Extreme Demand Avoidance in Children with Autism Spectrum Disorder: Refinement of a Caregiver-Report Measure

Abstract

ObjectivesExtreme/“pathological” demand avoidance (PDA) describes a presentation found in some children on the autism spectrum, characterized by obsessive resistance to everyday demands and requests. Demands often trigger avoidance behavior (e.g., distraction, excuses, withdrawal into role play). Pressure to comply can lead to escalation in emotional reactivity and behavior that challenges.MethodsPreviously, the Extreme Demand Avoidance Questionnaire (EDA-Q) was developed to quantify resemblance to clinical accounts of PDA from caregiver reports. The aim of this study was to refine the EDA-Q using principal components analysis (PCA) and item response theory (IRT) analysis on parent/caregiver-report data from 334 children with ASD aged 5–17 years.ResultsPCA and IRT analyses identified eight items that are discriminating indices of EDA traits, and behave similarly with respect to quantifying EDA irrespective of child age, gender, reported academic level, or reported independence in daily living activities. The “EDA-8” showed good internal consistency (Cronbach’s alpha = .90) and convergent and divergent validity with other measures (some of which were only available for a subsample of 233 respondents). EDA-8 scores were not related to parental reports of ASD severity.ConclusionsInspection of the test information function suggests that the EDA-8 may be a useful tool to identify children on the autism spectrum who show an extreme response to demands, as a starting point for more in-depth assessment.