Correlates of accommodation of pediatric obsessive-compulsive disorder: Parent, child, and family characteristics

Objective: Pediatric obsessive-compulsive disorder (OCD) is a chronic, impairing condition associated with high levels of family accommodation (i.e., participation in symptoms). Understanding of factors that may engender accommodation of pediatric OCD is limited. This study conducted exploratory analyses of parent-, child-, and family-level correlates of family accommodation, considering both behavioral and affective components of the response. Method: The sample included 65 youths (mean age 12.3 years, 62% male) with OCD and their parents who completed a standardized assessment battery composed of both clinical and self-report measures (e.g., Children's Yale-Brown Obsessive-Compulsive Scale, Brief Symptom Inventory). Results: Family accommodation was common, with the provision of reassurance and participation in rituals the most frequent practices (occurring on a daily basis among 56% and 46% of parents, respectively). Total scores on the Family Accommodation Scale were not associated with child OCD symptom severity; however, parental involvement in rituals was associated with higher levels of child OCD severity and parental psychopathology and with lower levels of family organization. Comorbid externalizing symptomatology and family conflict were associated with parent report of worse consequences when not accommodating. Conclusions: Although these findings must be interpreted in light of potential type I error, they suggest that accommodation is the norm in pediatric OCD. Family-focused interventions must consider the parent, child, and family-level variables associated with this familial response when teaching disengagement strategies.