The EDA-QA

The Extreme Demand Avoidance Questionnaire for Adults (EDA-QA) is a self-administered questionnaire that measures traits and behaviours related to Pathological Demand Avoidance (PDA) in adults (age 18+) with IQ in the normal range (IQ >=80).

Take the test here:

Who the test is designed for

• Adults (age 18+) of average or higher intelligence.^[1]The Measurement of Adult Pathological Demand Avoidance Traits (Egan, Linenberg & O’Nions, 2018)

What it tests

The EDA-QA was developed to measure behaviours in clinical accounts of extreme/pathological demand avoidance.

In 2003, PDA was proposed as a separate entity within the pervasive developmental disorders, instead of being classed under pervasive developmental disorder not otherwise specified (PDD-NOS),^[2]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003) but it’s still considered to be an offshoot of the autism spectrum. Like autism, PDA is a spectrum.

Versions & translations

A version for children and adolescents is also available. Originally called the EDA-Q, it has been superseded by the EDA-8. The EDA-8 contains only 8 of the 26 items of the EDA-Q; the 18 items that were dropped showed less consistency with child age, gender, ability, or independence.^[3]Extreme demand avoidance questionnaire | Liz O’Nions

• EDA-8 (ages 5–17)

Taking the test

The EDA consists of 26 statements, giving you 4 choices for each statement:

1. Not True
2. Somewhat True
3. Mostly True
4. Very True

Scoring

• Scoring range: 0–78
• Threshold score: n/a
  • Although a threshold has not been established, scores greater than 45 indicate a high risk of showing features of PDA
  • Lower scores mean you likely do not

Generating your score

If you’re scoring manually, the test items are scored as follows:

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

Scoring methods

You can take the test using two methods of scoring:

1. Self-scoring, if you want documentation of your answers
2. EDA-QA

Validity

How reliable, accurate, valid, and up-to-date is the test?

The EDA-QA is a 26-item self-report adaptation of the observer-rated Extreme Demand Avoidance Questionnaire (EDA-Q) for use with adult populations.^[4]Development of the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q): preliminary observations on a trait measure for Pathological Demand Avoidance (O’Nions et al., 2013)

• The original EDA-Q for children showed good sensitivity and specificity for the construct, and had an internal reliability (Cronbach’s alpha) of 0.93.^[5]Development of the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q): preliminary observations on a trait measure for Pathological Demand Avoidance (O’Nions et al., 2013)
• The EDA-QA remained highly reliable, with an internal reliability of 0.97.^[6]The Measurement of Adult Pathological Demand Avoidance Traits (Egan, Linenberg & O’Nions, 2018)

Discussion

Dr. Natalie:

• The test was quick and easy; however, I found some questions a challenge to interpret. Also, I found the wording pathology-based—words like complain, obsessively, and outrageous. That may skew people’s answers, compared to if the wording was more neutral.
• Some of the questions may pertain more to children, and it should be noted that this test is adapted from the children’s version. This can be seen in questions about temper tantrums, which may appear as swearing rather than throwing ourselves on the floor in public places.
• I scored 32, which is below the threshold. This made sense to me, as the test is shown to have good sensitivity (the number of people who have the disorder and are identified by the test). The test is also shown to have good specificity (the number of people who do not have the disorder and are identified as not having the disorder by the test).
• The test is quick to take and easy to self-score.

Eva:

We noticed that perhaps particularly for autistic people, there is a distinct risk of misinterpreting the statements on this test. I sure did. Based on what I understood PDA to be, I felt I probably have it to a degree. But the more research I read on PDA, the more I realize how significantly I misunderstood it. And indeed, I don’t have it; I scored only 13 on the test, which is far below the threshold.

So to avoid the potential of other people misinterpreting the test or PDA itself, below is a list of feedback we received on what autistics felt would make the test clearer, and my responses to their suggestions, based on my understanding of the research literature.

