Decreased family accommodation associated with improved therapy outcome in pediatric obsessive–compulsive disorder.

Abstract

Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitivebehavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to examine whether the amount of family accommodation provided to pediatric OCD patients is associated with treatment outcome, and whether decreases in accommodation are associated with improved outcome. The sample consisted of 50 youth (aged 6-18 years) who participated in 14 sessions of family-based cognitive-behavioral therapy for OCD, and their parents. Participants completed measures at pre-treatment and post-treatment. Results indicated that family accommodation was prevalent among families of pediatric OCD patients and that such accommodation was associated with symptom severity at pre-treatment. In addition, decreases in family accommodation during treatment predicted treatment outcome, even when controlling for pre-treatment OCD severity/impairment. Results suggest that the level of accommodation provided by the family may indicate an important obstacle to, or predictor of, treatment outcome in pediatric OCD. Directions for future research are discussed. KeywordsFamily Accommodation; Children; Treatment Predictors; Obsessive-compulsive disorder; Cognitive-Behavioral Therapy Although efficacious treatments have been developed, about 20-40% of children with OCD do not respond to treatment, and many who benefit remain symptomatic following treatment completion (Benazon et al., 2002; POTS, 2004). OCD may develop into a chronic disorder that negatively impacts child and family functioning (Piacentini et al., 2003) by preventing the Correspondence concerning this article should be addressed to Lisa J. Merlo, Department of Psychiatry, University of Florida, Box 100234, Gainesville, FL 32610-0234. lmerlo@ufl.edu.. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ccp NIH Public Access (Amir, Freshman, & Foa, 2000;Bolton, Collins, & Steinberg, 1983;Calvocoressi et al., 1999;Ferrao, et al., 2006;. Children have frequent interactions with family and rely upon them for assistance with activities of daily living. As such, approximately 70% of families accommodate some, if not all, of their child's OCD symptoms (Allsop & Verduyn, 1990;.Although counter to adaptive functioning, FA is often well-intentioned. Clinical experience suggests that parents believe family functioning is...

Cognitive Behavior Therapy for Comorbid Obsessive-Compulsive Disorder in High-Functioning Autism Spectrum Disorders: A Randomized Controlled Trial

“…There was some indication that family factors (family accommodation) were associated with treatment outcome in the present study and this is consistent with findings of other anxiety intervention studies in ASD 5 and outcome in general pediatric OCD treatment studies 40 . Group and individual psychological interventions for anxiety disorders in this group should then seek the engagement of relevant care-giving/supportive individuals in treatment.…”

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety

“…Instead, exposure therapies should be selected over EMDR for youth populations. Other treatments that focus on supportive listening or nondirective approaches only instead of directly addressing the client's fears (e.g., client-centered therapy, relationship counseling) have also been tested and have failed to meet criteria for Levels 1-4, perhaps because these treatments inadvertently work to ''accommodate'' anxiety, which has been shown to predict anxiety severity and treatment outcomes (e.g., Merlo, Lehmkuhl, Geffken, & Storch, 2009). …”

Obsessive-compulsive disorder in children and adolescents: Parental understanding, accommodation, coping and distress

“…However, Merlo, Lehmkuhl, Geffken & Storch (2009) showed that reductions in family accommodation, achieved through family-based cognitive-behavioural therapy, were associated with positive response to treatment in the affected relative.…”