Pathological Demand Avoidance

[Music] [Music] welcome back Richard it's good to see you though I feel like I just saw you we recorded a podcast for for this past weekend and as we said at the end of that podcast we are um tipping our toe into releasing a couple of podcasts each week just to get some more information out there and um so this is podcast number two for this week right there's so much going on um in so many different Realms um that that uh address the whole mental health mental illness uh education parenting um getting older there's so many things going on right now that it's that it's uh we feel a little stingy uh just trying to pick one topic when there are so many things that need to be discussed also um we're getting more and more responses from viewers and listeners and they're asking if we can talk about different subjects and you and I run into things weekly that we'd like to talk about so um and one of those we're g to talk about one of those today um we we call it a we were a little bit um uh alarmed at first because we thought this sounds like a new diagnosis and so we thought we better take a closer look at this and that's what we wanted to do today yeah before we do that one however um as we were preparing this in the week prior to the um to the podcast another article floats across the internet and it lands up in our computers and the title of it is um a high school teacher says students cry when asked to read out loud and there sub types of feeding into those moods is decreasing resil we want students to be resilient to be able to tolerate uh distress and to overcome obstacles and the subtitle is should teachers be providing Grace understanding empathy sympathy or should they be pushing students to discomfort in the classroom as a way of getting them accustomed to handling stress um and and discomfort and so we we put um this is in the show notes there's if you want to read the article you can you you certainly can look it up but embedded in the article is a u is a video a Tik Tok video of a high school teacher going into this lengthy explanation of okay you're teaching a class and the students are not you have a student who's not paying attention and then at the end of the class the student comes up and wants some extra help even though he wasn't paying attention when you were presenting the material and her argument is look you're the teacher forget about the fact that he wasn't attending you still offer help you you can't just shut the student out you can't tell them no you weren't paying attention so you don't get my help it's a teacher's obligation to provide assistance and and and what they said here is that the teacher was criticized for not being empathetic you know there's all these uh comments of course for not being empathetic to the stresses that most teenagers face combined with the heightened emotional state of Simply being that age there was a book written a few years ago called the codling of the American mind and it it brought that up as I was reading it because the student said she wasn't feeling it at all I I love the f I just I she the student wasn't feeling it at all however instead of giving her space and asking for a private conver ation after class the teacher deliberately called her out to participate in class which resulted in the student crying and running out of the room but the teacher then responded I think that feeding into these moods decreases resilience and that behaving at an acceptable Baseline regardless of your personal feelings is a reasonable expectation right this is I think that this is a an incredibly challenging um issue and and it and it leads to the the primary topic as you said you know it's great that this came in today because we were asked to talk about a particular topic that we'll get to in just a second but it is so difficult because on one hand you want to be mindful and sensitive and aware and and and offer Grace to students who are struggling with different things however as suggested by the Ty of that book The the codling of the American mind are we are we encouraging and fostering this anxiety and this stress and these emotional experiences by decreasing expectations um there there's a there's a Tik tocker that I that I follow and his name is escapes me right now it just came to mind as I was saying that and he recently posted that you know by decre what are we doing by decreasing expect on students the decrease expectations students are going to tend to live up to our expectations as long as they're not ridiculously high they're going to tend to live up to our expectations so if we lower our expectations they're going to meet those expectations but they're going to be below what the students could probably be capable of so what are we doing with that right and you know the other thing that struck me as I was reading this article about the teacher and listening to that to the other teacher the Tik Tock teacher um talk about um well no the student wasn't paying it this whole idea of um of um the the this this delicate period of adolescence that these kids are G we've always gone through it I went through it 80 or 90 years ago I mean we all go through the this difficult adolescent period and it and it struck me as I was reading these this um article and and the responses to it schooling K12 schooling is a preparation it's a preparation for life you're not expected to be a finished project a product you are expected to learn to become strong to learn to be resilient to tolerate distress to tolerate discomfort in the safety of a classroom because you don't want to discover all this stuff on the job or when you're married or when you have children that's not the time to but there's this thing a lot today it's like I have to get all A's all the time okay but you're not a finished product if you're getting all a then you're not being challenged all right um right reaching that level of of competence um should get you to the next level of competence where you are challenged where you don't get an A because you don't know the material if you're getting a and everything it's not just because you're working hard it's because there isn't enough challenge in the work that you're doing if if there was you wouldn't be getting all A's but school should be a preparation it should be a time where you hear things that make you uncomfortable when I was teaching at the University level they introduced