The Extreme Demand Avoidance Questionnaire – Adult (EDA-QA) is a self-report measure of pathological demand avoidance (PDA) for adults (Egan et al., 2019). PDA is characterised by an extreme desire for autonomy and control, high levels of anxiety, and difficulties with emotional regulation, leading to avoidance or resistance when faced with perceived demands or expectations.
The Extreme Demand Avoidance Questionnaire – Adult (EDA-QA) is a 26-item self-report measure designed to assess characteristics associated with extreme demand avoidance in adults aged 18 years and older (Egan, Linenberg, & O’Nions, 2019). This behavioural profile is also known as pathological demand avoidance, pervasive drive for autonomy, or PDA. The measure assesses behaviours such as resisting ordinary demands, using coping strategies to avoid demands, mood variability, difficulties with authority, and a strong desire to control interactions. The EDA-QA was adapted from the 26-item EDA-Q, a parent-/caregiver-report measure developed for children and adolescents (O’Nions et al., 2014a), which has largely been replaced by an 8-item version called the EDA-8 (O’Nions et al., 2021).
EDA-QA Example Item
Extreme demand avoidance is conceptualised as an anxiety-driven desire for autonomy and self-determination, which can lead to the avoidance of, or resistance to, perceived demands and expectations, even those that align with the person’s own wishes or goals (Newson, Le Maréchal, & David, 2003; O’Nions et al., 2014b). Individuals may perceive demands as threatening to their sense of autonomy and control, triggering anxiety, distress, and responses that others may find challenging. This can manifest through social strategies (such as making excuses, negotiating, or distracting), outright refusal, withdrawal, or intense emotional reactions (such as outbursts or meltdowns).
It is important to note that extreme demand avoidance remains a topic of ongoing discussion and debate, with several competing conceptual positions:
Some clinicians and researchers conceptualise demand avoidance as a specific profile that occurs within the autism spectrum, characterised by unique features that distinguish it from other presentations of autism (Newson et al., 2003).
Others suggest that demand avoidance may represent an anxiety-driven response arising from the interaction between autistic traits — such as desire for predictability, difficulties with uncertainty, sensory sensitivities, and interoceptive differences (difficulty recognising internal states/capacity) — and environmental demands that conflict with these autism-related characteristics (O’Nions et al., 2018; White et al., 2023). Some researchers further emphasise that, from this perspective, demand avoidance can be understood as rational avoidance behaviour for autistic individuals navigating environments that do not accommodate their needs (Moore, 2020).
Still others suggest that demand avoidance characteristics may represent a set of behaviours that can occur across various diagnostic profiles, not exclusively within autism. From this perspective, demand avoidance might be observed in individuals with different neurodevelopmental, anxiety, or behavioural conditions (Green et al., 2018).
An alternative view proposes that what appears as PDA may reflect a pattern of comorbidity, where the combination of multiple co-occurring conditions (such as autism, anxiety, and conduct difficulties) produces the characteristic demand avoidance presentation (Green et al., 2018).
Currently, PDA is not formally recognised in the DSM-5-TR or ICD-11 as either a standalone diagnosis or as part of diagnostic criteria for autism or any other diagnosis. Nevertheless, identifying and measuring demand avoidance characteristics can provide valuable clinical information. Understanding the extent of demand avoidance can help clinicians recognise patterns of distress or resistance, assess the functional impact of demand-avoidant behaviours, adapt communication styles and environmental expectations, tailor support approaches to prioritise autonomy and reduce anxiety, and inform discussions with the individual and their support network about effective strategies. The EDA-QA provides a standardised way to quantify these characteristics, informing clinical formulation and further assessment needs, and helping individuals better understand the factors contributing to demand-avoidant behaviours.
The EDA-QA yields a total score between 26 and 104, with higher scores indicating greater levels of demand avoidance characteristics.
The respondent’s score is expressed as a community percentile based on normative data for adults in the general population (White et al., 2023) and as a clinical percentile based on data for adults recruited from online forums and support groups for PDA and Autism, many of whom reported that they had been formally diagnosed with a mental disorder, including autism (61.5%) and PDA (9.8%) (Egan et al., 2020). A graph is presented comparing the respondent’s score to the normative distribution of scores among these samples, with shaded areas around the means corresponding to scores between the 25th and 75th percentile. The percentiles and graph contextualise the respondent’s score relative to the typical scores of adults overall and those in the clinical sample. If administered more than once, a longitudinal graph is presented for the respondent’s score, which is useful for monitoring any changes in demand avoidance characteristics over time.
