LOW DEMAND APPROACH TO SUPPORT AUTISTIC INDIVIDUALS

Part of the Autism profile can present as Demand Avoidance. These demands act as a very real threat to the person's safety and they can present in slightly differing ways; but the ways to support them remain similar.

WHAT ARE DEMANDS?

Demands are any direct request placed on the child

“Go take off your coat and hang your bag” – an everyday request in school but already two demands placed on the child.

“Write 2 lines in your book and remember capital letters” – another daily instruction but a further two demands placed on the child.

“Go outside for break”

“Wash your hands”

“Are you going to eat your snack?”

WHAT HAPPENS?

Depending on the levels of felt safety the child has with the adult giving the demands, as well as daily lenience to sensory exposure, meeting of basic needs (tired, dehydrated, fed) there may be an element of compliance, especially if a routine of hanging bag and coat is understood. But as the demands continue to fill their tolerance bucket and as the tasks become more complex, a sense of injustice grows “I wanted to be first in the line”, “he continued talking”, “I was sitting still” etc. etc. the emotional bucket will overspill and the demands will activate the limbic response (flight, fight, freeze), and will result in a seeming irrational response but to the child, that threat is just as real as the sabre tooth tiger to the caveman. 

DEMAND AVOIDENT TYPES:

PDA -  Pathological Demand Avoidance

This is the most talked about area of demand avoidance. If any demand is placed on someone with PDA it is likely that they will use every day excuses such as, “I can’t go to the park as my foot hurts” or use the identity of a character “Cats don’t like the park”. They often appear ‘socially able’ compared to Autistic individuals without a PDA profile but will resist everyday demands. Sometimes it can feel like an impassable wall or an internal tug of war where their body wants to do ‘the thing’, whether it be meeting basic needs or activities they enjoy, but their brain puts on the brakes, hard, and does not allow them to do the task. They require a need for control and autonomy in situations and will not value the role of a teacher or adult being right or in charge simply because they are older.

To make this more complex, PDAers will find everyday tasks demanding too, not just ones others place on them, so this can be the ability to access the toilet, prepare food, make food, clearing up a mess, especially if someone else has, in their perception, made the mess. A range of factors work to this from sensory, sense of injustice, task overwhelm but in PDA it will have a consistency to it and not fluctuate due to external factors.

Children with PDA really struggle in mainstream education due to the complexity of the brain differences and lack of flexibility in the current school structure.

For further information see: https://www.pdasociety.org.uk

Oppositional Demand Avoidance

This presents as a direct shut down to most demands placed on the child such as refusing to complete tasks, being unable to do their favourite activities at the last moment etc. This is not a wilful rudeness or a choice of behaviour but a perceived threat to their survival, a disconnect from their rational brain as they are unable to process what is being asked of them in that moment. There is security and control in staying put, understanding that they are at least safe in the moment but there could be unexpected events around the corner which are outside of their ability to process. It is really hard for these individuals to accept praise and have high levels of shame with crippling low self-esteem.

Their communication and social skills will be more inline with other Autistic children (low for age and stage). They will still struggle with everyday demands but will be more independent and happier to complete tasks when they are in control or have made the decision to do so.

HOW TO SUPPORT THIS

Supporting PDA and ODD have very similar approaches which stem from reducing demands placed on the individual. Allowing them autonomy in choices, showing the child that you see them, there for them. How and which demands are reduced will work differently for every family, classroom, teacher and pupil – along with complexities of managing the needs of other pupils.

Continue containment approaches and keep boundaries the same and predictable but work on holding choices – “shall we hang our bag or coat first?” they may still resist, excuse it, ignore the request, but allow processing time, and repeat the request verbally whilst physically offering a hand to support the transition. This can work throughout the day keeping choices flexible but simple “shall we work on question 1 or 2 first?”(It’s okay to break ‘the rules’).

The sooner the demands are dropped on to the child, the quicker they will feel safe and then slowly everyday demands can be tolerated, but keep the language in check as their bucket will soon spill over/accumulate which could lead to meltdowns, unpredictable behaviour, dysregulation, go from 0-100 with no warning and ESBA (Emotional School Based Avoidance) if the demands become intolerable.

Use of rewards only if they can be supplied continuously at the same level without moving the bar – so if one line of work gets a sticker- this will need to continue, two stickers for two lines (when they are ready) for example. Each child will respond differently to rewards, accepting praise so work with parents to see what works best for that child. Gamifying tasks may work as an alternative.

If everyday excuses are made, accept that the child is unable to complete the demand at that moment and that is their only method of communicating this need. But working towards a low demand approach long term, should allow the child to take part in more activities and school participation.

TASK AVOIDANT (linked more to ADHD)

This will least likely be seen in a school setting where a child has a mixture of ADHD/Autism traits. They will show as quiet and compliant at school which can be known as masking/good girl behavior, but parents may say they are unable to get the child to complete any independent tasks at home – no rewards or strategies or reminders or asking them will help this. The brain is overwhelmed with what to do, where to start, the mental energy it takes to have the executive function to complete the tasks is too much and they will avoid it with “yes, I’ll do it later”. They will however be able to go to the park or access other activities that they enjoy.

HOW TO SUPPORT THIS

Fundamentally a child who is unable to complete age related tasks still needs handholding/physical support. No amount of asking them to do it will change the capacity to understand what is expected of them.

Further suggestions to support their growth:

Body Doubling – if you are able to contain them (have sections in their bedroom, items have a home, get on top of the chaos for them) then you should be able to start working with them (think parallel play!) where you keep them focused, help out and show them how you complete tasks too.

Reset photos – if you can, take photographs of what you mean by ‘clean and tidy’ (remember they are 2 separate tasks!) and print the photos so children have a visual reference for what is being asked of them.

Gamify tasks – create a Tetris grid – the child ‘wins’ the Tetris pieces according to the task they have accomplished – brushing teeth, brushing hair, washing face, placing some pens in the bathroom and letting them fill the grid!

In school, a child like this will often struggle to understand what is asked of them, struggle to finish work at the rate of their peers, and not be able to recall much of the subject 1 or 2 weeks later.

For further understanding see https://www.riskandresilience.org.uk/about

SAFEGUARDING – BASIC NEEDS

It is important to remember that a demand avoidant profile touches every part of that child’s life, this isn’t just over tricky or complex tasks and can really affect even their basic needs – the demand to go to the toilet, eat food, stay hydrated. So when working with these children be extra vigilant that basic needs are met – offering food in a quiet space or a sharing platter in intervention work (the parents will be happy to send in some chopped up fruit and vegetables), group reminders to have a drink, and extra trips to the bathroom – or supporting a ‘bathroom buddy’

“Could you support Tommy making his way to the toilet? And would it be helpful if you tried for a wee whilst you are there?”. We understand from Maslow that if the basic needs are not met, safety needs will not be accessed which is much lower down than learning/self-actualisation areas on the pyramid.

If you would like any further information or support in this area please contact us: hello@lighthousetherapyhub.co.uk