Psychological and Neurodevelopmental Correlates of Extreme Demand Avoidance in a Clinical Sample, an Exploratory Study

Extreme/pathological demand avoidance (EDA) is a behavioral profile characterized by the avoidance of everyday demands, with significant impact on the individuals and those around them. Little is understood regarding the correlates and drivers of EDA; understanding these better may lead to targeted interventions and support strategies. Cross-sectional data from parent-rated measures were analyzed for 63 children referred to a specialist neurodevelopmental clinic in the United Kingdom. The relationship between EDA traits and a number of psychological (intolerance of uncertainty, anxiety, emotional dysregulation [reactivity and dysphoria], cognitive inflexibility, alexithymia [i.e., difficulty identifying emotions]), and neurodevelopmental (autistic and ADHD) traits was tested. No differences in EDA traits were found by diagnostic group (autistic vs. not-autistic) or gender (male and female). Across the whole sample, EDA traits were negatively correlated with age and positively correlated with emotional dysregulation reactivity, ADHD traits, cognitive inflexibility, intolerance of uncertainty and alexithymia. EDA was not associated with autistic traits or anxiety. Path models were used to identify which cognitive and behavioral features predicted EDA scores, once inter-correlations among predictors were controlled for. Only emotional dysregulation, ADHD traits and age predicted EDA-Q scores. Further research is needed to assess how these variables contribute to EDA in larger more diverse samples, capturing potentially unmeasured variables, and exploring possible mediation pathways.