Quick note: The following research review uses the term Extreme Demand Avoidance (EDA) instead of Pathological Demand Avoidance (PDA). This current post will use the acronym EDA.
Research Article Title: Understanding the Contributions of Trait Autism and Anxiety to Extreme Demand Avoidance in the Adult General Population
A Question
Have you ever found yourself avoiding a task, even when you know it needs to be done? For some, this isn't just procrastination, it could be a manifestation of Extreme Demand Avoidance (EDA). Recent research sheds light on this complex profile, highlighting its strong connections to anxiety and autistic traits.
What is Extreme Demand Avoidance (EDA)? What are the FUNCTIONS of the expressed behaviors?
At its core, demand avoidance behaviors are often described as learned coping mechanisms. They develop in response to extreme anxiety triggered by an aversive stimulus or demand. By avoiding or delaying an imposed demand, a person can regain a sense of control over the situation, which in turn reduces their anxiety. This reduction in anxiety then reinforces the avoidance behavior, creating a cycle. Initially, avoidance may be limited to aversive tasks, but it can eventually extend to activities a person with a EDA profile typically enjoys
Adults with an EDA profile frequently report very high levels of anxiety, often describing it as their primary emotion. They may experience a lack of control as catastrophic, feeling that "If I feel out of control everything goes very wrong, very quickly". This avoidance, ironically, is likely to increase anxiety in the long term, creating a self-perpetuating and potentially amplifying cycle of anxiety and avoidance, similar to what is seen in research on procrastination. Studies have shown that anxiety, especially intolerance of uncertainty, is associated with demand avoidance behaviors in children, even when controlling for an autism diagnosis.
EDA and Autism: Similarities and Differences
The relationship between EDA and autism is complex, with both similarities and distinct differences.
Both autism and EDA profiles share characteristics such as:
- Anxiety
- Challenges with effort initiative
- Difficulties with performance feedback
- A heightened need for control
- Social communication challenges
However, there are also key differences:
- Individuals with an EDA profile may engage in socially manipulative behaviors.
- They might use role-play as a coping and avoidance mechanism.
- They are often influenced more by social factors compared to what is typically described in autism.
How Does EDA Develop and Persist? Who does it affect?
EDA is thought to emerge in childhood and can continue into adulthood. Early descriptions of EDA came from experiences at a specialist clinic assessing children with atypical autism, and follow-up studies found that many of these individuals remained highly demand avoidant in adulthood, though some had become less so. Anecdotal evidence from clinicians also supports the continuation of EDA into adulthood.
It's believed that EDA traits may decrease as a child gets older, possibly due to improvements in skills like self-regulation, communication, and the ability to self-advocate. While it's possible this trajectory of diminishing behaviors continues throughout adulthood, some research has found no relationship between EDA traits and age in adults. Interestingly, anxiety disorders in the general population tend to decrease with age, which could also play a role in reducing demand avoidance behaviors if anxiety is a primary driver.
Regarding gender, initial ideas suggested an equal sex ratio for EDA, supported by some studies. It has also been suggested that EDA might represent a more typically female autism profile, which would align with a more balanced sex ratio compared to the typical 3:1 male-to-female ratio seen in autism. However, findings on sex ratios in EDA are inconsistent, with some studies reporting higher traits in women, and others in men. Given these mixed findings, it's considered important to account for age and sex in investigations of demand avoidance traits.
Current Research Sheds Light on Predictors
To better understand the relative importance of autistic traits and anxiety in predicting demand avoidance in the adult general population, White et al., 2023 conducted two studies. Recognizing the lack of clear diagnostic criteria for EDA, they measured demand avoidance traits in the general population and included autistic traits and anxiety in their models, controlling for other emotional symptoms like depression and stress.
Study 1 Findings: The first study, involving 267 UK residents, indicated that anxiety was the most important predictor of demand avoidance traits. Autistic traits were found to be a weaker unique predictor than expected and were even weaker than depression and stress in some analyses. While men reported significantly higher demand avoidance than women, sex was not a particularly useful predictor when accounting for inter-correlations.
Study 2 Findings: Due to the relatively small sample size and the use of an abbreviated autism measure (AQ-10) in Study 1, a second, larger study (549 UK-based participants) was conducted using the full Autism Spectrum Quotient (AQ). The results of Study 2 suggested that both autistic traits and anxiety are comparably important when predicting demand avoidance.
Overall Conclusion: Taken together, these studies underscore that both autism and anxiety are significant factors contributing to Extreme Demand Avoidance. This research supports previous findings linking anxiety and EDA, particularly in children. Understanding these connections is crucial for developing more effective support strategies for individuals experiencing EDA.
Researchers: White, R., Livingston, L.A., Taylor, E.C. (2023) Understanding the Contributions of Trait Autism and Anxiety to Extreme Demand Avoidance in the Adult General Population. Journal of Autism & Developmental Disorders, 53, 2680–2688. https://doi.org/10.1007/s10803-022-05469-3.
