Information on the EDA-Q

The ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q) is a measure designed to quantify traits of extreme/‘pathological’ demand avoidance (PDA) in children aged 5-17, on the basis of parent or teacher-report. The questionnaire was developed to make sure that PDA traits were being measured in a consistent way for research purposes.
 
The questionnaire was designed with input from clinicians working in a variety of settings in the UK who had experience of PDA. A preliminary validation study was conducted, in which parents reported on their child’s behaviours and the diagnoses they had received, as well as completing the new questionnaire. Scores on the EDA-Q were significantly higher in children whose parents reported that they had been clinically identified as having PDA than in all comparison groups, including children reported to have ASD with disruptive behaviour.
 
We ran analyses to find a cut-off score that would best differentiate PDA from comparison groups. Different risk cut-offs were required for older and younger age groups. A cut-off score of 50 was appropriate for ages 5-11 years and 45 for 12-17 years. These cut-offs identified individuals at risk of having a profile consistent with PDA. However, a comprehensive assessment by an experienced clinician, including a detailed developmental history, observation of the child, and information from a range of sources is required when considering whether a child displays PDA features. It is possible for an individual to be rated by parents or teachers as having behaviours associated with PDA but, after a full assessment, for a different clinical description to be deemed more appropriate.
 
In particular, current research on PDA has focused on individuals who display both PDA features and autism spectrum disorder. This work suggests that PDA features are dimensional within the autism spectrum, and that taking them into account in a diagnostic formulation can provide a more accurate description of the child’s behaviour. Studying individuals with this presentation will allow us to identify more tailored behavioural management approaches. However, less attention has been paid to the overlaps between PDA features and other conditions besides ASD. When conditions are defined by lists of behavioural features there will be interconnections and overlaps. More research is needed to explore these possible overlaps.
 

Translations of the EDA-Q
 

At present, the EDA-Q is available in both English and German. Anyone wishing to translate the questionnaire into other languages should contact liz.onions@kuleuven.be

Extreme demand avoidance questionnaire (EDA-Q)

To be completed by parent and/or teacher. One box to be ticked per question. ‚Äč

    Not true   Somewhat true Mostly true Very true
1 Obsessively resists and avoids ordinary demands and requests.        
2 Complains about illness or physical incapacity when avoiding a request or demand.        
3 Is driven by the need to be in charge.        
4 Finds everyday pressures (e.g. having to go on a school trip/ visit dentist) intolerably stressful.        
5 Tells other children how they should behave, but does not feel these rules apply to him/herself.        
6 Mimics adult mannerisms and styles (e.g. uses phrases adopted from teacher/parent to tell other children off).        
7 Has difficulty complying with demands unless they are carefully presented.        
8 Takes on roles or characters (from TV/real life) and 'acts them out'.         
9 Shows little shame or embarrassment (e.g. might throw a tantrum in public and not be embarrassed).        
10 Invents fantasy worlds or games and acts them out.         
11 Good at getting round others and making them do as s/he wants.         
12 Seems unaware of the differences between him/herself and authority figures (e.g. parents, teachers, police).        
13 If pressurised to do something, s/he may have a ‘meltdown’ (e.g. scream, tantrum, hit or kick).        
14 Likes to be told s/he has done a good job.        
15 Mood changes very rapidly (e.g. switches from affectionate to angry in an instant).        
16 Knows what to do or say to upset specific people.        
17 Blames or targets a particular person.        
18 Denies behaviour s/he has committed, even when caught red handed.        
19 Seems as if s/he is distracted 'from within'.        
20 Makes an effort to maintain his/her reputation with peers.         
21 Uses outrageous or shocking behaviour to get out of doing something.        
22 Has bouts of extreme emotional responses to small events (e.g. crying/giggling, becoming furious).        
23 Social interaction has to be on his or her own terms.         
24 Prefers to interact with others in an adopted role, or communicate through props/toys.        
25 Attempts to negotiate better terms with adults.         
26 S/he was passive and difficult to engage as an infant.         

How to score the EDA-Q

Questions 1 - 26 (apart from questions 14 and 20)
Not true = 0
Somewhat true = 1
Mostly true = 2
Very true = 3

Questions 14 & 20
Not true = 3
Somewhat true = 2
Mostly true = 1
Very true = 0

Results

For children aged 5 to 11 a score of 50 and over...
For children aged 12 to 17 a score of 45 and over...

...identifies individuals with an elevated risk of having a profile consistent with PDA.

The EDA-Q should not be considered a diagnostic test. For diagnosis, a thorough assessment by an experienced professional is required.

The EDA-Q has been developed as a part of ongoing research into PDA:
O’Nions, E., Christie, P., Gould, J., Viding, E. & Happé, F. (2013)
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