Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: Nature, clinical correlates, and treatment response

• Published in: Comprehensive psychiatry 2018-01, Vol.80, p.1-13
• Main Authors: La Buissonnière-Ariza, Valérie, Schneider, Sophie C., Højgaard, Davíð, Kay, Brian C., Riemann, Bradley C., Eken, Stephanie C., Lake, Peter, Nadeau, Joshua M., Storch, Eric A.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adolescent; Age; Anxiety disorders; Anxiety Disorders - complications; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Attention deficit hyperactivity disorder; Child; Child & adolescent psychiatry; Child psychology; Children & youth; Combined Modality Therapy; Comorbidity; Depression - complications; Depression - psychology; Families & family life; Family - psychology; Female; Humans; Male; Neuroses; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - complications; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Parents - psychology; Pediatrics; Quality of life; Severity of Illness Index; Teenagers; Treatment Outcome
• ISSN: 0010-440X; 1532-8384
• DOI: 10.1016/j.comppsych.2017.07.012

Family accommodation is associated with a range of clinical features including symptom severity, functional impairment, and treatment response. However, most previous studies in children and adolescents investigated family accommodation in samples of youth with obsessive-compulsive disorder (OCD) or anxiety disorders receiving non-intensive outpatient services. In this study, we aimed to investigate family accommodation of anxiety symptoms in a sample of youth with clinical anxiety levels undergoing an intensive multimodal intervention for anxiety disorders or OCD. We first assessed the internal consistency of the Family Accommodation Scale – Anxiety (FASA). We next examined family accommodation presentation and correlates. The FASA showed high internal consistency for all subscales and total score, and good item and subscale correlations with the total score. All parents reported at least mild accommodation, and the mean levels of family accommodation were particularly high. Child age, anxiety severity, and comorbid depressive symptoms predicted baseline accommodation. However, the association between anxiety severity and family accommodation no longer remained significant after adding the other factors to the model. In addition, family accommodation partially mediated the relationship between anxiety severity and functional impairment. Finally, post-treatment changes in family accommodation predicted changes in symptom severity and functional impairment. These findings suggest the FASA is an appropriate tool to assess family accommodation in intensive treatment samples. Further, they underline the importance of addressing family accommodation in this population given the particularly high levels of accommodating behaviors and the evidence for adverse outcomes associated with this feature.