My Teen's Brain has Tenants (And None of them Pay Rent)

PDA, OCD, intrusive thoughts and the fine art of finding rainbows in 'crazy'

It's half past five in Table View, my youngest is midway through a twenty-minute report on who-said-what-to-whom, and Olivia drifts into the kitchen with hands freshly scrubbed for the fourth time since lunch.

"Mom," Liv says. "I had another one."I know exactly what "one" means. A thought. A horrible, uninvited, completely out-of-character thought that kicked down the door of my child's mind, put its muddy feet up on the furniture and refused to leave.

I'll be honest with you, because honesty is the only currency worth trading in this parenting game. In our early years, there were days when those thoughts, said out loud across the dinner table, made me seriously question the wisdom of leaving the safety of my bedroom.

I'm a qualified educator, a Neurodiversity Facilitator, and a person who has sat through more professional development workshops than I've had hot cups of coffee. None of it prepared me for my child calmly describing something dark that had popped into their head, then looking at me with eyes that said, 'please tell me I'm not a monster'.

These days, I put down whatever I am about to stick into the airfryer, I look at my kid, and I say something like, "Well, that one's a bit dramatic, isn't it? Must be a slow day in your brain's horror department." And Liv laughs. And the spell breaks, just a little.

Let me explain how we got here.

Meet the tenants: what intrusive thoughts actually are

Intrusive thoughts are unwanted thoughts, images or urges that barge into the mind uninvited. They're often violent, taboo, disturbing or just plain bizarre.

Here's the fact I wish someone had tattooed on my forearm years ago: almost everybody has them. 

A large international study led by researcher Adam Radomsky, covering thirteen countries, found that around 94% of people had at least one unwanted intrusive thought in the previous three months.The difference isn't whether you have them. It's what your brain does next.
Most people have a weird thought ("What if I just swerved into the oncoming lane on the N1?"), shrug, think "well, that was odd," and carry on singing along to the radio.

In someone with OCD (Obsessive-Compulsive Disorder), the brain grabs that thought, puts it under a spotlight and starts shouting: Why did you think that? What does it mean? What kind of person thinks that? The thought gets sticky. It loops. Anxiety climbs. The person often does something to make the awful feeling go away, like a ritual, a check, a wash, a mental review or a request for reassurance. That's the "compulsive" part.
Here's the crucial, beautiful, counterintuitive bit. Clinicians call intrusive thoughts in OCD ego-dystonic, which is a fancy way of saying they clash with who the person actually is and what they value. People are tormented by them precisely because they would never act on them. A child who is terrified by a violent thought is, almost by definition, a child who finds violence abhorrent. The horror is the proof. 

My eldest child, who would never hurt me and protects me at all costs, told me recently the thought was smashing my head into the steering wheel until my brains leaked out. I was driving at the time. A frightening thought for both of us. But that is it. A THOUGHT.

That's why I tell Liv, over and over: "These thoughts are so far out there because they're things you would never do."

OCD tends to show up in childhood or adolescence, and it affects roughly 1 to 3% of people (myself included, though to a lesser degree). It also turns up alongside autism far more often than chance would predict. Estimates vary widely between studies, but it's a well-recognised pairing that clinicians watch for.

Where PDA walks in (and refuses to take its shoes off)

Professor Elizabeth Newson first described Pathological Demand Avoidance (PDA) in the UK in the 1980s. Many people in our community now prefer the name Pervasive Drive for Autonomy. PDA isn't a separate diagnosis in the DSM-5 or ICD-11, and here in South Africa you'll seldom see it written formally on a report. It is, however, widely understood as a profile within the autism spectrum. 

At its heart is an anxiety-driven need to avoid demands and stay in control. And "demands" doesn't just mean "clean your room."
 It can be a question, a suggestion, a praise sticker (DO NOT use these people!), the time on the clock, or a bodily need like hunger or the bathroom.

So what happens when a nervous system that experiences everyday demands as a threat shares a body with a brain that throws frightening thoughts around and insists on rituals to manage them?You get a young person living in a permanent tug-of-war, with anxiety as the rope.

At their core, both PDA and OCD are about anxiety and control, and both are deeply uncomfortable with uncertainty.
Here's the irony that makes me want to laugh and cry in the same breath: OCD issues its own demands. Wash again. Don't touch that. Check it once more. The PDA brain bristles at being told what to do by a parent or teacher, and now its own head is bossing it around. There's no escaping that particular manager. No wonder my child is exhausted by bedtime.

The germ paradox, or: the Great Hair-Wash Standoff

Let me paint you a picture every parent of a PDA-OCD teen will recognise.

Olivia washes their hands after touching almost anything. Taking an object from someone else's hand is a genuine challenge, because there's no way to control the germ factor. Where has that person been? What have they touched? Has that pen been near a mouth? A taxi rank? The Grand Parade? The risk assessment happens in a split second, and it is exhausting.And yet.
For my PDA kid, washing hair and changing clothes can be such an enormous demand that it's utterly overwhelming. It isn't laziness, and it isn't defiance. It's a nervous system slamming on the brakes. So the hair doesn't get washed and the jersey stays on for one more day. Then OCD kicks in, and Liv is plagued by worry about the germs that are presumably now holding a braai in their hoodie.PDA says I can't. OCD says you must. And my child sits in the middle, caught between two very loud voices, neither of which is mine.

