Real World” BCBAs, the “Behavior Crisis”, and Pathological Demand Avoidance
Presented by Kaitlin Wilder
In daily practice in “real world” settings like schools, homes, or, community practice BCBAs report their conventional ABA strategies failing to support PDA and other “problem” behavior of conversational humans with disabilities served by BCBAs. This CEU provides theory and research to describe the evolution of the modern day “behavior crisis” including current knowledge of PDA, and providing ACT as a workable solution for BCBAs in real world settings where resources are limited and there is no shortage of “problems” to solve.
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About this CEU
In daily practice in “real world” settings like schools, homes, or, community practice BCBAs report their conventional ABA strategies failing to support PDA and other “problem” behavior of conversational humans with disabilities served by BCBAs. This CEU provides theory and research to describe the evolution of the modern day “behavior crisis” including current knowledge of PDA, and providing ACT as a workable solution for BCBAs in real world settings where resources are limited and there is no shortage of “problems” to solve.
Credits
1 CEU · 60 min
From the talk
What was covered
What pathological demand avoidance is, how it differs from escape, and why Kaitlin Wilder uses ACT as ABA in real world settings.
- Treat PDA as a threat response, not plain escape. Plan to lower the threat before you ask for action.
- Run your function check on what the person is moving away from on the inside. Do not stop at what you can see from the hallway.
- Expect a PDA profile to switch avoidance strategies, so stop reading each new strategy as a new function.
- Drop escape extinction and tolerance drills with conversational clients. Ask instead what is workable for this person today.
- Check your own state practice rules for the words psychotherapy and counseling before you call your work ACT in writing.
- Start your own ACT practice before the next session: pause, name the hard feeling, and give yourself one moment of self-compassion.
What PDA Means, and Why the Second Name Matters
PDA stands for pathological demand avoidance (strong pushback against being asked). Kaitlin Wilder points out that it has a second name: pervasive drive for autonomy (a deep need to self-direct). She says both names are accurate. One name looks at the behavior from the outside. The other looks at what the person needs.
PDA is not a diagnosis in the DSM (the manual that names disorders) in the United States. It is usually called a behavior profile of autism. So a person may hold an autism diagnosis and show a PDA profile on top of it. Wilder flags why that gets messy in real practice. Many people see themselves in PDA without an autism diagnosis. Others may be autistic and simply choose not to get tested. She called the whole sorting process very subjective.
Her stance is neuroaffirming (honoring how a brain works). If someone has heard of PDA and relates to it, she will help them use that lens. That holds whether or not they have an autism diagnosis. She then pushes the idea wider than clients. In her model, the practitioner's brain gets affirmed too. That is not a soft aside. It is the base she builds the rest of the talk on.
everyone's brain works the way that it works and I believe that should be honored.
From the talk — Kaitlin Wilder
Escape, Avoidance, and PDA Are Three Different Things
Conventional ABA (the standard behavior analytic approach) sorts behavior by what you can see. Escape maintained behavior (behavior that gets someone out of something) is judged from the outside. Wilder says ACT (acceptance and commitment therapy) asks a different question. It asks what is happening on the inside, in that moment, in that setting.
Her example is a hallway at work. You are chatting with a coworker about weekend plans. Out of the corner of your eye you spot the person you owe something to. You did not finish it last week. So you keep the conversation going and look too busy to talk. An observer would score that as attention. The real job of the behavior was to avoid one person.
That is the gap she wants practitioners to hold. The topography (what the behavior looks like) stays the same while the function changes. With a PDA profile, a lot is going on inside. There is the threat response, the rigidity, and the person's own history. The thing in front of them is only part of it. So a demand that looks small to you can read as a threat to them.
If you observe this from the outside, It will look. The same.
From the talk — Kaitlin Wilder
The Timeline That Built the Behavior Crisis
Wilder walked the group back to 1975. That is when IDEA (the federal special education law) took effect. It gave students the right to a free, appropriate public education. Before that, a school could turn a child away for being too disabled. Many people with disabilities were institutionalized instead. She stressed how recent that is. It was about 51 years ago.
PDA showed up in the literature around 1987. At that time it sat under PDD-NOS (an older catch-all autism label). Her point: those people were in the system, but we were not really seeing them. Then 1997 brought the IDEA reauthorization and positive behavior supports (school wide reward and praise systems). She thinks those can do good for many students. She also thinks they are not enough for this profile.
