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Family Accommodation in Pediatric Obsessive–Compulsive Disorder: Investigating Prevalence and Clinical Correlates in the NordLOTS Study

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Abstract

Family accommodation (FA) involves the actions taken by family members, particularly parents, to accommodate a child´s obsessive–compulsive disorder (OCD) symptoms, reducing distress or impairment. This behavior may maintain compulsive and avoidant behavior, preventing corrective learning or habituation. This study aims to investigate the prevalence and factors influencing FA in a large Scandinavian sample of children with OCD. We assessed 238 children using standardized diagnostic interviews, OCD symptom severity assessments and questionnaires evaluating functional impairment and internalizing and externalizing symptoms. FA was measured using the Family Accommodation Scale, a 12-item clinician-rated interview. Our results confirmed a high frequency of accommodation, with approximately 70% of primary caregivers reporting some accommodation daily and 98% at least once per week. FA was associated with increased OCD symptom severity, contamination/cleaning symptoms, internalizing and externalizing behavior, and functional impairment. Linear regression analysis showed that high levels of FA are specifically associated with lower age, higher OCD symptom severity, parent-reported impairment, internalizing, and externalizing symptoms. A path analysis revealed that FA partially mediated the relationship between OCD severity, externalizing symptoms, and child’s age, highlighting the role of FA in the progression of OCD and related symptoms. The findings emphasize the importance of evaluating FA before initiating treatment and specifically addressing it during the therapeutic process.

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Funding

The Stiftelsen Clas Groschinskys Minnesfond Agreement concerning the research and education of doctors in Region Västra Götaland, TrygFonden, The Lundbeck Foundation, Central Region Denmark’s Research Fund, The Danish Council for Strategic Research, the Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), the Norwegian Research Council, and the Norwegian Extra Foundation supported the research presented in this article through project grants. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Faculty of Psychology, University of Iceland, Reykjavik, Iceland

    Gudmundur Skarphedinsson

  2. Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway

    Nor Christian Torp

  3. Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway

    Nor Christian Torp

  4. Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Trondheim, Norway

    Bernhard Weidle

  5. Norwegian University of Science and Technology, Trondheim, Norway

    Bernhard Weidle

  6. Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark

    Sanne Jensen, Katja Anna Hybel, Judith B. Nissen, Per Hove Thomsen & Davíð R. M. A. Højgaard

  7. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Tord Ivarsson

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All authors (GS, NCT, BW, SJ, TI, KH, JBN, PHT, DRMAH) contributed to the conception and design of the study or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, approving the final version for publication, and agreement to be accountable for that all aspects of the work are appropriately investigated and resolved.

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Correspondence to Gudmundur Skarphedinsson.

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The trial was approved by the Norwegian, Swedish and Danish Committees for Medical and Health Research Ethics and the Medical Products Agencies.

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Skarphedinsson, G., Torp, N.C., Weidle, B. et al. Family Accommodation in Pediatric Obsessive–Compulsive Disorder: Investigating Prevalence and Clinical Correlates in the NordLOTS Study. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01602-0

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