this concept of a trigger warning okay that you had to warn students that you were going to use a phrase or talk about a topic that they might find offensive well it's in it's in high school and it's while you're going to school while you're in college is where you learn to deal with your discomfort to deal with your to to tolerate things that you never had to tolerate before you're being introduced him for the first time in your life and I think we're taking that away um we don't want you to be uncomfortable we want you well my goodness if you don't experience some distress how are you going to develop tolerance how will you develop understanding right and and again this all leads to the the actual topic of this podcast and that is we we had a listener right in and um a colleague a fellow uh therapist WR in and ask about this new diagnosis or this new thing that's being referred to as a diagnosis we'll say and that is pathological demand avoidance um it's not the it's not PDA that we used to think about as PDA um it's PDA pathological demand avoidance and we had heard about it and um again this list wrote in about it and so we we thought we would talk about it because it is it is very relevant uh to what's happening in schools and in life today um and you know it comes across again people will come in and talk about they have this diagnosis of pathological demand avoidance and of course as we look into it it's not really a diagnosis it's it's a it's a sort of a diagnostic label or profile of people that people experience and and we were interested though to find out that it came out of the the UK England Bernie when this was first brought to you was it um how was it presented was it did somebody have a question about it or was it I think my child has this or how no well the the primary the question came that from as I said another therapist saying that they're working with um families and that the families are talking about their kids having these path this pathological demand avoidance and it's something that families are struggling with with working with their kids okay now the pivotal question for me is are these families raising a child with autism no oh okay well there there in right that was my fear when I first heard about pathological demand avoidance my fear I didn't know what it was but I thought man how do how do you I mean kids have been saying no for a few million years right um how do you where's this going what is this about and that's what sort of let us down to take a closer look at it see where it comes from absolutely and so it it does come from as I said the the UK and it's it it's a a phrase that's used as you just suggested in conjunction with uh children and uh teenagers and individuals with autism spectrum disorder right um and it it has to do with uh this their their difficulty with meeting some of the social expectations some of the deficits they have with social communication and social interactions um you know we we when we think about autism those are sort of uh some of the Hallmark features of of autism the the poor social SKS the the social uh communication difficulties some of those restrictive and repetitive beh behaviors and activities and interests and things like that those that's what we really think about with autism but but the but the UK they basically have the same definition of autism that we have right right the sort of social communication repetitive behaviors um must be present early th those three principles apply in the US as well as the UK right but in the UK they seem to also in include some other things ah okay um you know a need and we see this in children with autism but we don't necessarily consider a diagnostic feature but um but they they also include this need to for control um often times associated with anxiety and distress um but they have they have this drive to to avoid uh many times children with autism have a drive to avoid demands um and expectations um especially if it's outside of their particular interest or their particular Focus so things that they don't enjoy doing things I don't want to do um and because of when you think about the interplay between maybe was some developmentally appropriate avoidance which all kids avoid doing things they don't really want to do combined with their maybe some of the challenges communicating and the challenges they have with some of the social interactions and social the combination of those two seemed to help facilitate this idea of pathological demand avoidance but it stems from and I think it's interesting that the UK adds these other dimensions and and it's and the woman who did this you know she did it back in the 1980s um this idea that children with autism are resist they are anxious there's high anxiety because they're struggling to manage their world as as as well as they can so we know that they we know that they have anxiety and we know that they they have this need for control they want to control what they can because there's little that they can control but also it's it's sometimes difficult to get children with autism to do what you want them to do whether it's a request or a demand or an expectation if they don't want to do it if they don't enjoy doing it they're going to resist and they're going to resist in a in a pretty intense uh way pretty dramatic way and they will just they they'll battle with you so that's what she's trying to capture with this notion of PDA but she's talking about it in the context of autism right that she it seems as though from what we can tell that that was used as a sort of a separate component but all within the broader category of autism spectrum back in the 80s it was called pervasive developmental disorders but all within the broader umbrella of of the autism spectrum disorders um and when you think about those key characteristics that that she kind of outlined it's that that tendency to resist or avoid right what many would consider ordinary life demands um they um they they seem to be somewhat manipulative I remember you know early on in in our work um oftentimes professionals as well as parents and teach teachers and stuff would say all kids with autism spectrum can't be manipulative um they don't understand the social skills well enough well no they can be manipulative so um but they but they use some of that manipulation to avoid um you know some of that some of those expectations and demands that are placed