Working with autistic children who present with characteristics consistent with Pathological Demand Avoidance (PDA) can challenge music therapists to rethink ideas of leadership, participation, and what it means to “do therapy.” As a neurotypical practitioner, I have found this space both confronting and transformative — a constant negotiation between stepping back, tuning in, and resisting the urge to direct.

PDA was recently acknowledged in Australia as a behavioural profile of autism in the 2023 National Guideline for Autism Assessment and Diagnosis. While not a formal diagnosis, awareness is growing, with characteristics increasingly noted in reports. Music therapists are more likely to encounter clients with high anxiety in response to demands, requiring flexible, individualised approaches. However, music therapy literature on PDA is limited. In my practice, around one in five clients show PDA characteristics. This presentation contributes to emerging conversations on adapting our work to better support these participants in an evolving healthcare context.

Using two de-identified case vignettes, I share reflections on supporting autistic children with PDA characteristics through music therapy. One child used music to build emotional awareness and language skills; another connected through music when verbal interaction was avoided. Therapy unfolded in individual, indirect, and unpredictable ways. I also reflect on my experience as a neurotypical therapist in this work.

The presentation further considers how to align this open-ended, client-directed practice with structured systems like the NDIS. I will share ways I’ve advocated for functional outcomes while maintaining neuroaffirming, responsive work, and how I communicate the value of “doing less” when less is actually more.

Rather than offering answers, this presentation aims to open a conversation. It invites music therapists to reflect on how we hold space for autonomy, challenge internalised ideas about conformity, and innovate in response to the needs of neurodivergent participants with PDA characteristics.