13/02/2026
I've been sitting with something from supervision this week that I keep thinking about.
After years of working with children who have experienced complex developmental trauma, I'm noticing something in my PDA work that's shaking up how I understand what these children are going through.
The level of burnout and the depth of nervous system exhaustion that I'm seeing in PDA children of all ages is extraordinary. More extreme, in many cases, than children who've experienced what we'd traditionally define as severe trauma.
And it's made me wonder: what if we're not fully understanding the extent of the trauma these children are experiencing?
I want to be clear that I'm not claiming these are new or original ideas. Many others - clinicians, researchers, autistic advocates, PDA adults - have spoken about the intersection of PDA and trauma, about autonomy violations, about nervous system impacts.
What I'm sharing here is my attempt to bring together these existing threads of thinking and reflect on them through the lens of both my work as a clinical psychologist and my lived experience as a parent of neurodivergent children. These are my reflections, not groundbreaking theory - but I think they're important conversations we need to keep having.
We know PDA children often experience trauma from the systems around them. We see it clearly in schools that punish them for nervous system responses they can't control, in repeated experiences of being misunderstood and labeled "naughty" or "defiant," in exclusions, restraints, and isolation. We see it in social rejection from peers and adults, and in the accumulated impact of all of this on their sense of self and safety in the world.
This is real trauma. Significant trauma. And we're getting better at recognising it.
But what if there's more? What if these children are born with nervous systems that are more sensitive to sensory experiences and more attuned to other people's emotions? What if this heightened sensitivity means their threat system is activated repeatedly from the very beginning - not by discrete traumatic events, but by the everyday sensory and emotional overwhelm that most nervous systems filter out or tolerate?
And what if this repeated activation of their stress response - this constant state of nervous system overwhelm - is what drives the intense need for autonomy and control that we recognise as PDA? Perhaps the demand avoidance isn't the starting point. Perhaps it's a protective response that develops after months and years of a nervous system that's been chronically activated by sensory input and emotional attunement that feels overwhelming and uncontrollable.
Think about a baby with this kind of nervous system. Everything is done TO them, and they're experiencing it all with heightened intensity. Being picked up when they didn't initiate it, nappy changes, being dressed and undressed, having their face wiped, being put down for sleep when they're not ready, being fed. But it's not just the lack of control - it's the sensory intensity of all of it. The physical sensations of clothing, labels, seams. Unexpected sounds, lights, temperatures. Being touched in ways they can't control or predict. And possibly feeling and absorbing the emotions of the adults around them - sensing stress, frustration, tiredness, anxiety - without any way to regulate or make sense of it.
They have no autonomy at all. No way to communicate their need for control. No way to escape the sensory and emotional overwhelm. And their nervous system is registering threat. Repeatedly. Multiple times per day.
Then think about toddlerhood and early childhood. Being strapped into car seats, pushchairs, highchairs. Teeth brushing, hair washing, nail cutting. Mealtimes with expectations about what, when, and how to eat. Potty training. Being told when to get dressed, what to wear. Transitions between activities. Social expectations from adults and peers. Starting nursery or preschool. Being told to share, take turns, sit still, be quiet. The constant sensory assault of daily life - tags scratching, socks feeling wrong, food textures, background noise. And all the while, picking up on the emotions of everyone around them - teachers' frustration, other children's distress, parents' worry.
Every day. For years.
That's not occasional stress. That's chronic, ongoing nervous system dysregulation - a constant state of threat response with insufficient recovery time. The cumulative load is huge.
Many of you are doing incredible work with low-demand approaches. You're modifying environments, reducing pressure, honouring your child's need for autonomy. You're doing everything "right."
And yet sometimes it doesn't feel like enough. Your child is still deeply struggling. Still burned out. Still in crisis.
What if that's because we're preventing NEW trauma accumulation (which is essential and you should absolutely keep doing), but we're not always addressing what's already accumulated? The nervous system impact that's already there. The established threat patterns. The internalised beliefs about the world being unsafe. The backlog of dysregulation.
Just like with any complex trauma, environmental change alone - while necessary - isn't always sufficient for healing. The child might also need active support for nervous system recovery. Processing. Safety-building. Expanding their window of tolerance. Both/and. Not either/or.
Here's what gives me hope: compassionate, attuned parenting means we're SEEING these children's needs. We're not forcing them underground. We're recognising their distress signals. We're identifying PDA earlier. We're responding with understanding rather than punishment.
This means we have the opportunity to support these children WHILE they're still children. To help them process and heal from the trauma accumulation before it becomes decades of buried pain. To help them develop a sense of self that isn't built on shame and masking. To give them tools and understanding and nervous system regulation support at a time when it can make a profound difference.
The adults I work with who have unrecognised, unsupported PDA often carry wounds that run incredibly deep - years of being misunderstood, punished, told they were broken or difficult or lazy. Years of forcing themselves into compliance at enormous psychological cost.
Your children might be struggling now, but they have something those adults didn't have: parents who see them. Who understand. Who are willing to fight for what they need. Who are learning alongside them.
That recognition and support - even when it feels like it's not enough - is laying a foundation that can prevent so much of the long-term damage.
Does any of this resonate with your experience? Have you noticed that low-demand approaches, while essential, haven't been the complete answer? Do you see this level of accumulated nervous system impact in your child? When you think back through your child's early years, can you see how their threat system might have been activated over and over, even in the most loving, attuned home?
What would it mean to think about your child's distress not just as PDA, but as PDA plus significant trauma - trauma that's accumulated from years of sensory and emotional overwhelm, from a nervous system that experiences the world with such intensity?
I'm still processing this thinking. I don't have all the answers. But I wanted to put these reflections out there because I think we need to keep having these conversations.
These children aren't just struggling with demand. They're often carrying a trauma load that we haven't fully recognised or named. And they deserve support that addresses the full extent of what they're experiencing.
I'd love to hear your thoughts. What are you noticing with your own children? Does this way of thinking about PDA and trauma shift anything for you?
