Practising Psychologists’ Accounts of Demand Avoidance and Extreme Demand Avoidance in Children and Adolescents

This qualitative study explored practising psychologists’ understandings and clinical experiences of demand avoidance and extreme demand avoidance (EDA) in children and adolescents. Through semi-structured interviews, psychologists described demand avoidance as a spectrum of behaviours, with EDA characterised by intense anxiety, need for control, and extreme responses to everyday demands. Participants highlighted significant challenges in assessment, including overlap with other neurodevelopmental and mental health presentations, inconsistent terminology, and limited consensus about EDA as a distinct profile. Psychologists emphasised that traditional behavioural or compliance-based approaches often escalated distress, whereas flexible, relational, low-demand, and anxiety-informed strategies were perceived as more effective. The study highlights the need for clearer conceptual frameworks, improved professional training, and greater consistency in assessment and support approaches to better meet the needs of children and adolescents with high demand avoidance.