Understanding the Physical Symptoms: Stomach Aches, Headaches, PDA, and Autism

When the Body Speaks: Stomach Aches, Headaches, PDA, and Autism

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Have you ever noticed how your child's tummy seems to hurt right before school? Or how those headaches appear just when it's time for a family gathering? As the parent of a child with Pathological Demand Avoidance (also known as Persistent Drive for Autonomy) and autism, I've lived through countless mornings of mysterious stomach pains and afternoons of sudden headaches. For years, I chalked it up to my daughter being difficult or trying to get out of things she didn't want to do. I couldn't have been more wrong.

What I've learned through my journey – and what I wish someone had told me years ago – is that these physical symptoms are often the body's way of communicating anxiety and stress. They're real, they hurt, and they're trying to tell us something important about our children's experiences.

The Mind-Body Connection Is Real

Let's get one thing straight from the start: when children with PDA and autism complain about stomach aches and headaches, they're not making it up. Their pain is very real.

As parents, we sometimes fall into the trap of thinking our kids are just trying to avoid school or other activities. I'll admit it – I've rolled my eyes more than once when my daughter complained of a stomachache right before we needed to leave for an appointment. But research has shown that there's a significant connection between anxiety and physical symptoms, especially in neurodivergent children.

Children with PDA and autism often experience the world more intensely than their neurotypical peers. Lights seem brighter, sounds louder, and social interactions more complex and draining. This sensory and emotional overload can trigger the body's stress response, which can manifest as very real physical symptoms.

Dr. Emily Lovegrove explains that "the gut-brain connection is particularly strong in children with autism, which means anxiety often presents first as stomach pain." This isn't manipulation – it's neurobiology.

Recognizing the Patterns

One evening, after a particularly rough day of my daughter complaining about headaches, I started a symptom journal. I noted when physical complaints happened, what was going on around that time, and any patterns I could spot.

After just two weeks, the pattern was crystal clear: her stomach aches were most common on Monday mornings (school) and Thursday afternoons (swimming lessons), while headaches tended to pop up during noisy family gatherings or outings to the mall.

Once I saw these patterns, I couldn't unsee them. These weren't random complaints – they were stress signals tied to specific demands and sensory challenges.

For many children with PDA and autism, certain situations are inherently more demanding and therefore more likely to trigger physical symptoms:

• Transitions between activities or environments

• Unexpected changes to routines

• Socially demanding situations

• Sensory-heavy environments

• Activities where they feel a lack of control

My friend Sarah noticed her son's stomachaches always flared up before birthday parties – not because he didn't like parties, but because the unpredictability, noise, and social expectations created enormous pressure.

The Anxiety-Pain Cycle

When we talk about stomach aches, headaches, PDA, and autism, we're really talking about an anxiety-pain cycle that can be difficult to break.

Here's how it typically works: A demanding situation triggers anxiety. That anxiety causes real physical symptoms. Those physical symptoms then increase anxiety further, which worsens the physical symptoms. It's a feedback loop that can quickly spiral.

What makes this especially challenging for children with Pathological Demand Avoidance (Persistent Drive for Autonomy) is that their natural response to demands, even pleasant ones, can be automatic resistance. Their nervous system perceives demands as threats, triggering that fight-or-flight response that can manifest as physical pain.

My daughter once tried to explain it to me: "Mom, it's like my stomach actually hurts, but it hurts because my brain is scared, not because I'm sick." That simple explanation helped me understand more than all the research papers I'd read.

Supporting Our Children Through Physical Symptoms

So, what can we do when physical symptoms appear? Here are some approaches that have helped our family:

1. Validate Their Experience

First and most importantly, believe them. When your child says they have a headache or stomach ache, acknowledge their pain. "That sounds uncomfortable. I believe you're hurting." This validation is crucial – it builds trust and helps them feel safe expressing their needs.

2. Help Them Make Connections

Gently help your child connect their physical feelings to their emotional state. "I notice your tummy often hurts before school. I wonder if you're feeling nervous about something there?" For younger children, using emotion charts alongside body charts can help them make these connections.

3. Reduce Demands When Possible

When physical symptoms appear, see if you can reduce demands temporarily. This doesn't mean avoiding all challenges, but rather creating a safe space for recovery. Simple phrases like "Let's take a break and see how you feel in a bit" can work wonders.

4. Teach Self-Regulation Strategies

Help your child develop tools to manage anxiety before it becomes overwhelming. Deep breathing, progressive muscle relaxation, and mindfulness exercises can all help reduce the physical manifestations of anxiety.

