Tag: EBSA

Jan 26 2025

Book review: The Teenager’s Guide to Burnout by Dr Naomi Fisher and Eliza Fricker

I recently reviewed Understanding Pathological Demand Avoidance Syndrome in Children, this book follows that theme – I’m reviewing The Teenager’s Guide to Burnout by Dr Naomi Fisher and Eliza Fricker. The Teenager’s Guide is a far easier read, directed at teenagers rather than adults although it includes a section at the end for adults.

Dr Naomi Fisher is a clinical psychologist well-known for her work on the mental health of children, parenting and schooling. She experienced many different schools in different countries as a result of her parents’ life-style. Eliza Fricker is an illustrator and author and has experience of the issues covered in the book and drew the illustrations.

The book starts with some generally comments about stress and burnout which could apply to anyone, it’s useful in setting the scene although I did worry whether I’d got the right book. Perhaps surprisingly the book doesn’t mention “autistic burnout” except in the final section for adults where Fisher says that burnout is burnout, some children are neurodivergent but that’s not the key feature.

The action quickly moves on to school which in general is what will cause burnout in teenagers. The process of burnout is divided into four sections:

  1. Breakdown – burnout often seems to come out of the blue, a child is “fine at school” and then suddenly can no longer go in. It is traumatic for parents as well as children. Fisher (rightly) attributes this largely to the school environment and emphasises that a return to school should not be the short term gaol. This stage is about re-connecting with the child, it turns out our family sessions of Fortnite were actually a pretty good thing to do!;
  2. Repair – this is when we start to find the new normal with a child at home not at school, and a family rearranged to accommodate. There is often sadness here at the life apparently lost. This stage is about the teenager trying to find some enjoyment in life;
  3. Learning from the journey – this is about learning about what went wrong; why was it that school became unbearable? Sometimes as parents we will discover that our well meaning efforts were just pressuring our child and worsening the problem. I think of our efforts to get our son to see a counsellor here;
  4. The Road Ahead – this is about finding another path to education, outside of mainstream school. Part of the current process is, typically, to pressure children by telling them that mainstream school is the only option and they will be a failure if they don’t attend. Fisher describes it as a myth, really it is an outright lie;

Fisher believes that a key mistake most people make is to see a return to mainstream school as the goal throughout this process. If an adult had a burnout as a result of a high stress job we probably wouldn’t see going back to that job as the goal. She sees the school environment as being the problem which reflects the WHO recognition of burnout as an “occupational phenomena”. She cites increasingly high pressure methods used in schools to control behaviour (see SLANT), enforce attendance (“your parents will be fined and may go to prison if you don’t go to school”) and recover the academic progress lost during the pandemic. I have to say I agree with all of this.

Fisher is scathing about schools, pointing out her experience of so many different school systems highlights which school rules are in fact unnecessary she mentions UK uniform rules and the UK tradition of calling teachers “Sir and Miss” as examples of this. The world doesn’t end if you don’t wear a school uniform and address your teachers by their first name.

Fisher says a little about why burnout is an increasing problem, some of it is changes in the world – particularly the pandemic. She mentions world events like climate change meaning there is little to hope for in the future, as a child of the seventies and eighties I can say there is no change there – we feared nuclear annihilation! She says that in the past those suffering from burnout might have been diagnosed as having glandular fever or simply truants. It strikes me that in the past twenty years or so we have been become (on the face of it) much more understanding of mental health issues in adults but we don’t extend that sympathy to children.

I found her comments on friends and social development interesting, one of the key worries of those educating at home is the lack of social interactions. However, Fisher points out that frequently younger children have a quite limited social circle covering only family and relatives. Friendship at secondary schools has the air of protection, being in with a group so you are not alone at lunch time or the school gate, not the target of bullying. That said she provides a long list of venues outside school where teenagers might find new friends.

I suspect this book will be mainly read by parents; teenagers in the process of burnout are likely only receptive to it at stage 4 (The Road Ahead). The best time for an adult to get this book would be prior to stage 1, perhaps when the first signs of issues at school appear but it is useful at any time in the process. I heartily wish no one needed this book.

The Teenager’s Guide is great: for affirming we are not alone, for providing reassurance and also for providing some strategies to try for a better future. Although it is purportedly written for teenagers it is fine for adults, making for an easy read with short recaps at the end of each chapter. There are some handy tables / exercises which also act as summaries.

Jan 20 2025

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.