The Demand Avoidance and Autonomy Questionnaire (DAAQ): Development of a new measure of demand avoidance

Background Pathological demand avoidance (PDA; also described as persistent/extreme demand avoidance or a pervasive drive for autonomy) is a complex, debated construct. It most often refers to a pattern of behavior characterized by intense distress and avoidance of both external and internal demands across home and community settings and is frequently discussed as a profile of autism spectrum disorder (ASD). Progress toward resolving the scientific controversy around PDA has been limited by the lack of consensus definitions and robust clinical measurement tools. Existing PDA measures (e.g., the Extreme Demand Avoidance Questionnaire; EDA-Q/EDA-8) have conceptual and psychometric limitations, including limited assessment of functional impact on basic needs (i.e., hygiene, eating, sleeping) and toileting. We developed the Demand Avoidance and Autonomy Questionnaire (DAAQ) to capture PDA-relevant behavioral expression and basic-needs impacts using contemporary measurement-development methods. Methods Self-identified adult parents/legal guardians of children aged 4–17 with a suspected PDA profile (N = 707) completed the DAAQ 60-item pool and other parent proxy measures (EDA-8, CAST, SDQ, and PROMIS Parent Proxy–Global Health). Analyses included exploratory and confirmatory factor analyses and item response theory (graded response models), differential item functioning (DIF), as well as reliability, convergent/discriminant validity, and known-groups validity. Results Factor analysis supported retention of 36 items across three factors in the DAAQ: Behavioral Expression (20 items), Basic Needs (10 items), and Toileting (6 items). Differential item functioning for child age, education, school type, and sex; and parent age and education did not result in any items being deleted. Convergent validity was supported via moderate correlations with the EDA-8, and discriminant validity was supported by generally negligible-to-small associations with prespecified measures. Known-groups comparisons differentiated groups as hypothesized (e.g., higher DAAQ scores among children with higher demand avoidance, greater basic needs difficulties, and co-occurring ASD). Conclusions This paper describes a new, methodologically sound measurement tool to facilitate screening for and characterizing demand avoidance among children and adolescents in research and clinical settings. Given the controversy surrounding the existence of PDA and how to classify it, DAAQ scores should not be interpreted as diagnostic, and associations with autism-screening measures should be interpreted cautiously. The rigorous measurement development approach, strong preliminary reliability and validity, and inclusion of a general PDA behavior factor as well as basic needs and toileting impact factors are strengths of the DAAQ. Future work should evaluate performance in clinician-characterized samples, develop self-report versions, and further assess validity (e.g., predictive validity and sensitivity/specificity).