Vol.:(0123456789) 1 3 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-019-04078-x ORIGINAL PAPER Family Accommodation in Autism Spectrum Disorder Inbal Feldman 1  · Judah Koller 1  · Eli R. Lebowitz 2  · Cory Shulman 3  · Esther Ben Itzchak 4  · Ditza A. Zachor 5,6 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Family accommodation occurs frequently among families of children with OCD and anxiety disorders, with higher levels of accommodation repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children. This is the frst examination of family accommodation of restricted and repetitive behaviors (RRBs) in children with autism spectrum disorder (ASD). Parents of children with ASD (N = 86) completed questionnaires assessing their children’s RRBs and parental accommodation of these symptoms. Most participants (80%) reported engaging in accommodation at least once a month and family accommodation was signifcantly positively correlated with RRB severity. These results sug- gest accommodation of RRBs follows a pattern similar to that reported in obsessive compulsive and anxiety disorders, and highlight avenues for potential parent-based interventions. Keywords Autism spectrum disorder · Restricted and repetitive behaviors · Family accommodation · Parent–child interaction Parent behavior plays a role in the presentation, course and response to treatment of numerous childhood psychopathol- ogies (e.g., Ginsburg et al. 2005; Lebowitz et al. 2014b; McKee et al. 2008; Yap and Jorm 2015). Within obses- sive–compulsive disorder (OCD) and across the anxiety disorders, much work has highlighted a particular form of parent behavior termed family accommodation (Calvocoressi et al. 1995; Lebowitz et al. 2016; Lebowitz et al. 2014b; Lebowitz et al. 2013). Family accommodation describes the ways in which family members, mostly parents, of children with emotional disorders modify their behavior to help their child avoid or alleviate distress and negative afect caused by the disorder (Lebowitz and Bloch 2012; Lebowitz et al. 2014b). Data indicate that family accommodation is common among families of children with OCD and anxiety disorders and that this pattern is associated with negative sequelae, both proximally and distally. High levels of family accom- modation are associated with greater severity of anxiety or OCD symptoms (Caporino et al. 2012; Lebowitz et al. 2013, 2016; Lebowitz et al. 2014b; Storch et al. 2007), poorer psy- chosocial functioning (Caporino et al. 2012; Lebowitz and Bloch 2012; Storch et al. 2007), and elevated parental dis- tress (Lebowitz et al. 2013; Lebowitz et al. 2014b). Moreo- ver, high levels of family accommodation predict poor treat- ment outcomes in children with OCD and anxiety disorders (Lebowitz and Bloch 2012; Lebowitz et al. 2016; Kagan et al. 2016). These fndings have already yielded clinical beneft through the development of efcacious parent-based interventions that target the reduction of family accommo- dation, and highlight the possibility that the study of family accommodation in children with other disorders could yield similar contributions. Autism spectrum disorder (ASD) is a group of neurode- velopmental disorders characterized by persistent defcits in social communication and social interaction as well as the presence of restricted and repetitive behaviors and/or * Judah Koller judah.koller@mail.huji.ac.il 1 Seymour Fox School of Education, Hebrew University of Jerusalem, Mt. Scopus, 9190501 Jerusalem, Israel 2 Yale Child Study Center, Yale University, New Haven, CT, USA 3 Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel 4 Department of Communication Disorders, Ariel University, Ariel, Israel 5 The Autism Center, Assaf Harofeh Medical Center, Zerifn, Israel 6 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel