Measuring Family Accommodation of Childhood Anxiety: Confirmatory Factor Analysis, Validity, and Reliability of the Parent and Child Family Accommodation Scale – Anxiety

Abstract

Objective: Research on family accommodation is burgeoning, implicating it in the development, maintenance, and treatment of childhood anxiety. Additional data are needed to guide theory development and clinical application in this area. The factors underlying family accommodation measures have never been confirmed, nor have any test-retest data been reported. The study's objectives were to provide confirmatory data of the factorial structure and the first test-retest reliability data on the most widely used measure of family accommodation of child anxiety, the Family Accommodation Scale -Anxiety (FASA), and the child-rated FASA-CR.Method: Participants were 331 children (51% female; mean age = 10.44 yrs, SD = 2.95; 84.6% White) and their parent, presenting consecutively to an anxiety disorders program. Exploratory factor analysis (EFA) was conducted first on a random sampling of 105 child-parent dyads; factors were confirmed with confirmatory factor analysis (CFA) in the remaining independent sample of 226 dyads. Test-retest reliability (mean retest-interval = 10 days) was examined for FASA and FASA-CR. Convergent validity was examined in relation to child anxiety symptoms, and parenting stress. Divergent validity was examined in relation to child depression symptoms.Results: EFA and CFA supported a two-factor model of family accommodation, representing Participation in child-anxiety-driven behaviors, and child-anxiety-related Modification of family routines and schedules. Test-retest reliability was satisfactory for parents and adolescents; less so for children aged 6 to 12 years. Conclusions:Family accommodation is a key construct in childhood anxiety, with two underlying factors that can be validly and reliably assessed using FASA and FASA-CR. Keywordsanxiety disorders; family accommodation; child and adolescent; parent; factorial structure Six years have elapsed since the first systematic study of family accommodation of childhood anxiety disorders (Lebowitz et al., 2013). In that time, interest in the phenomenon of parents changing their behaviors to avoid or alleviate child anxiety-related distress, has burgeoned (for recent reviews see:

Assessing Symptom Accommodation of Social Anxiety Symptoms Among Chinese Adults: Factor Structure and Psychometric Properties of Family Accommodation Scale Anxiety—Adult Report

“…Our factor analysis confirmed that the Chinese FASA-AR comprised two correlated factors: participation in symptomrelated behaviors and modification of functioning. Previous findings (Lebowitz et al, 2013(Lebowitz et al, , 2019 differed on which latent factor item 5 (avoiding doing things, going places or being with people because of the symptoms) loaded. Our results supported the model distributing this item to the modification of functioning factor (Lebowitz et al, 2019).…”

“…The main differences between the two scales are that the FASA is reported by accommodators, i.e., parents of anxious children, while the FASA-CR is reported by anxious children themselves. Both scales established two related PAR and MOD factor structures, with evidence of good psychometric properties including internal consistency, convergent and divergent validity, and test-retest reliability (Lebowitz et al, 2019). In addition, the factor structures and psychometric properties of the FASA were previously identified on a crosscultural sample of accommodators from the United States and Israel (Lebowitz et al, 2013), supporting the potential of the cross-cultural properties of FASA and FASA-CR.…”

“…Although symptom accommodation reports were corroborated, including PAR and MOD factors (as reviewed in the previous paragraph), previous literature suggested that there are two slightly different two-factor models: model 1, supported by Lebowitz et al (2019), in which items 1-4 are loaded on PAR and items 5-9 are loaded on MOD; model 2, supported by Lebowitz et al (2013), where items 1-5 are loaded on PAR and items 6-9 are loaded on MOD. The difference between Bayesian information criterion (BIC) values was employed in order to compare these two competing non-nested models.…”

“…Specifically, we choose to modify FASA-CR, instead of the SAAS, because of the following characteristics: (1) the target of anxiety disorders makes it easy to adapt to SAD; (2) the reporters of the measure are sufferers, which brings clinical convenience, as adult sufferers are usually the direct source of information regarding their social anxiety symptoms and related accommodation behaviors; and (3) adults may live alone or seek help alone. Finally, the FASA-CR demonstrated a good two-factor structure and sound psychometric properties, in contrast to the SAAS (Lebowitz et al, 2019).…”

“…There are two common groups of accommodating behaviors categories: participation in symptom-related behaviors (PAR) and modification of daily functioning (MOD; Calvocoressi et al, 1995). Indeed, this two-factor accommodation (including the correlated PAR and MOD factors) is consistently identified and validated across psychopathology (Albert et al, 2010;Storch et al, 2017), ages (Lebowitz et al, 2013(Lebowitz et al, , 2019, and cultures (Gomes et al, 2015;Mahapatra et al, 2017).…”