Lately, there’s been a huge rise in conversations about PDA (Pathological Demand Avoidance aka Pervasive Drive for Autonomy). Some of it has been incredibly validating for people who’ve never had language for what they experience. And some of it… well, some of it has gotten a little muddy.
Let’s name it gently: there are a lot of content creators right now framing PDA as a catch-all for any kiddo who resists doing things. And while the visibility is good, the oversimplification isn’t. It’s not that these creators mean harm. Many are trying to support families in real distress. But the result is that many parents are walking away convinced their child is PDA when what they’re actually seeing is demand avoidance…and those are not the same thing.

Demand Avoidance Is Common (and Valid)
Most neurodivergent people show demand avoidance in some way. Honestly, it’s a reasonable response to a world full of sensory overload, executive functioning challenges, and often inflexible expectations. Avoidance can show up as procrastination, shutdowns, meltdowns, or even hyperfocus on literally anything else but the thing you’re supposed to do. Sound familiar?
These responses make sense. But they don’t automatically mean someone is PDA.

So, What Makes PDA Different?
Pathological Demand Avoidance isn’t just about avoiding things you don’t want to do. It’s a specific Autistic profile where perceived demands trigger a threat response in the body. Not “I won’t.” Not “I don’t like this.” But “I can’t, because my nervous system has gone into literal survival mode.”
This is where the autonomic nervous system (ANS) comes in. For people with PDA, requests (even ones that seem minor, friendly, or just expected) can ignite the same kind of physiological response you’d expect from someone in danger. It’s not attitude. It’s not oppositional behavior. It’s the body protecting itself.

Why the Distinction Matters
When we blur the line between demand avoidance and PDA, we risk giving the wrong support to the wrong kid.
Sometimes, what looks like PDA is:

• Anxiety + sensory overload
• A trauma response
• Executive dysfunction
• A need for agency
• Or honestly, just a child being pushed too hard, too often

That’s not PDA. That’s a nervous system asking for accommodations. his isn’t about gatekeeping. It’s about getting it right so the child’s nervous system can feel safe and the adults around them can respond in a way that’s actually helpful. PDA is real. So is demand avoidance. But they’re not interchangeable. In my opinion collapsing them into one category does more harm than good.

Learning from Lived Experience
I also want to acknowledge that some of the most important learning I’ve done around PDA has come from Kristy Forbes. Her work and her lived experience have changed how I show up...not just as a therapist, but as a parent and a person. From Kristy, I learned the concept and practice of radical acceptance...not performative tolerance, but deep, full-body acceptance of another person’s neurobiology and autonomy. That framework has helped me unlearn old patterns, center safety, and offer more meaningful support. I’m so grateful for everything she has shared; it’s made me better in every role I hold.

Welcome to the Therapy Center of Buda, where our practice is rooted in affirming and inclusive therapy. Unlike many traditional speech and occupational therapy clinics, we are grounded in the neurodiversity movement and prioritize creating a supportive and positive environment for all our clients. Here are the key features that define our approach:

• Neurodiversity Paradigm Aligned: We are staunch advocates of the Neurodiversity Paradigm, recognizing and endorsing the myriad ways in which brains naturally function within the human spectrum. Our practices repudiate Applied Behavior Analysis (ABA) and the behavioral modification approaches it entails. We offer a compassionate and respectful alternative that refuses to rely on coercion, behaviorism, or reward systems. Instead, we foster an understanding and supportive environment focused on intrinsic growth and personal well-being.

