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Quite simply, these like avoidance, are FUNCTIONAL and you must genuinely strive to affirm, validate and universalize the PDA functionality of anxiety rather than see it as a “symptom”. You are addressing the pain and confusion stuck in their emotional filter and looking for ways to elicit this to better understand it together.

Anxiety is a consequence of a hyper attuned nervous system that processes large amounts of detail and uses thinking to organize information to master the environment.

It will always be there. It is an ALERT system that when it’s too high it tells the person that they are working VERY hard to navigate complexity, scanning and assessing for safety.

When the alert goes off and anxiety is HEIGHTENED this client needs to understand their bodily signals that indicate this so that they can find safety through relationship, alone time, meeting sensory needs or any number of ways that work for that individual child and their environment.

Your practice work can assist in bringing an emotion to embodiment when looking to engage with the experience of heightened anxiety or reactivity. Given the imagination of the PDA child and adult you can ask them to visualize an experience that represents how they feel. Ask them where they have sensations while visualizing.

The system is simply struggling to integrate the experience and emotion. You will consider ways to support the unfolding awareness of the experience that utilize natural strengths of the PDA autistic.

One child may describe reactivity as the feeling of crashlanding a rocket ship and imagine a parachute to slow the process. His parachute might literally be art since drawing is calming.

One adult may describe reactivity as driving too fast on a highway and crashing into the median. They can imagine floating in water instead to elicit nervous system safety and that a simple shower or bath is very calming for them.

An eclectic mixture of embodiment, somatic and mindfulness techniques, in the midst of talk therapy, is very integrating.

If the PDA child will always have a certain amount of anxiety how is this a “pathology”? Like any trait it can harm or help them.

It has a functional purpose. What is it?

PDA children are a canary in the coal mine. Other children need safety calm and just right demands but the PDA’er MUST have them.

Heightened anxiety simply tells them they don’t have enough of what they need. Ask them what they need.

Validate this and tell them the alert system can be trusted! And you will do your best to listen to it with them.

Help them find words to identify what they need or ask them to imagine what could help. Accommodation of those needs reduces anxiety but also connects to and affirms their growing personhood.

If you see anxiety, expect there to be confusion under the surface. TOO much confusion leads to high anxiety which can often create OCD like thinking meant to manage and control the high degree of attenuation.

Therefore, when you see OCD like thinking in a PDA person this has been functional and protective. Do not attempt to change the thinking and behavior or palliate the anxiety but to explore the experiences connected to the confusion. You are approaching them from a strengths-based perspective.

You will be surprised how many PDA kids and adults have once been diagnosed with OCD and who “go in remission” when their autism is understood and accommodated by themselves and their family.

REACTIVITY: How do you normalize and validate THIS? This is often seen in PDA practice and is what parents are most concerned about. It can lead to safety issues, complex trauma and crisis.

How can you conceptualize the FUNCTION of reactivity to validate and affirm the PDA child and adult even though it can do harm?

PDA young people are incredibly sensitive with a heightened rejection sensitivity much stronger than what occurs in those with ADHD alone.

PDA people will break down each word that is said looking for meaning. And get stuck on one word said not hearing the rest in context if it triggers RSD.

We have to be very cognizant of our language and diffuse any and all attenuation that can develop purely from word choice alone.

As a result, I look to offer context for the reactivity that can lead to aggression and crisis. Not to dismiss or downplay any potential for harm but to understand the autistic confusion that caused it and work to affect the people and environment around the child.

When a PDA person is activated, they will NOT hear you. You will activate them further if you look to set limits on a reaction or talk your way through it. It is just not constructive. You must stand back and allow it to unwind.

I tell children and their parents that BIG feelings can lead to BIG reactions. Even adults struggle with this. GROWING up with BIG feelings can also lead to GROWING into BIG passions and BIG dreams and aspirations.

The question is where do those big feelings go, how do they understand them, and can they over time find the words to share them instead? Their mind will mature. With time.

So, it is vital that this be generalized into an understanding of day-to-day family life so that shame and blame don’t accumulate. The hurt reactivity causes create organic experiences of shame and embarrassment. But it can be held in safety as well if it isn’t interpreted. It simply points to a very common need in PDA emotional development which is a need for “space” to consider and reflect on complex emotions before they can be understood and communicated.

Can the family and the child learn to disengage to unwind reactivity and reconnect when calm?

BIG feelings require distance and time to understand. In the moment it all looks confusing, murky and unclear. To take time means to take space from the BIG feelings.

I encourage a “letting go” and moving away from it to look at later with a bit of distance.

You the therapist can serve as a conduit to improve family relationships this way.

As you can see, it is vital to put into perspective an unfolding PDA child’s development so that parents learn to accept the intensity in their families while also holding open the possibility for change and what it looks like.