A Systematic Review of Family Accommodation in Autistic Youth: Anxiety Disorders, Obsessive-Compulsive Disorder, and Restricted and Repetitive Behaviors

Family accommodation (FA) is a term describing the change in behavior seen in parents and caregivers as they attempt to effect change in their child or adolescent's anxious behavior-usually by allowing avoidance, attempting distraction, or attempting to manage distress. FA has been well-documented in children and adolescents with anxiety and obsessive-compulsive disorders; however, there has been less summarized on the degree to which autistic youth and families engage in accommodation. This review aims to establish the phenomenology of FA in autistic youth related to comorbid anxiety, obsessive-compulsive disorders, and restricted and repetitive behaviors (RRBs). This review also aims to summarize how FA is currently addressed in treatment within this population. Using PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic youth, (b) there was a clearly delineated autism participant group, and (c) at least one quantitative outcome measure of FA was included. Seventeen articles were included in the review. Several themes emerged including (1) high rates of FA in autistic youth across OCD, anxiety, and RRBs, (2) some form of parental involvement in treatment, and (3) decreased rates of FA post-treatment. Overall, family accommodation appears to be present to at least the same degree, if not more so, in families of anxious autistic children and adolescents as their non-autistic but anxious counterparts. Family accommodation also often appears to be an important consideration with treatments for anxiety and OCD in autistic youth.