Assessment & Research

Individual differences, ADHD, adult pathological demand avoidance, and delinquency.

Egan et al. (2020) · Research in developmental disabilities 2020
★ The Verdict

In adults, ADHD and antagonistic personality predict demand avoidance far better than autism traits.

✓ Read this if BCBAs working with demand-avoidant adults in clinic or forensic settings.
✗ Skip if Clinicians who serve only young children with classic autism and no ADHD concerns.

01Research in Context

01

What this study did

Egan et al. (2020) asked adults to fill out online surveys. They wanted to know what best predicts pathological demand avoidance, or PDA.

The team looked at ADHD traits, autism traits, and big-five personality scores. They also asked about rule-breaking behavior.

02

What they found

ADHD traits, antagonism, and low emotional stability together explained most of the PDA scores. Autism traits added almost nothing.

In plain words, adults who are impulsive, argumentative, and moody report the strongest avoidance of everyday demands.

03

How this fits with other research

Winburn et al. (2014) showed that children labeled with PDA have both autism-level social problems and conduct-level defiance. Vincent moves the lens to adults and says ADHD plus personality, not autism, drives the picture.

Gibbs et al. (2023) found the same pattern for victimization: ADHD traits predicted multiple victimizations in adults, while autism diagnosis did not. The two studies conceptually echo each other—ADHD links to adult risk, autism alone does not.

Johnson et al. (2021) warned that child PDA research is built on shaky parent-report tools. Vincent sidesteps that mess by using adult self-report and still finds a clear signal, suggesting the adult form may be more reliable to assess.

04

Why it matters

If you assess an adult who avoids demands, screen for ADHD and personality factors first. Targeting impulsivity and emotional regulation could ease demand avoidance more than autism-specific strategies. Try breaking tasks into tiny steps and adding choice to reduce perceived demands.

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Add an ADHD screener and a brief personality checklist to your intake packet for demand-avoidant clients.

02At a glance

Intervention
not applicable
Design
survey
Sample size
126
Population
mixed clinical
Finding
positive
Magnitude
large

03Original abstract

BACKGROUND: Pathological Demand Avoidance (PDA) is a developmental disorder involving challenging behaviour clinically linked to Autism Spectrum Disorder (ASD). Many of the problematic features of PDA are often seen in persons with attention deficit hyperactivity disorder and impulsivity. ADHD and impulsivity are also common in the backgrounds of offenders. AIMS: Method and procedure: We examined if self-reported ASD, ADHD, impulsivity, and general personality traits such as low conscientiousness and low emotional stability predicted self-reported PDA scores, and which constructs contributed to the prediction of delinquency, recruiting 132 participants (mean age 34.6 years, SD = 10.9, range 18-68), of whom 126 cases had complete data. OUTCOMES AND RESULTS: Many of these constructs, but particularly ADHD (r = 0.71, p < 0.001) were significant correlates of PDA, the correlation between ASD and PDA was small, and did not predict PDA. Multiple regression indicated that a combination of higher attention deficit, antagonism, and lower emotional stability predicted 65 % of an individual's PDA score, but that their PDA score did not contribute to the prediction of delinquency. CONCLUSIONS AND IMPLICATIONS: This research indicates that, for community adult populations, self-reported individual differences in ADHD, emotional instability, and antagonism appear to better predict PDA than ASD. The association PDA has with delinquency may reflect these constructs, which are also correlates of offending.

Research in developmental disabilities, 2020 · doi:10.1016/j.ridd.2020.103733