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Autism and ADHD Pathway

What you can expect when going through the Autism and/or ADHD Assessment Pathway

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Part of
Autism and ADHD Pathway

What you can expect when going through the Autism and/or ADHD Assessment Pathway

1

Pre Assessment Autism and ADHD Pathway

Receiving support at the earliest stage without the need for a diagnosis. Making a smooth transition to assessment for those who require it.

Pre Assessment Autism and ADHD PathwayAutism and ADHD SENCO Discussion Group
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Assessment

Equality of access and service quality across the county ensuring NICE compliant assessments for those who require it.

Assessment pathway for Autism and ADHDPosition statement on private Autism and ADHD AssessmentsPosition statement on Demand Avoidance

Types of demand

It is important to remember that demand avoidance happens with both positive experiences of things a person wants to do and negative experiences as well. This is a can’t, not won’t situation.

Below are some examples of the ‘demands of everyday life’ that a person experiencing demand avoidance may resist.

  • a direct demand (an instruction, such as ‘brush your teeth’, ‘put your coat on’ or ‘complete your homework, chose something from the shop)
  • an internal demand (for example willing yourself to do something, or bodily needs such as hunger or needing the toilet)
  • an indirect or implied demand (including any expectation, such as a question that requires an answer, food in front of you that you are expected to eat, or a bill arriving that needs to be paid).

The overwhelming anxiety of realising that a demand cannot be avoided, or that these forms of resistance have been exhausted, may result in meltdown or panic, potentially including aggression. These states are usually out of the person’s control.

What causes demand avoidance?

Autistic people as well as other neurodivergent people may avoid demands or situations that trigger anxiety or sensory overload, disrupt routines, involve transitioning from one activity to another, and activities/events that they don’t see the point of or have any interest in. This may also be relevant to children and young people who struggle with attachment.

We are still at an early stage of working out what causes demand avoidance. It is thought that both anxiety about an event (anticipatory anxiety) and difficulties with tolerating uncertainty and predicting what things might look like, may impact demand avoidance.

It is also acknowledged that demand avoidance can cause anxiety itself due to the perception of loss of control (autonomy).

Are we encouraging negative behaviour?

No, we are simply adapting our communication style and moving away from a behaviourist approach.

Children and young people who struggle with demands are amongst the most complex and most vulnerable groups of neurodivergent individuals. They have often been misunderstood and labelled as naughty or disruptive in the past. Using the right strategies to support children and young people who struggle with demands are helpful to all children and young people.

Please remember that children and young people want to do well and that when they cannot do something, the anxiety they are experiencing is very real. If we can understand why demands are difficult and adapt our approach, then we can show our children and young people that we can be flexible too and that things can change for the better.

In Somerset we promote the SCERTS approach, ie Social Communication, Emotional Regulation and Transactional Supports. This approach has specific tools to support energy and emotional regulation, which are helpful to support those children and young people who have been identified as having a demand avoidant profile

Five helpful ideas for supporting a person who struggles with demands

  1. Think ahead Have a look at the day or week ahead and anticipate any areas which are likely to be tricky. Plan ways to offer support, reduce demands were possible and give time and connection to discuss the upcoming event.
  2. Give advanced notice It often takes neurodivergent people longer to process new things. Giving advance notice helps give more processing time and allows your child/young person to know what is going to happen. For some people having a visual timetable can be really helpful.
  3. Monitor stress levels and adjust demands The amount we can all cope with varies from day to day. Think with your child/young person about the activities which fill and empty their stress bucket. Make sure if there have been lots of demands in a day/week that you build in time for activities which help replenish their energy levels.
  4. Create Space Have a safe and private space at home and at school where the child or young person can go to reset when they feel overwhelmed. This may contain sensory items or items connected to interests which help your young person to regulate. When out and about have a grounding or sensory kit with you to provide support. Agreeing an exit strategy: knowing how to remove themselves from a situation, and having a safe space to retreat to, can help reduce a child’s anxiety.
  5. Keep Calm As difficult as this one is, the calmer you are able to stay the quicker your child/young person will be able to co-regulate with your support. Practice your own self care and try and remember that your child/young person is having a difficult time not trying to be difficult.

