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Supporting demand avoidance

What is demand avoidance?

This term refers to a set of behaviours which include:

  • opting out
  • refusal to comply
  • avoiding instructions, requests or demands either directly or indirectly

These behaviours can be frustrating and puzzling for others to understand. Sometimes those around the young person can feel manipulated or controlled by the behaviour, although this may not be the intention of the young person.

This presentation is often driven or influenced by the anxiety of the young person. It may not be obvious on the surface that the young person is anxious, however avoidance of demands, others expectations or pressure can be one strategy for managing uncomfortable and overwhelming feelings of anxiety, especially when the young person has limited other coping strategies.

Things that make demand avoidance more likely

  1. High levels of anxiety
  2. Difficulties with social communication and relationships
  3. Confusion or misunderstanding about what is happening, what another person is doing or what an activity involves and how it ends
  4. Difficulties coping with and managing emotions, which means the young person may have limited problem solving or coping strategies to deal with difficult situations and how they feel
  5. Some young people with autistic spectrum disorder (ASD) appear to be more vulnerable to a demand avoidant presentation

Understanding the role of anxiety within demand avoidance

It is important to consider whether demand avoidant behaviours are a sign of anxiety within a young person. It can be helpful to focus on reducing and managing anxiety, rather than getting caught up in confrontation and arguments which can often end up in one person ‘digging their heels in’ or a flat out refusal.

This means demands and expectations from others may need to be adapted on a day-to-day basis according to the child’s level of anxiety and tolerance. It is helpful to see this in terms of the person having a particular ‘threshold’ in relation to their capacity for tolerating demands. This threshold is partly determined by the level of anxiety they feel at any given point in time. So understanding and managing the person’s anxiety or the things they find stressful is often the starting point for managing demand avoidance. Once this is managed effectively then the person is more likely to be able to tolerate demands, is less likely to use avoidance as a coping strategy, and their confidence in a given situation is likely to increase.

The young person’s level of anxiety or stress in a situation may be influenced by many factors, including:

  • support structures and help available to the person in the environment or occasion, which are tuned into the young person’s needs and coping strategies
  • familiarity and predictability of the event, place, people – especially if its been positive in the past
  • availability of familiar and trusted relationships who understand the young person (such as a key worker, parents, or carer) within an environment or event
  • communication or interactional style in which the demands or instructions are given to the young person

Other background influences may include peer relationships, bullying, and forthcoming transitions.

When things are going well for the young person and their anxiety is low, their threshold for accepting demands and requests is likely to be higher. When things are more difficult and their stress levels are raised, their threshold for demands will be lower.

 It usually falls to the adults around the child to try to keep the anxiety dial as low as possible as this will allow for increased demand tolerance. The frequency in which these dials need adjusting varies from child to child and will change over time and will also be influenced by other things such as sleep, hunger, or ill health. There may be time periods where they need constant fine-tuning to try and keep things on as even as keel as possible. Other times there might be quite long settled spells when much less adjustment is needed.

Strategies and approaches

Children and young people who can be demand avoidant often benefit from a less directive and more flexible approach, which aims to reduce stress and develop confidence and skills.

  1. Disguise demands or expectations – make them playful or part of a game be indirect (avoid direct instructions) doing the activity yourself and create opportunities for them to join in (for example ‘I’m going to…’ ‘I wonder where…is.’)
  2. Don’t lie, trick or cajole to get someone to do something. It may work at first but they will soon ‘catch on’.
  3. Negotiate, compromise, and give the young person choices. Allow them some sense of control when you safely can but be consistent in how you do this and don’t over complicate things. Keep your language and the options simple and straightforward.
  4. Be flexible where you can. Avoid digging your heels in and getting stuck into a demand or confrontation where possible. Avoid arguing it’s only likely to make the behaviour worse.
  5. Have a ‘toolbox’ approach to managing difficulties. For example, one strategy will work for a while, but then may stop working. Have a range of strategies that you use and come back to after a while, as they may be useful in the future.
  6. Neutral stance, try to stay calm and avoid high expressed emotions, as this is only likely to make the person more anxious and less able to listen and process what is happening.
  7. Use natural consequences rather than punishments, sanctions or threats. For example, if someone throws their iPad you may want to remove it until they have calmed down but threatening to take their ipad off them unless they do what you want is only likely to increase their stress and make behaviour worse.
  8. Where possible use boundaries or rules as set by something external to you so you are not personally asking them to do something, ‘the school rules are …’ You can also try using characters of interest to depersonalise demands.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: LDM2

Resource Type: Article

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