What is Symptom Accommodation for Pediatric OCD?

Posted on 10/27/16 06:38:pm

accommodation.jpgExposure and response prevention (ERP) treatment for obsessive-compulsive disorder (OCD) isn’t easy, especially when you’re a child or teenager. Every day, your treatment team is asking you to face your worst fears and avoid using your repetitive behaviors or rituals to control your anxiety. Because treatment can be difficult, it’s necessary for parents to be actively involved in their child’s care plan and not participate in symptom accommodation.

“Symptom accommodation is the actions taken by parents, siblings, family members, friends, teachers and anyone who unintentionally reinforces a person’s OCD by catering to their anxiety,” says Stephanie Eken, MD, regional medical director at Rogers Behavioral Health. “Research tells us that at least 70% of parents or family members engage in symptom accommodation and I would say much of the remaining 30% probably aren’t aware they are accommodating.”

Common ways in which parents participate in symptom accommodation include:

  • Allowing a child to miss an activity because they’re anxious about it
  • Participating in a child’s ritual for them, checking and re-checking that doors and windows are locked
  • Assisting in a child’s ritual, purchasing a certain brand of soap in bulk at the child’s request or opening a door for a child who is afraid of contamination
  • Providing reassurance, answering a child’s repetitive questions to their exact standards, even if you don’t know the answer
  • Waiting for a child’s rituals to be completed or changing your schedule
  • Decreasing the child’s age-appropriate responsibilities, doing chores or homework for them

Parents accommodate for a variety of reasons. “Many parents have provided reassurance to their children without OCD and it worked for those kids,” says Dr. Eken. “But for children with OCD, providing reassurance is a time-consuming bottomless pit and will only fuel the child’s anxiety in the long-run.” Parents are also more likely to accommodate if their child has severe OCD symptoms or a disruptive behavior disorder, such as ADHD; there is a high amount of stress in the family; or if one or more of the parents has OCD.

In the beginning, parents may think they’re being too harsh for reducing their accommodation—or that’s it’s easier to soothe their child’s anxiety in the moment, especially if they’re having an outburst. “Several studies have shown that symptom accommodation can worsen or maintain a child’s symptoms because they’re never able to experience habituation,” says Dr. Eken. “When a child habituates, they get used to their anxiety over time and realize they have the ability to ride it out, without using their compulsion.”

Those with higher rates of family accommodation are also at a higher risk of having refractory OCD. “Refractory OCD is difficult to treat OCD and patients may not experience as great of symptom reduction,” says Dr. Eken. “But once families engage in cognitive behavioral therapy (CBT) treatment and ERP, accommodation tends to decrease because it’s something we purposely discuss.”

So what should parents do? “At Rogers, we like to talk about parents as coaches,” says Dr. Eken. “When parents, the child and the therapist are a united front against OCD, the child can more easily receive motivation and consistent messaging. Parents help their child complete gradual exposures and process that their anxiety isn’t dangerous. It doesn’t feel good, but it can’t hurt them.”

It’s also important for parents to find time for themselves. “Reading a book, going on a date, doing something that has nothing to do with your child can help you be more present and energetic during treatment,” says Dr. Eken. “Support groups can also be helpful and allow parents to share their challenges and successes with others who understand their struggle.”

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