Skip to main content
SpringerLink
Log in

A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Family accommodation of symptoms is counter to the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can pose an obstacle to positive treatment outcomes. Although increased attention has been given to family accommodation in pediatric OCD, relatively little is known about associated child and parent characteristics, and their mediating/moderating effects. This study examined a structural equation model of parent and child variables related to parent reports of family accommodation. Sixty-one children with OCD (ages 6–17 years, 39% female) and their parents were recruited from a university-based clinic. They were administered clinician- and parent-rated measures of child OCD symptom severity, OCD-specific impairment, internalizing problems, and externalizing problems as well as parent anxiety, depression, empathy, consideration of future consequences, and accommodation. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment; child internalizing problems mediated the relationship between parent anxiety and family accommodation; and parent empathy and consideration of future consequences interacted to predict family accommodation. Child externalizing problems were significantly associated with family accommodation but neither of these two variables was associated with parent depression. Findings suggest that reductions in family accommodation might be maximized by routinely screening for comorbid psychopathology in children with OCD and their parents, and using prescriptive or modular approaches to intervention. Directions for future research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Non-normality was addressed using square-root transformations. Results did not vary substantively when analyses were conducted with transformed variables. Thus, results of analyses with non-transformed variables are reported.

References

  • Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: Research Center for Children, Youth, & Families.

    Google Scholar 

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park: Sage.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Barrett, P., Healy-Farrell, L., & March, J. S. (2004). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 46–62.

    Article  PubMed  Google Scholar 

  • Batson, C. D., & Coke, J. (1981). Empathy: A source of altruistic motivation for helping. In J. Rushton & R. Sorrentino (Eds.), Altruism and helping behavior. Hillsdale: Erlbaum.

    Google Scholar 

  • Bentler, P. M. (1988). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.

    Article  Google Scholar 

  • Bor, W., & Sanders, M. R. (2004). Correlates of self-reported coercive parenting of preschool-aged children at high risk for the development of conduct problems. The Australian and New Zealand Journal of Psychiatry, 38, 738–745.

    Article  PubMed  Google Scholar 

  • Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park: Sage.

    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. The American Journal of Psychiatry, 152, 441–443.

    PubMed  Google Scholar 

  • Caporino, N. E., Morgan, J., Phares, V., Murphy, T. K., & Storch, E. A. (2010). Parent beliefs about accommodating of obsessive-compulsive symptoms. Unpublished data.

  • Carey, K. B., Henson, J. M., Carey, M. P., & Maisto, S. A. (2007). Which heavy drinking college students benefit from a brief motivational intervention? Journal of Consulting and Clinical Psychology, 75, 663–669.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy of childhood anxiety disorders. Behavior Therapy, 35, 263–287.

    Article  Google Scholar 

  • Conger, A. J. (1974). A revised definition for suppressor variables: A guide to their identification and interpretation. Educational and Psychological Measurement, 34, 35–46.

    Article  Google Scholar 

  • Davis, M. (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85.

    Google Scholar 

  • Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113–126.

    Article  Google Scholar 

  • Derogatis, L. R. (1993). The Brief Symptom Inventory (BSI): Administration, scoring and procedures manual (3rd ed.). Minneapolis: National Computer Systems.

    Google Scholar 

  • Galinsky, A. D., Maddux, W. W., Gilin, D., & White, J. B. (2008). Why it pays to get inside the head of your opponent: The differential effects of perspective taking and empathy in negotiations. Psychological Science, 19, 378–384.

    Article  PubMed  Google Scholar 

  • Geller, D. A. (in press). Practice parameters for the assessment and treatment of pediatric obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry.

  • Haslam, D. M., Pakenham, K. I., & Smith, A. (2006). Social support and postpartum depressive symptomatology: The mediating role of maternal self-efficacy. Infant Mental Health Journal, 27, 276–291.

    Article  Google Scholar 

  • Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  • Jöreskog, K. G., & Sörbom, D. (2006). LISREL 8.80 for Windows [Computer software]. Lincolnwood: Scientific Software International, Inc.

    Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D. A., Rao, U., & Ryan, N. D. (1997). Schedule for affective disorders and schizophrenia for school age children, present and lifetime version: Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York: Oxford University Press.

    Google Scholar 

  • Kenny, D., & Judd, C. M. (1984). Estimating the nonlinear and interactive effects of latent variables. Psychological Bulletin, 96, 201–210.

    Article  Google Scholar 

  • Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York: Guildford.

    Google Scholar 

  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.

    Google Scholar 

  • Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20, 561–592.

    Article  PubMed  Google Scholar 

  • MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84–99.

    Article  Google Scholar 

  • MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000). Equivalence of the mediation, confounding, and suppression effect. Prevention Science, 1, 173–181.

    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, 355–360.