This is the part I wish more people understood. When you see a teenager who seems "obsessed with germs" but hasn't showered, you aren't looking at a contradiction or a con. You're looking at two conditions arm-wrestling inside one person.

Fingers, cuticles, and the art of multitasking rituals

Then there's the bit that makes me twitch, as a fairly germ-conscious neurotypical mother.The same teenager who won't take a cup from my hand will scratch their head and chew the sleeve of their top, with a side order of fingers and whatever is left of their cuticles.For me, that's a germ nightmare. For Liv, it's a seamless, multitasking sequence of the rituals and soothing behaviours that carry them through the day.It's worth knowing that skin-picking, nail-biting and similar habits belong to a group called body-focused repetitive behaviours. The diagnostic manuals place some of them in the same family as OCD. Chewing clothing is also very common in autistic people as a way of regulating the senses. In other words, these aren't "bad habits" to nag away. They're a nervous system trying to cope.It's exhausting to watch, and I won't pretend otherwise. That's exactly why I treasure the moments when I can distract Liv, make them laugh, and watch those shoulders drop an inch from their ears.

What I've learned to do (and what I'd tell any parent, teacher or granny)

1. Take the thought at face value. When a child or teen trusts you enough to say "I had a terrible thought," it isn't a confession. It's a cry for a reality check. If anything, appreciate the enormous trust it took to say it out loud. They didn't have to tell you. They chose you.

2. Don't flinch (or at least, flinch on the inside). Your face is the first thing they read. If you look horrified, the OCD brain files that away as evidence: See? Even Mom thinks it means something. Aim for calm and a little bit bored.

3. Name it for what it is. Unwelcome. Burdensome. Genuinely frightening for them. Not a plan, not a wish, not a secret desire. Just noise.

4. Use humour (gently). I joke about the thoughts. I never joke about my child or their fear, only about how ridiculous the thoughts their brain produces are. Humour shrinks a monster down to the size of a cartoon.

5. Don't get dragged into the debate. Long rounds of "but are you sure I wouldn't…?" can actually feed the OCD loop, because reassurance becomes another ritual. Give one clear, kind answer, then move on.

6. Move the body, change the channel. I remind Liv to try to put the thought away, and then we do something. Usually that something is supper. Peeling potatoes is surprisingly good therapy. Once those thoughts start to spiral, anxiety rises fast and my child is held hostage. Getting the hands and mind busy with something else is how we negotiate the release.

7. Get the right support. The best-researched treatment for OCD is a form of cognitive behavioural therapy called exposure and response prevention (ERP), sometimes alongside medication.

For PDA young people, though, a rigid, demand-heavy approach can backfire badly. Look for professionals who understand PDA and are willing to adapt: collaborative, low-pressure, and led by the young person wherever possible.

A small but important note: intrusive thoughts are thoughts a person fears and fights. If a young person ever talks about something they want to do, or a plan to hurt themselves or someone else, that's a different situation. Trust your gut and reach out to a professional, or to an organisation like SADAG, straight away. Taking thoughts at face value includes taking those ones seriously too.

A quick word to the village

To teachers, coaches, aunties, family friends and the lovely lady at the Woolies till: if a neurodiverse young person shares something unsettling with you, please don't recoil. Don't report them to the principal before you've drawn breath, and don't decide they're "disturbed."
Ask yourself whether you might be looking at a frightened child with a noisy brain. If you are, they've just paid you the highest compliment possible: their trust.And if they refuse the pen you're holding out and then chew their own jersey sleeve thirty seconds later, smile.You've just seen the germ paradox in the wild.

Looking for the rainbows

Here's what I really want to say.

This same teenager, with obstacles aplenty, still does their chores, because they know there are days when I simply don't have the capacity to. This same teenager wants to sit down for dinner as a family and share their news. They do it even though their youngest sibling is an absolute diva, the reigning queen of long stories, and the self-appointed reporter of every infraction committed in our household since 2019.

This same teenager laughs and smiles and talks excitedly about learning to drive. (May the angels, the saints and every deity on the K53 syllabus help me with that one. I've already started stretching my emergency-brake foot.)And sometimes I just stand at the microwave/airfryer (I'm a culinary wonder-really) and marvel at this child.

The road of neurodiversity is bumpy, and so is raising neurodiverse kids and watching everything they have to push through. We all have things to overcome, but theirs are by no means insignificant.So look for the rainbows. Catch the smiles. 

Live for the good moments. There are many of them. Only some of us are fortunate enough to see them and share in them.

I count myself very fortunate indeed.You don't have to do this alone.

It really does take a village. Maybe you're parenting a child or teen with PDA, OCD, intrusive thoughts or anxiety. Maybe you're a neurodiverse young person trying to make sense of your own wonderfully complicated brain. Either way, let me be part of your village.

This article shares lived experience and general information. It isn't a substitute for individual assessment by a qualified health professional.#PDAawareness #AutismParentingSA #NeurodiversityCapeTown #OCDandAutism