PDA and Your Guide to Successful Sleep Training

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Let’s face it! Trying to make changes to any child’s routine can sometimes feel like a painstaking process. Especially for our kids with autism, there can be a lot of rigidity around the not-so-great routines. Getting pushback, even when the changes are necessary, will absolutely happen!

Over the last few years, the team and I have come across more special needs kids diagnosed with PDA, or Pathological Demand Avoidance. And, the idea of making even the tiniest changes with these kids seems like an impossibility. Professionals often tell parents that it can never happen.

But, that’s not the case.

The team and I have learned a thing or two about navigating PDA and rigidity when it comes to the sleep training journey. If you’ve considered making sleep changes for your child, be sure to read this first.

First, what exactly is Pathological Demand Avoidance (PDA)?

I want to be sure to answer this because some families might’ve stumbled on this blog not knowing their child has this. Or, they might be new to the diagnosis and still figuring it out.

PDA is massive resistance to any task that is given that seems like a demand. We all know that sometimes kids just don’t want to do what their told. However, with PDA this resistance can be over the smallest tasks. If it feels like a demand, a child with PDA will just. not. go. with. it. Typically, kids with Autism and/or ADHD will have some PDA.

When a child is defying a demand, this can take many forms. For example, extreme focus or attention on another task, sensory stimming, screaming, tantruming, crying, being extremely silly, inability to transition, and more. For some, tantrums can last for hours at a time.

What is causing this intense response to simple demands and requests?

Unfortunately, PDA is very often looked at superficially. It’s treated as a psychological problem without the deeper understanding of what is happening in the brain.

When a child with PDA is absolutely losing over the simplest ask, this is an anxiety response. For many kids with PDA, requests, demands, etc. are changes. And, no one really loves change. So, what happens? The brain starts to perceive this change as a threat. And, that’s when the anxiety response comes.

Some kids might ruminate or overthink about what will happen, or they want it to be perfect, or they start to catastrophize. Then, your child will go through the physical responses of that anxiety and fear. This is the “fight, flight, or freeze” response.

All the ways a child with PDA might respond to a demand in the previous section can be categorized under those 3 F’s.

When we understand that this response is neurological, not psychological, it allows us as parents and caregivers to respond differently.

Why does my child with PDA sleep poorly?

Depending on your child’s sleep struggles, there are two major reasons they cannot get a good night’s rest. Identifying these issues are crucial to knowing how to navigate your child’s PDA.

Sleep independence

For over 80% of the children we work with, sleep struggles stem from not being able to self regulate through the night. If your child needs you to in any way, shape, or form, they are going to need that help a couple times, or multiple times at night. This leads to broken, poor quality sleep.

By learning sleep independence, your child is able to develop their own ways to get to sleep and use those tools time and time again to get to sleep faster.

Not sure if independence is the way to go? Make sure to check out this blog about why this is a key step for a great night’s sleep.

Sensory regulation

Sensory processing is a key part to a good night’s sleep. Whether your child is autistic, ADHD, or a dual diagnosis, they most likely have mild or severe sensory processing issues. They can be sensory seeking, easily overstimulated, or a bit of both.

All of this can disrupt the sleep process because your child’s brain is either looking for more stimulation, or just trying to process it all.

In my experience, children who have anxiety often have a sensory processing system that’s just a little too sensitive. And, again — PDA is an anxiety response! If we can help your child to regulate their system, this will not only help ease anxiety, but it will probably help with the independence process, too.

How do I get my child with PDA sleeping well?

When making any changes to a child’s sleep schedule, routines, set up, etc it’s important to make changes gradually.

Choice and Voice

Remember, you have a child that DOES NOT like any demand, big or small. So we cannot just give them a new routine and tell them they have to follow it. But, we can give them choice. When your child has choice, they feel more control over the situation and are much more likely to comply.

So what do we give choice over? Lots of things!

Let’s use the bedtime routine as an example. You might have a particular order you want to follow. You can give your child choice over what quiet time activity to do, bedtime snack, book to read, PJs to wear, song to sing. Heck, your child might be able to choose each night what order to do their routine in. In these cases, write the bedtime routine activities on paper and have your child put it in their preferred order.

Do you have difficulty getting your child to transition? Let them choose how much time they spend on the activities they like. Or, let them choose to go to their room or to the next activity running, jumping, hopping, etc.

