Revealed: The Differences Between Oppositional Defiance Disorder (ODD) and Pathological Demand Avoidance (PDA)

Revealed: The Differences Between Oppositional Defiance Disorder (ODD) and Pathological Demand Avoidance (PDA)

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When it comes to supporting pupils with additional needs in school, having the right strategy is crucial. However, some conditions can (on the outside) appear very similar.

In this episode of School Behaviour Secrets, we discuss the similarities and differences between two very different conditions - Pathological Demand Avoidance and Oppositional Defiance Disorder.

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Emma Shackleton 0:00 ODD is a condition where pupils find it hard to manage their impulses and is driven by that really strong need for control. Control is the big pull factor here. Simon Currigan 0:12 Whereas PDA is a condition where they're moving away from anxiety. Anxiety is a massive factor. What they're trying to do is escape overwhelming demands, which is a slightly different thing, but it can result in very similar behaviours. Hi there. My name is Simon Currigan and welcome to a freshly baked episode of school behaviour secrets. Philosopher Walter Benjamin once said "boredom is the dream bird that hatches the egg of experience" We'll provide the boredom you provide the egg. I'm joined as ever by non boring co host Emma Shackleton. Hi, Emma. Emma Shackleton 1:26 Hi, Simon. Simon Currigan 1:27 Emma, before we go any further into the show today, I'd like to ask you a quick question. Emma Shackleton 1:31 Come on, then. Let's hear it. Simon Currigan 1:32 Is there something like a job or a task or a part of your life that you have to do that you really dislike? Emma Shackleton 1:40 Okay, something I dislike, I guess driving in rush hour traffic springs to mind it really winds me up, how much time is wasted crawling through city centre traffic when I could be doing so many other more productive things. But I have to get from A to B. So until we get the private jet. That means sitting in traffic. Why do you want to know? What's the relevance this week? Simon Currigan 2:05 I'm asking because in this week's episode, we're exploring the difference between ODD which is Oppositional Defiant Disorder and PDA which is Pathological Demand Avoidance syndrome. And while on the face of it, these two conditions can look similar, refusal, not following requests or instructions, not doing work, defiance, rejecting authority, that kind of thing. They're actually very different conditions. So we're going to dig into that. Emma Shackleton 2:32 Okay, sounds good. Because as we always say, you do have to match the right strategy to the right need. Just before we jump into the episode, though, how do you fancy paying it forward with a small good deed, we really do rely on word of mouth recommendations. So if you find the school behaviour secrets podcast interesting and useful, and you know anybody else who might like it to do them a favour by opening your podcast app and clicking the Share button. Simon Currigan 3:02 Now, without further ado, let's creep into the kitchen, pinch our noses tightly and open that pungent tin of smoked herring that we call behaviour. Emma Shackleton 3:12 Okay, so let's start by looking at the two conditions and how to recognise them in the classroom. And we'll start with O D, D. So ODD stands for Oppositional Defiant Disorder. oppositional means opposing, as in taking an opposing view, or being opposed to doing something you've been asked to do. So most commonly in school, this would look like refusing to do your work or follow the teachers instructions, or actually doing the exact opposite of what they've been asked to do. If you ask them to write in pen, they'd get a pencil. If you ask them to walk quietly down the hall, they'd run and shout, that kind of thing. Simon Currigan 3:58 Interestingly, ODD is actually a form of impulse control disorder. So what is impulse control disorder? So Viktor Frankl famously wrote there's a gap between stimulus and response. So we have an idea, something happens to us. And then we have an idea about how to react. And there's a gap where we evaluate whether that's a good idea or not, and then we act and an impulse control disorder means that that gap is either very short or hardly existent at all. So we're doing very little assessment of an idea that we might get before we carry it out. So someone might take our pencil and our immediate thought might be, I'm going to thump them. And then there's a gap where we might evaluate that idea and think about whether it's going to get us into trouble and how it's going to affect our relationship with the other child. Before we then act and we might then decide to change our action or we might decide to carry on and thump them. But there is an assessment there that requires a little bit of time. And if you have difficulty controlling your impulses, that idea bubbles up into your head and before you've assessed it in any great depth, your body just sort of executes that idea. And the thing to bear in mind when we're talking about odd here is that no two