Using Intensive Interaction with those who present within 'a broad spectrum of demand avoidance'.

At a recent Intensive Interaction Forum meeting held here in Leeds, we discussed:

'Using Intensive Interaction with service users who present with some level of demand avoidance'.

Emerging from this discussion were some issues that I thought might be useful for others (health professionals, teachers, parents, carers, etc) to consider when working with, or caring for, people (i.e. adults and children) who present with some level of demand avoidance (i.e. not just at a diagnosed ‘pathological' level).

The sections below are taken from the minutes of our Forum meeting:

Pathological Demand Avoidance (PDA) is an increasingly diagnosed neuro-developmental condition, coming under the ASD heading. However we (the Intensive Interaction forum attendees) generally thought that we had worked with a range of service users who fitted somewhere along a 'broad spectrum of demand avoidance’ (rather than it just presenting at some diagnostically labelled ‘pathological' level). This spectrum of demand avoidance was described as differing widely in its form and severity, depending on the characteristics of the individual service users. 

We then addressed 3 aspects of working with people who present with some degree of demand avoidance: 
1. Why might demand avoidance occur for some service users?  
2. How might demand avoidance be presented? 
(and 3. How might Intensive Interaction help ameliorate the impact of demand avoidance for such service users? - but I will cover this in another, later Blog). 

So:

1.  Why might someone be (or become) demand avoidant?

• Anxiety, including social anxiety.

• Fear of the unknown, and a wish to avoid uncertainty.

• Fear of failure, getting something wrong, or disappointing others.

• Needing to control a situation, so therefore being unwilling to be controlled by another.

• Not fully understanding a demand, this then leading to anxiety about their ability to complete the demand.

• Previous negative experiences or trauma.

• Lack of positive interaction and /or socially supportive feedback.

• Low confidence or self-esteem and/or negative self-worth or self-view.

• Lack of social skills.

• Neuro-developmental issues (incl. an official P.D.A. diagnosis).

• Not being interested in the current activity being offered (i.e. not actually being demand avoidant).

2.    How might a service user’s demand avoidance be presented?

• Responding negatively to every day requests (not just ‘challenging’ things).

• Verbally declining (“no thanks”) or refusing (“NO!”) tasks that the person has the ability to do, or even actually likes doing.

• Ignoring or not responding to requests or the presentation of an activity.

• Changing the topic or closing down a conversation e.g. “it’s okay luv”, “Not just now”.

• Giving apologies before not doing something.

• Creating a distraction away from any given demand.

• Hiding offers of activities e.g. destroying letters, leaflets or invites etc.

• Responding negatively to positive comments or even to any praise given by others.

• Social withdrawal e.g. shutting eyes, avoiding eye contact.

• Physical isolation e.g. staying in bed, staying in a room, not going out.

• Physical withdrawal e.g. leaving the room, turning their back, etc.

• Physically pushing people away, out of their space.

• Failing to choose between some offered positive choices.

• Having a ‘Melt-down’ and/or causing environment damage.

So I suppose the question I should now ask others who weren't at our meeting is:

Do the above points ring true? ...are they accurate? ... are they sufficient? 

Is there more to add on these two aspects of working to support those with demand avoidance? (before we think about how Intensive Interaction might help such people?)

Please let me know your thoughts ...

p.s.This year's Intensive Interaction Weekend Workshop in October will be looking at these issues in more detail ... for further information on this professional development event, or if want an application form, please email me at: graham.firth@nhs.net