Pathological demand avoidance is associated with extremely high levels of anxiety although there is much talk of what came first and it is a bit of a chicken and egg situation, do demands cause anxiety or does anxiety cause demand avoidance? I do think however that which ever came first they fuel each other.
I have wondered for a while now why sensory processing differences are not held up as a cause of or contributing to demand a avoidance too? The national autistic society says that many people on the autism spectrum have difficulty processing every day sensory information and that:
A person who struggles to deal with everyday sensory information can experience sensory overload, or information overload. Too much information can cause stress, anxiety, and possibly physical pain. This can result in withdrawal, challenging behaviour or meltdown.
I know that although my son has not been diagnosed with a separate label of sensory processing disorder (as most aren’t) that he does experience sensory input far more keenly than the majority of the population and it has always been something that he talks about causing him discomfort whether it is because things are too loud, too bright, feel or taste horrible (to the point of aversion), or overwhelmingly smelly.
Of course these things do have an upside too and he has at times talked about them being his superpowers. He can;
- Smell someone in the street smoking a cigarette even three floors up with the windows closed.
- Taste the change of a brand of ingredient in a home cooked meal with multiple ingredients or if it has come out of a packet that wasn’t freshly opened.
- Hear and separate the slightest far off noise, or single bum note in a piece of music.
- Feel the slightest brush against him even in his sleep.
- Pick out the tiniest details from a mile off and detect the smallest changes of light even with his eyes closed.
Experiencing the world in this way must be both amazing and completely overwhelming. I imagine it being like walking around with high definition 3D, full volume surround sound, extreme smellyvision and spider senses and you can’t turn off any of it. From what I hear from autistic adults anxiety also increases sensory sensitivity, you can see how challenging this must be at times for anyone but even more so for our highly anxious PDA children who are trying to make sense of the world around them.
So I think it is important when using strategies associated with PDA like giving choice, non direct instructions and allowing time it is also important to consider the sensory impact of the activity. So before you try and get a PDA child out of the door for school, an appointment or even a fun activity why not ask yourself a few questions first?
- Are my child’s clothes comfortable? They may not be if they are new and unfamiliar, have scratchy labels in sensitive areas, do not fit well, or the material is overly rough or overly smooth or has a lot of seams or badly finished seams.
- Are my child’s shoes comfortable? Many autistic children struggle with shoes and socks so you need to make sure the sock is on the foot right with the heel in the right place and not to tight or too loose around the toes. If the socks have seams (most do but you can by special seamless socks) they may be better turned inside out to prevent the sensation of rubbing. Shoes should fit well and to the child’s taste – for my son they are better a little too big otherwise he feels his foot is squeezed, The shoe is on the foot right with no bumps in the tongue, no rips to the lining, no grit in the shoe, no wear to the insole.
- Is the place I am taking my child too very bright/load/smelly/or have other sensory challenges like mud or sand.? Every person’s sensory sensitivity’s are different so think about your experiences with your child and where they seemed comfortable and where they did not. My son for instance can not stand sand, some autistic children love the sensation of it and like to be buried in it or even try to eat it however.
- Is there is some way I can remove or minimise the sensory challenges or the impact of them. If I can’t then is it a good idea to still go? So for example I may take my son into town during the week in school time if we need to go so it is quieter but not if it was school holidays when it would be very busy, the noise, people brushing against him and colour of a seaside town would overload him. I would not choose to take him to the beach (even though we live right by the best coastline in the country) because he can’t stand sand, we would perhaps have an ice cream sitting on the harbour wall instead,
- Have I talked to and reassured my child about any possible sensory challenges that might be involved or previously experienced with the activity? It’s all very well you knowing that it is a quiet time of day or that you have arrange for the music to be turned off at a trampoline park or it is an autism friendly showing at the cinema but have you explained this to your child. If they don’t know they still feel unable to go anticipating the sensory threat. It is best to explain in advance and not once they have already become anxious as they may not then be able to regulate themselves back into a state where they can go or enjoy it if they do.
Never be afraid to ring ahead to venues and ask them about quiet times or if they have an autism hour or can turn off music or lights (or to ask them once you are there). The same with school, if your child is struggling ask if you can see the classroom to see where your child sits, is it right by the coat racks where there might be a lot of noise or under a bright light or by a south facing window for example?
Tackling sensory issues won’t stop demand avoidance but it can help reduce anxiety which may make the demand avoidance more manageable for them.
Pathological Demand Avoidance is on the autism spectrum, for more information visit the PDA Society‘s website by clicking the link (in blue).
Also see my other blog posts