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Weeks GA, Sakmar E, Clark TA, Rose AM, Silverman WK, Lebowitz ER. Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01705-2. [PMID: 38755332 DOI: 10.1007/s10578-024-01705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/18/2024]
Abstract
Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderation is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious children (N = 243, 6-12 years), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with parent-reported separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.
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Affiliation(s)
- Gillian A Weeks
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Elcin Sakmar
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Taylar A Clark
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Anastasia M Rose
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Wendy K Silverman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Onyeka OC, Spencer SD, Salloum A, Jiannetto K, Storch EA. The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy. J Affect Disord 2024; 346:252-259. [PMID: 37924982 PMCID: PMC10843667 DOI: 10.1016/j.jad.2023.10.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Caregiver behaviors such as family accommodation (FA) are negatively reinforced by reduced distress in the short term, but ultimately maintain symptoms. It is important to explore the role of FA on symptoms and impairment. The current study examined the relationship among FA, posttraumatic stress symptoms (PTSS), and functional impairment in a sample of children and their caregivers who completed trauma treatment. METHOD Participants included 183 children and their caregivers (M age = 7.89; 55.19 % female; 73.22 % non-Hispanic; 51.37 % White). Data consisted of parent-reported measures collected at baseline, post-treatment, and 12-month follow-up from a randomized control trial (RCT) comparing Stepped Care CBT for Children after Trauma and Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Correlational, mediation, and hierarchical linear regression analyses were conducted to test the interrelationships among FA, child PTSS, and child functional impairment. RESULTS FA was significantly, positively associated with total PTSS and functional impairment at baseline. Baseline FA partially mediated the relationship between baseline total PTSS and baseline functional impairment. Lastly, greater pre- to post-treatment changes in FA were mostly associated with relevant outcome variables at post-treatment and 12-month follow-up. LIMITATIONS Study limitations include use of a single informant, cross-sectional data analysis, lack of differentiation among trauma types, concerns regarding generalizability. CONCLUSION Assessing FA may be a helpful tool in better understanding how child PTSS relates to functional impairment following exposure to trauma. This study is clinically relevant it offers insight on the relationship among FA, PTSS, and functional impairment for families involved in trauma treatment.
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Affiliation(s)
- Ogechi Cynthia Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Katie Jiannetto
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Weeks GA, Sakmar E, Clark TA, Rose AM, Silverman WK, Lebowitz ER. Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment. RESEARCH SQUARE 2023:rs.3.rs-3621755. [PMID: 38045422 PMCID: PMC10690319 DOI: 10.21203/rs.3.rs-3621755/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety symptoms. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderator is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious youth (N = 243, 6-12 yrs), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.
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Emerson LM, Adams D. Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism. J Autism Dev Disord 2023; 53:3710-3716. [PMID: 35362802 DOI: 10.1007/s10803-022-05534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child's life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and severity and impact of their child's anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.
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Affiliation(s)
- Lisa Marie Emerson
- School of Health Sciences, University of Canterbury, Kirkwood Avenue, Christchurch, 8041, New Zealand.
| | - Dawn Adams
- Autism Centre of Excellence, Griffith University, Brisbane, Australia
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Cabrera VM, Buitron V, Patriarca GC, Rey Y, Lebowitz ER, Silverman WK, Pettit JW. Parent Accommodation Contemporaneously Mediates the Association Between Youth Irritability and Youth Anxiety Treatment Outcome. Behav Ther 2023; 54:852-862. [PMID: 37597962 PMCID: PMC10440415 DOI: 10.1016/j.beth.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Research documents that child and adolescent (youth) irritability and anxiety have high co-occurrence, and anxious-irritable presentations are associated with greater impairment than anxious nonirritable presentations. This study examines the association between irritability and youth anxiety treatment outcome and tests a conceptual model of the associations among youth irritability, parent accommodation, and youth anxiety severity following cognitive behavioral treatment (CBT). Participants were N = 128 clinic-referred youths ages 6 to 17 years (M = 9.76 years; 57% female) who met criteria for primary anxiety disorder diagnoses and completed a 12- to 14-week CBT anxiety protocol. Parent- and youth-report on youth irritability, parent accommodation of their child's anxiety, and youth anxiety severity were assessed pretreatment and posttreatment. Using parent-report, youth irritability at pretreatment was associated with high parent accommodation of youth anxiety and high youth anxiety severity at posttreatment. The association between irritability and youth anxiety outcome was mediated contemporaneously by parent accommodation at posttreatment. These findings show that parent accommodation of their anxious-irritable children's anxiety may account for high youth anxiety severity following treatment. Developing strategies to target irritability in anxious youth and/or reduce parent accommodation in the presence of youth irritability represent important directions for future research.