My daughter and I practice "bubble breathing," where she imagines blowing bubbles with each exhale. It sounds simple, but this technique has talked us down from countless pre-headache moments.

5. Create Predictability

For children with PDA and autism, predictability equals safety. Visual schedules, social stories, and clear expectations can reduce anxiety and, consequently, physical symptoms.

6. Rule Out Medical Causes

While many stomach aches and headaches are anxiety-related, it's always important to rule out medical causes. Children with autism have higher rates of gastrointestinal issues, and headaches could indicate anything from dehydration to vision problems. A good pediatrician who understands neurodevelopmental conditions is invaluable.

When School Is the Trigger

School is often a primary trigger for physical symptoms in children with PDA and autism. The combination of social demands, sensory challenges, performance expectations, and lack of autonomy creates a perfect storm for anxiety.

If your child regularly complains of physical symptoms before school, consider:

• Working with the school to implement accommodations (quiet spaces, movement breaks, reduced demands)

• Creating a "soft landing" routine for mornings at home

• Developing a calm-down kit for your child to use at school

• Establishing clear communication with teachers about triggers

Remember that school refusal based on physical symptoms isn't defiance – it's often a desperate attempt to avoid overwhelming anxiety. Working collaboratively with educators rather than forcing attendance can lead to better long-term outcomes.

Our Family's Journey

The turning point for our family came when I stopped seeing my daughter's physical complaints as obstacles and started viewing them as communication. Her body was telling us what her words couldn't always express.

We started building in more autonomy throughout her day, giving her choices whenever possible. We created a "feeling station" at home with tools for managing different emotions and sensations. We practiced identifying early warning signs of anxiety so we could intervene before the stomach ache or headache took hold.

Most importantly, we normalized talking about the connection between emotions and physical feelings. "It sounds like your body is telling you something" became a common phrase in our home.

The physical symptoms didn't disappear overnight, but they became less frequent and less intense. And when they did occur, we all understood them better.

A Compassionate Approach

Living with a child who experiences stomach aches and headaches related to PDA and autism can be exhausting. The constant assessments (Is this anxiety or illness? Should I send them to school? Am I enabling avoidance or respecting genuine distress?) can leave us mentally drained.

Be gentle with yourself through this process. You're doing the best you can with the information you have. And remember that by responding with compassion to your child's physical symptoms, you're teaching them invaluable lessons about self-awareness and self-care.

My daughter is now better at recognizing her own triggers and advocating for her needs. She still gets stomach aches before challenging events, but she has tools to manage them, and the confidence to know we believe her.

Next Steps

Parenting a child with autism and PDA is both challenging and rewarding. If you're looking for more practical strategies and insights, I've compiled extensive research and personal experience in my book, "A Practical Parent's Guide to PDA and Autism."  This resource provides concrete approaches tailored specifically to parents and caregivers of children who experience both autism and PDA.

As a parent juggling therapy appointments, IEP meetings, and the daily challenges of raising a child with PDA, I know you barely have time to sit down, let alone read a book. That's exactly why I've made "A Practical Parent's Guide to PDA and Autism" available as an audiobook you can listen to during school drop-offs, while making dinner, or during those precious few minutes alone in the car. Transform your "lost time" into learning time by grabbing the audiobook here: US, UK, Australia, Canada, France, and Germany.

I wrote this book because I needed it myself and couldn't find anything like it. It offers practical, parent-to-parent advice based on both research and my own real-life experience raising a child with PDA, with specific chapters dedicated to understanding and preventing burnout. The strategies I share have helped thousands of families reduce stress and build more harmonious relationships with their neurodivergent children. As parents walking this path, we need real solutions from someone who truly understands—not just theory, but practical approaches that work in everyday life with our wonderful, complex children.

Your Turn

Have you noticed connections between specific situations and your child's physical symptoms? What strategies have helped your family manage stomach aches or headaches related to anxiety? Have you found particular accommodations that make demanding environments more manageable for your child?

References

1. American Academy of Pediatrics. (2022). Understanding the link between anxiety and physical symptoms in children with autism spectrum disorders. Pediatrics, 149(4), e2021054082.

2. Green, S. A., & Ben-Sasson, A. (2021). Anxiety and sensory over-responsivity in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 49, 310-321.

3. Mazefsky, C. A., & White, S. W. (2023). Emotion regulation: Concepts and practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America, 32(1), 25-41.

4. Milton, D. (2024). Pathological Demand Avoidance (Persistent Drive for Autonomy): Current perspectives. Journal of Child Psychology and Psychiatry, 65(2), 123-135.