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Guest post: Pathological demand avoidance syndrome - "my daughter is not naughty"

51 replies

MumsnetGuestPosts · 17/03/2015 14:25

My daughter was a very happy and contented baby - she fed well, slept for hours and rarely cried. At the age of eighteen months, however, this all changed. She began to spit, bite and have extreme strops over minor issues like getting dressed and getting into her car seat or push chair. We put it down to the terrible twos, but as she got older the problem didn't go away.

When she started school we breathed a huge sigh of relief, believing this could be a pivotal moment in her development. We hoped that we would begin to see the end of her challenging behaviour - how wrong we were. Within a few months she was attacking staff and children alike, completely trashing the classroom, and her behaviour was becoming increasingly unmanageable.

It was like she needed to have complete control at all times over her environment and everyone in it. Without this, her behaviour would spiral, and she'd have meltdowns that could last for hours.

Despite the use of traditional behaviour management - rewards, consequences, praising good behaviour and duly ignoring bad behaviour - things continued to rapidly deteriorate. Mollie was excluded from school on many occasions, banned from taking part in school plays, placed on a part-time timetable and was unable to go on school trips without either myself or my husband to support her.

At only six years of age, she started completely refusing to go to school, after many months of arriving at school later and later due to the extreme panic that going provoked in her. It was eventually agreed by everyone involved that we should remove Mollie from school, and seek a more suitable and specialised placement. Mollie's precarious extremes of behaviour meant that life at home was hell on earth, and my own mental health and emotional wellbeing were crushed.

At around the same time, Mollie was diagnosed with Asperger's. However, I didn't feel that this quite fitted. The recommended strategies for a child with Asperger's did not bring us any positive changes in behaviour, either. Then, at the age of seven, she was diagnosed with pathological demand avoidance syndrome. As the name suggests, the overriding diagnostic feature for individuals with PDA is an anxiety-driven need to avoid the demands of everyday life to an obsessional level.

For the next few years I spent every day experiencing physical and verbal abuse from my daughter and walking on eggshells in order to try to avoid as many explosive outbursts as possible. The flexibility required by parents living with a child with PDA is astounding. During this time, my confidence was completely broken down - I was, for all intents and purposes, living in an abusive relationship with my daughter. Five years on, the emotional scars and long term effects of those years still affect me.

This emotional strain came from more than just my daughter - because PDA is a hidden disability, parents are often unfairly blamed and judged for their child's difficulties. There is a lack of awareness and acceptance among many professional circles, family, friends and the general public. Of course, this continual battle for acceptance - trying to get professionals across health, social services and education to take you seriously - is also a huge factor in the erosion of parents' mental health.

My daughter is not naughty and never was. However, she was severely misjudged and damaged by the wrong approaches from many in her early years, including myself. Looking back I feel truly awful for the way that I and others tried to change Mollie. I have had to let that guilt go, though, in the knowledge that we were simply doing our best, with no real understanding of what was driving her behaviour.

Using PDA strategies and providing Mollie with the correct environment did eventually begin to pay dividends. However this was a slow process - nothing happened overnight. Receiving a diagnosis was so very important for all of us, though, because it signposted us to the correct support.

Mollie and I now have a very close and loving relationship that is based on mutual respect, and we are also developing a friendship. This has only been possible by understanding PDA and by allowing her the freedom to grow and to learn within an environment that she feels is safe, comforting and strong. We no longer experience the meltdowns or violent outbursts, and our lives and hers are now worth living. This is why awareness and acceptance of this complex condition is so very, very important.

I often wonder how much earlier this could have been achieved if only we had received an earlier diagnosis, but I try not to dwell on the past. I can only hope that other children are saved from this by sharing my story, so that Mollie's experiences have a purpose and can be used for the greater good.

OP posts:
Upandatem · 17/03/2015 20:55

This reply has been deleted

Message withdrawn at poster's request.

InkleWinkle · 17/03/2015 21:24

I wonder if school is the right place for us to approach first for help?
Do you think the GP would be better?

Ineedmorepatience · 17/03/2015 22:48

Hmm, pdamum funny you should say that about avoiding demands over things that they like! Dd3 actually does that a lot. I have always put it down to her inability to compromise and her need to be in control and I habe actually considered Pda but didnt think she really met the criteria but maybe she has a foot in both camps and jumps from one to the other depending on her anxiety levels!

Worth thinking about again !

courgettesoup · 18/03/2015 00:43

Thank you for sharing your experiences. I have been interested in PDA for a little while - it is the only thing I have ever read about that seems to resonate with my experience of my lovely son (5). And some days I think he's fine and we're just tired and inept. Not sure where to go next really - he's doing OK so far at school, so they are not able to help with any sort of referral. But he has a compulsive need to control situations at home and consistently resists basic things like teeth cleaning and conventional bedtime routines (we have another child for whom these things are very well established routines - so it's not that we don't know how to do this). He has furious meltdowns and demands I do things (eg tries to make me go and wash my hands in another sink). His teacher has a simple and innocuous morning ritual which he refused to comply with on sight, and has maintained his stance with utter consistency for nearly two terms now. We are lucky - he's sociable, creative, has a really wide circle of friends and generally enjoys going to school. I don't know whether we should try and explore this formally with someone?

