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When Families Won’t Play Ball: A Case Example of the Effect of Family Accommodation on Anxiety Symptoms and Treatment

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Abstract

Family accommodation is a pervasive problem among families of youth with anxiety disorders that frequently perpetuates anxiety symptoms and oppositional behaviors occurring in response to anxiety. Unfortunately, this problem is addressed all too infrequently in the literature regarding empirically supported treatments for anxiety disorders. The purpose of this report is to present a case of severe family accommodation for a young child with anxiety and oppositional behaviors. This case highlights the detriment of family factors such as accommodation, maternal distress, and anxious modeling as well as provides strategies for adapting an empirically supported treatment protocol (i.e. cognitive-behavioral therapy) to address such family factors. Behavioral and cognitive behavioral techniques, described within, were modified and utilized for treatment of a 6-year-old with significant anxiety symptoms. With adaptations, despite complicating family factors, behavioral treatment was successful in alleviating clinical symptoms of anxiety in a young child. This case exemplar suggests that treatment adaptation can produce successful outcomes in terms of symptom reduction; however, for circumstances in which families are particularly challenging, full remission may not be achieved should family accommodation fail to be eradicated.

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References

  • Achenbach, T. M., & Rescorla, L. (2001). ASEBA school-age forms and profiles. ASEBA.

  • Bögels, S. M., & Brechman-Toussaint, M. L. (2006). Family issues in child anxiety: Attachment, family functioning, parental rearing and beliefs. Clinical Psychology Review, 26(7), 834–856.

    Article  PubMed  Google Scholar 

  • Bouton, M. E. (2004). Context and behavioral processes in extinction. Learning & Memory, 11(5), 485–494.

    Article  Google Scholar 

  • Calvocoressi, L., Lewis, B., Harris, M., Trufan, S. J., Goodman, W. K., McDougle, C. J., et al. (1995). Family accommodation in obsessive–compulsive disorder. American Journal of Psychiatry, 152(3), 441–443.

    Article  PubMed  Google Scholar 

  • Catania, A. C., & Reynolds, G. (1968). A quantitative analysis of the responding maintained by interval schedules of reinforcement. Journal of the Experimental analysis of behavior, 11(3S2), 327-383.

  • Chorpita, B. F. (2007). Modular cognitive-behavioral therapy for childhood anxiety disorders. New York: Guilford Press.

    Google Scholar 

  • Chu, B. C., Skriner, L. C., & Zandberg, L. J. (2013). Shape of change in cognitive behavioral therapy for youth anxiety: Symptom trajectory and predictors of change. Journal of Consulting and Clinical Psychology, 81(4), 573.

    Article  PubMed  Google Scholar 

  • Cooper, P. J., Gallop, C., Willetts, L., & Creswell, C. (2008). Treatment response in child anxiety is differentially related to the form of maternal anxiety disorder. Behavioural and Cognitive Psychotherapy, 36(01), 41–48.

    Article  Google Scholar 

  • Creswell, C., & Cartwright-Hatton, S. (2007). Family treatment of child anxiety: Outcomes, limitations and future directions. Clinical Child and Family Psychology Review, 10(3), 232–252.

    Article  PubMed  Google Scholar 

  • Ferster, C. B. S., & Skinner, B. F. (1957). Schedules of reinforcement. New York, NY: Appleton-Century-Crofts.

    Book  Google Scholar 

  • Hudson, J. L., & Rapee, R. M. (2001). Parent–child interactions and anxiety disorders: An observational study. Behaviour Research and Therapy, 39(12), 1411–1427.

    Article  PubMed  Google Scholar 

  • In-Albon, T., & Schneider, S. (2006). Psychotherapy of childhood anxiety disorders: A meta-analysis. Psychotherapy and Psychosomatics, 76(1), 15–24.

    Article  Google Scholar 

  • Kendall, P. C. (1993). Cognitive-behavioral therapies with youth: Guiding theory, current status, and emerging developments. Journal of Consulting and Clinical Psychology, 61(2), 235.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clincal trial. Journal of Consulting and Clinical Psychology, 65(3), 366.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76(2), 282.

    Article  PubMed  Google Scholar 

  • Lattal, K. A., St Peter, C., & Escobar, R. (2013). Operant extinction: Elimination and generation of behavior.

  • Lebowitz, E. R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., et al. (2013). Family accommodation in pediatric anxiety disorders. Depression and Anxiety, 30(1), 47–54.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lewin, A. B., Park, J. M., Jones, A. M., Crawford, E. A., DeNadai, A. S., Menzel, J., et al. (2014). Family-based exposure and response prevention therapy for preschool-aged children with obsessive–compulsive disorder: A pilot randomized controlled trial. Behaviour Research and Therapy, 56, 30–38.

    Article  PubMed  Google Scholar 

  • Marien, W. E., Storch, E. A., Geffken, G. R., & Murphy, T. K. (2009). Intensive family-based cognitive-behavioral therapy for pediatric obsessive–compulsive disorder: Applications for treatment of medication partial-or nonresponders. Cognitive and Behavioral Practice, 16(3), 304–316.

