9 year old boy with PDA and Autism, needing connection before challenge

A 9 year old boy with PDA and Autism, unable to engage in therapeutic challenge until he felt safe enough to trust the process.

School-aged child with a profile of Pathological Demand Avoidance (PDA) and Autism Spectrum Disorder (ASD).

The child required a strong therapeutic alliance, not just therapeutic activities. He found it difficult to feel safe enough to engage in challenging therapeutic tasks due to a private logic characterised by assumed inadequacy and fear of failure. Building trust was essential before any skill-based goals could be meaningfully addressed.

The therapist recognised that his nervous system needed consistent experiences of safety, respect, autonomy, and acceptance before he could access challenge. As a result, therapeutic alliance was prioritised over task completion, with an emphasis on connection before expectation.

Relationship-based, play-led occupational therapy focused on building therapeutic alliance. The therapist used a respectful, low-demand approach, following the child’s lead, holding space for his experiences, and communicating in ways that honoured his autonomy. Sessions prioritised co-regulation, trust, emotional safety, and genuine connection rather than structured task progression.

Following an extended period of trust-building, the child felt safe enough to invite his therapist to witness him take on a meaningful challenge. He independently completed the most difficult pattern in Colour Code #100.

He succeeded.

Most significantly, he then gave his therapist permission to celebrate alongside him. This moment of shared joy represented far more than task completion; it reflected increased trust, confidence, and willingness to engage with challenge in the presence of another person.

His confidence continues to grow, along with his belief in his own capabilities and his capacity to tolerate therapeutic demands within a trusted relationship.

Photo credit: Smart Toys and Games (2026)