Tag: Autism

Book review: When the Naughty Step Makes Things Worse by Dr Naomi Fisher and Eliza Fricker

Another book in the parenting thread: When the Naughty Step Makes Things Worse by Dr Naomi Fisher and Eliza Fricker.

The title describes the central theme of the book; some children simply don’t respond to the widespread, traditional punishment / reward method of parenting. If you try to put them on the Naughty Step they will refuse to go, and get ever angrier about it. As the authors highlight a motivated child has a higher stamina for opposing your parenting strategies than you have for executing them! You will typically have other things to worry about; a child can fully commit their energies to opposition.

They describe these children as “pressure sensitive” – they are made anxious when they feel under pressure to do something and their behaviour arises from this – finding ways to avoid the thing, elsewhere this is given a diagnosis of “pathological demand avoidance” (PDA). Their answer to pressure sensitive children is “low demand” parenting with the aim of widening the child’s “window of tolerance” for demands over a long period.

Fisher talks about how parenting was “invented” in the 1950s with the work of Baumrind and their demandingness/responsiveness model. It extends behaviourism, which sees animals trained by a combination of reinforcement (reward) and punishment, to the training (raising) of children with the addition of responsiveness which is trying to meet the needs of the child and being emotionally warm with them.

I sometimes wonder what fraction of animals refuse to be trained under the behaviourism model. When I reviewed Other Minds (all about octopuses) I read about efforts to measure the intelligence of three octopuses:

… two octopuses in their study put in some effort to carry out the tests presented whilst Charles insisted on squirting water at the experimenters and being otherwise uncooperative. It does make you wonder whether measures of animal intelligence are more a combination of willingness and intelligence. 

The authors refer to behaviourism models of parenting, somewhat tongue in cheek, as Good Parenting(TM). It is relevant to highlight the contrast because much of the internal battle for a low demand parent is the opinions of others, and whether they are right: are we here because we are poor parents? what does my parenting look like to other people? What are people thinking? Largely the author’s prescription is to ignore these outsiders except where necessary (other family members and professionals with important roles).

Thinking about pressure sensitive children it is easy to see how they struggle at school where systems of punishment and reward are becoming ever harsher. Furthermore in a classroom environment there is little scope for responsiveness. Therefore schools end up being strictly authoritarian environments which absolutely don’t work for a fraction of children, and greatly stress a further proportion. My experience of schools is that they have little appreciation or understanding of the existence of pressure sensitive children. Many of the children mentioned in the book have been pushed out of the mainstream school system, some are in special schools or home education.

After the preamble chapters talking about the group of children in question, and earlier models of parenting, The authors spend several chapters talking about different aspects of low demand parenting in practice, communication, behaviours, emotions, and screens. They are pretty positive about screens – highlighting that games like Minecraft offer pressure sensitive children a complex world which they control completely and often it is the only thing they will engage in. Most of the practices of low demand parenting are captured in acronyms – REACH, FLASH, JOIN UP. The core is to throw away your previous concepts of Good Parenting(TM) and seek a more equal relationship with your child (rather than trying to force them into conformance), join them with what they are interested in (for a while my wife and I played Fornite with our son), and focus on the necessary (sitting at the table eating healthy homecooked meals without your elbows on the table may be an ideal but sitting in front of the TV eating beige food is actually fine).

It is a bit difficult to judge the age group this book targets, much of the start feels like a discussion of younger children – at primary school and earlier but there are frequent mentions of children going into adolescence. One of the stories in the final chapter tracks that of my now 13 year old son almost exactly – apparently fine and doing very well in school until the demands of secondary school were overwhelming with an exit into online school.

There is a chapter on self-care for parents, a subject touched on earlier in the book in coping with the disapproving looks of other parents. This chapter uses techniques like radical acceptance, visualisation and mantras which I’m familiar with from counselling.

Despite being over 400 pages long When the Naughty Step… is an easy read. The text is broken up with Fricker’s cartoons, personal stories and various tables and exercises. Each chapter ends with a dialogue between Fisher and Fricker (which I found really useful), a bullet point summary and some suggestions for further reading.

I sometimes worry I have joined the cult of Fisher / Fricker, in common with many parents whose children have not been entirely straightforward to raise, I will enthusiastically recommend their books (and webinars). I think the core of their success is that they identify very clearly how our children are, when few others do, and reassure us that it is not the end of the world, when most are trying to convince us it is.

