Difference between ODD and PDA?

[Kanin]

Hi all, I'm looking for some information about the difference between oppositional defiant disorder and pathological demand avoidance. Are they both on the autism spectrum? ODD seems to have a reputation that a kid just enjoys being defiant and/or has some malicious intent, but PDA is more of a sensory/communication/anxiety thing. Is that distinction at all in the right ballpark?

[Lecka]

PDA is part of the autism spectrum.

ODD is not.

A lot of things have reputations with some people.  I don’t think that ODD is widely assumed to mean malicious etc.  It probably really depends on a lot of things.

I don’t think there is any reason someone could not have both diagnoses.

I think in the United States, PDA is not a stand-alone diagnosis and is not described in DSM-5.  I think ODD is.

I don’t think it’s possible to draw many conclusions from either diagnosis, beyond the most basic level.  Which is not very satisfying — but I think it’s the case. 
 

That is all just my own impressions.  I could be wrong about details.  

[mitten]

As I understand it, PDA is diagnosed in the UK and not the US, so if you're in the US and have PDA-like symptoms, you're going to get an autism + ODD diagnosis. ODD is not itself considered to be on the autism spectrum.

Arguably, the two diagnoses are different ways of interpreting similar behaviors, with different implications. I'm not saying that they are definitely the same thing, but I suspect there is overlap and a lot of subjectivity.

I have a child with ASD with oppositional behavior (but no ODD dx so far). Some days, it does seem like he just enjoys being defiant ... but ultimately I know there is more underlying those behaviors. Things are a lot harder for him than for the average person. But it would be easy for someone who isn't his mother to look at his behavior and attribute malice.

[Lecka]

I guess what I think is — anybody who is going to go “you’re a bad kid, I’m washing my hands of you” about ODD is not going to go feel sympathetic to PDA.  

I think someone sympathetic to ODD will be sympathetic to PDA and vice versa.

Someone who is interested in knowing why someone described as having PDA acts in certain ways, will probably show that same interest about ODD.  
 

I have been familiar with some kids who were described as — Aspergers with behavior issues — and they could have a very bad reputation with some people, while other people were much more understanding and problem-solving.  I think once people figure out “oh you mean kids who are doing such-and-such” or “oh this kid does these things” — the label does not matter because people will go “oh that’s what they are calling this now.”

 

I have heard of people having more options for their kids with an autism diagnosis than without, or having access to more effective help with an autism than without.

 

I have heard the same for anxiety.

 

I have heard of some very cookie-cutter stuff that can be recommended for ADHD backfiring and then better results coming after getting bumped up to the next level of trying to figure things out and provide support.  But Ime I saw a lot of things start out as “it’s just ADHD do this,” and only get bumped up from there if basic ADHD recommendations were not working.  

[Lecka]

If you are in the United States, I would not expect many people to have heard of PDA.  
 

If it’s only autism parents talking about it — plus a few professionals — it is just not common knowledge.
 

I don’t see it getting into the DSM unless they go a really different direction than they have.  And then if it’s not autism, is it not a category of something already in the DSM?  Like — is it so different from ODD that it should be it’s own category?

 

And then things not in the DSM are just going to be on the niche side.  

[mitten]

12 minutes ago, Lecka said:

I guess what I think is — anybody who is going to go “you’re a bad kid, I’m washing my hands of you” about ODD is not going to go feel sympathetic to PDA.  

I think someone sympathetic to ODD will be sympathetic to PDA and vice versa.

Someone who is interested in knowing why someone described as having PDA acts in certain ways, will probably show that same interest about ODD.  

I think this may be true, but I also think that the way ODD is usually framed is less likely to lead to sympathy, either for the kid or for the parents. I have read a lot online about ODD and have noticed a lack of interest in what's actually motivating the child (whereas people who talk about PDA are trying to figure this out) as well as a lot of parent-blaming. Apparently ODD is caused both by too little discipline and too much discipline; you can't win.

[Lecka]

There are always people trying to figure things out, and people with a distinct lack of curiosity.  
 

PDA right now is totally self-selecting people trying to figure things out.

 

If it becomes more widespread I think you will see the same things.  
 

Hopefully not as much — but still to some extent, that is my opinion.  

[mitten]

1 minute ago, Lecka said:

 

PDA right now is totally self-selecting people trying to figure things out.

 

That's a very, very good point.

[Lecka]

I fully believe there are many people who have a heart for kids with ODD, who desire to “find out makes them tick.”  Are they well-represented on the Internet — maybe not. 

[Lecka]

It might be that more sympathetic people use another term, besides ODD, on the Internet, because they think it is an overly negative label. 
 

Maybe they prefer another word.  
 

I suspect this. 

[Lecka]

Like — behavior needs?  ED classroom strategies?  Just guessing.  I don’t really know, but I see things like this with other things that are similar. 

[Lecka]

Behavior challenges?

[Lecka]

Behavioral needs?