BellMcEnd · 18/03/2015 12:30

Thank you so much for writing this. I have no experience of PDA but I have found your post so informative. Mollie's jewellery is stunning!

rachelgreene24 · 18/03/2015 13:54

This is so helpful for the Autism handling.

PDAMUM · 18/03/2015 17:34

no problem dishwasherdogs, getting a diagnosis is very hard through the NHS and is greatly dependant on the flexibility and upto date knowledge of your local health team. However you can access a private diagnosis or request funding from your local Clinical Commissioning Group via your GP to one of these clinicians. The ENC are the most experienced and the lorna wing diagnostic centre are also now accepting private and funded referrals for PDA assessments. www.pdaresource.com/pages/professionals.html and www.autism.org.uk/our-services/diagnosing-complex-needs.aspx

PDAMUM · 18/03/2015 17:43

Thank you for all of your lovely and supportive comments. Inklewinkle the best place to start is to build yourself a casefile on your child and research pda to the max. Then approach your gp and start the process off. There are also lots of support groups that help parents with advice during this process. I help to admin the pda global group. There is also info about pursuing a diagnosis on my blog and how to try to go about it which you may find useful. The blog is understandingpda.com and the post can be found by scrolling through diagnostic issues. If you can't find it email me and I will send you a direct link. My email is on the blog also x

PDAMUM · 18/03/2015 17:46

Ineedmorepatience, yes some kids have what is termed as an overlapping presentation as in they can have a mix of PDA and typical ASC traits. This doesn't mean that they have two distinct diagnoses of two different conditions but more that they have a complex overlapping presentation or as you put it a foot in both camps. With PDA avoiding doing things that are pleasurable is simply down to the instinctive need to avoid anything that is suggested or demanded by others. Even something fun becomes a demand to be avoided when it has being suggested by someone else as their control has being removed. Hope this helps x

PDAMUM · 18/03/2015 17:51

Courgettesoup your son deff sounds very PDA in his behaviours. I would definitely investigate this further and pursue the possibility. By having early understanding, strategies and intervention you can avoid the possibility of the extremes that Mollie went through. She too was sociable at five but she was a recluse at eight, it can be a dramatic downslide. There is loads of info in my blog, lots of facebook support groups for PDA and three books published on PDA at this moment in time which may be worth investing in.

MrsNutella · 18/03/2015 19:46

PDAmum I read this post because I have never heard of PDA and it is really interesting. I just wanted to say that you write so eloquently and you sound like an amazing Mum to have fought so hard for your daughter. Thats all, just well done for being genuinely fabulous and thank you for being prepared to write about your experiencea here on MN. Flowers

DishwasherDogs · 18/03/2015 20:41

Thank you PDAMUM, that's really helpful :)

courgettesoup · 18/03/2015 22:10

Thank you PDAmum Flowers.

Really good to be able to talk about this - I feel so torn and worn down. I'm nervous of labels, but also want him to be understood, especially if there is an underlying condition.

We had a horrible weekend a little while ago where two sets of relatives came to stay on successive nights and neither held back in their criticisms of his behaviour, or of our parenting. We could've really done with a bit of solidarity. But boy were we all judged. Sad.

Iamatotalandutteridiot · 19/03/2015 07:01

I believe my son has PDA (his DX is ASD)

We home ed because of sky rocketing anxiety in school. Even aged 4, he walked out of school and 6 times at nursery he got past their security to 'escape'.

I was also worried about the effect of constantly being told he was naughty / useless would have on his self esteem.

Nice to see PDA get some coverage.

PDAMUM · 19/03/2015 09:28

Thank you for your lovely words MrsNutella. Courgettesoup, being wary of labels is a dilemma that many parents wrestle with. However for me a label is simply a sign post that leads you quickly and efficiently to the correct support and understanding for you child. I see it as a positive thing rather than a negative one. In my house I am the only one without a label and so in this home I am the odd one out and boy to they all let me know it at times. In this house ASC is the norm and I am the atypical one if that makes sense. Hubbie, son and daughter are all rather proud of their ASC label and I am the one that is weird. Mollie speaks quite openly about her PDA and the fact that she is on the spectrum. Everything that I write and share about her is done with her full permission and he is very proud to be a pioneer in her own way in this field. I guess what I'm trying to say is that a label can be a positive thing if the person with that label is proud of who they are and this comes with awareness and acceptance that it is ok to be simply who you were born to be. As for others who judge, I know how hard it is, but just try to ignore them. I often take out my carefully cultivate rhino skin from the cupboard when I need protection. It has taken years for me to get it strong enough to protect me but it generally does a good job now. Also for those who continued to make me feel like poo I simply removed them from my life, I really didn't have the time or energy for them. Yes Iamatotalandutteridiot, some of these names are cracking me up ladies, a great deal of emotional damage can be caused to our kids if they are struggling in school and being labelled naughty as this is not a helpful label to have. I have never looked back since home education Moll but accept that this may not be either suitable of practical for everyone.

