Occupational Therapy for ADHD and PDA Profiles
Some children are not refusing. They cannot right now.
For children with ADHD, the gap is usually between knowing what to do and being able to start it, switch out of it, or stop.
For children with a PDA profile, a Pervasive Drive for Autonomy, an ordinary request can register as a threat to their autonomy, and their nervous system responds the way it would to any threat.
Both get read as defiance. Neither is.
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Executive functioning: starting, sequencing, switching, finishing, and time
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Regulation and movement, rather than asking a child to sit still and try harder
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Routines that survive a bad day, not only a good one
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Attention and concentration in the settings that matter: home, classroom, homework
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Protecting self-esteem, because children with ADHD hear far more correction than their peers do
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Working with the school on accommodations and expectation
Energy as a finite daily allowance
One idea we come back to often. Getting dressed, concentrating, coping with noise, holding still in a classroom: each of those costs something from the same limited pool, and rest is the only thing that refills it. Made concrete, often with objects a child can hold and count, it gives them a way to say I have not got enough for that right now before they reach the point of having none left.
How we work with a PDA profile
We say PDA profile, or Pervasive Drive for Autonomy. We do not use the older word, because it is deficit language and the PDA community has largely moved on from it.
Being demand-aware changes how we speak, not just what we do:
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We reduce the demand a child perceives rather than pushing through it
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We use indirect, collaborative language. I wonder if... rather than first, then
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We offer genuine choice, including the choice to say no
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We protect autonomy, because for a PDAer autonomy is a nervous system need, not a preference
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We do not rely on direct commands, ultimatums or pressure to comply
Declarative language means commenting rather than instructing. I notice the shoes are still by the door rather than put your shoes on. Sometimes it means dropping the word you altogether so that nothing lands as aimed at the child.
It only works if the autonomy behind it is genuine. A demand-avoidant child will detect pressure hidden inside a technique, and the moment they do, the technique stops working. That is the part most guidance leaves out.
This is one of the areas we have the most depth in, and it is often why families come to us after other therapy has not worked.
Capacity changes, and that is not inconsistency
A child who managed something on Tuesday and cannot manage it on Thursday is not being difficult. Sensory load, regulation, executive demand, environment and felt safety all move. We meet children where they are on the day, not where we expected them to be.
We work from the idea that kids do well if they can. When a child cannot meet an expectation, we look underneath it at the unmet need, the missing skill, or the state their nervous system is in.
Frustrations also stack. An outburst is rarely about the thing that appeared to set it off, which is why the moment worth acting on is earlier than it looks. A lot of what we do with families is learning to read the build-up, because that is the window where support can still be taken.
What that rules out
Reward charts, sticker systems and token economies. They focus on what a child is doing rather than why, and they do not build the regulation, flexibility and communication a child actually needs. This is a firm house position.
Children and young people aged 2 to 17 who are ADHD or AuDHD, or who have a PDA profile, including children who are undiagnosed but show these traits.
Every child is screened before we begin, so the fit between family, child and therapist is right from the start.
Frequently asked questions
A few common questions we hear from families starting out
Do you use reward charts for ADHD?
No. We are explicitly anti-behaviourist. Reward systems focus on what a child is doing rather than why, and they do not build regulation or flexibility.
Does my child need a PDA diagnosis?
PDA is not a standalone diagnosis in Australia. It is a profile, most often described alongside autism. We work from the profile, not from the paperwork.
What if my child refuses to come to sessions?
That is information, not a failure. We would look at what the session is asking of them and change it. Sometimes that means starting at home, or starting with the parents.
Do you work with schools?
Yes. Often the most useful change is in the classroom environment and in what is being expected.
Still Have Questions?
We understand every child and family is different. If you're unsure where to start or would simply like to talk things through, our team is always happy to help.
You can contact our team via phone, email, or our enquiry form and we'll help guide you through the next steps.
If you'd like to take the next step, you can complete our Getting Started Form below.