[Susan in TX]

PDA is a sub-type of autism. ODD is not. Also:

"In a nutshell, children with ODD will benefit from more rigid boundaries and good use of reward and consequence schemes; children with PDA do not respond in the same way. In PDA, the avoidance of, and refusal to comply with, everyday demands is driven by high anxiety. It is not caused by an inherent desire to be oppositional and gain attention."

https://www.stephstwogirls.co.uk/2016/12/strategies-for-pda-pathological-demand.html

Susan in TX

[Lecka]

That website does not ring true to me for talking about ODD and what I think best practices are for children/youth with behavior needs.  
 

 

[Lecka]

I thought if another one — “trauma informed.”  Trauma informed is surely self-selecting for people who are not wanting a strict, harsh approach, etc.  

But probably a lot of kids people are trying to reach through trauma informed practices are going to be diagnosed ODD.  
 

But people who care about trauma-informed stuff aren’t going “these horrible ODD kids blah blah.”  
 

Edit:  but I think it is still “about” that to some extent

Edited February 28, 2021 by Lecka

[Lecka]

There’s also PBIS — positive behavior interventions and supports.

 

[Lecka]

I have been thinking about this and I think bottom line — people who are going to lump all the “behavior kids” together in a group and think it’s poor parenting etc etc etc are going to do that regardless of whether a label is PDA or ODD.  I don’t think kids can get a pass that says “well I am deserving of compassion and understanding, not like those other behavior kids.”  
 

If they are having outward behaviors, that is going to be enough to be labeled as “a behavior kid” by some people.  Period.  If somebody doesn’t care a kid has autism, I don’t possibly see how that person would suddenly care about PDA.  And some people do not care!  
 

And somebody who does care will care about other kids, too, I think.  
 

But I think if PDA just equates to a label for behavior issues it is going to get that response from people who think “oh those behavior kids.”  
 

The good news is a lot of people want all kids to succeed and have soft spots for kids who are having a hard time.  

[Lecka]

I am in favor of PDA to the extent it makes it easier for people to find resources, strategies, community, etc!  Those are so valuable.  
 

But to say it’s not going to have a negative connotation to some people because it’s not ODD or some people won’t just see certain behavior issues and make judgments about parenting — I am doubtful.  
 

 

[Alte Veste Academy]

7 hours ago, Susan in TX said:

PDA is a sub-type of autism. ODD is not. Also:

"In a nutshell, children with ODD will benefit from more rigid boundaries and good use of reward and consequence schemes; children with PDA do not respond in the same way. In PDA, the avoidance of, and refusal to comply with, everyday demands is driven by high anxiety. It is not caused by an inherent desire to be oppositional and gain attention."

 

13 hours ago, Kanin said:

Hi all, I'm looking for some information about the difference between oppositional defiant disorder and pathological demand avoidance. Are they both on the autism spectrum? ODD seems to have a reputation that a kid just enjoys being defiant and/or has some malicious intent, but PDA is more of a sensory/communication/anxiety thing. Is that distinction at all in the right ballpark?

I have a kiddo who never fit the diagnostic criteria for ASD, but when I read about PDA, I realized that it fit him perfectly. If only we lived in the UK. LOL My personal experience rings true with what Susan posted. PDA here is anxiety driven and any perceived defiance is actually just shutting down. On the other hand, in my previous work with kids diagnosed with ODD, the behavior related to that diagnosis is more like ramping up.

In my experience, PDA looks more like a kid with a self-protective posture who feels literally unable to act vs ODD looking like a kid with an "in your face" posture unable to back down.  

Edited February 28, 2021 by Alte Veste Academy

[Melissa in Australia]

8 hours ago, mitten said:

I think this may be true, but I also think that the way ODD is usually framed is less likely to lead to sympathy, either for the kid or for the parents. I have read a lot online about ODD and have noticed a lack of interest in what's actually motivating the child (whereas people who talk about PDA are trying to figure this out) as well as a lot of parent-blaming. Apparently ODD is caused both by too little discipline and too much discipline; you can't win.

 

???

It can be caused by other things 

 Twin 1 has ODD - it is part of the indicator that he has FASD.

 

it isn't fun at all . I am getting sick of being yelled at 

 

[Lecka]

What I have heard is that behavior that outwardly looks like ramping up or outwardly looks like shutting down (and then shutting down can be perceived as defiance) both can have the same root causes and look the same on the inside, even if outwardly one looks like acting out and one looks like shutting down.

I don’t think that is super meaningful.  (Edit — making a distinction based on inward or outward.)

That’s just my opinion.

I also think even in UK PDA is currently recognized as within the autism spectrum, so I think someone would need to fit in the autism spectrum for a diagnosis.

Whether someone has a lot of characteristics but the is diagnosable or not is a whole can of worms and a lot of things can fit and be helpful even if possibly not being diagnosable.  On the other hand if there has not been a quality evaluation maybe it would. A lot of people do read about criteria for autism and think it wouldn’t fit, but then it turns out in practice things don’t work the way they come across from reading about them.  