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Affiliation(s)
| | - Victor Buitron
- Center for Children and Families, Florida International University
| | | | - Yasmin Rey
- Center for Children and Families, Florida International University
| | | | | | - Jeremy W Pettit
- Center for Children and Families, Florida International University.
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Kitt ER, Odriozola P, Gee DG. Extinction Learning Across Development: Neurodevelopmental Changes and Implications for Pediatric Anxiety Disorders. Curr Top Behav Neurosci 2023; 64:237-256. [PMID: 37532964 DOI: 10.1007/7854_2023_430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Alterations in extinction learning relate to the development and maintenance of anxiety disorders across the lifespan. While exposure therapy, based on principles of extinction, can be highly effective for treating anxiety, many patients do not show sufficient improvement following treatment. In particular, evidence suggests that exposure therapy does not work sufficiently for up to 40% of children who receive this evidence-based treatment.Importantly, fear learning and extinction, as well as the neural circuitry supporting these processes, undergo dynamic changes across development. An improved understanding of developmental changes in extinction learning and the associated neural circuitry may help to identify targets to improve treatment response in clinically anxious children and adolescents. In this chapter, we provide a brief overview of methods used to study fear learning and extinction in developmental populations. We then review what is currently known about the developmental changes that occur in extinction learning and related neural circuitry. We end this chapter with a discussion of the implications of these neurodevelopmental changes for the characterization and treatment of pediatric anxiety disorders.
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Affiliation(s)
| | - Paola Odriozola
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, CT, USA.
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Alcan E, Anderson T, Lebowitz ER. Frequency and Correlates of Fathers' Accommodation in Pediatric Anxiety Disorders. Child Psychiatry Hum Dev 2022; 53:1047-1061. [PMID: 34009552 PMCID: PMC9470656 DOI: 10.1007/s10578-021-01190-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Previous studies investigating family accommodation (FA) in pediatric anxiety disorders have primarily relied on mothers' reports, while data on FA by fathers remains scarce. We examined the frequency and correlates of fathers' FA of anxious children and compared fathers' and mothers' reports of FA. Participants were 69 parents of treatment-seeking children and adolescents with a primary anxiety disorder. FA was highly prevalent amongst fathers, with the majority of fathers participating in symptom-related behaviors and modifying family routines due to child anxiety. Fathers' accommodation levels were significantly correlated with fathers' reports of child internalizing symptoms, child externalizing symptoms, and fathers' own anxiety symptoms. Fathers' and mothers' reports of FA were moderately correlated, whereas their reports of their respective distress related to the need to accommodate were only weakly correlated. Fathers reported a significantly lower frequency of FA than did mothers. These findings highlight the importance of obtaining reports from both fathers and mothers when assessing FA. Results are particularly relevant to family-focused and parent-based interventions designed to address and reduce FA amongst parents of clinically anxious children.
