Episode 11: Exploring Pathological Demand Avoidance

Chris welcomes Dr. Neal Christensen, a licensed psychologist who has been working with neurodivergent youth with a focus in Outdoor Behavioral Healthcare for over 20 years. In this episode, Chris and Dr. Christensen discuss a little-known behavioral profile called Pathological Demand Avoidance (PDA). PDA is an extreme avoidance of everyday, age-based demands (think of brushing your teeth as a young child). They explore the characteristics of this profile, and different treatment approaches that are effective. This is an insightful conversation full of knowledge for clinicians and laypeople alike.Links:Autism Learning Lab Website: https://www.autismlearninglab.com/Email: [email protected] Dr. Neal Christensen: https://elementsprograms.com/our-story/our-team/neal-christensen/Eclipse by Elements Program: https://elementsprograms.com/programs/neurodivergent-program/Quotes:[5:57 - 6:23] Dr. Neal: Because there’s so little awareness of PDA (Pathological Demand Avoidance), I think of it as like an invisibility, an invisible disability. And so a lot of professionals you know, will overlook it and say it is something else, it’s a different condition, a different diagnosis, and so, yeah, that’s where I think, unfortunately, like, a lot of these families and individuals suffer because they’re just misunderstood.[13:41 - 14:25] Dr. Neal: When you’re working with kids, in particular, you know, you’re oftentimes setting up, kinda, I’ll just say, you know behavioral schedules, and you know, some form of behavioral modification which would be you know, punishments and rewards right? We do that as, as parents at home with our children, ‘if you unload the dishwasher, you get some game play’ or whatever. But these are, these patterns of what I’d say these kinda more typical behavioral consequencing plans don’t really work because the demand itself is so stressful, that their consequence, whether it be a reward or punishment, isn’t more motivating than the, than the motivation to avoid the stressor. [17:04 - 18:03] Dr. Neal: I will say that we have to look at these individuals from a person standpoint rather than a behavior standpoint. Recognizing that these individuals have difficulty, genuine difficulty, right, it’s not, they’re not, I would say when we’re talking about PDA it’s not willful, they don’t want to make their lives and everybody else’s lives hard, it’s that they don’t believe they’re capable or that it’s possible and they’re just trying to help themselves feel better - all of us are. You know, we just, I’ll say maybe you and I, maybe have a better ability to cope with you know, challenge and stress. We’ve internalized those things and our nervous systems are better regulated and so, remembering we’ve got to start with the individual and then remembering, right, that we’ve gotta work on helping them feel safe in their own bodies…