 

Edited February 28, 2021 by Lecka

[Lecka]

https://www.amazon.com/High-Functioning-Autism-Difficult-Moments-Practical/dp/1942197241/ref=mp_s_a_1_4?dchild=1&keywords=aspergers+difficult+moments&qid=1614518682&sr=8-4
 

This is an author who talks about how inward behavior can look, outwardly, like acting out or like shutting down.

I would really have a major misunderstanding and misimpression of PDA if it doesn’t include kids who ramp up and act out.  I have totally assumed it includes kids who act out when they shut down.  

I could be reading into things for sure.  

[Lecka]

https://www.pdasociety.org.uk/life-with-pda-menu/family-life-intro/meltdowns/
 

I read this as including outward behavior.  
 

To be honest — I do not know if autism is diagnosed differently in the UK.  Here (US) it totally comes across to me as being included in the autism spectrum.  Which does mean — it can be real and it can have its own best practices.  But that is just how autism is.  

[mitten]

5 hours ago, Melissa in Australia said:

 

???

It can be caused by other things 

 Twin 1 has ODD - it is part of the indicator that he has FASD.

 

it isn't fun at all . I am getting sick of being yelled at 

 

I was being facetious in the bolded part; sorry if that wasn't clear. I have read things, including medical articles, that said ODD is caused by too little discipline AND by too much discipline. Basically finding any way they can to pin it on the parent, regardless of parenting style. I don't believe that's actually the cause.

[Lecka]

6 hours ago, Alte Veste Academy said:

PDA here is anxiety driven and any perceived defiance is actually just shutting down. On the other hand, in my previous work with kids diagnosed with ODD, the behavior related to that diagnosis is more like ramping up.

Okay -- I totally agree that inward behaviors can be anxiety driven and actually just shutting down.  I totally agree. 

I think (and this is a thing) that inward or outward behavior is not a good way to judge behavior, it is better to look for root causes -- which are often the same.  It is also the case that some kids will have a mix of inward and outward behavior -- not always just one or the other.  

I am cherry-picking, looking for things that support what I already think, but -- looking at this website: https://www.pdasociety.org.uk/life-with-pda-menu/family-life-intro/understanding-behaviours/ 

I see a lot of things that to me signal they are talking about outward behavior using respectful language (which I am in favor of).  

There is a lot of use of respectful language, as well as minimizing use of labels especially labels that have a stigma, so I can see why a search for ODD would not come up with results from people trying to avoid a stigma.  

This is a really big issue!  There is a lot of stigma around behavioral needs, and a lot of people want to get around the stigma.  It is recognized as a problem.  

But then I think that people who are using the term ODD -- may be self-selecting as people who are not trying to get rid of the stigma.  And then of course some people are using it just because it is what is in DSM-5 and they are not people who do have a stigma associated with it.  But there are people who do, too.  

What happens is -- a word that was originally meant to be respectful, just becomes a new word that has a stigma.  Like -- the word "behavior."  My understanding is that this word is meant to be neutral and respectful.  It is meant to be different than, say, "throwing a tantrum."  But once people start using the word "behavior" as equivalent to "throwing a tantrum," (which I do not agree with, btw), then the word "behavior" now has the same stigma that "throwing a tantrum" used to have.  Or -- something like that.  On that PDA website, they are saying "don't call it a behavior, call it a meltdown."  Well -- already there are people who have a negative connotation for the word "meltdown."  Will it have to have a new word for it, too, once people just say "meltdown" the way they say "behavior" now?  "Behavior" has become a really loaded word, that is for sure.  Depending on who is using it!  It is an issue that one person uses the word intending to be neutral, but the person hearing it hears it as bringing a stigma or judgment.  While other people are just throwing the word around in a totally judgmental, labeling, incurious way.    

[Melissa in Australia]

7 hours ago, mitten said:

I was being facetious in the bolded part; sorry if that wasn't clear. I have read things, including medical articles, that said ODD is caused by too little discipline AND by too much discipline. Basically finding any way they can to pin it on the parent, regardless of parenting style. I don't believe that's actually the cause.

Ah I see, sorry. 

I have great difficulty so. Etimes with translation from American English to Australian English and miss finer details 

[Kanin]

Thanks, all. This is very helpful!

 

 

[mitten]

55 minutes ago, Melissa in Australia said:

Ah I see, sorry. 

I have great difficulty so. Etimes with translation from American English to Australian English and miss finer details 

No worries. I should have been clearer.

[SanDiegoMom]

My two cents with very little actual knowledge behind it:  My husband and I threw around the ODD label for my undiagnosed ADHD kid. She held it together during school but at home our relationship was pretty horrid for years.  She usually fought against everything we asked her to do, even sometimes if it was something she wanted to do.  I feel looking back that if she had gone the opposite direction (shutting down) it would have been PDA.  She had SO much anxiety, struggled so much with school and social anxiety and executive functioning, and she was constantly in fight or flight mode. (She usually chose fight, though we did have a gash in her bedroom screen that shows she also sometimes used flight)