It is important to note that no clinical cutoff scores have been validated for the EDA-QA. Therefore, it is recommended that EDA-QA scores be interpreted dimensionally rather than categorically. However, to aid in clinical interpretation, NovoPsych has developed the following qualitative descriptors based on how an individual’s score compares to scores within community and clinical samples.
Clinicians should be aware that higher scores indicate a profile of demand avoidance that may require tailored treatment approaches. Some strategies that work well for many autistic individuals (such as clear routines, structured schedules, and explicit expectations) may be counterproductive for those with greater levels of demand avoidance characteristics, as these can paradoxically increase anxiety and avoidant responses. A low-demand, collaborative approach that prioritises autonomy, flexibility, and anxiety reduction is often recommended.
The EDA-QA was validated in a sample of 347 adults (94 male, 230 female, and 19 non-binary or gender fluid) aged 18 to 84 years (Mean = 36.9, SD = 12.8) recruited from a variety of specialist online blogs and community forums focusing on the needs and concerns of persons with autism (Egan et al., 2019). Over half reported that they had been formally diagnosed with a mental disorder, including depression (28%), autism (16.7%), anxiety (15.3%), and ADHD (8.1%), and a further 26.6% believed they had a mental disorder which had not been diagnosed.
Factor analysis supported a predominantly unidimensional structure, with one main factor reflecting general demand avoidance and a smaller secondary factor related to fantasy and role-play. Both one- and two-factor models showed acceptable to good fit, and the authors recommended using a single total score based on all 26 items (Egan et al., 2019).
The EDA-QA demonstrates good internal consistency, with Cronbach’s alpha coefficients ranging from 0.87 to 0.94 across studies (Egan et al., 2019; Egan et al., 2020; White et al., 2023).
Test-retest reliability and inter-rater reliability have also been examined. In a subsample of 32 participants who provided ratings at different time points (retrospectively as a child and currently as an adult) and were also rated by peer informants (mostly parents and siblings), significant correlations were found across raters and time points, ranging from r = 0.48 to r = 0.74 (Egan et al., 2019). These findings suggest reasonable stability and agreement, though further research with larger samples and standardised, longitudinal test-retest intervals would strengthen the evidence base.
Convergent Validity: The EDA-QA shows theoretically consistent relationships with other measures:
Discriminant Validity: The EDA-QA shows weaker or negligible correlations with constructs that should be theoretically distinct, such as extraversion and intellectual functioning (Egan et al., 2019), supporting discriminant validity.
Predictive Validity: Multiple regression and dominance analyses in community and general population samples indicate that anxiety and autistic traits are the most important predictors of EDA-QA scores, with anxiety emerging as particularly salient in some studies (White et al., 2023). These findings align with theoretical models suggesting that demand avoidance behaviours may represent an anxiety-driven response, particularly in the context of autistic traits.
Known-Groups Validity: In the original child version, EDA-Q scores successfully differentiated children identified with PDA from multiple comparison groups, including typically developing children, autistic children without disruptive behaviour, autistic children with disruptive behaviour, and children with disruptive behaviour alone (without autism or PDA) (O’Nions et al., 2014a). This demonstrates that the measure can distinguish PDA characteristics from both autism presentations and general conduct/behavioural problems. However, similar validation studies comparing groups of adults have not yet been conducted with the EDA-QA; therefore, no clinical cutoff scores have been validated for the EDA-QA. Interestingly, Egan and colleagues (2019) found no significant difference in EDA-QA scores between participants with and without a self-reported formal diagnosis of autism, suggesting that demand avoidance characteristics may not be specific to autism but may occur dimensionally in the general population.
Normative data for the EDA-QA are based on the following study samples:
Extreme demand avoidance remains a topic of ongoing discussion and debate amongst researchers and clinicians, with several competing conceptual positions. Some conceptualise it as a distinct behavioural profile that can occur within the autism spectrum, characterised by unique features that distinguish it from other presentations of autism. Others suggest it may represent an anxiety-driven response arising from the interaction between autistic traits (such as desire for predictability, difficulties with uncertainty, sensory sensitivities, and interoceptive differences) and environmental demands that conflict with these autism-related characteristics.
