Family Accommodation of Child and Adolescent Anxiety: Mechanisms, Assessment, and Treatment

Abstract

TOPIC-Anxiety disorders are the most common mental health concern for youth. Unfortunately, a substantial number of children and adolescents do not respond positively to current evidencebased interventions and/or relapse. As pediatric anxiety disorders are fundamentally a systemic phenomenon, focusing on the ways in which parents become involved in their children's anxiety symptoms may be a promising alternative approach to treatment.PURPOSE-To inform psychiatric mental health nurse practitioners (PMHNPs) about the phenomenology, associated neurobiology, and assessment of family accommodation (FA) as well as clinical interventions targeting FA. FA refers to ways that parents adapt their own behaviors to reduce their children's anxiety-related distress.SOURCES USED-A literature search was performed using Psyc-INFO and PubMed.CONCLUSIONS-Current findings indicate a high prevalence of FA associated with pediatric anxiety disorders. FA has a potentially deleterious impact on course of illness and treatment response and is associated with greater caregiver burden. Potential neurobiological underpinnings of FA include dysregulation of parent cortico-limbic circuitry and the oxytocinergic system. PMHNPs are in a unique position to identify families engaged in problematic FA, educate their clientele, provide psychotherapy services with the goal of reducing FA, and consult with multidisciplinary team members. Search termsAssessment; family accommodation; neurobiology; nursing; oxytocin; pediatric anxiety disorder; treatment Anxiety disorders are the most common mental health concern for children and adolescents, with lifetime prevalence estimates ranging upwards of 30% (Costello, Egger, & Angold, 2005;Merikangas et al., 2010 ). Pediatric anxiety disorders are chronic illnesses and are often associated with physical health concerns (Gandhi, Cheek, & Campo, 2012). They significantly impair the functioning of youth and burden families (Keller et al., 1992).Correspondence to: Eli R. Lebowitz, eli.lebowitz@yale.edu. Conflict of interest statement: KRN and WKS declare that they have no conflicts of interest. HHS Public AccessAuthor manuscript J Child Adolesc Psychiatr Nurs. Author manuscript; available in PMC 2016 August 04. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptPsychiatric mental health nurse practitioners (PMHNPs) are in a valuable position to be agents of positive change, working at the crossroads of medicine, mental health, youth, and their families. In the current paper, we aim to discuss the need for additional treatments for youth with anxiety disorders, introduce family accommodation (FA) and its role in pediatric anxiety, and present potential neurobiological systems involved in FA. We will conclude with the assessment of FA and its modification through parent-based interventions. Our goal is not to be comprehensive, but to provide an overview of the topic and discuss the implications for PMHNPs. Clinical Interventions for Pediatric Anxiety DisordersFrontline interventions for ...

Cross-generational influences on childhood anxiety disorders: pathways and mechanisms

“…Family accommodation was first studied in the context of obsessive–compulsive disorder (OCD) and greater family accommodation was found to predict more severe symptoms and worse impairment (Calvocoressi et al 1995; Lebowitz et al 2012). More recently, family accommodation has been studied in anxiety disorders, and has been found to be highly prevalent among parents of anxious children (Lebowitz et al 2013; Norman et al 2015). Examples of family accommodation in anxiety disorders are parents sleeping next to a child with separation anxiety, answering repeated reassurance seeking questions from a child with generalized anxiety, or speaking in place of a child with social phobia.…”

Family accommodation in obsessive-compulsive and anxiety disorders: a five-year update

“…Norman et al . [62], in a recent review of accommodation in anxious children, emphasized two neurobiological systems that potentially modulate family accommodation: the cortico-limbic neural network and the oxytocinergic system. The amygdala is consistently implicated in fear and anxiety.…”

Oxytocin response to youth-mother interactions in clinically anxious youth is associated with separation anxiety and dyadic behavior

“…One clinical implication is that maintaining physical contact with parents is likely to be negatively reinforced in youth with SAD. Mothers of youth with SAD report engaging in high levels of family accommodation, in particular maintaining proximity to the youth (Lebowitz et al, 2013; Norman, Silverman, & Lebowitz, 2015). Family accommodation can cause significant distress to mothers and the accommodating interactions are often fraught and tense (Lebowitz, Panza, & Bloch, 2016).…”