Sensory Reactivity and Intolerance to Uncertainty: What Characterises Demand Avoidance Behaviours in Children and Adolescents with Pathological Demand Avoidance?

This quantitative study investigated the underlying factors associated with extreme demand avoidance (EDA) behaviours in children and adolescents with and without a Pathological Demand Avoidance (PDA) profile. Using parent-reported data from 795 participants across autistic + PDA, autistic, and neurotypical groups, the study examined the roles of anxiety, autistic traits, sensory reactivity, and intolerance of uncertainty (IU). Findings showed that higher levels of anxiety and autistic traits were consistently associated with increased demand avoidance across all groups. However, sensory reactivity—particularly sensory sensitivity and sensory-seeking behaviours—uniquely characterised children with autism + PDA, distinguishing them from other groups. In contrast, intolerance of uncertainty was only a significant predictor in neurotypical children. The study supports the view that demand avoidance behaviours are largely anxiety-driven, with sensory processing differences playing a key role in PDA presentations. The findings highlight the importance of recognising sensory needs and adopting personalised, strengths-based, and environmentally responsive approaches to better support children and adolescents with PDA profiles.