PDA – consider the evidence

Rebecca McElroy's letter ('PDA – is there another explanation?', January 2016) is evidence of the poor level of understanding of PDA by professionals. She makes no mention of the fact that PDA is a presentation within the autism spectrum, which arises as a result of the high anxiety that a youngster experiences, leading them to avoid even low-level demands at school and at home. This anxiety generates a need for the youngster to be in control. Without this axiomatic understanding of the role of anxiety in PDA Ms McElroy falls into the trap of seeking the spurious and erroneous explanation of linking PDA to an attachment disorder.

In my experience, as a specialist consultant educational psychologist, working almost exclusively with youngsters presenting with PDA, the link by many professionals to attachment disorder is often a label of convenience. Indeed one consultant child and adolescent psychiatrist with whom I have been working recently remarked that she has 'felt under pressure from other members of the multiagency network to think about attachment issues in relation to (this) case. I often feel that when professionals can't explain a constellation of behaviours they use the rubric of "attachment disorder" as a catch all which is meant to miraculously encapsulate the difficulties (and is also meant to bring about the solution)' (personal communication, 20 December 2015).

Using attachment disorder as an explanation for PDA fails to consider the provenance of the youngster's anxiety-driven need to be in control. Neither does it explain the negative thinking and beliefs which underpin the youngster's extreme need to avoid engaging in tasks not of their choosing which they perceive as too difficult to complete.

My research (Dyer, 2015) has shown that about 30 per cent of youngsters with PDA in a small scale study (N = 20) are out of school placement because the levels of anxiety they experience in a school setting are too high for them to self-manage. This results either in meltdowns in the school or, frequently, in acts of containment within school and meltdowns at home. When the latter occurs, it is then convenient for professionals to play the two contexts off against each other, and arrive at the erroneous conclusion that the behaviour in the home occurs as part of an attachment disorder.

We do need more research into the dynamics of PDA: my forthcoming book on the subject sets out a clear need to examine, from a learning analytics perspective, those factors which trigger the anxiety in PDA, and how they can be addressed. It also sets out a research agenda for PDA.

We must be careful to ensure that the unestablished link between PDA and attachment disorder does not become the dominant discourse simply because professionals have failed to consider the more likely evidence-based explanations.

Dr Hilary Dyer  
Worcester

Reference
Dyer, H. (2015, 16 September). Opening Pandora's Box: First insights from the National Ex-PDA Research Project. Research presentation to the Bristol Autism Research Group, University of Bath.