From: julianlzb87@gmail.com   
      
   Many parents believe pathological demand avoidance is a real disorder,   
   but pseudo-clinical labels are harming kids, not helping   
      
      
   When my son was little, he used to complain every time he was asked to   
   do anything that wasn’t playing or eating biscuits. He had a particular   
   aversion to the daily routine. Tell him to brush his teeth and you would   
   get a dramatic, outraged “Again?” followed by an awful lot of fussing.   
   We had to wrestle him into the bathroom twice a day, and it went on for   
   years.   
      
   If he was the same age now, I might decide he had something called   
   “pathological demand avoidance” or PDA. This is thought by some to be a   
   variety of autism, while others argue it can also attach to ADHD, or   
   float free of both. Whatever, the basic idea is that unwanted demands   
   from adults cause persistent anxious refusal in certain children, in a   
   way that needs a specialist technique to handle. The respected clinician   
   Elizabeth Newson came up with the idea in the 1980s, but it took a few   
   decades to catch on. As can be seen by the number of Mumsnet threads on   
   it, PDA is now virally embedded into parenting discourse, popularly   
   treated as a disorder or even a “disability” that explains what makes   
   some challenging kids tick.   
      
   Yet PDA does not appear in any mainstream diagnostic manual. This alone   
   suggests therapists and parenting coaches should approach the notion   
   with caution. Unfortunately, there is little chance of this happening,   
   because the liberal validation is helping to keep many of them in business.   
      
   Here are two basic problems with the concept, though. First, it cannot   
   possibly be true that every child who really hates being asked to do   
   things has a disorder. So how do we tell the difference? To be   
   meaningful at all, PDA cannot be an unfalsifiable hypothesis — so what   
   do false positives look like in this area? I have searched the   
   literature for an answer and found none that satisfies.   
      
   Second, the official instruction for parents in this situation is to   
   stop making direct requests. You are supposed to find more indirect,   
   collaborative ways to reach your goal instead. That is reasonable advice   
   for many occasions, but applied generally it is in danger of keeping the   
   problematic behaviour going. The child will learn that when he is asked   
   to do something tedious and gives a resounding no, the adult concerned   
   will modify her behaviour instead. This is obviously not a recipe for   
   getting an enthusiastic yes the next time. If anxiety is present, there   
   will be no building up of tolerance either.   
      
   Before you know it, you have persistence, and start to qualify for   
   professional concern.   
      
   It can’t be a coincidence that a rise in PDA is supposedly happening   
   just as there is a reduction in socially acceptable ways of dealing with   
   defiance. The trend is away from laying down the law — or in my case   
   hustling a small boy towards the bathroom while ignoring the daily   
   wailing — and towards negotiation, empathy and “gentle” ways of dealing   
   with disputes. Yet in most cases negotiation is pointless and   
   counterproductive — this is not the Paris peace accords, you are not   
   Henry Kissinger and he is only four. “Negotiating” with a young child   
   who is kicking off usually means giving them what they want and feeling   
   useless about it. What used to be manageable has become a source of stress.   
      
   A related problem is the general undermining of parents’ confidence.   
   Social media is the source of endless discussion by professionals about   
   the approved way to handle kids they’ve never met. Child-rearing is now   
   presented as a science, not an art; a difficult technique that you   
   should always be trying to master, keeping up with any “advances” in how   
   to do it. Those who have well-behaved kids congratulate themselves,   
   rather than admitting that often it’s a matter of luck. Meanwhile, those   
   who have unruly or oppositional offspring feel shame and look for   
   official-sounding explanations that don’t amount to the (usually false)   
   “you’re crap at this parenting lark”.   
      
   This may seem a niche discussion but I think it points to wider failings   
   of the therapeutic professions. Some of them have what might be called   
   PLD: pathological labelling disorder. Yet what counts as dysfunctional   
   behaviour in children is affected by context. It partly depends on what   
   a parent feels able to cope with; and this is influenced by trends   
   within therapy itself. Acting as if parenting is a complex puzzle to be   
   solved, and neurotically fussing about the range of acceptable   
   solutions, means pseudo-clinical labels like PDA are only going to   
   increase in popularity. Worse: perversely, they are harming many of the   
   kids concerned, not helping. Sooner or later young recipients will   
   become conscious of the label, and may well go along with the story too:   
   a disorder is in charge of their minds and bodies, and it can’t be   
   helped. Again, this is not an inducement to overcoming antisocial habits   
   that can only hold them back.   
      
   Perhaps for a very few children PDA is a helpful classification, but for   
   most it is not. After a few years, a lot of gin (mine) and a lot of   
   shouting (his), my own bolshie little boy turned into a charming,   
   accommodating young man — and with perfect teeth too. I can’t claim much   
   credit: looking back, I think he did most of the hard work. I’m just   
   thankful we avoided professionals with PLD along the way.   
      
   Kathleen Stock   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)