14 Mar Implications and Treatment Recommendations for Family Accommodation in Pediatric OCD
Pediatric onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses for children and adolescents. Research suggests that the prevalence of pediatric OCD (POCD) is estimated to be about 3%. Symptom manifestations can lead to severe impairment and conflict within the family. Serious mental health symptoms can cause significant strain on the family. Often, families are left trying their best to help their child manage these challenging symptoms.
Yale School of Public Health defines Family Accommodation (FA) as family members, usually the parents, involvement in the compulsive behaviors of children and adolescents. FA includes family participation in or helping the child in their ritualistic behavior or avoidance. This participation might include providing reassurances, changing family routines to accommodate compulsive behaviors, or physically assisting the child in engaging in these behaviors. Research shows that engaging compulsions reinforces obsessive and intrusive thoughts and can strengthen them.
Research conducted in 2012 and reported in the Expert Review of Neurotherapeutics journal found that FA commonly occurs in families with a child experiencing POCD. The study found that the level of FA is strongly associated with symptom severity. Additionally, that accommodation levels were negatively associated with treatment outcomes. Family Accommodation predicted more severe OCD symptoms after behavioral treatment, adversely impacting family functioning. Significant improvement with treatment in OCD is often associated with reductions in family accommodation. This research supports that assessing FA is critical clinical data in treating youth with OCD.
Another study conducted in 2021, reported in the Italian Journal of Pediatrics, found that FA is common in children and adolescents with OCD. The presence of FA impaired the child’s global, social, and role functioning. Additionally, FA resulted in psychological distress in the single parent. This data further supports that examining and addressing the presence of FA needs to be a focus of the treatment of OCD in children and adolescents. Additional research reported in the 2019 journal of Child Psychiatry and Human Development suggested that increased levels of Family Accommodation are associated with a poorer treatment outcome in OCD in adolescents.
The Family Accommodation Scale for Obsessive-Compulsive Disorder, Parental Report Version (FAS-PR) is a the FAS-PR is a 13-item parent-report measure designed to assess accommodation of a child’s OCD-related behaviors over the previous month. Practitioners treating POCD should consider the inclusion of assessing FA in parents. Therapies targeting FA may successfully improve treatment outcomes in pediatric OCD.
The most effective means of supporting families struggling with FA behavior include psychoeducation and Family-Based Cognitive Behavioral Therapy. Research supports psychoeducational interventions for parents helps to build an understanding of the symptoms and treatment of OCD. This intervention can effectively help the mental health professional guide the parents in reducing the FA behaviors the family is engaging in that may adversely impact the child’s symptoms.
Cognitive Behavior Therapy, specifically using techniques in Exposure and Response Prevention, is proven effective in helping children learn to manage symptoms of OCD. A case study conducted in 2018 found that employing a family-based CBT approach promoted successful treatment outcomes. A Journal of Family Psychology meta-analysis into the treatment of obsessive-compulsive disorder identified that family-inclusive treatment interventions supported better treatment outcomes for a patient with OCD.
Family accommodation directly relates to increased symptom severity, poorer functional outcomes, and reduced treatment response. Clinical research supports screening for FA and inclusion of the family unit in the treatment intervention to reduce the frequency of FA behaviors and helps the family support the interventions introduced to the child. This research calls to action psychologists to utilize the FAS-PR as standard practice in working with families and youth presenting with OCD.