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Affiliation(s)
- Ena Alcan
- Department of Clinical Psychology, Experimental Psychopathology, and Psychotherapy, Institute of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| | - Tess Anderson
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Kitt ER, Lewis KM, Galbraith J, Abend R, Smith AR, Lebowitz ER, Pine DS, Gee DG. Family accommodation in pediatric anxiety: Relations with avoidance and self-efficacy. Behav Res Ther 2022; 154:104107. [PMID: 35613517 PMCID: PMC9271364 DOI: 10.1016/j.brat.2022.104107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/06/2022] [Accepted: 05/04/2022] [Indexed: 11/02/2022]
Abstract
Pediatric anxiety disorders are common, impairing, and chronic when not effectively treated. A growing body of research implicates family accommodation in the maintenance of pediatric anxiety. The present study aimed to quantify previously untested relations among family accommodation and two theoretically linked constructs: avoidance and self-efficacy. Eighty youths between ages 8 and 17 (53 with anxiety disorders, 27 non-anxious controls) completed measures of family accommodation and self-efficacy. In addition, avoidance was assessed using two distinct measures of avoidance: a clinician rating of real-world behaviors and a laboratory task-based index. As predicted, youths with anxiety disorders reported greater family accommodation than non-anxious controls. Across the sample, greater family accommodation was associated with greater avoidance, as measured using both clinician rating and the laboratory task, as well as with lower self-efficacy. In an exploratory mediation model, self-efficacy partially mediated the relation between family accommodation and clinician-rated avoidance; however, it did not mediate the relation between family accommodation and task-based avoidance. Considering the robust association between family accommodation and anxiety in youths, this addition to our understanding of related cognitive and behavioral factors provides important preliminary insight, which can guide future research on potential targets for early identification and intervention for pediatric anxiety.
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Affiliation(s)
| | | | | | - Rany Abend
- National Institute of Mental Health, Bethesda, MD, USA
| | | | | | - Daniel S Pine
- National Institute of Mental Health, Bethesda, MD, USA
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Murthy NS, Balachander S, Nirmala BP, Pandian RD, Cherian AV, Arumugham SS, Reddy YCJ. Determinants of family functioning in caregivers of persons with obsessive-compulsive disorder. J Affect Disord 2022; 305:179-187. [PMID: 35247483 DOI: 10.1016/j.jad.2022.02.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is known to cause significant burden to patients and their caregivers. However, there is limited data on its impact on family functioning, especially from families with an adult member having OCD. METHODS Four hundred subjects, which included treatment-seeking adult OCD patients (n = 200) and their caregivers (n = 200) were recruited. Patients were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Caregivers were evaluated using the MINI, the Caregiver Strain Index (CSI), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Socio-Occupational Functioning Assessment Scale (SOFAS), the Family Accommodation Scale (FAS) and the Connor-David Resilience scale (CD-RISC) in a cross-sectional interview. Family functioning was measured using the OCD Family Functioning (OFF) Scale. Structural equation modeling (SEM) was carried out to evaluate the relationships between the patient and caregiver variables to predict family functioning. RESULTS From the best-fitting path model, we ascertained that OCD symptoms did not have a direct relationship with family dysfunction. Their effects were in turn was mediated by family accommodation, anxiety, caregiver stress/burden and depression. "Contamination & washing" was the only significant symptom dimension within the model. Caregiver resilience was found to predict only their individual functioning, and not family functioning. LIMITATIONS Study sample included patients from a tertiary care OCD service, only one caregiver from each patient's family was interviewed. CONCLUSIONS Evaluating family functioning, addressing it as part of interventional modules for patients and caregivers may help improving treatment outcomes.
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Affiliation(s)
- Nithyananda S Murthy
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | - Srinivas Balachander
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India
| | - B P Nirmala
- Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | | | - Anish V Cherian
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatric Social Work, NIMHANS, Bangalore, India
| | - Shyam Sundar Arumugham
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India
| | - Y C Janardhan Reddy
- OCD Clinic, National Institute of Mental Health & Neuro-Sciences (NIMHANS), Bangalore, India; Department of Psychiatry, NIMHANS, Bangalore, India.
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Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment. Child Psychiatry Hum Dev 2022; 54:905-912. [PMID: 34997892 PMCID: PMC10140011 DOI: 10.1007/s10578-021-01304-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/12/2022]
Abstract
Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.