children with odd are the same. And we have to treat them as individuals. But there are some common threads to their behaviour. So let's dig down and have a look at that. ODD tends not to be diagnosed until the age of four and above, for very good reasons. Before that age, it's quite normal for kids to have tantrums and refusals when they're asked to do something. Many children go through the terrible twos, the age, when they start to get a little bit of independence, they're able to move around safely, they can communicate effectively. And they discover that they don't like adults putting limits on their wants, or their actions, they know what they want, they want to go out and get it without an adult standing in their way. And that can result in tantrums and saying no, and stamping your feet and that kind of thing. Now, most kids will grow out of those tantrums by the age of four, or at least grow out of having them frequently, because they're starting to learn to regulate their emotions a little, they're starting to accept social expectations, and they're becoming a little bit more reasonable. But if those tantrums carry on for longer, then it might be a sign that something else is going on. It could be not necessarily is but it could be a sign that the child's behaviour is being driven by something like Oppositional Defiant Disorder. Emma Shackleton 6:30 Interestingly, as well, ODD can actually develop in teenagers as kids reach adolescence. So children who were quite easygoing and reasonable that primary school can suddenly change their behaviour. And again, this might be a sign of teenage onset ODD. And just to be clear, here, this is going beyond the stereotype of an argumentative or grumpy teenager, we're talking about significantly challenging behaviours at home and at school, that are predominantly oppositional in nature. The tricky thing is that odd often presents in children alongside other conditions. So you'll often see a child with the diagnosis of Attention Deficit Hyperactivity Disorder, and ODD, or they might have autism and ODD. In fact, about four out of ten students with ADHD, also end up with an ODD diagnosis. And that makes sense, really, if you think about that idea that it's an impulse control disorder, because that's a strong factor of ADHD to obviously, ODD can only be diagnosed by a medical professional, not by a teacher, or anybody who works in education. But here are the kinds of behaviours that you might see that could be, could be related to ODD. Simon Currigan 8:00 Yeah, we want to stress the could be there, don't we? Emma Shackleton 8:02 Yeah. Simon Currigan 8:02 So number one, kids with ODD are often touchy, they get angry very, very quickly. In general, they have kind of like this irritable mood pattern, they look resentful. And this is true when they're interacting with adults in the class. And with other children in the class. They're the sort of kids that will overreact to comments from other children or adults, they can be resentful and speak really harshly sometimes to the other pupils. Another behaviour you might see in the classroom, number two, is, you know, obviously, given that this Oppositional Defiant Disorder, they are defiant and argumentative, and we don't mean a little bit here. We mean a lot. This is the sort of child who loves drawing you in for a power battle, arguing about every little thing. If you're teaching a child with ODD it can feel like every day is a series of battles over quite minor things. Children with ODD can argue endlessly, refuse to follow school routines or expectations, challenge the need for them to be there. They'll deliberately annoy the other kids, and then refuse to take responsibility for the actions that they have taken. They'll often blame the other children or they'll blame you or the school or the environment that they're in. It's all unfair. And behaviour number three, the child will often display a vindictive quality, they'll hold on to grudges, and then plan their revenge in a calculated way, and then carry it out. So they're not reacting in the moment. They're thinking about things that have happened to them they consider unfair, and planning ahead and serving their revenge cold. Now, we don't know what causes ODD and there have been lots of suggestions but interestingly, it does not look like parenting is a factor but we do have a good sense of what appears to drive a lot of that behaviour and that have a sense of control. When a child with ODD feels like they're in control of their own decisions and actions, and they're working towards something that they feel is valuable or make sense to them, and they have control over it, then you tend to see fewer behaviour issues. Emma Shackleton 10:19 it's really quite tricky, isn't it? Simon, because lots of those behaviours that you've described could also be for other reasons, like a stress response or an anxiety or something difficult that the child is going through. So it can be really difficult to unpick can't it. Simon Currigan 10:34 Absolutely. And they have to be long standing behaviours that you've seen, I think it's for six months, at least, I think that's the criteria that doctors