Parental Accommodation as a Mediator of Parenting Style on Changes in Pediatric Obsessive-Compulsive Disorder Symptoms

Pediatric obsessive-compulsive disorder (OCD) is often a debilitating psychiatric condition. Despite the established efficacy of exposure and response prevention (E/RP) alone or in conjunction with serotonin reuptake inhibitor medication, up to half of youth with OCD do not experience symptom remission or return to baseline functioning after either treatment. Family accommodation (i.e., accommodating compulsive behaviors) is one factor associated with poor E/RP response, but less is known about how parent factors might predict response to E/RP via accommodation. The current study is the first to examine how parenting styles predict accommodation and subsequent E/RP response, specifically in an intensive outpatient program. Participants included 76 youth 11-17 years old (M = 14.11; SD = 2.15) diagnosed with OCD. Latent growth curve models examined parenting styles (indulgent, neglectful, authoritarian, authoritative) at baseline as predictors of concurrent accommodation and latent baseline and change in OCD symptoms. As expected, indulgent parenting indirectly predicted (through higher accommodation) higher baseline OCD (95%CI [.09, 1.55]) and less decrease in symptoms (95%CI [.002, 1.72]). Similarly, neglectful parenting indirectly predicted higher baseline OCD (95%CI [.20, 1.74]) and less decrease in symptoms (95%CI [.02, 1.80]). Unexpectedly, authoritative parenting predicted higher accommodation (β = .28, p = .020) and indirectly predicted higher baseline OCD (95%CI [.08, 1.56]) but not symptom change. Authoritarian parenting did not predict accommodation or OCD baseline or symptom change. When all parenting types were in the model, only neglectful parenting uniquely, indirectly predicted higher baseline OCD (95%CI [.26, 1.92]) and less symptom decrease (95%CI [.08, 2.16]); authoritativeparenting directly predicted faster symptom decline (β = -.13, p = .001). Overall, results suggest that parenting styles might contribute via family interpersonal processes to adolescents’ response to exposure-based OCD treatment. These findings provide evidence for the utility of assessing accommodation and parenting styles during pediatric OCD treatment