on them yeah and you you know that because they'll either shut down completely or they'll battle with you they'll become aggressive well those are those are socially manipulative ways of avoiding the demands right yeah they they're not necessarily really sophisticated at it yeah and they're not using all the little subtext and stuff that somebody who maybe has more social awareness would do but but they're still still doing it um but but again they they a lot of these social aspects contribute to their maladaptive ways and maladaptive response to any demands that's placed upon them that they really don't want to do um and again she referred to this as that pathological demand of ordinance right so go ahead yeah so so it's not a diagnosis per se what what it really is is just a cluster of traits that's often seen in children with autism spectrum disorder right now where we are we really have some concerns is that it is now it now seems to be that people are are starting to apply this to those outside or who those who are not on the autism spectrum this disorder Spectrum um kids who do not have um all the other characteristics and traits of of autism spectrum disorder perhaps they have anxiety perhaps they have some some other reactive uh challenges and adjustment issues but they don't have the autism spectrum um challenges but yet they're still kind of being labeled or identified as having um PDA and that's not where the you you know we have to talk about how that's different um and I think that that's where we get into this realm of the example that you started out this podcast with do we do we think about kids perhaps who don't have autism spectrum do we think about them as having pathological demand avoidance and so then we should work to help accommodate and and treat and and manage that or do we say no these are typical expectations and you don't have autism spectrum disorder and so we don't need to be thinking about it that way we need to address it in a different way right there's so many layers here because um in the early in the in the teacher uh article with that student okay there are students in classes who are struggling with mental health issues okay but again we're talking about a very small number right most of us about 80% don't really have a diagnosable disorder I mean we struggle with life but we don't we don't have that and so I think teachers schools know enough to say well this child really does have an issue you know and we're going to recognize that there are systems in place to identify children who truly are mental have mental illness but most students don't and most students just need to learn how to manage the challenges that life are going to bring to you you can't you know we talk about helicopter parents well or or snowplow parents or lawnmower parents where I want to get rid of all the challenges and just have success after success after success that's not life that's not real life we don't we are denying children the opportunity to become resilient to become um uh competent to become to develop grit you know when when that book was written about how to succeed how children succeed it's because they have to develop grit you don't develop grit with a constant series of successes a constant series of wins okay you have to be challenged and the best place to challenge developing children and Adolescence is in the protective Cocoon of a home and a school right that's what they're designed to do do they're designed to be safe places where you can learn to do this with the support with support of adults around you okay don't take that away don't don't don't subtract so if a child has autism I don't have any problem with this issue of PDA because many of them do have that I I'm not sure that I would have called many of them do have that however most students don't and I think if we if we nudge just a little bit and parents come in or kids come in because teenagers can go to Google they can go to the internet and find PDA and say oh my problem is I have PDA I I have pathological no you don't you're just defiant and oppositional right yeah I think that it be it creates one of our favorite terms a slippery slope it creates a situation where we are um not we're finding ourselves not holding kids accountable for what they be accountable for we not we're not as you said very well G not giving them the opportunity and I'll add not the we're not giving them the needed opportunity to create some of that resilience to create some of those skills you know look change happens um growth happens under stress right we growth doesn't happen in in a in a in a easy equilibrium you know there has to be some pressure that that causes the growth to happen and and if we we if we function in a in a in a world in a um environment where there's no pressure there's no push there's no encouragement there's no requirement to to stretch some of those some of that Comfort level then there will be no growth that's right right it's it's moving against adver you know think of a baby you move against gravity you know gravity is pulling you down but you're struggling to get up and it's moving against those forces that create development that create growth that create Mastery you have to be challenged you have to struggle this stuff is not easy we understand that and we all went through it we were all teenagers and we all had the same fears we all the same struggles we all the same challenges you don't take those away and make life easy that accomplishes nothing for anybody except for the small number of students who really do need those kinds of accommodations but that's a very small number it's not for the whole class right yeah you don't need trigger warnings you need to learn how to deal with things that are uncomfortable right yeah I think that we have a tendency to um this this is the topic for a whole another podcast um Richard we you and I talk a lot about this oftentimes not on camera about the pendulum switch uh um especially in education and and education has that tendency to go from one extreme to The Other Extreme and very rarely do they find themselves in the Middle where they need to be um and and this is I think is another one of those places where we've gone from you know we're not recognizing anything everybody has the same expectations no matter what your limitations or what your challenges or what your exper life experiences to all right so if you if you