I have a 13yo son who I love dearly and who has several diagnoses, including PDA. He is currently in a mainstream school, in first year of high school and is struggling. He is not meeting the requirements of the school and all parties are trying to see what we can do to help him to remain at the school, which he would like to do.

The school psychologist has been involved for a few weeks (first year of the high school) and I have explained his ASD + PDA diagnosis (he also has a number of other diagnoses listed below). She seemed to initially understand, but during an email exchange, I attempted to explain the difficulties we are having and I received a response which makes me uneasy. I don't know how to respond.I think it demonstrates a lack of understanding of PDA and I don't know how to respond constructively in a way that will benefit my son. I would value some advice.

My son has been diagnosed with: ADHD, ASD + PDA, Generalised Anxiety Disorder, Avoidant Restrictive Food Intake Disorder

He also has frequent school refusal. His ARFID is currently problematic and he is severely underweight, just above the threshold for mandatory hospital admission. He sees several clinicians regarding all of these and has done for approx 6 years. We have tried many, many different strategies over the years.

Here is the email from the school psychologist. I would really appreciate any advice on how respond. Thank you!

"Apologies it’s taken so long to reply, the last few days (of term) have been chaotic, tight up until the end. Great to hear about withholding the devices from him (note she suggested this and I said we had tried it and would be willing to try again). I think having him contribute to the plan and consequences is important. There is potentially more ownership rather than him “allowed” to be angry at you and (father) because “I didn’t get a say in this”. Ask him to contribute and if it is so far from what you and (father) propose, see where he can meet you. As parents, you are both well within your rights to set the rules and follow through with the consequences. If he does have the meltdowns and safety is a concern, continue to contact police and paramedics. Two things unfold here, (he) needs to understand that there are boundaries and consequences if boundaries are tested, that is how learning occurs. Additionally, it might be helpful to speak with (his community psychologist) at his next appointment about the longer-term work on his outbursts so that he has the tool set for being able to regulate his emotions. He is allowed to feel angry, annoyed, frustrated etc but learning how to effectively express and communicate that might be what he is lacking in.

I think in terms of the food, I can’t comment as I’m not a dietitian and I think it’s about picking one set of goals to work towards first and nailing it, rather than trying to “fix everything at once”. That would be overwhelming for all parties involved. If the main goal is to get to school, stay and school and engage in the work, let’s begin there. The food rewards can then be tackled if things improve naturally with getting to and staying at school. The hope is that you wouldn’t have to use food as a reward to get out of bed as the long-term goal. If we make the home environment super boring and unpleasant, then by virtue he will hopefully choose to attend school and thus you wouldn’t need to food as a reward. Baby steps first.

In terms of the sleep, that is a bit tricky for him at the moment with regards to the medication he is on. I can appreciate that challenge for everyone. He does however still have that choice of having a rest in the library as you mentioned and if he is stating that he is “too embarrassed” then he will need to accept/try push through the lethargy unfortunately or if there is a medication review coming up, advise the doctor of his lethargy complaints. I can appreciate being tired and trying to find the motivation to want to come to school and he would likely feel the same. Otherwise, the consequence will be pastoral care entries (this is a negative consequence or punishment) unfortunately.

I hope the appointment at (alternative school) went well (we are exploring suitable alternative schools). In terms of any sporting commitments throughout the term (I said he didn't want to do cross-country because of his asthma) if he has asthma, does he have an inhaler (of course he has an inhaler!)? Additionally, he would be expected to support his peers and that would be fine and recommended if he cannot participate. I think he can make use of the things he has already, you don’t need to spend more money. Some of the things that he’s identifying we might need to allow him to have the natural consequences for learning to happen and I can equally appreciate the difficulty with accepting that as a parent when we try so hard to help and prevent negative outcomes from occurring. Sometimes it is the motivation they need to shift/change gear. over the years."