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Family Accommodation of Symptoms in Adults With Obsessive-Compulsive Disorder: Factor Structure and Usefulness of the Family Accommodation Scale for OCD-Patient Version. J Psychiatr Pract 2022; 28:36-47. [PMID: 34989343 DOI: 10.1097/pra.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For individuals with obsessive-compulsive disorder (OCD), family accommodation of symptoms, such as over-reassurance, participation in rituals, or facilitation of avoidance, is one of the key factors associated with symptom severity, maintenance, and related impairment. Most studies have assessed accommodation behaviors based on reports from family members or other loved ones. Recently, a patient-rated questionnaire, the Family Accommodation Scale for OCD-Patient Version (FAS-PV) was developed to assess family accommodation from the patient's perspective. This study investigated the factor structure of the FAS-PV and clinical variables associated with patient-reported family accommodation in a sample of 151 treatment-seeking adults with OCD. A confirmatory factor analysis suggested that a 4-factor model best characterized the scale, with the following factors: (1) participation in symptoms, (2) avoidance of OCD triggers, (3) taking on responsibilities, and (4) modifying responsibilities. Internal consistency was high for the total score and for scores on the 4 subscales of the FAS-PV. Approximately 87% of the sample reported accommodation behaviors at some level. Family accommodation was positively correlated with OCD symptom severity and functional disability, and partially mediated the associations between these 2 factors, so that greater OCD severity was associated with greater accommodation, which, in turn, was associated with greater disability. Our findings parallel those of studies that have employed other versions of the FAS and suggest that the FAS-PV is a useful tool for assessing family accommodation of OCD symptoms from the patient's perspective.
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La Buissonnière-Ariza V, Schneider SC, McBride NM, Cepeda SL, Hart D, Haney B, Storch EA. Parental accommodation of symptoms in adolescents with chronic pain. J Child Health Care 2021; 25:225-239. [PMID: 32383401 DOI: 10.1177/1367493520923555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic pain in adolescents can be highly impairing. Parental reactions to their child's pain are important factors influencing pain perception and pain-related impairment in children and adolescents. The present study aimed to examine parental accommodation of pain symptoms using the Inventory of Parent Accommodations of Children's Symptoms (IPACS) to provide empirical support for the utility of this measure in parents of adolescents with chronic pain. We examined the prevalence, nature, and correlates of accommodation behaviors in 66 adolescents with chronic pain and their parents using the IPACS. All parents reported some level of accommodation of their child's pain symptoms. After controlling for pain severity, parental accommodation was associated with functional impairment. In addition, parental accommodation mediated the link between parental catastrophizing reactions to pain and child impairment and between child anxiety and depressive symptoms and child impairment. The IPACS appears to be a useful measure of parental accommodation of pain. Parental accommodation should be included as an intervention target when necessary. It is important to educate families about the negative consequences that can be related to excessive accommodation of pain symptoms and to provide effective resources to manage the impact of chronic pain and replace accommodation with more adaptive pain coping strategies.
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Affiliation(s)
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Dennis Hart
- Department of Rehabilitation, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Brandon Haney
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Iniesta-Sepúlveda M, Rodríguez-Jiménez T, Lebowitz ER, Goodman WK, Storch EA. The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators. Child Psychiatry Hum Dev 2021; 52:1-14. [PMID: 32246361 DOI: 10.1007/s10578-020-00987-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Given the importance of family accommodation for the course, treatment and prognosis of anxiety in pediatric populations, we conducted a meta-analysis to estimate the magnitude and potential moderators of the relationship between accommodation and anxiety severity. Study selection criteria were: (1) included quantitative measures of accommodation and anxiety severity, (2) sampled participants younger than 19 years, (3) a sample size greater than 10, (4) reported statistical data needed to compute effect sizes, and (4) be in English or Spanish. Search procedures included assessment of electronic databases, systematic reviews and empirical studies, and email inquiries. Effect size was Pearson correlation coefficient, assuming a random-effects model. Positive moderate association was observed for measures administered to parents. This was moderated by the percentage of children with separation anxiety and selective mutism. Global effect sizes were small for measures administered to children and when accommodation was reported by parents and anxiety by children. Implications for assessment and treatment are discussed.
