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Family accommodation is a pervasive problem among families of youth with anxiety disorders that frequently perpetuates anxiety symptoms and oppositional behaviors occurring in response to anxiety. Unfortunately, this problem is addressed all too infrequently in the literature regarding empirically supported treatments for anxiety disorders. The purpose of this report is to present a case of severe family accommodation for a young child with anxiety and oppositional behaviors. This case highlights the detriment of family factors such as accommodation, maternal distress, and anxious modeling as well as provides strategies for adapting an empirically supported treatment protocol (i.e. cognitive-behavioral therapy) to address such family factors. Behavioral and cognitive behavioral techniques, described within, were modified and utilized for treatment of a 6-year-old with significant anxiety symptoms. With adaptations, despite complicating family factors, behavioral treatment was successful in alleviating clinical symptoms of anxiety in a young child. This case exemplar suggests that treatment adaptation can produce successful outcomes in terms of symptom reduction; however, for circumstances in which families are particularly challenging, full remission may not be achieved should family accommodation fail to be eradicated.

Mothers of children with autism spectrum disorders (ASD) experience considerable amounts of distress and experiences of crisis. The Family Adjustment and Adaptation Response model provides a theory for understanding the experience of distress and crisis in families, and the purpose of the present study was to examine experiences of distress in mothers of individuals with ASD using this framework. We specifically investigated how parent empowerment and positive gain were related to their experiences of distress, whether as mediators or as moderators of child aggression. Participants included 156 mothers of children with ASD ranging in age from 4 to 21 years. Mothers completed an online survey of demographics, problem behaviors, family empowerment, positive gain, and distress. We conducted path analyses of multiple mediation and moderation. Results indicated that greater child problem behavior was related to less parent empowerment, which was related to greater maternal distress, supporting empowerment as a partial mediator. At the same time, greater child aggression was not related to maternal distress in mothers who report high rates of positive gain, suggesting that parent gain functions as a moderator. The implications for how and when clinicians intervene with families of children with ASD are discussed.

We examined the association between maternal psychological distress during offspring’s early development and offspring’s later distress in adulthood, as well as the influence of maternal characteristics at offspring’s birth and offspring’s characteristics in adulthood on distress. Data were obtained from the British Cohort Study, a longitudinal study of children born in a one-week period in 1970. Children were followed up multiple times from birth through to age 30. Results indicate that greater symptoms of maternal psychological distress during offspring’s early childhood are associated with greater symptoms of distress in adult offspring. A large component of this association is indirect, occurring through mother’s distress in later childhood and offspring’s problem behavior during adolescence. Findings that the association between maternal and offspring’s distress is more indirect than direct support arguments that early maternal distress has long-term consequences for offspring.