    Article  Google Scholar 

  • May, A. C., Rudy, B. M., Davis, T. E., & Matson, J. L. (2013). Evidence-based behavioral treatment of dog phobia with young children: Two case examples. Behavior Modification, 37, 143–160.

    Article  PubMed  Google Scholar 

  • Merlo, L. J., Lehmkuhl, H. D., Geffken, G. R., & Storch, E. A. (2009). Decreased family accommodation associated with improved therapy outcome in pediatric obsessive–compulsive disorder. Journal of Consulting and Clinical Psychology, 77(2), 355.

    Article  PubMed Central  PubMed  Google Scholar 

  • Muris, P., & Field, A. P. (2010). The role of verbal threat information in the development of childhood fear. “Beware the Jabberwock!”. Clinical Child and Family Psychology Review, 13(2), 129–150.

    Article  PubMed Central  PubMed  Google Scholar 

  • Murray, L., De Rosnay, M., Pearson, J., Bergeron, C., Schofield, E., Royal-Lawson, M., et al. (2008). Intergenerational transmission of social anxiety: The role of social referencing processes in infancy. Child Development, 79(4), 1049–1064.

    Article  PubMed  Google Scholar 

  • Öst, L.-G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27(1), 1–7.

    Article  PubMed  Google Scholar 

  • Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.

    Google Scholar 

  • Rapee, R. M. (2012). Family factors in the development and management of anxiety disorders. Clinical Child and Family Psychology Review, 15(1), 69–80.

    Article  PubMed  Google Scholar 

  • Rapee, R. M., Wignall, A., Spence, S., Cobham, V., & Lyneham, H. (2008). Helping your anxious child. Oakland, CA: New Harbinger.

    Google Scholar 

  • Research Units of Pediatric Psychoparmacology Anxiety Study Group. (2002). The pediatric anxiety rating scale: Development and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1061–1069.

    Article  Google Scholar 

  • Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34(5), 453–458.

    Article  PubMed  Google Scholar 

  • Settipani, C. A., O’Neil, K. A., Podell, J. L., Beidas, R. S., & Kendall, P. C. (2013). Youth anxiety and parent factors over time: Directionality of change among youth treated for anxiety. Journal of Clinical Child & Adolescent Psychology, 42(1), 9–21.

    Article  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV: Parent interview schedule (vol. 1). Oxford: Oxford University Press.

    Google Scholar 

  • Skinner, B. F. (1969). Contingencies of reinforcement. New York, NY: Appleton-Century-Crofts.

    Google Scholar 

  • Storch, E. A., Björgvinsson, T., Riemann, B., Lewin, A. B., Morales, M. J., & Murphy, T. K. (2010a). Factors associated with poor response in cognitive-behavioral therapy for pediatric obsessive–compulsive disorder. Bulletin of the Menninger Clinic, 74(2), 167–185.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Geffken, G. R., Merlo, L. J., Jacob, M. L., Murphy, T. K., Goodman, W., et al. (2007). Family accommodation in pediatric obsessive–compulsive disorder. Journal of Clinical Child & Adolescent Psychology, 36(2), 207–216.

    Article  Google Scholar 

  • Storch, E. A., Jones, A. M., Lack, C. W., Ale, C. M., Sulkowski, M. L., Lewin, A., et al. (2012). Rage attacks in pediatric obsessive–compulsive disorder: Phenomenology and clinical correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 51(6), 582–592.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Lehmkuhl, H. D., Ricketts, E., Geffken, G. R., Marien, W., & Murphy, T. K. (2010b). An open trial of intensive family based cognitive-behavioral therapy in youth with obsessive–compulsive disorder who are medication partial responders or nonresponders. Journal of Clinical Child & Adolescent Psychology, 39(2), 260–268.

    Article  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766.

    Article  PubMed Central  PubMed  Google Scholar 

  • Zlomke, K., & Davis, T. E, I. I. I. (2008). One-session treatment of specific phobias: A detailed description and review of treatment efficacy. Behavior Therapy, 39(3), 207–223.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Neuropsychiatry, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th St. South Suite 460, Box 7523, St. Petersburg, FL, 33701, USA

    Brittany M. Rudy, Eric A. Storch & Adam B. Lewin

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  1. Brittany M. Rudy
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  2. Eric A. Storch
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  3. Adam B. Lewin
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Correspondence to Brittany M. Rudy.

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Rudy, B.M., Storch, E.A. & Lewin, A.B. When Families Won’t Play Ball: A Case Example of the Effect of Family Accommodation on Anxiety Symptoms and Treatment. J Child Fam Stud 24, 2070–2078 (2015). https://doi.org/10.1007/s10826-014-0008-3

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  • DOI: https://doi.org/10.1007/s10826-014-0008-3

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