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Affiliation(s)
- Marina Iniesta-Sepúlveda
- Department of Psychology, Catholic University of Murcia, Campus de los Jerónimos, 135 Guadalupe, 30107, Murcia, Spain.
| | - Tíscar Rodríguez-Jiménez
- Department of Psychology, Catholic University of Murcia, Campus de los Jerónimos, 135 Guadalupe, 30107, Murcia, Spain
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Liao Z, You C, Chen Y, Zhang J, Ding L. Psychometric properties of the Chinese version of the family accommodation scale for obsessive-compulsive disorder interviewer-rated. Compr Psychiatry 2021; 105:152220. [PMID: 33348295 DOI: 10.1016/j.comppsych.2020.152220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Family accommodation (FA) in obsessive-compulsive disorder (OCD) means that the relatives of patients are involved in, help or facilitate patients' ritual behaviors and avoidance, which is a frequent occurrence and underresearched phenomenon in China. Recent studies have suggested that FA is adversely associated with treatment response, contradictory to the goal of cognitive behavior therapy, a contributor to the maintenance of symptoms and increased symptom severity, and associated with low levels of family and social functioning. There is increasing interest and focus on establishing a family-based intervention for OCD treatment based on the inclusion of relatives by decreasing FA. The present study explored the psychometric properties of the Chinese version of the Family Accommodation Scale for OCD Interviewer-Rated (FAS-IR). METHOD A total of 109 patients with OCD and 91 primary relatives were assessed in corresponding patient and family measures, and the FAS-IR was administered to relatives by trained interviewers. RESULTS More than 90% of the relatives accommodated patients' symptoms with at least one kind of FA behavior over the previous week, and the incidence of extreme or everyday routines was as high as 59.3%. Exploratory factor analysis demonstrated two-factor structure for the whole scale, including (1) modification and facilitation, and (2) participation. Cronbach's alpha was 0.798 for the whole scale, and the interrater and test-retest reliability coefficients were 0.835 (95%CI: 0.603-0.937) and 0.882 (95%CI: 0.685-0.959), respectively. Convergent validity was supported in exploring FA and was associated with symptom severity, level of functional impairment and family functioning related to OCD. The FA was not significantly correlated with depressive symptoms rated by the patients, as evidence of acceptable divergent validity. There was no significant difference in FA total score based on patient gender, patient age, or relationship with patients. CONCLUSIONS The Chinese version of the FAS-IR demonstrated excellent psychometric properties for assessing the degree of FA, suggesting that it is a useful and valuable instrument in clinical and research settings.
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Affiliation(s)
- Zhenhua Liao
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Ciping You
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Ying Chen
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China
| | - Jinli Zhang
- Department of Psychiatry Rehabilitation Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Lijun Ding
- Department of Research and Education, Xiamen Xianyue Hospital, Xiamen, Fujian, China.
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15
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de Barros PMF, Polga N, Szejko N, Miguel EC, Leckman JF, Silverman WK, Lebowitz ER. Family accommodation mediates the impact of childhood anxiety on functional impairment. J Anxiety Disord 2020; 76:102318. [PMID: 33011554 PMCID: PMC7680363 DOI: 10.1016/j.janxdis.2020.102318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anxiety disorders are the most common childhood-onset psychiatric disorders and are extensively associated with child functional impairment. Data suggest that family accommodation plays a role in the association between anxiety severity and functional impairment in children, but more empirical evidence is needed. METHODS Participants were 425 clinically anxious children (ages 6-17 years), and their mothers. We first examined associations between child anxiety symptom severity, family accommodation, and child functional impairment. Next, we investigated the hypothesized mediation pathway linking anxiety severity to child impairment through increased family accommodation using structural equation modeling. We tested two models: one using parent ratings of their child's anxiety and the other using the child's self-ratings. Finally, we estimated the effect sizes of the mediation pathway in both models. RESULTS Family accommodation was significantly correlated with all the study variables. Child functional impairment was significantly correlated with parent-rated and self-rated child anxiety severity. Both structural equation models provided excellent fit for the data and supported the theoretical model by which family accommodation significantly explains part of the association between anxiety symptoms and functional impairment. The indirect effect sizes indicate that family accommodation accounts for between a fifth and a half of the impairment associated with symptom severity. CONCLUSIONS The data provide important empirical evidence that family accommodation mediates the association between child anxiety and functional impairment and accounts for up to 50 % of this association. These findings contribute to the growing understanding of the critical role of family accommodation and underscore the importance of assessing accommodation when evaluating and treating anxious children.
