Pathological Demand Avoidance Syndrome - Advice?

[BorstalBoy]

Hello,

A colleague of mine is working with a client who has been diagnosed with Pathological Demand Avoidance Syndrome which is related to, but very different from, ASD. This client displays challenging behaviour that can be quite violent and, unlike the lashing out seen in Autism, far more intentional and vindictive. The client has been known to carry out sustained scratching and biting attacks that can last for an hour or longer as well as making threats, etc. It sems that people with PDA do have theory of mind but lack empathy - a dangerous combination it seems to me.

I am currently researching on the internet but would be very interested to hear if anyone has any experience of working with similar individuals and whether they would have any advice, dos, don'ts or anything that might help. My colleague is understandably finding this client very difficult and draining to work with.

Thanks.

[nikkij]

Hello,

I have worked with 2 girls who were diagnosed with Pathological Demand Avoidance (PDA). The reason this disorder is similar to Autism and Aspergers is because it fits into the category of a Pervassive Developmental Disorder. This means a person has significant deficits in many areas of development, such as social interaction, communication and imagination. In each of the categories the deficits can be different, hense why we see differnt types of disorders...so on a large scale the disorders can be grouped as being similar, though when the disorders are broken down, they can be put into sub-groups which are actually quite different from each other...if that makes sense?

People with PDA can appear quite sociable, but apparently they lack a sense of social identity, pride and shame. One of the biggest 'traits' is that individuals who fit into this category will 'go out of their way' to avoid 'ordinary' / everyday tasks. The two girls I worked with would spend 2 hours crying, kicking, shouting etc rather than wash their plates!

Some inidivuals may seem like the perfect 'role models' in one setting, yet in another seem to have 'over the top tantrums'. The individual may be working exceptionally hard in one setting, but then needs to release all that frustration that they were really feeling in the next setting. Therefore teachers may not see the child's difficulties and they may not see any of the behaviours that are seen later at home.

Of the individual you were asking about are there certain requests that are more likely to increase his behaviours? How is he asked to do something, or to stop doing something? Does he have a routine or use a timetable of some sort so that he can determine what will happen next and what is expected of him? Is there a particular time of the day you are more likely to see behaviours? How does he communicate? Are there any early warning signs that things will esculate?

[BorstalBoy]

Hi Nikki,

Thank you for your reply, sorry it's been a while since I could get near a computer.

The client in question is actually an adult in their mid-thirties. Understanding routines and activities isn't really a problem. The service user is quite high functioning and intelligent but does have learning difficulties. This means that the violent behaviour is still relatively unsophisticated although this individual is very aware of what inflicts the most pain and will sometimes state the intention to hurt before carrying out attacks. Behaviour does often vary but seems to a large extent to be dependent on which staff members are on shift. Certain staff members are tolerated or respected, others not. I am currently trying o find out what works for those individuals and whether there are any patterns.

I hope this helps. There appears to be very little research or literature on adults with PDA, hence this appeal! Good luck with the people you work with.

Kind regards

[parker]

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