Pathological Demand Avoidance (PDA) and Oppositional Defiance Disorder (ODD): Flipping the Script on Labels and Finding Solutions When Nothing Seems to Work

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NOTE: Tuition includes one free CE Certificate (participant will be able to print the certificate of completion after passing the online post-test (80% passing score) and completing the evaluation). Instructional methods will include PowerPoint, didactic lecture, and others.

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Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of your profession.  As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your profession's standards.  

For Planning Committee disclosures, please see the statement above.  For speaker disclosures, please see the faculty biography.

 

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Earn up to 6.0 CE hours. Please see below, for more details, as credit amounts vary by jurisdiction and profession. 

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Course Level: Intermediate Format: Recorded asynchronous distance. Full attendance is required; no partial credits will be offered for partial attendance.

 

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This self-study activity qualifies for 6.25 continuing education clock hours as required by many national and local licensing boards and professional organizations. Save your activity advertisement and certificate of completion, and contact your own board or organization for specific requirements.

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PESI, Inc.  is an AOTA Approved Provider of professional development. Approved provider # 3322. This Distance-Learning Independent activity is offered at .625  CEUs Intermediate , OT Service Delivery; Foundational Knowledge. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.   Full attendance at this live activity qualifies for 6.25 contact hours.

 

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Handouts

Speaker

Amy Marschall, PsyD Related seminars and products

Sioux Falls Psychological Services

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Amy Marschall, PsyD, is a licensed clinical psychologist in South Dakota, working primarily with children and adolescents. She is trained in trauma-informed care as well as cognitive behavioral therapy, and in 2017 became certified in trauma-focused cognitive behavioral therapy. In her clinical practice, Dr. Marschall works with survivors of abuse, families in the foster care system, children with incarcerated parents, clients dealing with high-conflict divorce or separation, and those growing up with other chronic stressors and traumas.

Dr. Marschall was diagnosed in adulthood as AuDHD (Autistic and ADHD), which informs her deeply empathetic and lived understanding of neurodivergence.

She is also the author of three professional resources: A Clinician’s Guide to Supporting Autistic Clients, Telemental Health with Kids Toolbox, and Telemental Health with Kids Toolbox, Volume 2. These publications reflect her commitment to providing accessible, neurodiversity-affirming, and trauma-informed tools for clinicians working with children and adolescents in both in-person and virtual settings.

 

Speaker Disclosures:
Financial: Amy Marschall is the founder of Resiliency Mental Health and has employment relationships with RMH Therapy, ADHD Online, Prosper Health, AuDHD Therapists, A Change for Better, A Change for Better Fund, Grayce, and DotDash Meridith. She receives royalties as a published author. Amy Marschall receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Amy Marschall is a blogger with Resiliency Mental Health, Psychology Today, DotDash Meridith, and Everyday Health.

Additional Info

Program Information

Access never expires for this product.

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Objectives

1. Examine how trauma, neurodivergence, and developmental differences contribute to behaviors labeled as PDA and ODD. 
2. Differentiate between PDA, ODD, and other diagnoses such as Autism Spectrum Disorder and Intermittent Explosive Disorder using a trauma-informed lens. 
3. Choose neurodiversity-affirming, strengths-based strategies to support emotional regulation and felt safety in children with challenging behaviors. 
4. Evaluate the limitations of traditional behavior management models and the benefits of connection-focused, collaborative interventions. 
5. Utilize practical tools to build trust, support co-regulation, and foster resilience in children experiencing meltdowns, shutdowns, or aggression. 
6. Modify compliance-driven responses to approaches rooted in insight, empathy, and relationship-building by coaching parents and educators.

Outline

The Neurodiversity Paradigm: A Brief Overview

A way forward through affirming, trauma-informed care

• Neurodivergence, neurodiversity, and the shift toward neurodiversity affirming practice
• The medical model in mental health care: Help or harm?
• PDA and ODD as controversial constructs: Diagnoses or mislabels?
• Diagnostic critiques: Cultural bias, pathologizing autonomy, and misinterpreting trauma

Assessment & Diagnoses

A Trauma-Informed, Neurodiversity-Affirming Approach

• Medical vs. educational diagnosis
• Why labels like ODD and PDA remain debated in clinical practice
• When ODD reflects trauma, unmet needs, or neurodivergence
• PDA and the DSM™: Clinical relevance without formal recognition
• Differentiate PDA and ODD from
  • Autism Spectrum Disorder
  • Conduct Disorder
  • Intermittent Explosive Disorder
  • Disruptive Mood Dysregulation Disorder
• Determine the root cause of behavior:
  • Tantrums vs. meltdowns
  • Elopement, shutdowns, and aggression
  • Self-harm behavior
  • Environmental and relational context

“Behavior Problems” Through a Compassionate Lens

What lies beneath: the discomfort of changing established practices

• Trauma’s impact on brain development and behavior
• The neurology of neurodiversity
• Core principles for clinicians and caregivers:
  • Behavior as communication
  • Curiosity over anger, support over punishment
  • Shift from compliance-based to collaborative care
  • Reframe “defiance” as autonomy, fear, or sensory distress
• Case conceptualization examples

A Fresh Approach to Change the Narrative

Build insight, communication, and attachment

• Communication & Regulation Tools:
  • Educate kids and parents about the brain and neurodivergence
  • Expressing feelings: code words, escape plans, visuals, apps
  • Emotion regulation: butterfly hugs, stomp & roar, mindfulness
  • Movement and sensory strategies: safe spaces, sensory play, body-based tools
  • Routines and sleep: overcome barriers, hygiene plans, predictability across settings
• Strengthen Relationships
  • Regulation, choice, and responsibility; developmentally matched tools
  • Parent-child: child-led play, check-ins, and intentional connection
  • Educator-student: practical tools for authentic engagement
  • Building inclusive, responsive classroom environments
• Creative & Play-Based Interventions
  • Games, non-directive play, and creative outlets for big emotions
  • Research limitations and potential risks of misapplied strategies
• Risks and limitations of common interventions

Break Through Behavioral Roadblocks

In-the-moment responses to significant behaviors

• Suicide/self-harm statements
• Elopement
• Verbal and physical aggression
• Controlling behaviors
• When systems push back:
  • Navigate families and educators demanding strict discipline plans
  • Reframe resistance from adults who struggle to change

Target Audience

• Counsellors
• Social Workers
• Psychologists
• Marriage and Family Therapists
• Speech-Language Pathologists
• Teachers
• School Administrators
• Occupational Therapists
• Occupational Therapy Assistants
• Nurses
• Other Helping Professionals Who Work with Children