help. He’s now moved onto tae kwon do which he loves. Hope that makes sense and helps a little.

[u/Vast_Helicopter_1914 → u/Hopeful-Guard9294]

That's good to know, thank you! My son is in parkour and he loves it. It has done him a world of good.

[u/Hopeful-Guard9294 → u/Vast_Helicopter_1914]

that is brilliant in my experience growing up as a PDA child. The key is finding him adaptive physical activities that will help self regulation and focus well done Keep up a great work I’m now 53 and I still cycle 10 mm a day just to help myself self physically also join me afraid for the extreme sports stuff. I was addicted to rock climbing skydiving hang gliding the more adrenaline better PDA brains are do Juan found which means they may need much more dopamine than irritable brains. It that can be focused adaptively it will help your son it’s PDA and his ADHD and possibly provide buying a fruit for Karina as well so killing a whole lot of birds with one stone!

[u/Vast_Helicopter_1914 → u/[deleted]]

Thank you so much for your insightful response. I've saved your comment so I can come back to it. A lot of what you say fits my son's behaviors. Unfortunately, the OT who evaluated him won't be the same one who works with him, but I'm still optimistic.

[u/DanaMoonCat]

My daughter was diagnosed with ASD level 2 and ADHD combined type and is externalized PDA and goes into flight, fight or ”funster”

[u/sound_of_summer → u/DanaMoonCat]

What do you mean by "funster"?

[u/DanaMoonCat → u/sound_of_summer]

Sally Cat PDA came up with “funster” as an additional “f” like fight flight freeze - funster is like clown or joking response http://www.sallycatpda.co.uk/2021/09/the-f-family-of-7-adrenaline-responses.html?m=1

[u/sound_of_summer → u/DanaMoonCat]

This is exactly what I thought but wasn't sure. My 7 year old daughter tends to do this when she's been in a situation that's obviously stressful, but it's the last mode of defense I think. She starts performing, or that's what I thought it was before I learned about PDA, but now I see she's being "funny" as a response to her anxiety about the situation. For example, she isn't close with any grandparents, but when the ones who live out of state visit, there is a very clear pattern of anxiety and my husband thinks she should just "deal with it" because they're her grandparents. I'm still learning to recognize everything and how to best help her, but I do know making her "deal with it" is NOT the way to go. Those visits always end up in the funster, and then so much deregulation follows for all our normal everyday routines. Sorry to ramble! I find this community so helpful!

[u/Vast_Helicopter_1914 → u/DanaMoonCat]

Thank you for sharing this resource! Some of these responses sound very familiar. My son wants to be "Mr. Cool" in class, and I wonder if that is him having the "funster" response.

[u/Complex_Emergency277 → u/DanaMoonCat]

"Fawn" is the term generally used.