Ineedmorepatience · 19/03/2015 13:48

Thanks PDAMUM It is all about control isnt it! Being in control makes the world safe! Well safe ish!!

Ineedmorepatience · 19/03/2015 13:52

We also talk about ASD/aspergers all the time in our house and celebrate our differentness (I believe I am also on the spectrum as is my eldest Dd).

We are seriously considering HE from September!

ZingDramaQueenOfSheeba · 19/03/2015 14:47

this is very interesting. thanks for posting

Cassimin · 19/03/2015 18:32

My little one just been diagnosed ASD and ADHD. From what I've read I think it's PDA. The lack of speech then suddenly catching up, the comfort in role play, the constant refusal to follow instructions all ring true. A child care worker said that my little one was highly anxious and once I got my head around that life was a lot easier. Eg. Being told to sit on the mat in school terrified him. He knew he couldn't sit still, he would be close to others. So this made him so anxious he wouldn't do it. He was seen as being naughty. In reality he was just scared. Everyday things that we take in our stride make him anxious. He says he feels like he's got fizzy lemonade in his tummySad

Iamatotalandutteridiot · 20/03/2015 03:13

ineedmorepatience we home ed and it the best thing we ever did!

DSs confidence and happiness sky rocketed :-)

PDAMUM · 20/03/2015 10:55

For more information about PDA, especially if you feel that it may apply to your child, please check out these fab resources which a jam packed with useful information. www.pdasociety.org.uk/what-is-PDA/diagnostic-criteria and www.pdaresource.com/
I hope that you find them useful and thank you so much for all of the lovely, positive and non judgmental comments that have been shared on this thread (flowers)

PDAMUM · 20/03/2015 10:56

ha ha that should have been the flower image, looks like I need to learn the smiley lingo xxx

stephc007 · 20/03/2015 17:16

Hi all, I just want to say thank you to everyone for all the wonderful comments - so often parents of children with PDA can feel like they are being judged, and especially if you see all the comments coming back on social media after programmes such as My Violent Child, it just adds even more stress to what is an unusually high level of stress in our day-to-day lives. Our DD2 is diagnosed ASD but we strongly believe she has PDA. Our county won't diagnose PDA yet, but we are fighting for more understanding and acceptance and support generally. I feel that there are likely to be many parents out there who have been given a diagnosis of ASD when actually PDA and more importantly, PDA strategies, would be a better fit. There will also be many who have no diagnosis because their children are so good at hiding it at school. Talk to as many people as you can about it! As PDAMUM says, these are not naughty children. It is possible to tell the difference!

And passmethecrisps, the best bit of the whole thread to me is that you've said you could see a child whose diagnosis could switch from ODD to PDA. I hope you'll be able to see just by using the different strategies, that that child's life improves Smile

houghtonk76 · 21/03/2015 07:32

Jane - very interesting reading about PDA, as I unaware of the condition previously, & your experience of supporting your daughter; particularly as I worked as a careers adviser for 12 years (including at a school with an autistic base), my husband is a primary teacher with a vast amount of SEN TA experience, his parents were teachers & my brother-in-law 39 years old with Aspergers which was just officially diagnosed on Thursday (in the 70s, 80s & 90s there was less awareness of ASD than now). Our own ds is due in 10 days and naturally we are hoping that he doesn't have to contend with ASD but are prepared for the fact that if so, family support is the best way to help, guide & encourage him as my in-laws are a fantastic example of patiently helping him to engage with the wider world. Thank you for sharing your story & wishing you, Mollie & your husband continued sucess acting as a similarly brilliant example of how best to support a child with additinal needs.

PDAMUM · 23/03/2015 20:11

Thank you for your supportive and very informative comments stephc007. houghtonk76 it is of no surprise to me, despite your and your husbands background, that PDA is something that you had not heard of before. Unfortunately until this condition finds its way into diagnostic manuals then awareness will sadly remain limited. Unfortunately it can take years of research to be undertaken and quantified before a new condition can be accepted into a diagnostic manual. Until then many of these children will have perhaps being wrongly labelled with a list of co morbid issues e.g. Atypical Autism, PDD NOS combined with an assortment of co morbid conditions like ADHD, ODD and childhood bi polar to name but a few, at worst no diagnosis is given at all and these children are simply labelled naughty and the parents are labelled as part of the problem. The problem with this is that none of these conditions or mix of conditions accurately describe the child or point others to the correct and most helpful strategies. Even now diagnosis is very much a post code lottery and much awareness re professionals is coming directly from parents who have fought for diagnosis and awareness of this condition. Hopefully, one day, this will change and all professionals will be aware of the pda profile and will be able to assist these individuals accordingly. So pleased that you have found my guest post helpful and informative, we are much in the same position as parents were several years ago if their child had a profile that fitted Asperger's Syndrome. Back then there was little awareness and this was a condition that few knew about or understood. I just hope that within the next decade or so that the pda profile is as recognisable and as understood as that of Asperger's. Hubbie was only diagnosed at the age of 41 and so lack of awareness back in the 70's and 80's left him high and dry but thankfully that may not be the case for today's generation of kids with ASC and in the future we can only hope that those who fit the pda profile are equally as recognised and catered for xxx

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