Extreme Demand Avoidance in Childhood and Adolescence

The construct of extreme (pathological) demand avoidance (PDA) is relatively new and contested. Clinical reports indicate a population who resist everyday demands and have an extreme need for control resulting in daily challenges. The construct has no agreed conceptualisation with resulting impacts on research and clinical guidance. There is a need to identify rigorous and reliable methodological approaches to studying extreme demand avoidance, to support future research, and to provide guidance for clinicians supporting a vulnerable group. The first component of this thesis is a scoping review focusing on how extreme demand avoidance is conceptualised, and the methods used to study extreme demand avoidance in children and adolescents. Arksey and O’Malley’s (2005) methodological framework and the PRISMA-ScR was employed. The results were that a variety of study methods are in use, however, significant methodological limitations exist with impact on ability to substantiate the construct. Previous research indicates psychologists are involved with children experiencing extreme demand avoidance, yet their perspective is absent from existing literature. The second component of this study is a qualitative study that explored psychologists’ experience, conceptualisation and approach to demand avoidance and extreme demand avoidance and identify if there are parallels between accounts of demand avoidance and the construct of extreme demand avoidance in the literature. Online, semi-structured interviews of twelve psychologists working in private, educational and disability services were conducted. Reflexive thematic analysis in line with Braun and Clarke (2019) was used. The findings indicated that psychologists proceed with caution regarding working on the basis of an emerging construct focusing on explaining and supporting underlying needs using a neurodiversity affirmative approach.