• Neurotype Recognition & Community-Driven Support: In our dedication to embracing neurodiversity, we've developed specialized approaches for identifying and nurturing Autistic and Allistic individuals. We are acutely aware of the coping strategies, such as camouflaging (e.g. masking), Pathological Demand Avoidance (PDA), non-pathological demand avoidance, burnout, shutdown, and trauma unique to neurodivergence. Our evaluation process is intentionally designed to highlight strengths, fostering a profound sense of affirmation and pride. We celebrate traits of Autistic neurotypes, ensuring that our clients recognize and embrace their authentic selves without experiencing the shadow of deficit-focused narratives. This spirit of celebration is extended in our reports where we conscientiously use language that encourages pride and confidence, avoiding any implication of shame or apprehension.
• Specialized in Neurodivergent and School-Based Trauma: Our therapists are not only trained to understand and address the wide range of traumatic experiences, but we possess a deep expertise in recognizing the manifestations of trauma that are specific to neurodivergent individuals. We are adept at identifying and supporting those who have endured school-based trauma, which can lead to profound challenges such as school refusal, shutdowns, and burnout. We are dedicated to nurturing an empathetic and therapeutic environment to help mitigate these traumatic experiences and promote healing and resilience.

• Informed by Lived Experience: Our team isn't just versed in evidence-based practice; we actively follow and implement insights from researchers and specialists who themselves share the neurotypes they specialize in, offering us a profound level of understanding and connection. This lived-experience perspective is an invaluable asset to our practice. Moreover, our clinic takes pride in being locally owned and operated by an AuDHDer (Autistic and ADHDer), enriching our services with firsthand Autastic expertise.

• Allied and Gender Identity Affirming: We stand as allies with the LGBTQIA+ community, ensuring access to supportive environments that affirm every individual's gender identity and sexual orientation. Recognizing the importance of a secure and welcoming space, we are dedicated to creating a sanctuary where the journey of self-identity is honored, ensuring members of the LGBTQIA+ community feel safe, seen, and fully supported here at Therapy Center of Buda.

• BIPOC Embracing and Intersectionality Aware: Our commitment extends to affirming the identities and experiences of Black, Indigenous, and People of Color (BIPOC). We recognize the intersectionality of identity and the unique challenges that may arise at these crossroads. Every individual's diverse heritage is honored and respected in our therapy practices.

• Grounded in Social Justice and Championing Autonomy: Our practice is deeply embedded in the pursuit of social justice, guided by unwavering commitments to equity, fairness, and respect for every individual. Central to our ethos is the value we place on personal autonomy; we staunchly oppose any form of coercion or manipulative tactics in therapy, instead embracing the principle that our clients are the most vital members of the therapeutic team. Their modes of communication—whether through spoken words, augmentative and alternative communication (AAC) systems, gestures, written methods, or any diverse forms of expression—are always honored and held in the highest esteem. We are not just facilitators but partners, upholding the right of every person to self-advocate and be active participants in their therapeutic journey.

 

• Holistic Family-Centered Approach: We recognize that the path to wellness and understanding isn’t isolated to our client alone. Inherently, each client is a cherished member of a family network, and their experiences have a significant ripple effect on the family unit. We are keenly aware that neurodivergence is often a shared genetic journey, with various neurotypes enriching the family tapestry. When one member embarks on a therapeutic journey, it resonates throughout the family, from adjusting everyday dynamics to fostering deep empathy and appreciation for all neurotype presentations. Our therapy extends beyond the individual, providing the entire family with essential tools for reframing perspectives, unlearning ingrained misconceptions, and cultivating self-compassion. This comprehensive approach is crucial, as it ensures that every family member feels supported, validated, and prepared to thrive together in mutual understanding and respect.
• Celebrates Neurodivergence: At Therapy Center of Buda, we recognize neurodivergence as a vital expression of the human experience, not a condition to be corrected. We uphold the autonomy of each individual, ensuring that their personal communication styles, from spoken words to AAC systems and beyond, are deeply respected. Our therapeutic space cherishes personal needs and emotions, offering freedom to stim, self-regulate, and move through the world in a way that feels natural and fulfilling. Here, we operate without the pressure of imposed norms, allowing every individual to thrive according to their neurobiological needs, free from mandates like forced eye contact or compliance. We are committed to honoring and embracing the unique paths of neurodivergent individuals with unwavering support and admiration.

There are two contrasting views on the effectiveness of exposure to sensorially dysregulating stimuli in children: those who follow the behaviorist approach and those who support neurodiversity.

