As a parent or caregiver, you may face challenges when dealing with a child who resists everyday demands. This resistance might be associated with Pathological Demand Avoidance (PDA) or Oppositional Defiant Disorder (ODD). This article will explore these complex behaviours and their distinctions and provide actionable strategies to support your child.

What is Pathological Demand Avoidance (PDA)?

Pathological Demand Avoidance was coined by Elizabeth Newson in the 1980s to describe children who exhibit an extreme and pervasive pattern of avoiding demands, even those that are trivial or enjoyable. Alongside this behaviour, children with PDA may also display the following:

• Impulsivity and mood swings
• Social manipulation and role play
• Lack of sense of identity and poor self-awareness
• Obsessive interests and behaviours
• Anxiety and emotional dysregulation

While the scientific community does not widely accept PDA as a distinct diagnosis, it has provided a valuable framework for parents and professionals to understand the challenges faced by some children with autism spectrum disorder (ASD) or other developmental disabilities.

Understanding Oppositional Defiant Disorder (ODD):

Oppositional Defiant Disorder is recognized in the international classification systems DSM-5 and ICD-11. It involves a consistent pattern of angry, argumentative, or defiant behaviour towards authority figures, lasting at least six months and causing significant disruptions in various settings. Children with ODD may exhibit the following:

• Frequent and sudden temper outbursts
• Arguments and refusal to comply with requests or rules
• Blaming others and deliberate annoyance
• Resentfulness, spitefulness, or vindictiveness
• Difficulty in forming and maintaining friendships
• Lower self-esteem and academic performance

ODD is believed to stem from genetic, biological, psychological, and environmental factors. It often co-occurs with conditions like ADHD, anxiety, depression, conduct disorder, or ASD. Treatment for ODD generally involves behavioural interventions that aim to improve social skills, problem-solving abilities, emotion regulation, and the parent-child relationship.

Distinguishing PDA and ODD:

While both PDA and ODD involve resistance to demands, they have notable differences:

• PDA is not an officially recognized diagnosis, unlike ODD.
• PDA is more commonly associated with children having ASD or other developmental disabilities, while ODD can occur in any child.
• PDA involves avoidance of all demands, whereas ODD primarily revolves around defying specific authority figures.
• PDA is driven by anxiety and a need for control, while ODD is fueled by anger and a desire for autonomy.
• PDA is linked to more vital social skills and imagination, while ODD is connected to higher aggression and antisocial behaviour.

Strategies to Help Children with PDA or ODD:

Suppose you suspect that your child may have PDA or ODD. In that case, it is crucial to consult a trained mental health expert for an accurate evaluation and suitable guidance. Additionally, consider implementing the following strategies based on your child’s condition and circumstances:

1. Foster Understanding and Empathy: Try to understand your child’s perspective and empathize with their feelings. Validate their emotions and acknowledge the difficulties they face.
2. Avoid Power Struggles: Instead of imposing demands, try offering choices, negotiating compromises, or using humour and distraction techniques to diffuse confrontations.
3. Establish Structure and Predictability: Create a structured environment with clear rules and routines to minimize stress and uncertainty. Visual aids and reminders can be helpful.
4. Teach Coping Skills: Help your child develop coping mechanisms and self-regulation strategies. Teach relaxation techniques, breathing exercises, positive self-talk, and other methods to calm themselves when overwhelmed.
5. Reinforce Positive Behavior: Recognize and reinforce your child’s positive behaviours and achievements. Utilize praise, rewards, incentives, or privileges to encourage cooperation and compliance with reasonable expectations.
6. Seek Support: Connect with other parents or caregivers who have similar experiences. Online forums, groups, or communities provide opportunities to share challenges and learn from others.

Pathological Demand Avoidance (PDA) and Oppositional Defiant Disorder (ODD) encompass complex behaviours that can significantly impact children and their families. While distinct, both conditions require tailored approaches for understanding and management. If you have concerns about your child’s behaviour, seek professional help and implement the strategies mentioned in this article. Remember, you are not alone, and there is hope for improvement.

Reference: https://pubmed.ncbi.nlm.nih.gov/34320869/