Given that children with a PDA profile score lower on certain ASD characteristics compared to those with more typical autism/Asperger presentations, we would also expect EDA scores to diverge from measures of ASD severity. Other scales, such as the Strengths and Difficulties Questionnaire (Goodman, 1997), capture traits which, although elevated in PDA (O’Nions, Viding, et al., 2014b), are less conceptually central, and are therefore expected to diverge from EDA scores. These scales afford opportunities to examine convergent validity with the EDA-Q. Questionnaires have been developed that are designed for ASD populations such as the Emotion Dysregulation Inventory (EDI) (Mazefsky et al., 2018a, b Mazefsky et al., 2020), which measures emotional reactivity and dysphoria and the Home Situations Questionnaire - Pervasive developmental disorders version (HSQ) (Chowdhury et al., 2016), which measures resistance to daily demands. Non-compliance and emotional reactivity have become a focus for ASD research internationally. Refinement of the scale and analysis of item functioning in a sample of children with ASD is needed to improve the scale’s reliability and assess the extent to which it can measure differing severity levels of EDA traits (or sub-dimensions) in children with ASD. lower independence in daily living activities. Items may also behave differently, relative to the scale as a whole, in males vs. Therefore, the EDA-Q may contain items that add little to, or possibly detract from, the quantification of one or more underlying dimensions. However, given that the EDA-Q was designed as a checklist to quantify resemblance to Newson et al.’s ( 2003) description of PDA, the measure was not refined based on component loadings. Principal components analysis (PCA) of the scale, which was not restricted to those reported to have a diagnosis of ASD, suggested that all but three items loaded onto the first component at >. Assuming that typical autism and PDA features are not part of a single dimension of autism severity, in Newson et al.’s ( 2003) sample, those with the most severe PDA profiles would have comparatively fewer typical autism features, and those with the most severe typical autism profiles would have comparatively fewer PDA features. Either severe autism features (i.e., severe social and communicative impairments, echolalia, stereotypies, etc.) or significant challenges with behavior (including avoidance of routine demands/PDA features) would be necessary and sufficient for referral. Given the limited awareness of autism at the time and low estimates of autism prevalence (e.g., Wing & Potter, 2002), severe difficulties were likely needed to warrant a referral and assessment. This bias may have occurred in Newson et al.’s ( 2003) sample. Newson et al.’s ( 2003) findings may partly reflect a “collider bias” (Cole et al., 2010 O’Nions & Eaton, 2020): an unintuitive bias whereby the relationship between two factors is distorted when both factors independently increase the chances of being included in a research study or clinical cohort (they “collide”). Inspection of the test information function suggests that the EDA-8 may be a useful tool to identify children on the autism spectrum who show an extreme response to demands, as a starting point for more in-depth assessment. EDA-8 scores were not related to parental reports of ASD severity. 90) and convergent and divergent validity with other measures (some of which were only available for a subsample of 233 respondents). The “EDA-8” showed good internal consistency (Cronbach’s alpha =. PCA and IRT analyses identified eight items that are discriminating indices of EDA traits, and behave similarly with respect to quantifying EDA irrespective of child age, gender, reported academic level, or reported independence in daily living activities. The aim of this study was to refine the EDA-Q using principal components analysis (PCA) and item response theory (IRT) analysis on parent/caregiver-report data from 334 children with ASD aged 5–17 years. Previously, the Extreme Demand Avoidance Questionnaire (EDA-Q) was developed to quantify resemblance to clinical accounts of PDA from caregiver reports. Pressure to comply can lead to escalation in emotional reactivity and behavior that challenges. Demands often trigger avoidance behavior (e.g., distraction, excuses, withdrawal into role play). Extreme/“pathological” demand avoidance (PDA) describes a presentation found in some children on the autism spectrum, characterized by obsessive resistance to everyday demands and requests.
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