use. Emma Shackleton 10:41 Yeah, Simon Currigan 10:42 So we're not talking about a child going through a phase for a couple of months. This is a long term condition. Emma Shackleton 10:47 Okay, so let's compare that to pathological demand avoidance, or PDA, sometimes called PDA syndrome. PDA is a very specific form of autism that presents a little differently to autism generally, so it can be easily overlooked. But one of the important things to remember is children with PDA, often have all of the related difficulties or challenges related to autism, but they're not necessarily as obvious in the classroom. So there's a difference between demand avoidance and pathological demand avoidance. Simon Currigan 11:27 Yeah, demand avoidance is something we all get us adults or kids. And it essentially means not wanting to do something that you've been asked to do. So someone's placed a demand on you, then you don't like it, you're resistant to that demand. There's actually a term for in psychology called reactance. Demand avoidance from time to time in children is quite common. Depending on the task, or what we've asked them to do. We all have things that we don't like doing. We don't like being made to do them. We don't like being told to do things at certain times, and we will put up a little resistance. The key thing here is that feeling does not have a negative impact on our bodies, or our biology. And it doesn't represent a sort of general response to people placing demands on us or asking guests to do certain things. Now PDA is different. The pathological in pathological demand avoidance means abnormal, or dysfunctional. If you have PDA, and someone places a demand on you, your body reacts with a rush of stress chemicals that fuel huge amounts of anxiety, they put you in this heightened emotional state that feels like it's going to overwhelm you. And the more those demands feel outside of your control, the more anxious you become until you reach a point where you can't cope with those feelings anymore. So unsurprisingly, one of the behaviours you'll see in class is resistance to tasks. Usually, this starts with what's called social manipulation. That's where the child bargains, or they negotiate with you about how the task will be done, or whether it needs to be done. Or maybe they engage in task avoidance. So instead of getting on with a piece of work, they'll spend 20 minutes sharpening every pencil they can find in the classroom or looking through their drawer for just the right ruler. They find every sort of non violent means of avoiding that task to try and escape the anxiety associated with it. Emma Shackleton 13:27 Another behaviour that you could easily miss is doing whole class input. If the child feels like they can't cope with the demands of having to sit and listen to the teacher, they might use a strategy such as putting on a face that looks like they're listening, but their mind is actually deliberately focused elsewhere. It's kind of like a passive resistance. And then of course, if you keep pressuring and pressuring the child, and this social manipulation technique isn't effective for them, their anxiety is going to shoot up, and you're likely to see the child become overwhelmed. And that's where you're going to get a meltdown or see the child engaging in other escape behaviours, maybe walking out of the classroom or refusing for example, because you're pushing them towards that classic fight or flight response. That means while for other children, setting firm expectations, and holding them to account can be really effective and actually improve behaviour. For children with PDA. The opposite is true. Setting firm expectations and holding them to account is going to be counterproductive. It's like throwing more pressure into the pressure cooker. At some point, the walls won't hold any more, and the whole thing's gonna blow. Simon Currigan 14:47 One of the reasons why PDA can be confusing or get missed in the classroom is that if we ask a child with PDA to do something that we know they already enjoy, say it's a piece of artwork, if they're feeling anxious already, they may refuse to participate. This is because engaging in the task, even though it's something they like, it wasn't their own choice, they were being instructed to do it. So this can result in a behaviour pattern at a surface level. Anyway, that looks inconsistent. Some days, they might do the activity, and other days they won't. And what I should say is, as we record this, PDA isn't a diagnosis by itself yet. So if you're teaching a child affected by PDA, you'll often see a diagnosis of autism with a PDA profile or something similar. It's usually diagnosed alongside a primary diagnosis of autism. And in many places, PDA still isn't recognised or diagnosed at all. Emma Shackleton 15:51 PDA also reveals itself in lots of other ways in the classroom. And again, we'll always say every child is an individual, but many children with PDA also have difficulties with receptive language. And that can be masked by good expressive language, meaning that they might be articulate, and they might be good at talking. But actually taking in an understanding and processing