Obsessive-compulsive disorder (OCD) runs a chronic and impairing course and affects between 1.5 and 2.2 million children in the United States (2-3% prevalence rate).1,2
Pediatric OCD is associated with marked impairment in functioning.3-6
and a majority of these children also meet diagnostic criteria for at least one other psychiatric disorder (e.g., 75-84%).7
Due to the burden this disorder places on children and their families, it is important to examine variables that may be influential in its etiology, maintenance, and treatment.
Researchers have suggested that, within the context of the family, OCD demonstrates a bidirectional relationship. That is, families both influence and are affected by OCD behaviors.8
More specifically, the relationship between specific parenting behaviors and OCD has been examined;9-24
within this growing body of research, the phenomenon of parental accommodation has garnered the most research attention. The term accommodation is often defined as participation of family members in an individual's OCD-related rituals (e.g., aiding in ritual completion, facilitating avoidance of situations).9,12
Several studies have found high rates of accommodation among the families of individuals with OCD,20,24
as well as a significant, positive correlation between accommodation and family dysfunction,9,11,12,18,20
symptoms of anxiety and depression (as reported by patients and family members),9,11
and symptom severity.9,12,18,20
Collectively, however, little research has examined accommodation among children.10,14,15,18,24,25
and yet it is at this developmental stage where accommodation might exert its most pernicious effects.
In a recent study of 110 adults with OCD, only OCD severity and cleaning or contamination symptoms were associated with accommodation.26
The authors posited that patients presenting with particular OCD symptoms (i.e., washing/cleaning) might require modification to existing treatment protocols. Peris and colleagues20
examined correlates of accommodation, using the Family Accommodation Scale-Parent Report (FAS-PR), among the families of 65 children and adolescents with OCD. Parental involvement in children's rituals, as assessed via a Total Involvement subscale constructed by the authors (consisting of items 1-9 from the FAS-PR) demonstrated a significant, positive correlation with both OCD symptom severity and parental symptoms of psychopathology. Similarly, Storch and colleagues18
demonstrated that parental accommodation demonstrated a positive relationship to symptom severity and internalizing and externalizing symptoms (broadly defined by parent-report on the Child Behavior Checklist). The study by Peris and colleagues also highlights the potential importance of examining not only the relationship between child- and parent-level variables and accommodation, but also distinct, yet related facets of parental accommodation.
Several limitations are noteworthy to these studies of accommodation in childhood OCD 20, 18
and highlight the unique contribution of the current study to the literature. First, previous studies have utilized a 13-item version of the FAS-PR that, until recently, had not been validated for use among the families of children with OCD or in a parent-report format.27
Furthermore, the decision by Peris and colleagues to construct subscales (i.e., Total Involvement, Child Consequences) for the FAS-PR was based on clinical rather than empirical evidence. A recent factor analysis and examination of the scale's psychometric properties suggests that a 12-item version of the FAS-PR consisting of two subscales is most appropriate.27
In this study, Flessner and colleagues27
found that the FAS-PR consists of two distinct yet related subscales assessing parental involvement in their child's OCD-related rituals (Involvement in Compulsions) and the family's avoidance of stimuli that may elicit OCD-related behaviors (Avoidance of Triggers). Importantly, the items constituting these empirically-derived subscales are markedly different from that proposed by Peris and colleagues.20
Second, Peris and colleagues are the only researchers to examine the relationship between parent-level variables and accommodation in some forms. For example, the relationship with other parent-level variables (e.g., symptoms of depression, trait anxiety) remains unexamined. Third, no study has examined the role of specific symptom dimensions (i.e., washing/cleaning, ordering, checking, etc.) on parental accommodation of childhood OCD. The current study aims to address each of these limitations to prior research.
A recent study by Merlo, Lehmkuhl, Geffken, and Storch28
found that decreased parental accommodation was associated with improved treatment response to cognitive-behavior therapy (CBT) for childhood OCD. Although utilizing an unvalidated version of the FAS-PR, these preliminary findings suggest that understanding variables that may influence the degree to which a parent accommodates their child's OCD-related rituals may have important treatment implications. In turn, given that increased scores on the Involvement in Compulsions and Avoidance of Triggers subscales will impact total accommodation, understanding potentially unique variables that may influence these facets of parental accommodation may provide additional information regarding areas in need of more careful assessment (e.g., child's degree of oppositional behavior, specific symptom profiles, etc.) during the therapeutic process. Therefore, the primary aim of this study is to examine potential predictors of accommodation among the families of children with OCD utilizing both child- and parent-level variables. This study will be the first to examine the role various demographic and phenomenological (including symptom dimensions) variables play in predicting accommodation, as assessed via a newly validated, 12-item FAS-PR, and two empirically derived facets of accommodation (i.e., Involvement in Compulsions, Avoidance of Triggers).