If you're asking what is a PDA child, picture a child whose anxiety can rise sharply at even small or indirect expectations. At KidStart Pediatric Therapy in Burnaby, the first step with significant PDA symptoms is to temporarily let go of expectations, focus on the child's anxiety, protect their ability to initiate, and offer choices.
Why can small expectations trigger intense anxiety?
Children with PDA struggle not only with obvious demands and direct instructions. Even indirect guidance or small expectations can trigger intense anxiety. Focus on the anxiety first.
PDA stands for pathological demand avoidance. The PDA Society describes it as a profile of autism, where demand avoidance means finding everyday tasks or demands hard to manage. For background on autism itself, the NHS autism overview is a plain-language starting point.
PDA is not rare. About 1 in 31 eight-year-olds in the United States was identified with autism in the CDC's April 2025 report, up from 1 in 36 two years earlier. Among autistic children, around 1 in 5 show significant demand avoidance traits, according to a 2015 study by Professor Christopher Gillberg and colleagues. The PDA Society's 2023 parent survey found 91% of PDA children experience severe anxiety. That anxiety comes first.
Parents most often want to understand one thing first. A lot of the time, what adults do can potentially make the whole situation harder for everyone to manage.
A hidden agenda or indirect instructions can make the problem bigger and harder, especially for children with severe PDA or significant task avoidance.
What should parents do first?
Getting your mindset right comes first. Before any technique, change what you expect of the child in the moment.
With significant PDA symptoms or a challenging PDA profile, temporarily let go of expectations:
- Focus primarily on the child's anxiety.
- Maintain the child's ability to initiate.
- Offer choices and options so they always feel in control.
"Temporarily" matters.
An occupational therapist can help families build these approaches into daily routines. See how occupational therapy techniques help children with emotional regulation.
What do you say instead of "good job"?
Even "Oh, you did a good job" can become a burden. Without detail about what the child did, it can turn into a hidden expectation that the child must keep working hard or keep meeting the bar. For a PDA child, that becomes a problem quickly.
So what KidStart's occupational therapists do is let go of expectations entirely:
1. Cut out words like "good job" or "well done" that can create strong expectations. 2. State the facts about what the child is doing. For example: "Oh, you put this together," or "You spent 10 minutes completing this schoolwork."
Factual language lets the child feel what they are doing. It also invites them to share the moment and express their feelings in their own words. A lot of comments can later become expectations or demands. A child with significant PDA may perceive all of them as demands, even though you might not think of them as demands.
What if you slip back into old habits?
The biggest worry parents name is how much they have to unlearn. It takes time, and mistakes still happen. What KidStart's occupational therapists often tell parents is: don't worry about making mistakes. You probably won't be able to change your mindset entirely that quickly, and every child reacts differently in different circumstances.
Every time is different. Sometimes you say certain things, sometimes you don't, and they lead to different results. What is important is what you learn, and how you adapt in the moment.
When you catch a slip, try this sequence:
- Recognize that you slipped.
- Let the moment sit, and watch how the child reacts. They may slowly pull away.
- Wait for the response and regroup emotionally.
- Use a bit more nonverbal communication instead of saying anything.
- When the child reacts a little better and the anxiety eases, jump back in with different language, slowly.
Trying to fix the mistake too quickly just makes it more obvious. You do not need to be fast.
KidStart's Burnaby clinic serves Burnaby, Coquitlam and nearby communities. See all KidStart services, including behaviour consultation. Book a consultation at kidstartpediatrictherapy.com.
FAQ
Can praise hurt a PDA child?
It can. A vague "good job" may become a hidden expectation. Stating what the child did, such as "You put this together," avoids that.
What should I do first with a PDA child?
Get your mindset right. Then temporarily let go of expectations, focus on the child's anxiety, protect their ability to initiate, and offer choices.
What if I keep making mistakes?
Let the moment sit, wait, regroup, and try different language slowly. There is no right or wrong, only what you learn and how you adapt in the moment.
What does an occupational therapist do about sensory processing?
Sensory integration assessment and intervention is the main scope of practice for an occupational therapist. OTs use tests, observations and other tools, along with parent input, to understand a child's sensory processing and how it affects daily living. That is where an OT educates families about sensory regulation: how we take in sensory input, how our body makes sense of that information, and how we adjust and adapt to our environment.