language can be tricky for them. In addition, you'll also see children who simply don't understand the idea of social hierarchy. So it won't make any difference to them who is making the request, it doesn't matter whether it's the TA or the lunchtime supervisor, or their teacher, or their head or the king, it doesn't matter because they don't see that social hierarchy. And they don't feel like they need to behave in a different way, depending on the person in front of them. Simon Currigan 16:46 Yeah, absolutely. They sort of see themselves on a level with the adults don't they? Emma Shackleton 16:49 Yeah, Simon Currigan 16:50 They don't recognise the expectations in school. And whilst they tend to be good socially, at a surface level with the other children, you often find they get into arguments with their friends, because when they're playing, they're often quite controlling in their play or social interactions. And as a result of this, you'll often find that drawn to more easygoing, sort of pliable reasonable children, or younger children, who they have sort of more natural authority over and, and those younger children sort of do whatever they tell them to. And another common behaviour you see with children, PDA, is something called emotional lability. Now this is really interesting. When many children reach a heightened state they get overwhelmed, you might see a meltdown, it can take a very long time for them to recover from that they sort of get stuck in this heightened, highly stressed state, often for hours and hours and hours. emotional lability is the complete opposite to this, it's like a pendulum swinging from side to side, one minute, they're furious and angry or overwhelmed and incredibly anxious. The next minute, they're calm and happy. The pendulum swings from one side of the emotional scale to the next very, very quickly, or very, very unexpectedly. Emma Shackleton 18:03 So as you can see, PDA is quite a complex condition. And we've only had time to look at some aspects of it in the classroom here. There are lots of other classroom behaviours and traits that might reveal that PDA is affecting a child in your school. So you can see that all those some of the behaviour for ODD and PDA might actually look similar. Underneath the conditions are very different. ODD is a condition where pupils find it hard to manage their impulses and is driven by that really strong need for control. Control is the big pool factor here. Simon Currigan 18:41 Yeah, absolutely. They're moving towards control. Whereas PDA is a condition where they're moving away from anxiety, anxiety is a massive factor, the children aren't necessarily seeking control, what they're trying to do is escape overwhelming demands, which is a slightly different thing. But it can result in very similar behaviours. Emma Shackleton 19:01 But you can see why picking the right strategy for the right need would be really important here. Because in either case, a strategy that would work for ODD might accidentally make the behaviour of a child with PDA worse, and vice versa. So if you work with kids with challenging behaviour, and you're not sure why they're acting in that way, we've got a download that can help. It's called the SEND handbook. And what that will do is help you to link behaviours that you see in your classroom with possible causes such as autism, ADHD, and trauma. Simon Currigan 19:39 The idea here isn't for teachers to make a diagnosis. We're not qualified but if we can link classroom behaviours to possible causes quickly, it means we can get the right help and get early intervention strategies in place. Emma Shackleton 19:51 The SEND handbook includes useful information on ACE's that's adverse childhood experiences and you get lots of fact sheets about different behaviour needs in the classroom. And yes, we've also included strategies for ODD and PDA. It's a free download, so head over to our website click on Free Resources near the top and look for the SEND behaviour handbook. We'll also put a link in the episode description. And as we record this, that handbook has been downloaded over 20,000 times by teachers, school leaders and parents just like you. Simon Currigan 20:32 If you found today's episode enjoyable or you found it useful. Remember to open your podcast app and hit the subscribe button. So you never miss another episode. Subscribing isn't anything sinister. It just tells your podcast app to download and save every episode as it's released. A bit like the series link on your TV box and subscribing is completely free. And to celebrate subscribing to the podcast. Why not put grease where there shouldn't be grease? Emma Shackleton 21:01 What is that it? Simon Currigan 21:02 Yeah, absolutely. Subscribers, go out and have a lot of fun with that one. Get a little crazy. Emma Shackleton 21:07 Okay, that might not be the safest idea, but you're all responsible adults. I hope you found today's show valuable. And I'd like to finish by wishing you all an excellent week, and we look forward to seeing you on the next episode of school behaviour secrets. Bye for now. Simon Currigan 21:24 Bye

(This automated transcript may not be 100% accurate.)