ACT was not on the scene yet. The core relational frame theory (the theory behind ACT) book did not arrive until 2001. That is also the year No Child Left Behind brought standardized testing and accountability into schools. Pressure went up. Technology sped up every small task, so the hard work grew. ACT is still not named outright in the BACB (the board that certifies behavior analysts) test content outline. But features of it show up there now. She noted that change is only about four years old.
They could just say no. You're too disabled. To come here, no.
From the talk — Kaitlin Wilder
Why Rules Alone Did Not Close the Gap
So the expectation moved. In 1975 a school could say no. Now one classroom is asked to support many kinds of students, often in stressful settings. Wilder asked how the field handled that shift. Not by training people well. Not by giving each other support and compassion. We did it with rules.
She tied that to rule-governed behavior (behavior guided by stated rules). Humans are not very good at rules. Rules do not apply in every situation. When we try to follow one everywhere, odd things start happening. Add a team with different opinions and the mess grows.
Her hypothesis lands on the practitioner. You are not a bad professional. You are not behind. You did not miss the point in grad school. You are a person with a human brain, placed in a high pressure job. You are asked to support someone who is often overwhelmed, inside a system that is often rigid. That may be a school. It may be a home that runs on conventional discipline. She says that discipline does not lower the problems. It may even raise them.
You're just human with a brain.
From the talk — Kaitlin Wilder
Avoidance Through ACT: Behavior as a Threat Response
In ACT, Wilder said, avoidance is defined as the human threat response. If a person is avoiding, they are threatened on some level. That is the whole test. It does not require a diagnosis or a big event. She also made a strong claim: almost anything can serve as avoidance if you look closely.
Two parts of that matter for planning. First, people learn avoidance strategies without being aware of it, and then use them anywhere. Awareness can grow, but she says it has to grow slowly. Second, people will deny it. The honest answer in the moment is often I am not afraid, I do not care about that.
This is where she parts ways with the four functions. Those came out of lab research in 1994. She does not say they are wrong. She says they are not the whole story for talking clients in messy settings. ACT names what she calls the human functions of behavior. She did not teach those in part one. She pointed people to look up the core yearnings (ACT's term for underlying needs). Here's her practical tell. Suppose an FBA (a check on why behavior happens) comes back multi-function, and every plan still stalls. The issue may be using only one lens.
Human behavior. goes beyond the four functions. That were discovered in A lab.
From the talk — Kaitlin Wilder
Outcome-Based ABA Versus Process-Based Work
Wilder used a mountain to show the difference. Outcome-based work watches the person, applies a plan, and waits for the number to move. You did a good job when the problem shrank. She calls that climbing the peak of survival. Her warning is about the summit. When you get there, you do not know how to get down.
She leaned on A Liberated Mind, the layman's book by Steve Hayes, who created ACT. On page four he offers a hypothesis about why humans still struggle despite all our advances. Our brains were not built for this world. A tiger was easy. You ran, you lived, you knew you had won. Being good, liked, and happy is not scoreable like that. So we look around and assume everyone else has it.
The process-based version keeps the ABC (antecedent, behavior, consequence), and shifts the target. The aim is well-being, understanding, and the process itself. The thing in front of you is not good or bad on its own. That is your judgment, built from your own history. She applies the same test to clients. Making someone tolerate a demand until they give in is an outcome goal. She was blunt about one tool: no escape extinction (blocking the way out) in her practice.
how you feel along the journey. How you're going to feel when you arrive at your destination.
From the talk — Kaitlin Wilder
Is ACT In Scope for a BCBA? The Licensing Question
This came up live, and it is the question most practitioners ask first. Wilder's view is that ACT is ABA. She is not asking anyone to act as a mental health therapist. She is not treating a DSM diagnosis. She uses ACT as cognitive performance for human behavior. She teaches people to understand themselves and take back the power to choose.
An attendee from Tennessee raised a real limit. State rules for behavior analytic practice there exclude psychotherapy, cognitive therapy, and long-term counseling. Wilder said she had not heard that rule before and would look into it. Her guidance was to read the exact language in your own rules. Another attendee pushed back. She said those rules allow the principles of psychological flexibility (bending without breaking under stress). They also allow relational frame theory, as long as you do not diagnose or treat a mental health disorder. One guess in the room was that the limit is aimed at billing insurance for a diagnosis.