What about non-preferred (but necessary) activities, like teeth brushing? Give your child a choice over how long, or how many brushes back and forth they can do. A super helpful tool is a timer cube. Especially for non-preferred activities and difficult transitions, your child can choose the time they want to spend on things.

Prepare your child for what’s to come

Before starting any independence work with your child with PDA, it’s important to really evaluate your child’s sleep situation. What help do they need? What are all the tiny details? For example, if you lie with your child at night to sleep, are you giving touch support? Do you ever pick up and rock your child? Do they cuddle up with you? Identifying all these steps is crucial for actually implementing sleep training.

In addition, it is crucial to use a visual story to show your child the changes that are about to come. Social stories are a necessary and basically required tool for all families at Melissa Doman Sleep Consulting. By reading your child the bedtime social story, it gives them the chance to learn what’s happening. And, it gives consistent language around sleep.

It is important that your child hears their sleep social story at least 15 times before starting any changes at bedtime. This blog gives you more guidance on writing a social story.

Get additional sensory help for your child

Making sure your child’s sensory system is better regulated will help in several areas. They will be more calm going into sleep, and it will make it easier for staying asleep. When preparing for sleep training, consider asking your child’s therapist about sensory diet ideas and work on these at home. Sensory processing can be expansive! But some tools can help “kill two birds with one stone”.

One tool we love suggesting for our sensory sensitive kids is a lycra swing. This gives a child movement and light compression at the same time. And, it can be darker too which can further settle your child’s system. A commonly used technique for our PDA kids is joint compression massage, as it gives tactile and proprioceptive input in addition to calming an anxious mind.

At Melissa Doman Sleep Consulting, the team and I evaluate your child’s sensory profile and gives recommendations on what sensory techniques best serve your child for sleep success.

Get sleep training!

Once you’ve identified the help, make a plan to take this help away one piece at a time. If you do lie with your child, perhaps the first step is not giving touch support. Still lie with your child until they are asleep, but the first change is no touch. Then, when they are successful with this make the next change.

Again, don’t start any sleep training until you’ve figured out your plan and used your child’s social story. Without this, any change (no matter how small) will backfire.

And again, this is a process where you can give (some) choice. If your child simply needs you in the room without physical support, let them choose where the chair is each night. As long as it’s moving out of the room, the moves can be as small as needed.

Celebrate wins every step of the way

Now, this can be a bit tricky because many ASD and ADHD children with PDA don’t necessarily like praise, either. But, showing your child when they have been successful and resilient is crucial to getting any kind of traction.

You can start by simply talking to your child each morning about how the slept the night before. Or, can go over what they did well in their bedtime routine, or how they got out of bed fewer times. In addition, you can also highlight what they were able to do independently.

Some children do well with a visual check chart. Write the few things that your child is working on in the chart, and check off what they did well and what they still need to work on. For example, if staying in bed is on the chart, you can award a check mark. If they didn’t stay in bed simply say, “Hey, you still got out of bed 3 times last night. But that’s okay – you’re learning something that is tough. We can try again tonight!”

Regardless if you use external rewards or simply talk to your child about what they’ve done in the process, you are constantly reminding them of their success. And, when making changes that feel uncomfortable, constant reminders of success will create more success.

Navigating the rough patches with your PDA child

You and I both know that this isn’t going to be a walk in the park. This is a transition for everyone. It is important to expect and know what to do when things get tough. When you’ve given the choice, set things up for success, your child still might protest or resist. No matter how ideal your set up is!

In those moments, I encourage parents to use a particular formula when speaking to their child:

I see/hear… + I understand… + But…

For example, “I see that you’re really frustrated we need to brush our teeth. I understand that brushing teeth is not something you like. But, we brush to keep our teeth healthy.”

In this example, you can remind your child how much time they said they were going to brush for. Or if you’re in a real pickle, give the choice again. If your child chose 1 minute but that seems too much, offer 30 seconds or 40 seconds as a compromise.

I do not recommend offering many compromises, though. Kids like yours are experts in getting out of uncomfortable situations. Offer one, and then continue to use your formula until they are calm again.

Sleep success for your child with PDA

As you might have picked up on, sleep training a child with PDA in addition to other diagnoses is involved. But, it does not mean your child cannot learn to sleep well and independently. At Melissa Doman Sleep Consulting, we empower parents by providing them the exact roadmap to sleep success. We also know how to empower kids to make choices and love to sleep well.

If your child with ADHD and/or ASD has a PDA tendency or diagnosis, we are here to help!