All of my writing comes out of my daily experience as a therapist but also as a parent. My great-grandfather, the psychoanalyst and psychiatrist Leo Bartemeier, always wanted to work with kids, but he was told that his stature was too imposing and that he would scare them. This warning seems to have steered him in a different professional direction, but he worked closely with Anna Freud, a fact that shows he never moved away mentally from child psychology. As a dad of a 10- and 7-year-old, I certainly can’t move far away from it either. In particular, my wife and I struggle every day with the complex overlap of medical trauma, ADHD, nascent OCD, and explicit “Pathological Demand Avoidance” (PDA) in the language and behaviors of our youngest son. 

PDA is the loudest of the issues. Screaming in the day and the middle of the night. Outright refusal to oblige our requests or accept our offers of help. Hitting. Targeted insults. To say “it’s a lot” is to understate the visceral impact. My own trauma-related hypervigilance has been waking me up and keeping me awake at night for weeks. We are all suffering.


One of the biggest heartaches for me is that I possess a map to the room but I can’t get out. I understand what is happening with my son. I even have ideas about how, over time, to treat it. But this understanding still does not help. I see where we have to go, but the pace of the journey is not mine to set. I often keep saying to myself: this is this; this is this; this is this.


For those of you out there going through something similar, I want to share my recent insights about PDA. I am also aiming these words towards therapists who work with PDA kids but who might rely on somewhat outdated, scripted approaches to this issue.


Stages of development…via psychoanalysis

Bear with me as I walk through some foundational thinking about the conditions that set in motion what we experience as PDA. I build my theories on this foundation, so it also helps me to return to the source.


I’m attending the Lectures on Lacan seminar with Samuel McCormack, and the last lecture set the situation in this way:

  • First stage: Oral. The stage commences a loss, the loss of the breast. We call this weaning. The breast becomes a lost object and the process transforms us a great deal.  
  • Second stage: Anal. This is potty training, the loss of the ability to just pee or poo wherever we want. The lost object is feces, and the loss leads to dispositions later in life such as “retentiveness,” fastidiousness,” etc.
  • Third stage: Phallic. This one is a doozy, and it’s almost always misunderstood. This is the stage through which we enter language. We learn to speak signifier, as McCormack says. We must speak in this way, with these words, and with this grammar. The loss here is the cry, the undifferentiated vocal demand that satisfies all needs. From here on out, desire pulls us; the desire to return to something that never took place, namely a life in which our needs are just simply met without much ado or any ado at all.


PDA and The Cry

PDA is a manifestation of the loss of the cry. The suite of symptoms exhibited through the “Pervasive Demand for Autonomy” begin to foment when kids enter language, when they learn that there is a right way to speak. From this perspective, the explosive yelling makes sense. Faced with the demand to comply with the Symbolic order and the language games of consensus reality, the child simply screams. The scream is a version of the cry, and the cry at this stage is a refusal to consent to language. 


Consider the problem of question-asking. I have noticed that my son will not ask questions when he wants something. He will say, “I’m still hungry.” Or, sensing that we may be annoyed that’s still hungry despite eating nearly nonstop for hours, he will say, “I feel something but I don’t want to tell you.” I have often replied, “All you need to do is ask for what you want.” Yet he resists that. He will demand, but he will not ask. Even when I am the one who follows up with a question, the act of asking bothers him. “What do you want to eat?” He immediately does not know, as if there is no answer to the question. What’s going on here? What’s so scary about questions?


Viewed through the Lacanian discourse of the phallic stage, questions are a lure. If I ask a question, I consent to playing the language game through which needs can only be met through the specific syntax of question and answer. When my son melts down while not asking for what he wants to eat, is it possible that he is vocalizing his refusal to play the game in this way, to fit himself into this syntax, this way of relating with his father? This way of relating, after all, is on my terms, not his. The mere act of asking a question betrays the fact that the caregiver lacks the knowledge or the ability to know ahead of time how to satiate every need of the child. There are no more needs, only demands. What the child wants is a need without a demand, though that has never happened. The closest the child has come to such a utopian state was during the oral stage when crying would result in feeding. As such, the 7-year-old screams his cry.


How to “respond”

If the child with PDA resists the language being forced upon him, then the last thing we as parents want to do is respond with either a question or an answer. To ask, “What’s wrong?” is to compel the child to participate in the same game, the game he doesn’t want. Even giving the child a food at random in the hope of satisfying the hunger is an un-right move. The offer of food would be a proposed answer and a question all at once—“is this what you want?” Engaging in any conversation at all is likely to extend the melt down.


If PDA truly is an act of resistance against the forced compliance with the world of language, then only non-verbal responses have any chance at connecting with the child. In my house, we have two non-verbal utterances that seem to work (sometimes). One is a hug. You may be surprised at the power of a simple hug. It seems simple to do, but the act of slowing down and moving toward the screaming child with a gentle hug is actually quite hard to do. Practice will be needed. The other tool is what we call “the burrito.” We lay out a blanket on the floor and gesture for him to lay down. We then roll him up so tight that he becomes a 7-year-old version of a swaddled baby. As a burrito, the need to speak succumbs to the physical sensation of tightness, which seems to allow our son to physicalize the resistance he’s waging. 


Parents, our job is actually harder than we know. PDA kids require us to do the impossible, which is to exit the world of language. How hard is that exactly? Well, go ahead and try to do this: DO NOT READ THIS. Could you do it? Nope. Does your brain hurt when you try? Yep. The feeling of complying with that instruction is an indication of our firm rootedness in the world of language and meaning-making. Yet to meet the PDA kid where he is, we have to do the impossible, or at least to act as if we can. Hugging is a good starting point, so give it a try and report back.