A third perspective proposes that demand avoidance characteristics may represent a cross-diagnostic behavioural pattern — a set of behaviours that can occur across various diagnostic profiles, not exclusively within autism. From this view, demand avoidance might be observed in individuals with different neurodevelopmental, anxiety, or behavioural conditions. Finally, some researchers propose that what appears as PDA may reflect a pattern of comorbidity, where the combination of multiple co-occurring conditions (such as autism, anxiety, and conduct difficulties) produces the characteristic demand avoidance presentation.
Additional concerns have been raised about the PDA construct, including the risk of pathologising autonomy-seeking behaviour that may represent adaptive coping strategies for autistic individuals in environments that do not accommodate their needs. There are also concerns about the limited evidence base, which is still emerging amid ongoing uncertainty about the nature of the construct itself, and limited evidence from intervention studies.
Currently, PDA is not formally recognised in diagnostic manuals such as the DSM-5-TR or ICD-11, either as a standalone diagnosis or as part of diagnostic criteria for autism or any other condition. The debate partly reflects broader discussions about how best to classify and understand complex behavioural presentations, and whether new diagnostic categories are needed or whether existing frameworks can adequately capture these experiences. Regardless of these theoretical differences, there is consensus that individuals who experience significant demand avoidance can face substantial challenges and benefit from appropriate support. The EDA-QA provides a way to quantify these characteristics to inform clinical understanding and support planning.
The EDA-QA is primarily a screening tool that can help quantify demand avoidance characteristics during clinical assessment. It provides percentile comparisons to both general population and clinical samples, offering context for the extent of demand-avoidant traits or behaviours. Scores can be reviewed collaboratively with clients to increase insight and engagement, helping to identify specific triggers and situations where demand avoidance is most pronounced, which can inform tailored support strategies.
Whilst extreme demand avoidance may superficially resemble oppositional defiant disorder (ODD), there are important qualitative differences. Oppositional behaviour in ODD is typically interpreted as stemming from anger, irritability, or resentment, whereas demand-avoidant behaviour is interpreted as stemming from anxiety and a desire to manage perceived loss of control. Individuals with prominent demand avoidance often use coping strategies to avoid demands (such as distraction, negotiation, or excuses) rather than engaging in intentional manipulation. However, they may also resort to behaviours that could damage their social or professional reputation. For example, adults might shut down completely in work settings, use inappropriately informal communication with authority figures, or engage in avoidance strategies that clearly harm their own interests, showing less concern for reputation management than is typical in conduct problems. Crucially, the avoidance extends to demands the person genuinely wishes to fulfil – creating significant internal distress.
The relationship with anxiety is more complex. Research suggests that anxiety is strongly associated with demand avoidance characteristics, and many conceptualise demand avoidance as an anxiety-driven response to perceived threats to autonomy. However, demand avoidance appears to involve more than general anxiety alone – it specifically centres on a desire for control and self-determination in response to any perceived demand or expectation.
The EDA-QA focuses specifically on demand avoidance characteristics rather than oppositional behaviour or anxiety more broadly, though it’s important to assess these related areas as part of a comprehensive evaluation. Understanding whether someone’s difficulties primarily reflect demand avoidance, anxiety, oppositionality, or a combination can help tailor support approaches appropriately.
The evidence base for specific support approaches for young people with extreme demand avoidance characteristics is currently limited and still emerging. Based on clinical observation and parent reports, traditional support strategies that work well for many autistic individuals – such as clear routines, structured schedules, and explicit expectations – may be less effective or counterproductive for some people with prominent demand avoidance (O’Nions & Eaton, 2020). Instead, a low-demand, collaborative approach that prioritises autonomy, flexibility, and anxiety reduction is often recommended, though research examining the effectiveness of specific strategies is needed.
Strategies that have been reported as helpful include reducing direct demands where possible, offering choices, maintaining a calm and non-confrontational interaction style, and being flexible about how and when tasks are completed (O’Nions & Eaton, 2020). It’s important to recognise that what appears as “avoidance” often reflects genuine overwhelm rather than willful non-compliance.
