The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy

Background: Caregiver behaviors such as family accommodation (FA) are negatively reinforced by reduced distress in the short term, but ultimately maintain symptoms. It is important to explore the role of FA on symptoms and impairment. The current study examined the relationship among FA, posttraumatic stress symptoms (PTSS), and functional impairment in a sample of children and their caregivers who completed trauma treatment. Method: Participants included 183 children and their caregivers (M age = 7.89; 55.19 % female; 73.22 % nonHispanic; 51.37 % White). Data consisted of parent-reported measures collected at baseline, post-treatment, and 12-month follow-up from a randomized control trial (RCT) comparing Stepped Care CBT for Children after Trauma and Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Correlational, mediation, and hierarchical linear regression analyses were conducted to test the interrelationships among FA, child PTSS, and child functional impairment. Results: FA was significantly, positively associated with total PTSS and functional impairment at baseline. Baseline FA partially mediated the relationship between baseline total PTSS and baseline functional impairment. Lastly, greater pre- to post-treatment changes in FA were mostly associated with relevant outcome variables at post-treatment and 12-month follow-up. Limitations: Study limitations include use of a single informant, cross-sectional data analysis, lack of differentiation among trauma types, concerns regarding generalizability. Conclusion: Assessing FA may be a helpful tool in better understanding how child PTSS relates to functional impairment following exposure to trauma. This study is clinically relevant it offers insight on the relationship among FA, PTSS, and functional impairment for families involved in trauma treatment.

Automated summary

This study examined the relationship among family accommodation (FA), posttraumatic stress symptoms (PTSS), and functional impairment. The results showed that FA was significantly associated with PTSS and functional impairment. Baseline FA partially mediated the relationship between baseline PTSS and functional impairment. Changes in FA from pre- to post-treatment were associated with relevant outcome variables at post-treatment and 12-month follow-up.