Pathological Demand Avoidance (PDA): Natural Solutions

What is Pathological Demand Avoidance (PDA)

Pathological Demand Avoidance (PDA) represents a complex and often challenging behavioural profile observed within the autism spectrum, and often with children with ADHD, PANDAS and PANS. Unlike typical avoidance behaviours, PDA manifests as an intense and pervasive need to resist or avoid demands, leading to profound difficulties in everyday interactions and activities.

Children affected by PDA often endure high levels of anxiety, with their fight or flight response seemingly always active. This not only affects their mental well-being but also has far-reaching consequences on their immune, gut, hormonal, and overall health.

If you’re familiar with the challenges of parenting a child with PDA, you understand the immense strain it puts on the entire family. The impact of PDA behaviours can make life incredibly stressful and restrictive.

While behavioural therapies offer some relief, I want to share with you the most impactful interventions we’ve discovered through our clinical work—simple dietary changes and nutritional supplements. The solutions we’ve found are straightforward and safe. My goal is to empower you to reclaim your family’s well-being and help your child thrive.

Trudy Scott, a respected nutritionist from Australia recently published a blog post discussing the correlation between serotonin and Pathological Demand Avoidance (PDA), which deeply resonated with our clinical practice. I highly recommend Trudy’s book titled “The Anti-Anxiety Food Solution”, in which she shares her empowering and insightful approach to mood modulation.

Understanding the Complexity of PDA

Children (and often adults) with PDA may exhibit a myriad of symptoms and behaviours that can be perplexing and distressing for both them and those around them. These often extend beyond mere avoidance and can include sensory overload, emotional dysregulation, meltdowns, and even violent outbursts. Moreover, individuals with PDA may display a notable aversion to being questioned or given instructions, often becoming visibly annoyed or distressed in response.

Do you recognise any of these symptoms in your child? If so, please read on.  There is hope.  A multifaceted approach that addresses both behavioural and underlying biochemical imbalances is essential for effective support of PDA.

Exploring Biochemical Imbalances: Low Serotonin as a Key Factor

Low serotonin levels emerge as a significant factor in the children we work with in our clinic. Serotonin, a neurotransmitter known for its role in mood regulation and emotional processing, appears to be dysregulated in individuals with PDA. Consequently, children with PDA may experience heightened levels of anxiety, panic attacks, and obsessional behaviours, all of which are consistent with serotonin deficiency.

Manifestations of Low Serotonin

Low serotonin levels can manifest in various ways, including:

• Extreme anxiety
• Panic attacks
• Obsessional behaviours
• Worry and rumination
• Phobias
• Lack of confidence
• Depression
• Negativity
• Imposter syndrome
• PMS
• Irritability
• Insomnia
• Afternoon/evening cravings for carbs and sugar

Timing of Symptoms and Low Serotonin

Observing the temporal pattern of PDA symptoms can provide valuable insights into underlying biochemical imbalances. An increase in severity of behaviours in the afternoon/evening may correlate with the natural decline in serotonin levels during the day, for example. It is important to note that in some children, serotonin level is so low that it never reaches a point where the “feel good” factor kicks in and the behaviours can start from the moment a child wakes.

Children with PDA may exhibit remarkable resilience and manage to “keep it together” during school hours, appearing calm, composed, and compliant in the structured environment. However, once they return home, where demands may be less predictable or routines less structured, their ability to cope diminishes. This transition from a regulated school environment to a more unpredictable home environment may trigger heightened anxiety and emotional dysregulation, leading to meltdowns, outbursts, or other challenging behaviours.

Similarly, children with PDA may experience increased difficulty in managing their emotions and behaviours as the day progresses. The accumulation of stressors and demands throughout the day, coupled with declining serotonin levels, may exacerbate their symptoms, making it increasingly challenging for them to regulate their responses to stimuli or demands.

Addressing the root cause

Addressing gut health is key, as the microbiome significantly influences serotonin production. An incredible 98% of serotonin is synthesized in the gut, underscoring the gut-brain connection. Serotonin in the gut plays a pivotal role in gastrointestinal processes and may indirectly influence the brain via the vagus nerve, bypassing the blood-brain barrier.

