Poor emotional regulation in anxious kids is linked to greater family accommodation

A study involving children suffering from anxiety disorders and their parents found that greater emotion dysregulation in children was associated with greater family accommodation. In other words, children who were less able to regulate their emotional arousal tended to have families that made more changes in their behavior to help alleviate the children’s anxiety. Additionally, the link between the severity of a child’s anxiety and family accommodation was stronger in children who were less tolerant of distress. The paper was published in the Journal of Family Psychology.

Anxiety disorders affect a substantial proportion of children and can interfere with family life, friendships, and school performance. When inadequately treated, childhood anxiety can persist over time and increase vulnerability to later mental health problems.

Parents naturally try to reduce their child’s distress, but some forms of help can unintentionally contribute to the maintenance of anxiety. One such pattern, known as family accommodation, occurs when parents or other family members change their own behavior to help the child avoid anxiety-provoking situations or obtain reassurance. This can include repeatedly answering anxious questions, helping the child avoid feared situations, or participating in behaviors intended to make the child feel safer.

Although such responses may reduce distress in the moment, they can reinforce avoidance and deprive children of opportunities to discover that feared outcomes may not occur or that they can cope with them when they do. Greater family accommodation has consequently been associated with more severe anxiety symptoms and poorer treatment outcomes. The relationship may also operate in both directions, because children with more severe anxiety are likely to elicit greater accommodation from their caregivers.

Study author Whitney S. Shepherd and her colleagues conducted a study in which they examined the associations between emotion dysregulation, anxiety sensitivity, distress intolerance, and family accommodation in children suffering from anxiety disorders and their caregivers. They hypothesized that anxiety sensitivity, emotion dysregulation, and distress intolerance would all be positively associated with family accommodation after controlling for demographic factors and anxiety symptom severity. The study authors also wanted to explore whether emotion dysregulation, anxiety sensitivity, and distress intolerance moderate—meaning they influence the strength or direction of—the relationship between the severity of anxiety symptoms and family accommodation.

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They analyzed data from a study comparing a standard Supportive Parenting for Anxious Childhood Emotions (SPACE) program with a low-contact, therapist-supported bibliotherapy version of SPACE. Bibliotherapy is a therapeutic approach that uses carefully selected books or other written materials to help people understand psychological difficulties, develop coping skills, and support emotional or behavioral change.

Study participants were 90 children suffering from anxiety disorders or obsessive-compulsive disorder (OCD) and their parents. Children were between 7 and 17 years of age (10, on average) and had clinically significant symptoms of anxiety and/or OCD. 52% of participating children were girls.

This analysis used only data from a set of assessments completed at the start of the study. These included evaluations of children’s emotion regulation abilities (the Emotion Regulation Checklist, completed by parents), anxiety sensitivity (the Child Anxiety Sensitivity Index), distress tolerance (the Distress Tolerance Scale), family accommodation (the Family Accommodation Scale – Anxiety), and anxiety symptoms (the Pediatric Anxiety Rating Scale).

Emotion regulation abilities are children’s abilities to regulate emotional arousal and express emotions appropriately. Anxiety sensitivity is the tendency to fear anxiety-related sensations because they are interpreted as dangerous or likely to have harmful consequences. Distress tolerance is a person’s ability to experience and endure unpleasant emotional states without becoming overwhelmed or urgently trying to escape them.

Results showed that when children had more severe symptoms of anxiety, their parents tended to report higher family accommodation. When controlling for child age, gender, and anxiety symptoms, emotion dysregulation was associated with family accommodation as rated by parents. In other words, children who were less able to regulate their emotional arousal and to express emotions appropriately tended to have families who changed their behavior more in order to try to alleviate their anxiety.

“Interventions targeting children’s distress tolerance skills may help reduce family accommodation among families of children with high levels of anxiety. Additionally, targeting family accommodation in interventions for anxious children with low distress tolerance may help decrease child anxiety rates,” the study authors concluded.

The study contributes to the scientific knowledge about factors associated with anxiety symptoms in children. However, it should be noted that the cross-sectional design of this study does not allow researchers to derive definitive cause-and-effect conclusions from the presented results.

The paper, “Transdiagnostic Correlates of Family Accommodation in Anxious Youth,” was authored by Whitney S. Shepherd, Erika S. Trent, Orri Smarason, Hannah N. Sansone, Daphne M. Ayton, Amanda Palo, Abigail E. Candelari, Wayne K. Goodman, Andrew G. Guzick, and Eric A. Storch.