Other ideas which can help

Build Trust

Humour, curiosity and unconditional positive regard for your child/young person all help hugely to manage the challenge of demands. It is important that your child/young person realises that you are on their side and that you are working together as a team. The NEST approach can be really useful, find out more information about the NEST approach.

Adjust Expectations and Priorities

Parenting/teaching a child/young person who struggles with demands can mean taking a different approach with more compromise, flexibility, negotiation at the core. For example, does it really matter if they wear the same clothes to their grandparents or if they choose to eat the same food every time you go out? Does it really matter if they want to use the same rubber in the classroom and not share it with anyone else?

It is okay to have non-negotiable rules that are usually connected to keeping your child/young person safe. But rather than make a demand such as, ‘you must hold my hand when we cross the road’, ask why is it a good idea to hold my hand when you cross the road?  Because it keeps you safe. Provide the answer if the child can’t answer the question.

Other rules and expectations should be flexible where possible, and where possible offer simple choices, so that the child/young person maintains a sense of control, such as would you like to put on your shoes or your crocs?  Which pencil are you going to use to you your writing? The green one or the red one?

Explaining the Why and Depersonalised Rules

It can be really helpful to explain why rules exist. Many autistic and neurodivergent people, particularly those with ADHD will not do things just because they are socially expected however if you can explain the why, it becomes easier to consider.

It can also be helpful to depersonalise rules and place them with higher authority. Saying things like ‘we have wait at the crossing, that is the law to keep everyone safe’ or ‘the government tells us that all children must be kept safe by their parents’ can help to place the demand elsewhere.

Think about Praise and Punishment

Many neurodivergent children and young people who struggle with demands also struggle with any situation where the spotlight is on them. This includes being praised as well as being told off or embarrassed. Think about how you could give praise to your child or young person in a way that feels manageable to them. Helpful alternatives can include:

  • Indirect praise-talking about your child/young person to a third party where they can hear how proud you are of them. ‘I was so proud of Sarah last week; she went on the school trip to the cinema and really enjoyed the film’.
  • Offering spontaneous and tangible rewards ‘what a successful trip to town today, we are going to get milkshakes now as a treat’. ‘That was a brilliant assembly, we will play your favourite game in special time today.’
  • Allowing natural consequences rather than punishments ‘oh dear it’s raining, and your coat is at home, you can change your clothes when we get back home’. ‘Oh dear, you did not do your maths homework, we can do it together now, at the start of the lesson.’
  • Praising the results rather than the young person. ‘Wow this bedroom is so tidy, it looks like so much fun could happen in here now’. ‘This English essay is brilliant, with excellent descriptors and worthy of a top mark.’

Invitations to opt in and learn – We should always give our children and young people lots of opportunities to opt in and have a go. Keep things light-hearted, playful and fun. Adjust your language to be descriptive and not questioning. Model doing things yourself and see what happens! Use the child and young person’s interests.

Use indirect language to get going with a task:

inset-text

“I wonder if we can…”

“Let’s see if we can make something…”

“I can’t see how to make this work, can you…”

“Shall we see if we can beat the clock…”

“Maybe we could investigate…”

And try to avoid:

inset-text

“It’s time for you to…”

“You’ve got to…”

“You need to…”

“You must…”

Whilst it may initially feel like a very steep learning curve to develop a tailored, flexible toolkit of approaches, eventually it is likely to become second nature as you become more in tune with a child/young person’s strengths and needs.

Over time, as a child/young person’s self-confidence, emotional maturity and trust in the world develops, and as they gain more understanding of themselves, they can start to develop self-help tools and coping strategies of their own.

In summary

  1. Be prepared
    Have a range of choices available to the child or young person and think through how you will present them.
  2. Be flexible
    Be ready to scale back demands or change your approach if the child begins to panic.
  3. Be indirect
    Follow the indirect route from A to B, finding ways to ‘ask without asking’.
  4. Pick your battles
    What is really important for the child, and for you? What should you hold firm, and what can you be flexible about?
  5. Tune in to the anxiety and panic which underlies the child’s behaviour
    We don’t chastise children who are having panic attacks, we support them to calm down.

All the above ideas are useful to all children and young people whether they are neurodivergent or not.  So, let’s create neuro affirmative environments both at home and at school.

Last reviewed: February 20, 2024 by Qi

Next review due: August 20, 2024

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