Accommodation of Anxiety in Youth with Autism Spectrum Disorder: Results from the TAASD Study

ABSTRACT

Objective: Accommodation, or the ways in which families modify their routines and expectations in response to a child’s anxiety, is common and interferes with anxiety treatment outcomes. However, little research has examined family accommodation among youth with autism spectrum disorder and anxiety. The current study aimed to (a) identify pre-treatment correlates of accommodation, (b) examine changes in accommodation after treatment, and (c) assess relationships between accommodation and post-treatment anxiety severity.

Method: The sample consisted of 167 youth (mean age = 9.90 years; 79.6% male; 18% Latinx) with clinically significant anxiety and a diagnosis of autism spectrum disorder who were enrolled in a randomized clinical trial comparing two cognitive behavioral therapy interventions for anxiety and treatment-as-usual. Participants were evaluated for symptom severity and family accommodation at pre- and post-treatment.

Results: Results indicated that clinician-rated anxiety severity and parent-rated externalizing behaviors and autism spectrum disorder severity significantly predicted pre-treatment accommodation. Accommodation significantly decreased from pre- to post-treatment and non-responders showed significantly higher accommodation at post-treatment compared to responders. Finally, youth with higher pre-treatment accommodation had higher post-treatment anxiety.

Conclusions: Findings indicate that accommodation for anxiety is common among youth with autism spectrum disorder and anxiety. Furthermore, accommodation is implicated in treatment outcomes and should be targeted in treatment for youth with autism spectrum disorder and anxiety.

Disclosure statement

Dr. Kendall receives royalties from the sales of materials related to the treatment of anxiety in youth. All other authors have no conflicts of interest.

Notes

¹ All linear regression and ANOVA analyses were re-run using mixed effects models to account for the nesting of participants within sites. All outcomes were reproduced, suggesting comparable outcomes using both analytic approaches.

Additional information

Funding

Funding for this study was provided from the US National Institutes of Health awarded to Dr. Storch [R01HD080096], Dr. Kendall [R01HD080097], Dr. Wood [R01HD080098] and Ms. Frank [F31MH11221].