Other possible contributing factors to poor gut health, such as allergies, gluten or casein intolerance or coeliac disease must also be considered and appropriately supported/treated for optimal health outcomes.

Micronutrient imbalances may also contribute to the manifestation of PDA. In our clinical practice, we frequently encounter challenges associated with poor iron metabolism among children with PDA. Addressing this issue goes beyond simply supplementing with iron. It demands a comprehensive approach that considers factors including malabsorption, inadequate copper levels and impaired hydrochloric acid production. Similarly, low levels of vitamin D are widespread in this population. Adequate vitamin D is crucial for serotonin production, another example of the complex interplay of biochemical processes.

 

Assessing imbalances: which laboratory tests are appropriate?

When addressing poor iron metabolism, a comprehensive assessment is crucial, including blood panels with serum copper, plasma zinc, ceruloplasmin, and homocysteine levels measured alongside conventional iron markers. Where a blood draw is not possible, hair analysis and urine organic tests offer valuable insights. Screening for coeliac disease can be done using a finger prick test but we prefer a traditional blood draw, due a longer history of accuracy. Assessing vitamin D levels, whether through finger prick tests or blood draw, is straightforward.

Accurately measuring serotonin levels remains challenging. Symptom observation is valuable in identifying potential serotonin deficiencies: extreme anxiety, obsessional behaviours, difficulty regulating emotions, and insomnia are common signs. (See full list of associated symptoms above). If a child exhibits three or more of the symptoms of low serotonin, there is a likelihood of deficiency.

Practical Solutions 

Impact of diet

Optimise the diet with nutrient-dense, anti-inflammatory foods to support your child’s well-being and manage symptoms effectively.

Gluten elimination: Introducing a strict gluten-free diet for at least one month for children with pathological demand avoidance (PDA) can be a beneficial trial to gauge its impact on symptoms.

Transitioning to a wholefood based diet: Incorporate nutrient-dense, whole foods into your child’s diet. Focus on a foundation of  high-quality protein and fats from sources such as high quality grass fed or organic meats, poultry, fish, eggs, soaked or toasted nuts and seeds, as well as healthy fats from oily fish, extra virgin olive oil, ghee (where tolerated), beef tallow, and coconut oil.

Balancing carbohydrates: Source carbohydrates from root vegetables, fruits, and gluten-free grains (e.g. buckwheat, quinoa) to provide sustained energy release. Be mindful that nuts, pulses, and grains also contain anti-nutrients (compounds that inhibit nutrient absorption), which can be reduced through soaking, sprouting and thorough cooking.

Reducing processed sugars: It’s essential to reduce processed sugar, additives, and colourings in your child’s diet. Offer sweet foods only after a meal rich in protein and healthy fats. This approach can mitigate the impact on blood sugar by up to 40%, reducing the likelihood of mood swings.

Importance of breakfast: A breakfast rich in protein and healthy fats helps to establish steady blood sugar level and regulate mood throughout the day.

Try these breakfast ideas:

• Egg-rich pancakes
• Eggy bread
• Bacon and sausages
• Homemade or well-sourced gluten-free fish fingers or chicken nuggets or goujons, with beans
• Steak or chops with some crudites of cucumber and peppers
• Homemade meatballs with some fruit or crudites on the side

Lifestyle changes and activities for children with PDA: 

Establish a nurturing environment for children with PDA by creating spaces and activities that prioritise their comfort and autonomy. Here are some strategies to cultivate a supportive atmosphere in which children can thrive:

Activities:

• Establish a “no-pressure” zone where children can explore activities at their own pace without fear of demands or expectations.
• Introduce animal-assisted therapy sessions with gentle animals like therapy dogs or horses to provide comfort and companionship.
• Create a sensory-friendly space at home with calming lights, soft textures, and cosy corners for relaxation and self-regulation.
• Offer interactive digital platforms or apps that allow children to engage in virtual social interactions and creative expression without overwhelming demands.

