Autism
Highly Sensitive Neuroception and Pathological Demand Avoidance
Highly sensitive neuroception may be at the heart of PDA
PDA is currently categorized as a ‘profile of autism’. There is significant variance in recognition throughout the UK and in the wording used by different clinicians. Some clinicians will name ASD with Extreme Demand Avoidance, others refer to Pathological Demand Avoidance – profile of autism, whilst some remain true to Elizabeth Newson’s original wording and retain the word ‘syndrome’ at the end of PDA. The following links contain clarity in respect of the proposed diagnostic features.
For some with the PDA ‘profile of autism’, perceived danger, or a neuroception of threat, is almost constant in environments where everyday demands are all around, and complex social and sensory information is overwhelming. Flight, fight, and freeze are more widely known defence strategies. There is a further defence strategy that is less well documented though, known as fawn. The term fawn was first introduced by Pete Walker. Understanding why the fawn response is triggered and how it presents could help us to understand why some of our children’s needs remain unrecognized and unsupported for detrimental periods of time.
I will explore a brief introduction to the responses we might see showing up:
1. The survival response Flight is triggered when a person responds to a perceived threat with an intense urge to flee. This flight can be literal; running away, or it can be more subtle and symbolic. An example of the latter would be when the person suddenly absorbs themselves in an activity that they are passionate about; to feel distanced from the perceived threat.
2. The survival response Fight is triggered when a person responds aggressively to a stimuli that is frightening to them. This survival response overrides the individual’s connection with others and the fight responses are triggered unconsciously and unintentionally.
Once the nervous system has calmed, “feelings of shame and regret are likely to be profound, regardless of the person’s ability to verbalize these feelings.
3. The survival response Freeze is triggered when the person’s fear response to a perceived threat, takes them into a shutdown state. This can include being unable to respond to those around you, “staring” at the iPad or TV or into space in what looks like a daydream state. It can also include falling asleep outside of normal routine, something William does when he has been overloaded with sensory, social, and everyday demands. The easily overlooked and misunderstood freeze responses, which are characteristic of a person who is feeling traumatized and overloaded, can render a child’s difficulties invisible, especially in the busy context of school.
The freeze response can also be understood as the internal process known as dissociation. Dissociation becomes necessary in order to escape and protect the self from perceived danger. Freeze is also referred to by clinicians as hypervigilance (being on guard, watchful, alert) … associated with fear.
4. Fawning is largely unrecognized. This survival response occurs as a result of prolonged high stress situations. When the fawn response is triggered, we may observe an uncharacteristic mode of people pleasing, or deferring to the needs and wishes of others, whilst surrendering one’s own. Fawn is a survival response that can be triggered when a person feels at risk from the people or environment, they are in.
For example, if I am overwhelmed by something in the environment, or by the people around me my neuroception may trigger the fawn response. This can be thought of as compliance in order to avoid conflict.
Uncertainty and a lack of being able to predict whether a person or group of people may become angry if we fail to please them, is something we all weigh up. But for a person who is experiencing a neuroception of danger, aggravated by poorly developed skills in reading facial expressions, “prosody of voice” and the many complex nuances involved in social interactions; the fawn response may be triggered to protect the self from the perceived harm of an unknown response.
5. Flop (collapse) sometimes also referred to as Faint is part of our shutdown response. This immobilization is not a chosen response, rather it is a reflexive one, triggered to safeguard us.
Our survival responses and the very different ways in which they present, mean that those with highly sensitive neuroception or as Porges defines it; “faulty neuroception”, may present very differently in different contexts and with different people.
I have replaced the term “faulty” with “highly sensitive” as I believe that this is about a different, rather than faulty neural process. We can appreciate and be grateful for the neuroscience, without subscribing to a medical model, using terms such as ‘faulty’ or ‘disordered’. We can replace these with more respectful and accepting references to difference, and still benefit from the theory’s applications. Adapting the narrative does not take away from understanding the impact of having highly sensitive neuroception. I feel it is possible and incredibly important to validate the difficulties that arise when we have a different experience of the world, without describing something inside of the person as faulty or disordered.
More on Fawning:
The fawn response is much less likely to be triggered in an environment where the person feels safe; with a person who is well known to them. If as part of a trusting relationship, kind and gentle responses are the norm, then that person is established as predictable.
“Our nervous systems like predictable” predictable is safe. In safe relationships the Fawn response is much less likely to be triggered. In less well-known relationships or contexts such as school or hospital, the “Fawn” response may more likely to be triggered to avoid conflict and to maintain feelings of safety until back in the refuge of home. When a neuroception of threat is detected at home around adults who feel safe; one of our other survival responses are more likely to be triggered.
In relation to PDA, this may translate as demands being followed for some of the time, for some people, in more difficult to predict contexts. When the PDAer follows some demands for some people, some of the time, it can be very confusing to others around them. These changeable responses are actually very adaptive though and do make sense when considered within the context of a neuroception of threat.
I consider insights into fawning, as sitting supportively alongside the literature on masking.
PDA is complex and presents in nuanced ways, many of which are often confusing to the outsider. When the autonomic nervous system is triggered as a result of a neuroception of threat, we see “first-line defence strategies” that are social in nature. These are also being shaped by sympathetic nervous system activation and it is important to consider how this may impact communication and perceived sociability.
Based on the Research topic by Jessica Matthews:
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Corinne Allan
