 How do I handle non-negotiables, such as health? For the PDA, everything is considered negotiable. Medical appointments cause high anxiety and physical resistance, but sometimes are absolutely necessary. Also, trying to be as low-demand as possible, but it's feeling like I'm rather uninvolved, even if my son wants to be left to his own devices. We are at our best when we are both outside together, but he prefers not to leave the house. I find this extremely hard for my own mental health and I have to constantly worry about his physical health too. I know home is his safe space mentally, but really worry about body movement and fresh air. This is a really common concern for many parents. Sometimes, in the moment, the only thing we can do is radically accept what's happening, because the more that we put pressure on, the more that the resistance digs in at its heels and the fears grow and extends to other areas. Examples of this would be, if we continue to talk about our concerns around their health, getting outside and eating better and getting fresh air, the PDA response to that is to probably change the diet so that it's more and more unhealthy and to stay in their room more often and not get fresh air. This is separate from the child's conscious choice. I think this is really important to make the distinction between the PDA response and the conscious choice. Our children don't actively go, you want me to go outside and get fresh air? I'm going to go to bed then and I'm going to breathe in really stinky, unhealthy air. It's a PDA response to resist and to go against what somebody wants for us, because it's a compromise to autonomy. Therefore, the brain perceives it as a compromise to our safety. Whilst you might think that health is a non-negotiable, the PDA brain does not. It thinks that everything is negotiable. A medical appointment would cause high anxiety because it is a huge compromise to safety. What is a person going to do to me? Are they going to draw blood? Are they going to ask me to do something I don't want to do? How safe will I be? And if there's no baseline of safety there, if I can't trust that I'm going to be safe and have autonomy while I'm there, there's no way I'm going to get there. With something like that, as tricky as it is, many families find that we have to put that to the side for now, until the PDA has had enough evidence provided that they are safe and then they're able to build capacity to the point where they might be able to get in the car and go for a drive to the doctor, sit outside in the car, look at the building and go home. We're working up slowly, forcing a child to go in the car to the doctor would do incredible damage and it would borderline shifting into trauma, trying to be as low demand as possible, but it's feeling like I'm rather uninvolved that as parents, when we are actively supporting our children to be in this position, this is incredibly challenging. And one of the greatest challenges, as I mentioned before, is knowing that we're doing everything that we can and knowing that there's literally sometimes nothing else we can do. If we push the point, if we continue to go in there and say, I'm really worried about your health or why don't you come outside? We're going to risk the child staying in their room for longer. What I encourage families to do is if you know that it's hard for your mental health and you need to be out and getting fresh air, then it's really important for you to be able to organise that for yourself if you can. Looking after our own needs is really important, if not more, because we need to sustain ourselves because we're in it for the long haul. The fact remains that whilst we might be worried about him getting exercise and fresh air, our concerns around adding in those things does not change the fact that he's disabled right now, that he is in burnout right now, that he cannot do those things right now. It's like having an injured knee. If our child has an injured knee, we are probably really concerned about how long it's going to take before they can walk again, but we can't force the issue because if they get up and try and walk on that knee, it's going to be longer before they can actually walk because they're going to add injury to a pre-existing injury. It's like this with PDAs. If they're in burnout, then we cannot be telling them exercise and fresh air helps. We know it would help, absolutely, but they're unable to do that. No amount of worrying or trying to get them to do it is going to help. It's about allowing them to have that rest, resting the knee in order to build capacity, letting the anxiety de-escalate, giving it time because what needs to happen is that the brain needs evidence. It needs evidence to know that safety really is a thing. If my teen keeps refusing to go to her mental health appointments, she will be taken out of the system that has a waiting list of 18 months to get her to actually see the therapist in the first place. I don't know about you, but I read that and I think how absolutely ludicrous, ableist and discriminatory is the system. It almost encourages us to put that responsibility with our children who are unwell. It adds additional pressure. It's a form of bullying almost and I've seen it in action. I've seen mental health professionals tell families almost like a threat. You have to get them here. You have to be tougher. If our children can't, then they can't. Every child is different. Some of our children will be in burnout for weeks, some months and some for years and I want to say that I have the privilege of being in community with hundreds of families whose children do come out the other side and what it takes is incredible patience and incredible self-compassion and knowing that it's okay to panic. It's okay to feel everything that we feel and to hang in there because the stepping back and allowing the deep rest is what will build capacity and this means again going against a lot of the advice that we are given around how to recover our children from burnout. So many families, they do come back and many of them come back stronger in ways that allows them to set up their lives in order to help their children thrive and to avoid many of the triggers and barriers that they face to begin with.