find any discomfort in any that we need to provide accommodations and um we need to do something to help you know help relieve that pressure um I think in part that's because everybody today has become more litigious and school districts are scared to death of being sued by a parent who says well my kid has PDA and you're making them you know read out loud at in class or you're making them you know do a math project on the board math problem on the board and so you know we're going to sue the school board right School District are terrified of that and so they they Bend when they shouldn't Bend right and instead you know saying no we are the developmental experts we know what students need to learn and we know what students need to be able to do and this is one of those things right yeah we know that students don't want to get up in front of a class and do a speech but none of us did none of us were good at that at well some of us were I wasn't but you're very nervous when you get in front of the class but you have to work through you have to be challenged and work through that um those fears that's what makes you strong and competent not taking taking the taking the U expectation away so okay well we don't want to we don't want to we don't want to stress you too much no we do want to stress you we don't want to stress you excessively but we want to stress you enough so that there's growth right absolutely so when we get to things like this PDA this p no um the concept of PDA could pathologize all sorts of behaviors that have nothing to do with autism or neurodiversity or any kind of mental health issue kids say no and it's not pathological it's developmentally appropriate right but you have we have to learn how to manage that so we already see we're already beginning to see children and parents who are already bringing this issue up is I have I have a diagnosis no no you don't have a diagnosis you don't want to do what you're asked to do but that doesn't mean that you have a diagnosis I that's where we have to be very very careful a absolutely we agree that that PDA May apply to a maybe a subgroup um a subgroup children with autism spectrum that that's right and it's even a subgroup of that group right because everybody doesn't no so we're talking about what what this what comes out what's coming out of the UK is a legitimate it's a it's an explanation for a subgroup of children with autism right right so we're talking about a small number of children with autism and a subgroup of that population who have PDA if this notion of PDA enters a mainstream we're going to be we're g to it's going to be a mess it's it's going to be a it's going to be a problem both for professionals as well as families and we and we have no idea the long-term consequences of that I I think that we are seeing that because as you said you know with with some of the expectations for trigger warnings and things and we're not talking about trigger we're not even talking about trigger warnings for like you know we're going to talk about trauma or we're going to talk about abuse or something that that that deserves the trigger warning to say Hey you know we're going to talk about some challenging things today no we're talking about trigger warnings like I we need to let everybody know in class that you're going to have to do a paper and you're going to have to presentation at the end of the term right and and if you can't handle that you know let let me know no those are those are the requirements and expectations of the class and and you have to find a way to work through that and if you need you know if your anxiety is such that you need to work with a a therapist or a counselor to to work through that then do that I think that that's the other piece of this that that makes me feel a little bonkers sometimes and that that's you know we want to say that we our kid or whoever we have um pathological demand avoidance talk when they talk about they talk about all this anxiety and everything but they're not getting therap they're not doing anything about it right right they're not going to get therapy they're not going to get you know not not that medication is going to be the first place you want to jump with that but they're not developing any skills they're just avoiding and you're not doing anything about it you have to take some steps to work through that anxiety to work through all of that so that you can perform the task that you have to perform right that's right um you know we've we've talked about this before on the podcast that um frequently especially teenagers not just teenagers um older Elementary School students and teenagers will come in and say well I I can't work because I have uh I'm depressed I can't work because I'm too anxious I can't no no no no people with mental illness still work okay your mental illness what whether you do or don't have an official diagnosis it's not an excuse for withdrawing it's not an excuse for not working it's not an excuse for not doing an assignment um we all struggle with something ADHD or anxiety or depress all of us are struggling with some of those symptoms most of us are don't have a diagnosis but we struggle with the same characteristics sure it doesn't mean that you don't do tasks you still work people with mental illness still go to work and I have many many patients who come in and say I can't go to work because I have fibromyalgia I can't go to work because I have bipolar disorder no people with bipolar disorder take medication reduce their symptoms and go to work right yeah so we we have but we have to that that's starts in childhood that starts this is where you that's right that we have to give children the opportunity to learn how to overcome these things not to eliminate the challenges but to help kids teenagers young adults overcome the challenges that they're facing right absolutely all right I think that's it for today um we we have another similar diagnosis that we'll talk about in an upcoming podcast next week we can talk about that yeah we put that one together for next week yeah one's uh that was even more interesting to me maybe even more maybe even more fun than this one absolutely so all right until next time stay happy stay healthy and forget to be afraid [Music]

Channel: The Mental Breakdown

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Id: Nq9oRITOUIE

Length: 29min 53sec (1793 seconds)

Published: Wed May 08 2024