Ep. 184: Could Pathological Demand Avoidance Clarify My Child’s Challenges? with Dr. Casey Ehrlich
May 7, 2024
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Dr. Casey Ehrlich delves into Pathological Demand Avoidance (PDA) as a nervous system disability, offering insights on its root causes and misunderstood nature. She shares practical strategies for parents to navigate PDA behaviors and connect with their child, emphasizing the need for tailored support and understanding of neuroception-driven demand avoidance.
PDA is a nervous system disability tied to autonomy and equality perceptions, impacting basic needs like hygiene and safety.
Understanding autonomy and equality as key triggers for PDA behaviors can guide effective strategies in accommodating demand-avoidant children.
Deep dives
Understanding Pathological Demand Avoidance (PDA)
Pathological Demand Avoidance (PDA) syndrome is a complex neurodevelopmental condition that manifests as extreme avoidance of everyday tasks due to feeling overwhelmed by demands perceived as threats to autonomy. It is often connected to the survival drive for autonomy and equality, leading to disabling behaviors affecting basic needs like hygiene, eating, and safety. PDA can present differently across children, complicating recognition in research and clinical settings.
Root Causes and Observations of PDA
PDA is viewed as a nervous system disability triggered by a perception of lack of autonomy and equality, leading to equalizing and controlling behaviors. Parents and clinicians may initially explore sensory, social communication, and executive functioning as sources of demand avoidance before realizing the impact of autonomy and equality perceptions. Observing equalizing behaviors and understanding the role of autonomy and equality lens can provide insights into children's paradoxical actions.
Supporting Demand-Avoidant Children
Accommodating demand-avoidant children with autonomy and equality becomes crucial to mitigate nervous system responses. Strategies like using declarative language, humor, novelty, and sensory experiences can create safe environments. Implementing autonomy through unconventional methods, such as allowing freedom in daily tasks, lowering demands, and diffusing situations, can help reduce nervous system activation and foster trust.
Challenges in Recognizing and Addressing PDA
The overlap between PDA and other disorders often leads to misconceptions and delayed recognition, exacerbated by PDA's absence in the diagnostic manual. Research efforts are underway to prioritize PDA studies. Families and professionals face a lack of support due to limited awareness and resources, underscoring the need for greater understanding and tailored interventions to empower individuals with PDA.
Some parents may describe their child as very strong-willed. That child may show an extreme avoidance of everyday demands, expectations, and requests. But what if the behaviors are not an indication of strong will, but rather occur because a child feels overwhelmed by demands and perceives them as threats to their autonomy and self-control? Are there specific strategies that would be helpful when raising a demand-avoidant child or teen?
Today, we’re going to be talking about Pathological Demand Avoidance with Dr. Casey Ehrlich. She is the CEO and founder of At Peace Parents where she specializes in teaching parents and therapists practical skills in the home or clinical setting to accommodate neuroception-driven demand avoidance and nervous system differences through creative techniques.
Show Notes:
[3:10] - Pathological Demand Avoidance (PDA) is considered a nervous system disability. Dr. Ehrlich explains why this is and shares alternative names for it.
[5:41] - Many parents and clinicians have found that the strategies they have tried have not worked or made things worse.
[7:39] - Dr. Ehrlich describes a recent situation with her son that demonstrates sudden nervous system activation in PDA.
[9:33] - We need to understand the root cause of behaviors that are interfering with your ability to connect with your child.
[10:57] - PDA may show up as a regression or can surround a primary need.
[12:58] - PDA is often misunderstood.
[15:04] - With a background as a social scientist, Dr. Ehrlich explains some of the research about PDA and why many children and teens are not correctly identified.
[17:45] - Accommodations include autonomy, equality, trauma-informed play, nervous system signals of safety, communication, lowering demands, humor, novelty, and more.
[21:38] - PDA is happening on a subconscious level. It isn’t about emotions.
[23:37] - It can be confusing as a child gets older because they do begin using social strategies and we may not see escalation as nervous system dysregulation.
[27:46] - Pausing to de-escalate is crucial.
[29:24] - Is PDA only seen in people with autism?
[30:42] - Connections can only be made when PDAers feel a sense of safety.
[33:21] - Awareness is the first step.
[35:55] - Dr. Ehrlich learned more about PDA as a mother than a clinician.
[40:41] - Dr. Ehrlich hosted a podcast called PDA Parents where she talks about her experiences across eight episodes. She also hosts the At Peace Parents Podcast.
About Our Guest:
Casey Ehrlich, Ph.D. (she/her) is a social scientist, parent coach, and educator, and the CEO and founder of At Peace Parents. Casey brings 15 years of work experience and expertise in social science methodology to help parents and therapists understand how to connect with and accommodate PDA Autistic children. She is currently working on empirical research with the University of Michigan Medical School on Pathological Demand Avoidance in children and teens.
The Diverse Thinking Different Learning podcast is intended for informational purposes only and is not a substitute for medical or legal advice, diagnosis, or treatment. Additionally, the views and opinions expressed by the host and guests are not considered treatment and do not necessarily reflect those of ChildNEXUS, Inc. or the host, Dr. Karen Wilson.
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