Family Accommodation in Autism

Background: Family accommodation refers to the ways in which parents modify their behavior to help a child avoid or alleviate distress and negative affect caused by emotional disorders (Lebowitz & Bloch, 2012; Lebowitz, Scharfstein & Jones, 2014). Family accommodation is common among families of children with OCD and anxiety disorders and has been repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children, and with elevated distress in parents (Caporino et al., 2011; Lebowitz & Bloch, 2012; 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 the severity of the anxiety symptoms (Storch et al., 2015). The current study, an extension of preliminary results presented at this conference last year, represents the first to examine family accommodation of RRBs and the associations between accommodation and autism symptomatology.

Objectives: To examine the presence of family accommodation of RRBs and its relationship to autism symptom severity and other clinical characteristics at the time of ASD diagnosis.

Methods: Participants include 97 children (24 females; mean age = 6.71, SD = 3.14) diagnosed with ASD at a tertiary autism center in Israel, and their parents. All participants underwent comprehensive assessments including medical, neurological, cognitive, adaptive behavior and diagnostic assessments. Measures include the Family Accommodation Scale for Restricted and Repetitive Behaviors, (developed for this study), Repetitive Behavior Scale-Revised (RBS-R; Bodfish, Symons, & Lewis, 1998), Autism Diagnostic Observation Schedule 2 (ADOS2; Lord, DiLavore & Gotham, 2012), and the Vineland Adaptive Behavior Scales 2 (VABS-2; Sparrow, Balla & Cicchetti, 2005).

Results: Accommodation was prevalent, with 74/97 participants (76.29%) reporting engaging in accommodation at least once a month and 50 (51.55%) reporting daily accommodation of their child’s RRBs. Accommodation was positively correlated with RRB severity (r =.823, p <.001), indicating that increased accommodation was associated with increased severity of RRBs. RRB subtypes most highly correlated with family accommodation were ritualistic behaviors (r =.748, p <.001), insistence on sameness (r =.741, p <.001) and stereotypical behaviors (r =.727, p <.001). No significant correlation was found between family accommodation and ADOS comparison score (r =.112, p =.340). We further examined the correlations between family accommodation and the VABS subscales, finding a strong correlation between family accommodation and the VABS adaptive living skills and socialization subscales, respectively (r =-.404, p <.001; r =-.455, p <.001), but weaker correlation between the communication subscale and family accommodation (r =-.257, p =.024).

Conclusions: This study confirms initial evidence that parents of children with ASD commonly accommodate their child’s RRBs and that this accommodation correlates with symptom severity. While accommodation of RRBs may follow a similar pattern to those reported in OCD and anxiety disorders, such accommodation may be more associated with adaptive behavior than overall autism severity or communication level. Finally, these findings highlight a heretofore-unexplored aspect of autism symptomatology and an unexamined opportunity for intervention.