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Extreme /’Pathological’ Demand Avoidance

This article addresses the topics of debate and controversy that exist surrounding the classification of extreme/’pathological’ demand avoidance as a profile of the autism spectrum. A comprehensive overview of the existing and ongoing areas of research is given.

There is discussion of the behavioural traits displayed by individuals with a more classic profile ASD profile compared to those with the extreme/’pathological’ demand avoidant profile. Examples of some of the challenging behaviour that can be displayed by individuals with this profile are given. The unique challenges faced by care providers and schools are highlighted.

Ongoing work comparing extreme/’pathological’ demand avoidance to other behavioural profiles such as oppositional defiant disorder (ODD) and conduct disorder (CD) is discussed. Areas of overlap between these behavioural profiles and extreme/’pathological’ demand avoidance are explored and the differences recognised.

The dimensional nature of extreme/’pathological’ demand avoidance and its’ similarities to a more female-typical ASD presentation is discussed.

The paper concludes with descriptions of management strategies that can help children with the extreme/’pathological’ demand avoidant profile of autism. Ongoing research is needed into the recognition and diagnosis of extreme/ ‘pathological’ demand avoidance. The need to raise awareness was discussed.

Authors: Liz O'Nions, Francesca Happé and Essi Viding

First published: British Psychological Society DECP Debate, issue 160