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Affiliation(s)
| | - Natália Polga
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Wendy K. Silverman
- Yale Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Eli R. Lebowitz
- Yale Child Study Center, Yale University School of Medicine, New Haven, USA
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Lebowitz ER, Marin CE, Silverman WK. Measuring Family Accommodation of Childhood Anxiety: Confirmatory Factor Analysis, Validity, and Reliability of the Parent and Child Family Accommodation Scale - Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:752-760. [PMID: 31136200 PMCID: PMC6881529 DOI: 10.1080/15374416.2019.1614002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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.
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Lou C, Zhou X, Lebowitz ER, Williams LL, Storch EA. Assessing Symptom Accommodation of Social Anxiety Symptoms Among Chinese Adults: Factor Structure and Psychometric Properties of Family Accommodation Scale Anxiety-Adult Report. Front Psychol 2020; 11:1018. [PMID: 32581921 PMCID: PMC7287202 DOI: 10.3389/fpsyg.2020.01018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Symptom accommodation is an important interpersonal construct associated with more severe symptoms, lower levels of functioning, and worse treatment outcomes across various mental health conditions, including social anxiety. Research on this phenomenon is surprisingly absent in Chinese culture, where interpersonal relationships are highly emphasized. This may be due to the absence of a valid Chinese symptom accommodation measure for individuals with social anxiety symptoms. The current study aimed to examine the factor structure and psychometric properties of the Family Accommodation Scale Anxiety-Adult Report (FASA-AR) in Chinese adults. METHODS Three hundred and seventy-five Chinese undergraduate students with social anxiety symptoms completed a battery of self-report measures assessing symptom accommodation in relation to social anxiety symptoms and related impairments, as well as overall symptoms of anxiety and depression. RESULTS Confirmatory factor analysis supported a two-factor model of symptom accommodation, with factors named Participation in symptom-related behaviors and Modification of functioning. The multiple indicators multiple causes model indicated the indicators of the FASA-AR, mainly the participation in symptom-related behaviors subscale, were not invariant across gender. Internal consistency for the FASA-AR total score and subscale scores was good. Convergent validity of the FASA-AR was evidenced by significant positive association with ratings of social anxiety symptoms, social anxiety related impairments, and anxiety symptoms. Divergent validity was supported by non-significant relation with depression symptoms. Nearly all participants (94.7%) endorsed being accommodated to some extent in the past month. CONCLUSION Symptom accommodation is an important construct and is related to social anxiety symptoms among Chinese adults. The FASA-AR demonstrated a clear two-factor latent structure and possessed good psychometric properties that can validly and reliably assess symptom accommodation of social anxiety among Chinese adults.
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Affiliation(s)
- Congmei Lou
- Research Institute for International and Comparative Education, Shanghai Normal University, Shanghai, China
| | - Xiaolu Zhou
- Research Institute for International and Comparative Education, Shanghai Normal University, Shanghai, China
| | - Eli R. Lebowitz
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Laurel L. Williams
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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Abstract
Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology, and to avoid or alleviate distress related to the disorder. Research on family accommodation has expanded greatly in the past few years. The aim of this study was to provide a synthesized review of recent findings on family accommodation in psychopathology. Electronic databases were searched for available, peer-reviewed, English language papers, published between September 2015 and March 2018, cross-referencing psychiatric disorders with accommodation and other family-related terms. Ninety-one papers were identified and reviewed, of which 69 were included. In obsessive-compulsive disorder and anxiety disorders family accommodation has been linked to symptom severity, functional impairment, caregiver burden, and poorer treatment outcomes. Several randomized controlled trials explored the efficacy of treatments aimed at reducing family accommodation. A growing number of studies have reported family accommodation in eating disorders where it is associated with greater symptom severity and caregiver burden. Family accommodation has also been studied in other disorders, including autism spectrum disorders, tic disorders, and posttraumatic stress disorder. Research on family accommodation in psychopathology is advancing steadily, expanding across disorders. The study highlights the importance of addressing family accommodation in the assessment and treatment of various disorders.
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Affiliation(s)
| | - Basavaraj Shrinivasa
- Department of Psychiatric Social Work, Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anish V Cherian
- Department of Psychiatric Social Work, Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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