There is also no ACT certificate to collect. Wilder said that is on purpose. Any certification sold in ACT is a red flag to her. The creator wanted it open to everyone. That frustrates some behavior analysts who want hours to log and a box to check. Her standard is different. Learn the skills. Keep the work behavior analytic. Meet the seven dimensions (ABA's core quality markers). Stay inside your scope and your own ethics.
I'm a behavior analyst using act. to support their observable behavior as I have Always done.
From the talk — Kaitlin Wilder
Your First Step: Build Your Own ACT Practice
Wilder was direct about why most BCBAs do not use this yet. It is new. It is a conversation, not a protocol you apply to someone. It is dynamic, so it changes with every person and every setting. You have to respond in the moment. New things feel threatening to a human brain by default. Most ACT CEUs (continuing education credits) are heavy on theory. People leave with no idea what to do on Monday.
Then she named the loop. When we are uncertain, we are threatened. A threatened practitioner avoids trying the new thing, because a bad outcome would mean we are not helping. So nothing changes. That is the same threat response she described in clients, running in us.
Her homework was small on purpose. The first step of ACT, in her view and in the creator's, is to have your own practice. Between now and the next session, practice self-compassion. You will get the chance. When you notice you do not feel competent with a client, pause. Say that this is hard and does not feel fair. Then let that be okay. She also uses humor on purpose. One ACT process, called cognitive fusion (getting stuck on a thought), is about loosening that grip. People who find life threatening tend to welcome a laugh.
Take a pause. Notice that that is even occurring.
From the talk — Kaitlin Wilder
Common questions
What is the difference between escape and PDA?▾
Escape is judged by what you can see: the behavior got the person out of a task. PDA is a threat response happening inside the person, shaped by their history and their need to self-direct. The same behavior can serve either one, so the hallway view is not enough. Wilder's treatment rule is to lower the threat first, not to block the exit.
Is PDA an official diagnosis?▾
No. It is not in the DSM in the United States. It is usually described as a behavior profile that can sit alongside an autism diagnosis. Wilder notes many people relate to PDA without an autism diagnosis, and she supports them through that lens anyway.
Can a BCBA use ACT without acting as a therapist?▾
Wilder says yes, and that she uses ACT as cognitive performance rather than as treatment for a diagnosis. She is not diagnosing or treating a mental health disorder. Check the exact wording of your state's practice rules, since some exclude psychotherapy, cognitive therapy, and long-term counseling. Keep the interventions behavior analytic and stay in your scope.
Is there an ACT certification for behavior analysts?▾
No, and Wilder says that is intentional on the creator's part so the work stays open to everyone. She treats anyone selling an ACT certification as a red flag. The expectation is that you learn the skills, practice them, and judge scope for yourself.
What should I do first after this talk?▾
Start your own ACT practice before you try anything on a client. The next time you feel out of your depth with a PDA profile, pause and name it. Tell yourself this is hard and it does not feel fair, and let that be okay. Wilder treats self-compassion as the entry point, not as a bonus.
Why do my conventional plans keep failing with talking clients?▾
Wilder's answer is that conventional ABA is not wrong, it is partial. Suppose the FBA shows many functions and every plan stalls on social reinforcement. The missing piece is what the person is moving away from on the inside. Tracking that threat response gives you something to work with. Workability (what actually works for this person) beats following the protocol in perfect order.
About the speaker
Kaitlin Wilder is a BCBA (board certified behavior analyst) with about 15 years in practice. All of it has been outside the clinic. She has never worked in early intervention, never worked in a clinic, and never worked with a nonverbal person. Her first decade was in public schools, working with students labeled emotional and behavior disturbance. She then left that job and trained in ACT. She coached overwhelmed adults for a while. Then she came back to behavior analysis. Her first ABA therapy client in a public school had a PDA profile. This talk is part one of a three-part series she is teaching for the Behaviorist Book Club.
This summary was generated from the recording’s transcript. Quotes are taken word for word from the talk.
What you'll learn
- 1"Participants will be able to: • Define PDA and identify differences between escape, avoidance, and PDA and make considerations for treatment of each. • Describe the evolution of PDA in ABA and the treatment considerations to support this behavior profile • Define avoidance through ACT • Identify key challenges for BCBAs in real world setting supporting conversational humans with “problem” behavior • Identify ACT as ABA that brings a workable solution for current challenges"
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