When School Feels Impossible

Understanding “School Can’t” and Pathological Demand Avoidance (PDA)

Shifting from a ‘school refusal’ to a ‘school can’t’ lens

Often there are experiences around school participation and engagement that can be worrying, exhausting, and confusing. With an increase in disengagement and reduced attendance at school, followed by avoidance, distress, and feeling emotions intensely, these can be an indication that there are environmental factors in the learning environment signifying this distress.

This experience being described as ‘school can’t’ highlights the reduced tolerance and capacity to engage, attend, and participate in schooling. There is an underlying stress response that can vary in severity, with the focus being removed from ‘challenging behaviour’, to a nervous system response to the environment in which the child is attempting to navigate. There is a sense of the environment not feeling safe for the child, with specific school factors underlying this. Some of these factors can include difficulties in maintaining and building connections with others, increased demands, non-preferred activities, sensory overload, underlying learning difficulties, and differences in communication preferences.

School can’t experiences for PDAer’s

PDA is a neurodivergent profile, often characterised as an autistic subtype. It’s usually identified by an extreme anxiety-driven need to avoid everyday demands. Demands can emphasise or initiate a fight, flight, or free response, threatening a child's sense of safety and autonomy. Triggers can heighten a distress response, reducing the child’s ability to regulate. Activities and routines around dressing, sitting on the mat, following instructions, completing structured activities, using the bathroom, or meeting body needs (e.g. hunger, thirst), can elicit the stress response. This can lead to avoidance, refusal, negotiation, humour, distraction, dysregulation, and feeling emotions intensely. 

How PDA and school can’t can overlap

School environments can be compliance-driven, with a heavy focus on meeting demands. For example, demands are presented through following the schedule, transitioning between activities, responding to sensory input, social expectations, and performance pressures. For a PDAer this can lead to distress, burnout, masking, emotional collapse at home, and an inability to attend school. Often responses of shut down and refusal are later signs that the child has been navigating this constant state of distress for a long period.

Occupational therapy supports for PDAer’s and School Can’t experiences

From an occupational therapy lens, we focus on viewing school can’t through a regulation and capacity framework. We highlight and advocate that behaviours are a form of communicating, distress can emphasise unmet needs, and to support building on safety and regulation, before academic learning. The overall goal is to reduce demands, increase autonomy, and rebuild trust. 

Occupational therapy support areas;

• Identifying sensory patterns

• Building upon co-regulation supports, and empowering self-regulation

• Breaking down sensory, emotional, and environmental triggers

• Using a task analysis approach to identify barriers limiting participation

• Using assessments to determine underlying skill deficits

• Advocating and collaborating with schools to explore adjustments and accommodations

• Support parents to reduce burnout and empower the child, in support of building confidence 

Resources

School Advocacy Supports

• https://acd.org.au/

School Can’t Resources

• https://www.schoolcantaustralia.com.au/

PDA Resources

• https://www.pdasociety.org.uk/

Child’s Perspective on Sensory Processing

• https://www.youtube.com/watch?v=D1G5ssZlVUw

Collaborative and Proactive Solutions Model - Dr Ross Greene

• https://livesinthebalance.org/our-solution/

References

• Christie, P., Duncan, M., Fidler, R., & Healy, Z. (2011). Understanding pathological demand avoidance syndrome in children: A guide for parents, teachers and other professionals. Jessica Kingsley Publishers.

• Egan, V., Bull, E., & Trundle, G. (2020). What are the experiences and support needs of families of autistic children with extreme (or ‘pathological’) demand avoidance (E/PDA) behaviours? Research in Autism Spectrum Disorders, 80, Article 102515. https://doi.org/10.1016/j.rasd.2024.102515

• Newson, E., Le Marechal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within pervasive developmental disorders. Archives of Disease in Childhood, 88(595–600).

• O’Nions, E., Happé, F., Viding, E., & Noens, I. (2021). Extreme demand avoidance in children with autism spectrum disorder: Refinement of a caregiver-report measure. Advances in Neurodevelopmental Disorders, 5, 269–281.

• Truman, C., Crane, L., Howlin, P., & Pellicano, E. (2021). The educational experiences of autistic children with and without extreme demand avoidance behaviours. International Journal of Inclusive Education. Advance online publication. https://doi.org/10.1080/13603116.2021.1916108

• Woods, R. (2020). Pathological demand avoidance. In R. Woods (Ed.), Pathological demand avoidance: Concepts, contexts and controversies. Springer.