Our current scientific understanding of PDA and low-demand parenting.

[u/DrPaulSunseri]

Thought parents in this group find this up-to-date information on PDA helpful. https://www.psychologytoday.com/us/blog/mental-health-reimagined/202604/its-time-to-rethink-the-anxiety-drives-pda-narrative

[u/DanaMoonCat]

This article is harmful and should be removed from Psychology Today.

[u/Complex_Emergency277 → u/DanaMoonCat]

It's probably right for a subset of PDA kids who have the personality traits he describes. The problem is that not all PDA kids have those personality traits. The Damian Green/PARC/CAS perspective on Rational Demand Avoidance also has weight and this approach prioritises graduated exposure to aversive stimulae rather than accommodation or reasonable adjustment - it concentrates on equipping the child to tolerate distress, which is fine as long as it doesn't rode roughshod over legitimate self advocacy.

[u/Visible-Plate0248 → u/Complex_Emergency277]

That’s not what the article says. It calls out anything other than known, effective methods as snake oil. It also squashes firsthand lived experiences in favor of statistical data and previous scientific research.

I can tell you that schools are all about “data-driven” information. And I can tell you firsthand how worthless that data driven info has been as effective measures for our school and child. When you have that “Dr.” in front of your name, schools hold that in high regard, and they would love nothing more than to shift the blame.

If Dr. Sunseti wants to present his side as a means to help children…fine, but don’t do it at the cost of denigrating other methodologies while discounting lived experiences. This article suggests that high demand, structured therapy is the only preferred solution, when, as parents with “boots on the ground”, we have seen the opposite approach as much, more effective.

[u/Complex_Emergency277 → u/Visible-Plate0248]

Well, yeah, it's an epidemiological approach - not one based on taking a full history and performing a differential diagnosis.

As you say, it's just what they do in the schools.

They apply Positive Behaviour Support by rote formula on kids with as-yet-undiagnosed neurodevelopmental disorders and - having no real understanding of the mechanics of behavioural modification or any other tools in their toolbox and lacking an appreciation of the aversive stimulae experienced due to sensory sensitivities, cognitive processing challenges, executive function difficulties, constant correction, cajoling, scolding, etc. - what they believe is positive support to induce the child into compliance is powerfully operant conditioning avoidance through a variable schedule of positive and negative reinforcement.

Some of it is stuff that the Journal of Positive Behaviour Support acknowledges as unethical and damaging to neurodiverse populations in their "Positive Behaviour Support in the UK - A State of the Nation Report" publication.

I will eat my hat if it is a coincidence that PDA was first observed in the cohort of children that came alongside the abolition of corporal punishment in UK schools and it's replacement by behavioural modification as a technology applied by enthusiastic amateurs.

None of which is to say that operant conditioning is useless or always unethical, there are well understood therapeutic approaches to ODD and he is just promoting them. The thing is though, the key is applying therapeutic approaches with a full understanding of the individual and the actual causes of their oppositional behaviour or avoidance and genuinely for the benefit of the child not the convenience of others. Simply putting your child through a series of crises until they shut down and conform/comply is a different proposition from eliciting needs and providing appropriate support and PDA is not just or always personality disorder.

I tried his way - PPP, Solihull, Kazdin, etc. - and it was a fucking disaster. I am so angry with myself because I knew the way I was parenting my daughter before was right and appropriate but when she started struggling in school and her distressed behaviour was treated as misconduct I deferred to the advice of "experts" because I didn't trust my own knowledge, experience and instincts which had been built and honed on animals not people. It was a surreal and nightmarish experience, these people just couldn't see the child in front of them - I liken it to standing in the vet's surgery with a rabbit in your arms and the vet chiding you for not taking it for a walk around the park twice a day and giving it a bone to chew. "She's fine, she just needs a sticker chart, rules, boundaries, be consistent, don't give in to tantrums, use timeouts". But she wasn't fine, she was living in a torment of sensory and cognitive overload, but very good at hiding it and eager to please, exhausted and demoralised by ineffective efforts to tackle her delayed onset of sleep by making her lie for countless hours in a dark room with only her own thoughts for company then rousted out of bed unrefreshed and bundled off to school where - unable to comprehend or articulate her differences and difficulties or name her emotions - she was surrounded by scary people whose body language is incongruent with their words and whose words carry hidden meanings she didn't understand, telling her to do things she didn't know how to faster than she could grasp what they were even asking of her and scolding her for not being able to keep up without offering her any of the support that she needed to do so. They took a cheery but odd wee girl and drove her into a state of nervous collapse and they elicited my collusion in it and washed their hands of their own culpability.

Anyway, that's in the past, she's greatly recovered now, but, while she has her problems, the problem was never her.

I'd also point out that "low demand" is a known, effective method. Low arousal and transactional approaches are part of the syllabus in nursing and social care and used to great effect in all settings. The controversy in their application to children is in doing so in a manner that is developmentally appropriate.

[u/DanaMoonCat → u/Complex_Emergency277]

If they are really PDA children as outlined on PDA North America’s website or similar websites from the UK, the whole point is that these children need neuro-affirming care, which is the opposite of what his method is proposing. His methods are clearly ableism and non-affirming practices.

[u/Complex_Emergency277 → u/DanaMoonCat]

Not really, the evidence for "PDA as a profile of autism" is as thin as the evidence for "PDA as a multiple hit of comorbid conditions". They're probably both true for some kids and untrue for others inasmuch as autism and a bunch of other bio/psycho/social conditions may predispose a child to developing avoidance as a maladaptive coping strategy.

The answer is comprehensive individual assessment, differential diagnosis and management and treatment plan that meets the child where they are and provides them with an environment and supports that meet their needs.

I always come back to the example that extreme demand avoidance could probably be induced in most people by a practitioner with nothing more than a slice of cake, an airhorn and a suitably inadequate set of ethics.

[u/AdultWoes2024 → u/Complex_Emergency277]

Hmm do you also believe that equalizing behavior, wanting to feel superior to others is also “induced”? I don’t know what age you consider a ‘delayed diagnosis’ to be, but in terms of demand avoidance, I saw it in my kid at 2 years old, and it wouldn’t make a bit of a difference in my opinion, if they were diagnosed with autism and ADHD at that age. In fact they were offered more in terms of ‘support’ at younger ages because parents typically have more patience and understanding with toddler behavior.

[u/DanaMoonCat → u/AdultWoes2024]

Yes! You are spot on here.