• #2 — Add examples of what is meant by demand (e.g. housework).
  • I agree, examples would make it clearer.
• #6 — This statement confuses me, because isn’t that just a description of masking?
  • Indeed it is! Remember that PDA is on the autism spectrum, so one would expect they have a need to mask all the same.
• #9 — Use the word ‘meltdown’ instead of ‘tantrum’.
  • No, ‘tantrum’ really is the appropriate term to use here. Since PDA is a subtype of autism, people with PDA will definitely experience meltdowns. But they will also engage in tantrums to get their way. This is an important distinction. If you don’t engage in tantrums, this aspect of PDA won’t apply to you.^[7]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003)
• #11 — “Making them” comes across as almost really hard. It’s very much more subtle and about “getting them to do what you want” rather than forcibly making them.
  • It’s important to note that PDA also constitutes a spectrum of traits, so different statements of the EDA-QA may or may not apply to varying degrees. Having said that, if you have a tendency to tone down statements of the test, I think you might have to concede that it doesn’t apply to you. As autistic people we often have a need to control our environment to limit our overwhelm, but this is very different from the behavior statement #11 alludes to, which is deliberate manipulation to get their way.
• #13 — I’m not sure that kicking is going to be related to by adults. Inappropriate language, screaming, crying, and slamming things may be more relatable.
  • Yes, we may scream, cry, cuss, etc. during a meltdown. But kicking is not uncommon behavior in people with PDA; they are described as having a lack of concern for their effects and engaging in outrageous acts, thus drawing parallels with conduct problems and callous-unemotional traits.
  • ^[8]Pathological demand avoidance: Exploring the behavioural profile (O’Nions, 2013)
• #14 — ‘Praised’ would be a more appropriate way to put it than ‘a good job’; it’s higher up the scale.
  • I agree with this feedback. People with PDA are described as wanting others to admire them,^[9]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003) so I think “I like to be praised for doing a good job” is probably more applicable of a sentiment. Whereas for me as an autistic person without PDA, I really don’t need to be praised for most jobs I do.
• #18 — I never actually deny things when caught “red-handed” as an adult. I try to justify why it isn’t exactly what it seems. So an adult would probably show more sophistication in their response.
  • Ahh, but someone with PDA probably wouldn’t. Their behavior and responses can seem quite immature. They may apologize but reoffend at once, or completely deny the obvious.^[10]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003)
• #22 — I don’t think I could giggle if I tried. It’s always loud, inappropriate laughter.
  • Giggling is just an example. It can be loud laughter as well. Despite social awareness, people with PDA tend to show uninhibited behavior (e.g. unprovoked aggression, extreme giggling/inappropriate laughter, etc.).^[11]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003)
• #25 — I never quibble. I will argue semantics or try and negotiate.
  • That’s very characteristic of autism. But someone with PDA would be much more likely to quibble, cross boundaries, and engage in unproductive escalations (drama).^[12]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003)
• #26 — ‘Moody’ rather than ‘passive’ may be more appropriate.
  • Emotional lability is indeed a characteristic feature of PDA as well, but passivity is also an important feature. But the lability of mood was already addressed in statement #15, so it makes no sense to change ‘passive’ to ‘moody’ in statement #26.^[13]Pathological demand avoidance syndrome: a necessary distinction within the pervasive developmental disorders (Newson, Le Maréchal & David, 2003)

While PDA is defined as being on the autism spectrum, there are some major differences between the two. I suspect that because we tend to experience overwhelm and executive challenges (avoiding things that stress us, or perpetually putting things off), we identify strongly with the name Demand Avoidance. But the condition is much more than what the name suggests. It actually looks quite a bit like a cluster C personality disorder with some cluster B features (i.e. BPD and histrionic). So be careful with how you interpret the statements of the EDA-QA.

But also be aware that PDA constitutes a spectrum, so you would also find people with mild presentations. Presumably, they would receive a lower score on the test. But you would have to score 45 or higher to potentially qualify for a PDA diagnosis.

Extreme Demand Avoidance Questionnaire for Adults

Please answer the questions thinking about your behaviour during the last six months. Please read each item carefully and fill in the answer that best applies. For each question, you can choose from four possible options: ‘Not’, ‘Somewhat true’, ‘Mostly true’ and ‘Very True’. Please fill in all items. There are no right or wrong answers.

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