Family Accommodation of Restricted and Repetitive Behaviors in Children with ASD

Background: This study is the first to examine family accommodation of core ASD symptoms. Family accommodation has been defined as the ways in which parents modify their behavior to help a child avoid or alleviate states of distress and negative affect caused by emotional disorders (Lebowitz & Bloch, 2012; Lebowitz, Scharfstein & Jones, 2014). Research demonstrates that accommodation is common among families of children with OCD and anxiety disorders. Furthermore, high levels of accommodation have been repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children, and with distress in parents (Caporino et al., 2011; Lebowitz & Bloch, 2012; Lebowitz et al., 2013; Lebowitz, Scharfstein & Jones, 2014; Storch et al., 2007).

The only published study of family accommodation in children with ASD focused on accommodation of anxiety symptoms. Family accommodation was similar to that reported by parents of anxious children without ASD, and correlated with severity of the anxiety symptoms (Storch et al., 2015). There has yet to be an examination of family accommodation of RRBs, or its associations with RRB and autism severity. Previous research has found associations between ASD symptom severity and specific parental behaviors (e.g., Gulsrud, Hellemann, Shire & Kasari, 2016; Woodman, Smith, Greenberg & Mailick, 2015), underscoring the merit of such an examination.

Objectives: To preliminarily examine family accommodation of RRBs and its relation to RRB severity in children newly diagnosed with ASD.

Methods: Participants include 19 children (6 females; mean age = 7.71, SD = 3.72) diagnosed with ASD at a tertiary autism center located at a large medical center in central Israel, and their parents. All participants underwent comprehensive assessments including medical history and neurological examination, cognitive and adaptive behavior evaluations and diagnostic measures. Measures include the Family Accommodation Scale for Restricted and Repetitive Behaviors (FAS-RRB; Koller, Shulman & Lebowitz, 2016), the Repetitive Behavior Scale-Revised (RBS-R; Bodfish, Symons, & Lewis, 1998), the Autism Diagnostic Observation Schedule 2 (ADOS2; Lord, DiLavore & Gotham, 2012), and the Autism Diagnostic Interview-Revised (ADI-R; Lord, Rutter & Le Couteur, 1994).

Results: Accommodation was prevalent, with 17 out of 19 participants (89.47%) reported engaging in accommodation at least once a month and 13 (68.42%) reported daily accommodating their child’s RRBs. The most frequently reported forms of accommodation included participating in RRB-related actions (reported by 14 parents), assisting avoidance of RRB-related stimuli (14), and providing RRB-related items (13). Family accommodation was significantly positively correlated with RRB severity (r =.769, p <.001), indicating that increased accommodation was associated with more severe RRBs.

Conclusions: This preliminary study provides the first evidence that parents of children with ASD commonly accommodate their child’s RRBs and that the accommodation is positively associated with the severity of the RRBs. These results indicate that accommodation of RRBs may follow a similar pattern to what has been reported in OCD and anxiety disorders (Lebowitz et al., 2014). These findings add to the understanding of autism symptomatology, point to an important and previously unexamined area of research, and highlight heretofore unexplored avenues for potential interventions.