Behavioralists believe that exposing children to overwhelming stimuli repeatedly can help increase their tolerance and regulation around the trigger. However, this approach can actually be counterproductive and may teach children to suppress their emotions rather than regulate them. This is because the behaviorist approach focuses on changing behavior through conditioning, rather than addressing the underlying emotional and neurological factors that contribute to dysregulation.

On the other hand, neurodiversity-affirming supporters understand that exposure to overwhelming stimuli can cause actual harm to a child's developing brain and nervous system. They believe that every child's sensory experience is unique and that it is important to provide individualized support and guidance in regulating their emotions. Effective strategies include identifying and avoiding triggers whenever possible, providing calming activities and sensory experiences, and teaching specific coping skills for managing emotions.

Therefore, it is important to take an individualized approach to supporting children with sensory dysregulation. Exposing individuals to potentially harmful stimuli in an attempt to increase tolerance and the overt signs of dysregulation is invalidating to neurodivergent individuals. Learning sensory triggers, dysregulating stimuli, and regulating stimuli is the foundational work that when combined with a support personnel (e.g., parents, teachers, etc) providing support, co-regulation, and self-regulation is affirming of the individual’s neurotype. This approach will promote healthy brain development and long-term well-being.

Supporting research:

1. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1-11.
2. Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: Is there a causal relationship? Journal of Autism and Developmental Disorders, 40(12), 1495-1504.
3. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5), 894-910.
4. Dunn, W. (2001). The sensations of everyday life: empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55(6), 608-620.
5. Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. American Journal of Occupational Therapy, 62(4), 416-429.
6. Baranek, G. T. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Developmental Disorders, 32(5), 397-422.
7. Lane, S. J., Reynolds, S., & Thacker, L. (2010). Sensory over-responsivity and anxiety in typical children and children with autism and attention deficit hyperactivity disorder: Cause or coexistence? American Journal of Occupational Therapy, 64(3), 453-464.
8. Engel-Yeger, B., & Dunn, W. (2011). The relationship between sensory processing difficulties and anxiety level of healthy adults. British Journal of Occupational Therapy, 74(5), 210-216.
9. Jones, S. M., & Miller, G. E. (2013). The psychological costs of exposure to uncontrollable stressors in children and adolescents. Child Development Perspectives, 7(1), 29-34.
10. Glover, V. (2011). Annual research review: Prenatal stress and the origins of psychopathology: An evolutionary perspective. Journal of Child Psychology and Psychiatry, 52(4), 356-367.
11. Schore, A. N. (2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 7-66.
12. Schore, A. N. (2003). Affect dysregulation and disorders of the self. New York: W. W. Norton & Company.
13. Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In C. R. Figley (Ed.), Trauma and its wake (pp. 103-128). New York: Brunner-Routledge.

1. Hahn, E. J. (2011). Risk of harm to children who experience developmental trauma: Potential impact on their life span. Journal of Evidence-Informed Social Work, 8(4), 420-429.
2. Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child's developing mind. New York: Delacorte Press.
3. Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.
4. Mullen, E. M., & Gorman-Smith, D. (1998). Parenting in community context: The role of social support, social capital, and parenting efficacy. Family Relations, 47(4), 323-332.
5. Sajed, S., & Lee, H. (2018). Exposure therapy for posttraumatic stress disorder: An overview of evidence-based treatment. Korean Journal of Family Medicine, 39(4), 191-199.
6. DeKlyen, M., & Greenberg, M. T. (2008). Attachment and psychopathology in childhood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 637-665). New York: Guilford Press.
7. Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books.
8. Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W. W. Norton & Company.
9. Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford Press.
10. Fonagy, P., Steele, M., & Steele, H. (1991). Intergenerational patterns of attachment: Maternal representations during pregnancy and subsequent infant-mother attachments. Child Development, 62(4), 891-905.
11. Gunnar, M. R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology, 27(1-2), 199-220.

From time to time I meet people and they ask me HOW we are different than other clinics, well here are 8 of the things I explain to them.  In all honesty, it was difficult for me to narrow it down to 8.  I feel deep in my heart that we ARE different because we really do see TCOB as a family and we love each and every family that chooses TCOB.

