Understanding and supporting an autistic learner with demand avoidant behaviours
‘Jack told me he couldn’t write because he was a tiger. He said tigers have no thumbs and long claws so they can’t hold the pencil. Before I had the ‘ Understanding PDA’ training, I would have gotten cross or told him not to be silly. But after the training I would join in, become a tiger myself and try and grip the pencil with my tiger claws and roar. This made Jack laugh and feel more relaxed. Soon he was showing me ways he could hold the pencil and mark make. I let him give me lessons. This seemed to lower his anxiety and move things forward.
Now, every time he gives a reason why he can’t do something, I meet him where he is. Or join him in his play. I think he starting to trust me more now.’ A TA at Jack’s school
This is an extract from a case study I wrote for the ‘Good Autism Practice Journal’ in 2018. The Co- author is Hannah Leatherland. The case study: Jack (ficticious name)
Jack was 7 years old when this work started. Jack was educated in a small, rural, mainstream Primary School in the Southwest England. He was initially diagnosed with autism and ADHD and was supported using an Education Health and Care Plan (SEN Code of Practice 2014). Funding was provided for a Teaching Assistant (TA) with experience of working with an autistic child.
He is a boy of average to above-average intelligence, with an uneven academic profile including strengths in mathematics, science and spelling but difficulties with handwriting, grammar and creative writing, other than in stories of his choosing. His work was mainly written out by a Teaching Assistant as Jack often struggled to write. He spent a large proportion of his time outside the classroom. Unstructured times, such as break and lunch times could trigger his most challenging behaviour, making his relationships with peers difficult.
Jack began Year 2 in a mixed ability class with a new teacher. Initially, he was quite calm, and he accessed some of the curriculum as he enjoyed the novelty of his surroundings. After a few weeks, however, his behaviour rapidly deteriorated and he became violent towards adults and children with the occasional use of weapons, turning over and throwing furniture and explosive verbal outbursts. As a result, he received two fixed term exclusions. Jack failed to respond to tried and tested interventions, indicated for autistic learners such as visual timetables, structured learning and other TEACCH strategies (Treatment and Education of Autistic and Communication Handicapped Children, Schopler, 1966). He especially struggled with completing activities within a specified time frame. He found every day demands stressful and would display bizarre, disruptive, and sometimes challenging and dangerous behaviour, which could range from ‘pretending to be a tiger’ to avoid written work to turning over furniture in a rage or using a stick or other sharp object as a weapon. The school then sought the support of the local advisory teacher for autism (Catrina Lowri).
Extreme Demand Avoidance Assessment
The school contacted the advisory teacher who observed Jack’s behaviours and, with input from his parents and the class teacher, completed the Extreme Demand Avoidance Questionnaire (EDAQ) (O’Nions , Christie, Gould, Viding and Happé, 2013) as there was a feeling that interventions typically indicated for a child with autism and ADHD were unsuccessful. Although never designed as a diagnostic tool, the EDAQ is often used by educational professionals to indicate the presence of EDA in individuals with an autism diagnosis (O’Nions et al 2014).
The questionnaire is simple to administer with most questions scoring between 0-3. The level indicating the presence of EDA for children of Primary School age is 50. Jack scored 57, putting him well above the cut-off point. We sent the results along with notes we had made during observations to a paediatrician who subsequently diagnosed Jack with Autism Spectrum Condition (ASC). The descriptor ‘Extreme Demand Avoidant (EDA) behaviours’ was also We were mindful of the fact that as yet EDA is not a recognised diagnosis. EDA (PDA as described in 2002 when the interview was developed) is however, included in the Diagnostic Interview for Social and Communication Disorder (DISCO, Wing et al, 2002). Clinicians who have had training within the last 5 years are aware of the condition and may include reference to either PDA or ‘Extreme Demand Avoidance’ within written behavioural descriptors, although this varies from area to area (O’Nions et al 2013). The paediatrician who added the EDA descriptor to Jack’s diagnosis had this knowledge and worked closely with the advisory teacher and other professionals in line with the NICE Guidelines: ‘Quality statement for a diagnostic assessment by an autism team’ (NICE, 2014), to gain a full picture of his profile. Medical professionals widely acknowledge that children with ASC/ EDA require quite different management to those with more typical forms of autism so may be receptive to adding this behavioural descriptor (Gore-Langton et al, 2016).
The Advisory teacher had monthly to termly contact over a 2 year period with Jack or his parents, teachers and support staff. The second author was Jack’s class teacher and she had daily contact with Jack during term time for 2 academic years. They both also worked closely with Jack’s parents and other family members and educational professionals such as teachers, teaching assistants and other support staff including behavioural support workers and the Special Needs Co-ordinator (SENCo). There was also contact with outside agencies such as s Educational Psychologists, Speech and Language Therapists and Occupational Therapists. Behavioural data was recorded using Antecedent Behaviour Consequence (ABC) charts (Maag 1999) and written observations recorded by the TA and class teacher. This then fed into the Consistent Behaviour Support Plan (CBSP).
For more information about PDA/EDA and how to write a Consistent Behaviour Support Plan feel free to contact me.