Sensory Reactivity and Intolerance to Uncertainty: What characterises demand avoidance behaviours in Children and Adolescents with Pathological Demand Avoidance?

The present study addressed the underlying factors contributing to Extreme Demand Avoidance (EDA) behaviours in autistic children and adolescents with and without Pathological Demand Avoidance (PDA). Data from 795 children between the ages of 4-17 years old were analysed. Parents of 475 of autistic children and adolescents + PDA, 171 autistic children, and 94 neurotypical children completed an online composite questionnaire consisting of the characteristics of EDA, autism, anxiety, intolerance of uncertainty (IU) and sensory processing patterns. The findings showed that higher levels of anxiety and autism corresponded to higher EDA behaviours for all three groups. While IU and sensory reactivity were not found to be associated with EDA in the autism group; higher levels of IU corresponded with higher levels of EDA for the neurotypical controls. Importantly, this was the first study to illustrate higher levels of sensory reactivity, namely sensory sensitivity and sensory seeking, to uniquely characterise EDA in the children and adolescents identifying with autism + PDA. It is suggested that significant sensory reactivity may play a major role in the ability to undertake and/or in the avoidance of certain demands and situations for children with a PDA. Understanding the key underlying mechanisms behind EDA behaviours, could lead to a strengths-based approach, tailoring more comprehensive management strategies for autistic children with PDA, including those that address environmental sensory demands.