Diversity.  We all know the obvious forms of diversity; race, nationality, gender, socioeconomic status, general background, etc. But, lately I find myself discussing a lesser known type of diversity; neurodiversity.  Neurodiversity is the concept that neurological differences (e.g., Dyspraxia, Dyslexia, Attention Deficit Hyperactivity Disorder, Dyscalculia, Autistic Spectrum Disorders, etc.) are respected as any other human variation.  Therapy Center of Buda has always embraced diversity and we celebrate the diversity of our families.  We don’t believe in “cures” and we don’t want neurodivergent people to look neutrotypical.  In fact, suppressing the communicative efforts, including stims and non-spoken forms of communication have long been proven to be counterproductive to overall communicative and daily living success.  Rather, listening to each individual and their wants, desires, requests, and rejections is a way to honor their communication styles.   

Childhood Apraxia of Speech (CAS) is a motor speech disorder.  CAS is a relatively uncommon disorder (1-2 children per 1,000= 0.1-0.2%) and one of the lesser known disorders treated by Speech-Language Pathologists.  There are some identified causes of CAS (e.g., stroke, trauma, chromosomal abnormalities) but we are not truly sure of all of the causes. 

In a nutshell:
The child knows what he/she wants to say and the brain sends the message to the mouth (lips, jaw, and tongue) for appropriate placement to produce sounds, but the mouth doesn't cooperate.

TRUTH. Our words matter; chose them wisely. 

the Autism (aka ASD) is combined array (aka spectrum) of neurotypes. These neurotypes are natural variations. Autism itself does not require treatment, as it is not a sickness. But oftentimes Autistic individuals have co-occurring issues that decrease their ability to fully and effectively communicate their wants and needs or participate in acts of daily living. Autistics, just like neurotypicals, can range from non-speaking to speak eloquently and possess an extensive vocabulary. Knowing the characteristics of Autism  is the first step to early identification and self empowerment.  

Some characteristics of Autistic children are:

Halloween is a really fun time…for most kiddos. But for those having difficulty with communicating, trick-or-treating can be very difficult task and so stressful that some will exclude themselves from enjoying such an activity.  We truly believe that although we all may have differences these are simply that and we must find different ways to include all children that would like to participate.  One of our therapists came up with this simple craft you can do at home WITH your child to help give him/her a voice to be included in trick-or-treating. 

Did you know that Therapy Center of Buda offers Autism Testing?  Our Certified Autism Specialist and your pediatrician work together to collect all necessary data to identify if your child is on the Autism Spectrum. 

We will provide you a comprehensive report and explain the outcomes. If needed, our specialist will personally provide you with recommendations and access to local, state, and federal resources that may help your child. Call us today for more information!

What you should know:

1. We utilize the Autism Diagnostic Observation Schedule (ADOS-2) a well know diagnostic tool to identify Autism in children and adolescents.
2. Before we administer the ADOS we conduct a comprehensive speech-language evaluation.
3. Testing is conducted over 2 consecutive days.
4. Parents remain in the room and participate in data gathering!
5. We bill your insurance!
6. We test individuals 12 months to 21 years old.
7. Your pediatrician must support the testing (meaning if you are utilizing your insurance benefits they must send a prescription indicating ADOS testing is recommended).
8. Not only will you get a comprehensive report following your visit/s, but our specialist will personally provide you with recommendations and access to local, state, and federal resources that may help your child.

While playing with playdoh can give optimal time to address receptive language, expressive language, pragmatic language, sensory, fine motor, gross motor, and handwriting development not all kiddos are able to safely play with it. Sometimes kiddos eat the playdoh or they are gluten sensitivity.  Well, we have the solution! Follow the recipe below for some EDIBLE GLUTEN FREE PLAYDOH!

Edible Gluten Free Playdoh Recipe
Ingredients:
-Baby rice cereal
-Vegetable oil
-Cornstarch(or gluten-free cornflour if you are in the UK or Australia)
-Unsweetened Applesauce (you can substitute water if you don't have applesauce)
-Food coloring (optional)