Professional guidance from clinicians familiar with demand avoidance can help develop individualised approaches. However, more research is needed to establish which strategies are most effective for supporting people with demand avoidance characteristics.
Yes, the EDA-QA can be completed by adults regardless of whether they have an autism diagnosis. Whilst extreme demand avoidance has historically been discussed in relation to autism, research suggests that demand avoidance characteristics can occur dimensionally in both autistic and non-autistic adults (Egan et al., 2019; White et al., 2023). Studies using the EDA-QA have found that demand avoidance correlates with various factors, including anxiety, certain personality dimensions, and autistic traits, but can be present to varying degrees in people without diagnosed autism.
Clinically, the EDA-QA may be useful when assessing individuals who report significant difficulties with everyday demands and expectations, regardless of their diagnostic history. The measure provides percentile comparisons to both general population and clinical samples, allowing clinicians to contextualise scores appropriately. However, it’s important to remember that higher scores indicate the presence of demand avoidance characteristics rather than confirming any particular diagnosis. A comprehensive clinical assessment is needed to understand the full context of someone’s experiences, identify any underlying factors contributing to demand avoidance, and develop appropriate support strategies. The EDA-QA should be used as one component of a broader assessment process rather than in isolation.
Egan, V., Linenberg, O., & O’Nions, E. (2019). The measurement of adult pathological demand avoidance traits. Journal of Autism and Developmental Disorders, 49(2), 481-494. https://doi.org/10.1007/s10803-018-3722-7
Baker, S., Kaufman, H., Wotherspoon, J., Buchanan, B., & Hegarty, D. (2025). A Review of the Clinical Utility and Psychometric Properties of the Extreme Demand Avoidance Questionnaire – Adult (EDA-QA): Percentile Rankings and Qualitative Descriptors. https://doi.org/10.17605/OSF.IO/EJD85
Egan, V., Bull, E., & Trundle, G. (2020). Individual differences, ADHD, adult pathological demand avoidance, and delinquency. Research in Developmental Disabilities, 105, 103733. https://doi.org/10.1016/j.ridd.2020.103733
Egan, V., Linenberg, O., & O’Nions, E. (2019). The measurement of adult pathological demand avoidance traits. Journal of Autism and Developmental Disorders, 49(2), 481-494. https://doi.org/10.1007/s10803-018-3722-7
Green, J., Absoud, M., Grahame, V., Malik, O., Simonoff, E., Le Couteur, A., & Baird, G. (2018). Pathological demand avoidance: Symptoms but not a syndrome. The Lancet: Child & Adolescent Health, 2(6), 455-464. https://doi.org/10.1016/S2352-4642(18)30044-0
Moore, A. (2020). Pathological demand avoidance: What and who are being pathologised and in whose interests? Global Studies of Childhood, 10(1), 39-52. https://doi.org/10.1177/2043610619890070
Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595-600. https://doi.org/10.1136/adc.88.7.595
O’Nions, E., Christie, P., Gould, J., Viding, E., & Happé, F. (2014a). Development of the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q): Preliminary observations on a trait measure for Pathological Demand Avoidance. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(7), 758-768. https://doi.org/10.1111/jcpp.12149
O’Nions, E., Happé, F., Viding, E., & Noens, I. (2021). Extreme demand avoidance in children with autism spectrum disorder: Refinement of a caregiver-report measure. Advances in Neurodevelopmental Disorders, 5, 269-281. https://doi.org/10.1007/s41252-021-00203-z
O’Nions, E., Viding, E., Floyd, C., Quinlan, E., Pidgeon, C., Gould, J., & Happé, F. (2018). Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/”pathological” demand avoidance. Child and Adolescent Mental Health, 23(3), 220-227. https://doi.org/10.1111/camh.12242
O’Nions, E., Viding, E., Greven, C. U., Ronald, A., & Happé, F. (2014b). Pathological demand avoidance: Exploring the behavioural profile. Autism, 18(5), 538-544. https://doi.org/10.1177/1362361313481861
White, R., Livingston, L. A., Taylor, E. C., Close, S. A. D., Shah, P., & Callan, M. J. (2023). Understanding the contributions of trait autism and anxiety to extreme demand avoidance in the adult general population. Journal of Autism and Developmental Disorders, 53(7), 2680-2688. https://doi.org/10.1007/s10803-022-05469-3
