We have adopted a neurodivergent affirming stance when it comes to discussing the treatment of autism. We see autism as reflecting a brain type that is hardly “less than.” Rather, we recognize that autistic individuals are disproportinately responsible for some of the most important innovations that our society enjoys. Autistic individuals bring a capacity to perceive elements that “neurotypicals” might miss, whether related to social justice, patterns in the environment, creativity, or sensory experiences. At the same time, autism is associated with relatively high rates of seeking mental health services. Autism is linked to genuine mental health vulnerabilities. Autistic individuals are suspectible to anxiety, depression, emotion dysregulation, and behavior dysregulation. There are aspects to our environment than can create undue stress for persons with autism.*

As with most issues that we work with at CATS, we value parent/ caregiver involvement when it comes to building mental health resilience. It’s also common for us to need to address supports at school so that the child or teen is better understood by their education team and can certain accommodations. Many of our evidence-based approaches for addressing issues such as emotion dysregulation and behavior issues have been shown to be applicable and effective when autism is in the picture.

*We intentionally use both identity-first and person-first language because we recognize that people within the autism community vary in their preference of which type of language suits them best.

Common challenges associate with autism that may warrent mental health support:

• Transitions

• Inflexibility

• Friendship development

• Emotion dysregulation

• Meltdowns

• Sensory overwhelm

• Interpersonal conflict

• Overreliance on screens to self-regulate

  
  

We get a lot of questions about Pathological Demand Avoidance (PDA). PDA is not a recognized diagnosis in the United States, and it has not yet been validated as a construct in the scientific literature. However, many families find the framework to be helpful to understanding their child’s needs.

What is PDA?

• A theoretical concept and framework, not a diagnosis

• Considered, in theory, to be a part of the autism spectrum

• An anxiety-driven need to be in control and avoid other people’s demands and expectations

• Children with PDA have difficulty seeing boundaries and understanding their social obligations

How is PDA expressed?

• Making excuses

• Off-task behavior

• Negotiation

• Defiance

• Meltdowns

• Physical outbursts, explosive behavior, or aggression

What do we do about PDA?

• Personalized learning experience (to accommodate areas of special interest)

• Continual adjusting of expectations

• Flexibility and accommodations

• Explicitly evaluate and rank priorities (high, medium, low)

• Use planned ignoring for low-ranking priorities

• Reduce anxiety

• Build self-awareness

• Avoid unnecessary confrontation

• Support the needs of adults working with the child with PDA

Child and Teen Solutions (CATS) is a mental health clinic based in Seattle, Washington. We are staffed by psychologists and therapists who specialize in children, teens, young adults, and parent coaching. We offer both in-person and telehealth services. Our office is located in the Madison Park neighborhood, near Lake Washington.