    Article  PubMed  Google Scholar 

  • Pediatric OCD Study Team. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The pediatric OCD Treatment Study randomized controlled trial. Journal of the American Medical Association, 292, 1969–1976.

    Article  Google Scholar 

  • Peris, T. S., Bergman, L., Langley, A., Chang, S., McCracken, J. T., & Piacentini, J. (2008). Correlates of accommodation of pediatric obsessive-compulsive disorder: Parent, child, and family characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1–9.

    Article  Google Scholar 

  • Piacentini, J., Peris, T. S., Bergman, R. L., Chang, S., & Jaffer, M. (2007). Functional impairment in childhood OCD: Development and psychometric properties of the Child Obsessive Compulsive Impact Scale—Revised. Journal of Clinical Child and Adolescent Psychology, 36, 645–653.

    Article  PubMed  Google Scholar 

  • Ping, R. A. (1996). Latent variable interaction and quadratic effect estimation: A two-step technique using structural equation analysis. Psychological Bulletin, 119, 166–175.

    Article  Google Scholar 

  • Rapoport, J. L., Inoff-Germain, G., Weissman, M. M., Greenwald, S., Narrow, W. E., Jensen, P. S., et al. (2000). Childhood obsessive-compulsive disorder in the NIMH MECA Study: Parent versus child identification of cases. Journal of Anxiety Disorders, 14, 535–548.

    Article  PubMed  Google Scholar 

  • Rufer, M., Grothusen, A., Mass, R., Peter, J., & Hand, I. (2005). Temporal stability of symptom dimensions in adult patients with obsessive-compulsive disorder. Journal of Affective Disorders, 88, 99–102.

    Article  PubMed  Google Scholar 

  • Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., & Goodman, W. K. (1997). Children’s Yale-Brown obsessive-compulsive scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 844–852.

    Article  PubMed  Google Scholar 

  • Silverman, W., & Albano, A. (1996). The anxiety disorders interview schedule for DSM-IV: Child and parent version. San Antonio: Graywind.

    Google Scholar 

  • Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 290–312.

    Article  Google Scholar 

  • Steiger, J. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173–180.

    Article  Google Scholar 

  • Steketee, G., & Van Noppen, B. (2003). Family approaches to treatment for obsessive-compulsive disorder. Revista Brasileira de Psuiquiatria, 25, 43–50.

    Google Scholar 

  • Stewart, S. E., Beresin, C., Haddad, S., Egan Stack, D., Fama, J., & Jenike, M. (2008). Predictors of family accommodation in obsessive-compulsive disorder. Annals of Clinical Psychiatry, 20, 65–70.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Murphy, T. K., Geffken, G. R., Soto, O., Sajid, M., Allen, P., et al. (2004). Psychometric evaluation of the children’s Yale-Brown obsessive-compulsive scale. Psychiatry Research, 129, 91–98.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Storch, E. A., Geffken, G. R., Merlo, L. J., Mann, G., Duke, D., Munson, M., et al. (2007). Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Comparison of intensive and weekly approaches. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 469–478.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Larson, M. J., Muroff, J., Caporino, N., Geller, D., Reid, J. M., et al. (2010). Predictors of functional impairment in pediatric obsessive-compulsive disorder. Journal of Anxiety Disorders, 24, 275–283.

    Article  PubMed  Google Scholar 

  • Strathman, A., Gleicher, F., Boninger, D. S., & Edwards, C. S. (1994). The consideration of future consequences: Weighing immediate and distant outcomes of behavior. Journal of Personality and Social Psychology, 66, 742–752.

    Article  Google Scholar 

Download references

Acknowledgements

The contributions of Jeannette Reid and Adam Lewin, Ph.D. are acknowledged.

Author information

Authors and Affiliations

  1. Department of Psychology, University of South Florida, Tampa, FL, USA

    Nicole E. Caporino, Vicky Phares & Eric A. Storch

  2. Department of Pediatrics, University of South Florida, Tampa, FL, USA

    Nicole E. Caporino, Jessica Morgan, Tanya K. Murphy & Eric A. Storch

  3. College of Nursing, University of South Florida, Tampa, FL, USA

    Jason Beckstead

  4. Department of Psychiatry, University of South Florida, Tampa, FL, USA

    Tanya K. Murphy & Eric A. Storch

  5. Department of Pediatrics, University of South Florida, 800 6th Street South 4th Floor, St. Petersburg, FL, 33701, USA

    Eric A. Storch

Authors
  1. Nicole E. Caporino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason Beckstead
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vicky Phares
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tanya K. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric A. Storch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric A. Storch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caporino, N.E., Morgan, J., Beckstead, J. et al. A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder. J Abnorm Child Psychol 40, 133–143 (2012). https://doi.org/10.1007/s10802-011-9549-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-011-9549-8

Keywords

Search

Navigation