Traditional ‘Rewards and Consequences’ (as they relate to an individual with PDA)

It is fairly well documented by professionals, experienced in Pathological Demand Avoidance Syndrome that rewards and consequences do not tend to help the individual with PDA to modify their behaviour or to comply with requests or demands.  That being said, there will always be exceptions to the rule.  Even an individual, for whom this approach would usually be met with resistance or even anger, may occasionally take the bait and be able to comply in order to achieve the reward.  This may wrongly lead others to assume that rewards and consequences do have their place in successful PDA management.  But the reality of the situation may be that the reward only worked today because the individual’s anxiety levels allowed him to comply, rather than the reward being the pivotal feature. The difficulty with rewards and consequences is that results can often be short lived and may seldom produce any long term benefits or changes.   Also the use of rewards and consequences can, in many cases, actually cause an increase in challenging behaviour and appear to make it even more difficult for the individual to comply.

Possible Reasons Why Rewards and Consequences Do Not Tend to Work for Individuals with PDA

The most important reason may be that the individual simply can’t do what is being asked of them, regardless of the reward or the consequence that is on offer.  High anxiety and an instinctive need to avoid and to be in control at all times may simply override the ability of the individual to change who they instinctively are, in order to receive a reward or to avoid a consequence.

The individual may desperately want the reward or may desperately want to avoid the consequence but simply can’t, rather than won’t, do what is being asked of him or her.  Does offering rewards and consequences work as a successful strategy for making an individual with an eating disorder compliantly eat food?  Does offering rewards and consequences work as a successful strategy for helping the individual with OCD to stop obsessive thoughts, eliminate compulsive behaviour, that they need to do in order to reduce stress and feel calm, or to do things that their OCD may prevent them from doing so like swimming in a public pool that, in their eyes, is a pool of contamination?

I think that the answer on both counts would be no, because these individuals have complex mental health issues that need careful intervention and therapy.  Rewards and Consequences seldom help the individual with PDA to comply or to moderate their behaviour because, just like the individual with OCD or an eating disorder, they also need careful intervention and a different method of reaching and helping them to adjust challenging behaviour that stems from high anxiety, caused by a neurological condition.

The child with PDA may often feel like an adult and has difficulty in understanding why they are not allowed to have the same rights and choices as an adult.  Why do we expect children to never show the same behaviours that adults freely exhibit like being grumpy, short tempered, using bad language, shouting, having control over their own lives and so on.  The individual with PDA may feel deeply offended and patronised by being treated like a child, which is essentially who ‘rewards and consequences’ are typically aimed at, as a strategy of behaviour modification.  We don’t expect adults to have a reward chart on the wall where every aspect of daily life and behaviour are either rewarded or reprimanded with a consequence and so I guess that children with PDA do not expect to have this either.  I must say that I can see their point.

The individual with PDA may feel that a reward or consequence is deeply unfair and unjust if the thing that is being asked of them is something that they simply can’t achieve, due to high anxiety about complying, rather than being something that they simply refuse to do due to bring wilful and defiant.  Mollie has described rewards and consequences as nothing but blackmail and that the use of them makes her more angry and stressed and even less likely to be able to comply.  The use of rewards and consequences can actually have the opposite effect and make the individual less able to comply due to the applied pressure that the use of such strategies may present to the individual.  Rewards and consequences may only serve to make the individual feel even less in control, by giving the person administering the rewards and consequences the balance of control, having the armoury of the ‘carrot’ or the ‘stick’.

Not only can rewards and consequences be unsuccessful for changing the behaviour of an individual with PDA, they can actually be detrimental to the individual with PDA.  The use of rewards and consequences can be instrumental in raising anxiety levels, which may only serve to make the individual feel even more out of control of his or her own environment which can, in turn, lead to panic and meltdown.

Other Ways to Try to Deal with Challenging Behaviour

This, of course, doesn’t mean that individuals with PDA should be able to display all types of inappropriate or offensive behaviour, because that is not acceptable or fair on other members of the family or society.  What it simply means is that there may be more productive ways of reaching the desired outcome.

Activities that are against the law or pose a health and safety risk to themselves, or others obviously, need to be stopped.  However stopping a behaviour or removing an individual from a situation, where things are out of control for the safety of the individual or for others, is not the same as giving a planned consequence.  We are removing them as a natural consequence to non-negotiable behaviour but we are not then punishing the behaviour itself.

Individuals with PDA often follow rules and laws from a higher power and so, for many individuals, breaking the law is hopefully not going to be an issue.  Using a higher power or health and safety can help to enforce some rules and also a visual rule (e.g. a poster that says do not run at the side of the swimming pool) can be useful, productive and can be utilised for other areas of difficulty.

If the individual feels calm they are more likely to be able to follow simply demands, and so providing the individual with the correct environment is often key to helping produce positive behaviours.  The calmer and the more in control the individual feels, of his or her own environment, is the most likely to be a successful way of reducing challenging behaviour.  Helping the individual with PDA to present with acceptable behaviour is often more about a whole round holistic approach that simultaneously tackles many different angles at the same time, rather than simply trying to discipline challenging behaviour out of the individual.

Key areas to try to help keep the individual with PDA calm and therefore to reduce challenging behaviour

Getting school right and as PDA friendly as possible.

Getting home right with as much of a demand free and PDA friendly approach as possible, within the family unit.

The consistent use of basic PDA strategies by all people and agencies involved with the individual is a must.

Listen to the individual and learn to notice subtle hints that they are not coping and are struggling, and adjust your expectations accordingly.

Reduce triggers that may cause a flashpoint, or think of ways to reduce the stress that these triggers may produce.

Accommodate any sensory issues.

Work on promoting emotional well-being and confidence in the individual, because feeling worthless can cause deep unhappiness which can affect behaviour.

Caveat: I am not a professional and so this information is based solely on my own experiences of living with a child with PDA as well as from many years within support groups, along with advice and literature from professionals within this field and advice from other parents.  I have written this following a request from another parent and it is not my attention for this paper to in any way tell other parents how to deal with their children.  This is simply the method that has bought us the best results and my understanding of how rewards and consequences may be perceived by the individual, and why they appear to be an unsuccessful methods of modifying behaviour for the individual with PDA.