Book review: Understanding Pathological Demand Avoidance Syndrome in Children by Phil Christie, Margaret Duncan, Ruth Fidler and Zara Healey

Today I open up a new strand of reviews with Understanding Pathological Demand Avoidance Syndrome in Children by Phil Christie, Margaret Duncan, Ruth Fidler and Zara Healey. This is for reasons I alluded to in my review of 2024.

Pathological Demand Avoidance (PDA) is a condition first identified in children being evaluated for autism by Elizabeth Newson in the late 1970s.

The core of the PDA diagnosis is the idea that demands of a child causes them anxiety which results in a range of responses around refusing those demands, and developing strategies to avoid demand. This is a problem because often the child will refuse “demands” that would lead to things they wanted to do for example “Please put your shoes on so that we can go to the zoo” – “No!”. It also makes education and everyday life challenging.

The term did not enter the literature until around 2000, and its use has grown substantially since 2012 (see Google Ngram). This book was written around 2012. The current professional opinion on PDA appears to be that is a recordable trait for neurodivergence assessments but it is not a standalone diagnosis.

Understanding PDA is divided into 6 chapters:

  1. What is PDA?
  2. Positive Everyday Strategies – this is about managing PDA in the classroom;
  3. Living with PDA – this is about managing PDA at home;
  4. Providing the Best education for a child with PDA;
  5. Developing emotional well-being and self-awareness in children with PDA;
  6. Summing up and questions for the future;

The chapter “What is PDA?” is about diagnosis, it lists a set of diagnostic criteria and provides some examples of what these criteria look life in action. The criteria proposed for PDA are:

  1. Passive early history in the first year;
  2. Resists and avoids the ordinary demands of life;
  3. Surface sociability – sociability is used as a tool to avoid demands;
  4. Liability of mood;
  5. Comfortable in role playing and pretending;
  6. Language delay;
  7. Obsessive behaviour;
  8. Neurological involvement;

It places PDA alongside autism spectrum conditions broadly divided into “able autism” and “autism with additional learning disabilities”. Reading this I realised my son had some elements of the diagnosis but not many, I also noted that typically the children considered in this book were of primary school age – 5-10 years old. It was also a salutary reminder that our son’s behaviour is fairly mild, one parent reported being threatened by their 8 year old son with a knife! This was not the only example of violent behaviour in children.

Many parents reading this will be asking themselves whether their child fits this diagnosis, and many will be looking at the criteria and realising that they have at least some elements themselves. This presents issues in management of the condition but also provides valuable insights.

As someone with a background in physical sciences my predisposition is to see a diagnosis such as PDA as a concrete undisputable thing. However, it is better to see such diagnoses as a conversation opening to help discuss strategies for living with a child with PDA. The following chapters cover strategies for dealing with a child with PDA at home and in school. The strategies they come up with are as follows:

  1. Reducing demands;
  2. Disguising demands;
  3. Distraction;
  4. Offering choices;
  5. Ignoring undesirable behaviour;
  6. Flexibility and adaptability – learning to be willing to change plans;
  7. Depersonalising demands – a routine depersonalises demands;
  8. Staying calm and neutral – shouting can raise the “excitement” for a child, and so is something that might be sought;
  9. Dealing with bedtime difficulties – fortunately we don’t have these – they’re clearly a common problem;

This seems like an important section to read – it recognises that parents are not perfect and need to develop their own coping strategies. Parents also find themselves wondering where they went wrong to end in this position (they didn’t go wrong), and also feeling guilty for losing their tempers (which is common and natural). It also highlights that the impact of handling a child with PDA on other children including both siblings and class mates. Another lesson is that just because something on one day doesn’t mean it will work on another, the context and the child’s mood is important.

I found the chapter on handling PDA in school environments interesting, not for its relevance directly to me, but because government are keen on the idea of “inclusion” – teaching children on the autistic spectrum in mainstream schools. Reading the accommodations suggested for PDA pupils this seems unworkable, fundamentally because accommodations make a child stand out in a school and for children on the autistic spectrum that is something they definitely don’t want. Secondly, it is difficult to see how such approaches can be accommodated in class sizes of 30 or so typically found in mainstream schools. The authors comment that in the end success comes to the personal relationship between the child and the adult rather than any particular system.

I don’t think I would recommend this book, it is quite academic in style in a field that is not my own. It has to be seen a bit as a campaigning book for the PDA diagnosis written in 2012, so somewhat out of date. I found the National Autistic Society page on demand avoidance a useful alternative to this book. It provides a short summary of some of the key points in Understanding PDA with better context for the diagnosis’s wider, current relevance.