Lifestyle Habits:

• Embrace unconventional sleep routines that align with the child’s natural sleep patterns and preferences, allowing for flexibility and autonomy.
• Incorporate mindfulness practices into daily activities, such as mindful walking in nature or sensory-focused meditation exercises tailored to the child’s interests.
• Encourage “challenge-free” days where expectations and demands are temporarily suspended, allowing children to explore and engage with their environment without pressure.
• Utilise technology in innovative ways, such as virtual reality experiences or interactive storytelling apps, to provide engaging and stress-free entertainment options.

Nutritional supplements to support PDA

As previously mentioned, normalising iron and vitamin D levels can be crucial. Seeking professional guidance is important for balancing iron levels, as it can be complex, and in nearly all cases, simply taking iron supplements is insufficient.

Stabilising adrenal function and reducing the fight-or-flight response

Magnesium glycinate, phosphorylated serine and adaptogens like ashwagandha can be very beneficial. (The liquid form  of ashwagandha can be even be rubbed into the skin if your child is super sensitive). These supplements help mitigate the effects of chronic stress, a common feature in children with PDA, thereby enhancing their resilience and overall wellbeing.

Boost serotonin production

Amino acids play a crucial role in supporting neurochemical balance and mood regulation in children with PDA. Tryptophan and 5-HTP are precursors of serotonin, a neurotransmitter closely linked to mood and emotional stability. Tryptophan, in particular, serves as a precursor for serotonin production in the brain. It is important to start with a low dose and gradually titrate up to gauge individual tolerance levels and tailor the intervention accordingly.

One of the key advantages of tryptophan supplementation is its relatively rapid action. Unlike some interventions that may take weeks to produce noticeable effects, tryptophan can often yield discernible improvements in mood and behaviour within a short timeframe. This rapid response makes it a valuable tool in managing acute symptoms and providing immediate relief for children experiencing emotional dysregulation or distress.

Beyond its role in serotonin synthesis, tryptophan also contributes to other physiological processes essential for overall health and well-being. It serves as a precursor for niacin (vitamin B3) synthesis, crucial for energy metabolism and nervous system function. Additionally, tryptophan is involved in the production of melatonin, the hormone responsible for regulating sleep-wake cycles. Therefore, supplementation with tryptophan may also support improvements in sleep quality and duration, addressing another common concern in children with PDA.

 

Summary 

In summary, tackling the complexities of Pathological Demand Avoidance (PDA) in children demands a multifaceted approach integrating behavioural and biochemical interventions. Challenges like coeliac disease, gluten and dairy sensitivity, poor iron metabolism, gut health issues, and vitamin D deficiencies require comprehensive assessment and targeted interventions beyond simple supplementation. Recognising the intricate interplay of biochemical processes, such as serotonin production influenced by the gut microbiome, underscores the importance of addressing fundamental aspects like gut health and nutritional deficiencies.

Through tailored supplementation and symptom observation, we aim to optimise mood, behaviour, and overall wellbeing for children with PDA. By empowering families with knowledge and support, we strive to help children lead fulfilling lives despite the challenges they face.

Important Disclaimer: Understanding Supplements and Health Recommendations

The information provided in this blog post is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or the use of supplements.

The supplements mentioned in this blog post are not intended to diagnose, treat, cure, or prevent any disease. They are dietary supplements meant to complement a healthy lifestyle and should not be used as a replacement for a varied diet.

Before starting any new supplement regimen, it is essential to consult with your healthcare provider, especially if you have any pre-existing medical conditions, are pregnant or breastfeeding, or are taking medications. Your healthcare provider can help determine if a supplement is appropriate for your individual needs and circumstances.

The efficacy and safety of supplements can vary depending on individual factors, such as age, gender, health status, and medication interactions. Always follow the recommended dosage instructions provided by the manufacturer and discontinue use if you experience any adverse reactions.

Additionally, keep in mind that the regulation of dietary supplements may vary by country, and it’s essential to purchase supplements from reputable sources to ensure quality and safety.

By reading this blog post, you acknowledge and agree that the author is not liable for any consequences or damages resulting from the use of information or products mentioned herein.