A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder

Abstract

Family accommodation of symptoms is counter to the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can pose an obstacle to positive treatment outcomes. Although increased attention has been given to family accommodation in pediatric OCD, relatively little is known about associated child and parent characteristics, and their mediating/moderating effects. This study examined a structural equation model of parent and child variables related to parent reports of family accommodation. Sixty-one children with OCD (ages 6-17 years, 39% female) and their parents were recruited from a university-based clinic. They were administered clinician- and parent-rated measures of child OCD symptom severity, OCD-specific impairment, internalizing problems, and externalizing problems as well as parent anxiety, depression, empathy, consideration of future consequences, and accommodation. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment; child internalizing problems mediated the relationship between parent anxiety and family accommodation; and parent empathy and consideration of future consequences interacted to predict family accommodation. Child externalizing problems were significantly associated with family accommodation but neither of these two variables was associated with parent depression. Findings suggest that reductions in family accommodation might be maximized by routinely screening for comorbid psychopathology in children with OCD and their parents, and using prescriptive or modular approaches to intervention. Directions for future research are discussed.

An initial study of family accommodation in children and adolescents with chronic tic disorders

“…Alternatively, as it may be difficult for parents to only consider tic-related accommodation (resulting in ratings of more global levels of accommodation), this potentially could partially explain the non-significant association between family accommodation and tic severity, as well as the relationship between family accommodation and other symptomology (e.g., anxiety, externalizing problems). Consistent with findings in pediatric OCD [24,26,31], heightened levels of anxiety and depressive symptoms were linked to increased family accommodation. Youths may present with higher anxiety sensitivity, intolerance of distress, and motivation to complete tasks, increasing the amount of support needed from family members.…”

“…Across pediatric OCD and anxiety, accommodation is ubiquitous, occurring to some degree in virtually all families [14,[21][22][23][24][25][26][27]. Direct associations have been reported between family accommodation and obsessive-compulsive or anxiety severity [26][27][28][29][30], functional impairment [26][27][28][29], child externalizing behaviors [20,23,25,26,28,29,31], and family discord [21]. Accommodation in pediatric OCD and anxiety has been inconsistently related to child age with some finding inverse relations [25] and others finding no significant relationship [22][23][24]28].…”

Preliminary study of family accommodation in youth with autism spectrum disorders and anxiety: Incidence, clinical correlates, and behavioral treatment response

“…Among individuals with OCD who are typically developing, accommodation is quite common in families of children and adults, with incidence rates up to 100% and 89%, respectively (Albert et al, 2010;Peris et al, 2008;Storch, Geffken, & Merlo, 2007). Family accommodation is directly associated with obsessive-compulsive symptom severity and functional impairment (Caporino et al, 2012;Flessner et al, 2011;Merlo, Lehmkuhl, Geffken, & Storch, 2009;Storch et al, 2007;Storch, Larson, & Muroff, 2010), and mediates the relationship between symptom severity and functional impairment (Bipeta, Yerramilli, Pingali, Karredla, & Ali, 2013;Caporino et al, 2012;Storch et al, 2007). Several studies have found that family accommodation is directly associated with internalizing and externalizing symptoms (Lebowitz, Omer, & Leckman, 2011;McGuire et al, 2013;Storch et al, 2007;Storch, Jones, & Lack, 2012), while parental anxiety has been linked to increased family accommodation (Caporino et al, 2012;Flessner et al, 2011;Peris et al, 2008).…”

“…Family accommodation is directly associated with obsessive-compulsive symptom severity and functional impairment (Caporino et al, 2012;Flessner et al, 2011;Merlo, Lehmkuhl, Geffken, & Storch, 2009;Storch et al, 2007;Storch, Larson, & Muroff, 2010), and mediates the relationship between symptom severity and functional impairment (Bipeta, Yerramilli, Pingali, Karredla, & Ali, 2013;Caporino et al, 2012;Storch et al, 2007). Several studies have found that family accommodation is directly associated with internalizing and externalizing symptoms (Lebowitz, Omer, & Leckman, 2011;McGuire et al, 2013;Storch et al, 2007;Storch, Jones, & Lack, 2012), while parental anxiety has been linked to increased family accommodation (Caporino et al, 2012;Flessner et al, 2011;Peris et al, 2008). Family accommodation decreases following CBT (Barrett, Healy-Farrell, & March, 2004;Ferrao et al, 2006;Merlo et al, 2009) and lower baseline levels of family accommodation and greater decreases in family accommodation following treatment are associated with better treatment outcomes (Garcia et al, 2010;Merlo et al, 2009).…”

“…Second, we examined correlates of family accommodation, specifically anxiety symptom severity, functional impairment, internalizing and externalizing problems, and ASD-related social functioning. Based on previous research with families of children with OCD and anxiety (e.g., Caporino et al, 2012;Lebowitz et al, 2013;Storch et al, 2007;Thompson-Hollands et al, 2014), we expected that family accommodation would be positively related to all of these variables. Although no data exist with regards to ASD-related social functioning, we expected to find a direct association in that families would be more likely to accommodate anxiety symptoms among youth with more significant social impairments.…”