Supporting Children with PDA using Play and Trauma Informed Practice

It has been almost 12 months since I wrote my first blog about PDA and Play Therapy, and since then my knowledge of PDA and my confidence in the benefits of using Play Therapy with children with PDA has continued to grow. But with that increase in knowledge and confidence has come even more questions. Questions about the source of the anxiety that drives demand avoidance, and about the mechanisms through which play therapy can assist children to cope more effectively with the world around them.

These questions have lead me to form the view that looking at PDA through a trauma-informed lens can help therapists, parents and educators better understand a child’s needs and reactions, and find more effective ways of supporting them.

Now I should clarify that I am not saying that PDA is caused by trauma – I believe the current view that PDA is a profile of behaviour that presents as part of an Autism Spectrum Disorder. However, what I am saying is that the reaction an individual with PDA has to a demand is similar to a trauma response (an extreme emotional reaction to a distressing event, where the stress experienced exceeds the individual’s ability to cope), and by viewing it in this way, we are much more likely to be empathetic and open to adapting our behaviour to support a child’s needs, and have a better understanding of what individuals go through every day.

One of my PDA clients, aged 8, recently likened being at school to being controlled by a remote control, and I think it is a fantastic analogy to consider the experiences of individuals with PDA. Imagine this if you can … someone from work that you don’t know very well has been given a remote control that controls everything you do. You are completely under their control and they can make you do anything they want. How would you feel? Would you be calm and trust that this acquaintance will make sure you hold onto your dignity? Or would you panic at the prospect of being made to do something embarrassing and having no control over it? Most of us would feel the latter – a sense of panic; of being completely out of control; of being helpless and at the mercy of this person they don’t trust. This event may also, in some of us, trigger a trauma response that could go on to impact on our future wellbeing and behaviour.

Now imagine that the person with the remote is you, and the person being controlled is a child with PDA. Further, consider that every demand placed on them is like you controlling them with your remote. Can you see how distressing and how damaging repeatedly experiencing this situation would be?

Given that play therapy in its many forms is an evidence-based intervention for children who have experienced trauma, it makes even more sense to me now that it could be a pathway for healing and developing effective coping skills in children with PDA.

For the children with PDA that I work with, the overwhelming ingredient to positive experiences and therapeutic progress is trust, and that is only gained through developing a strong relationship and having a safe and secure place for them to be. Once that trusting relationship is established, and the child has the opportunity to take control of their life, even just for the hour that they spend with me, they are free to play, make, destroy or talk through their feelings and experiences at their own pace and in their own way. I believe this is where therapeutic progress can be made.

While there has been considerable focus over the last few years on how children with PDA can be supported by parents and educators at home and at school, ┬áthere seems to be little information available on how to help individuals with PDA to reduce their anxiety through therapy. It may be that the challenging way that individuals with PDA often present has created a barrier to children receiving support because more traditional ‘talking’ therapies don’t seem to work. But this is where I think Play Therapy fits in.

The more I work with children with PDA and their families, the more confident I feel that play-based, flexible interventions and trauma-informed practice can be utilised to support children with PDA to feel in control and capable of managing any challenges they might face.