The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators


Given the importance of family accommodation for the course, treatment and prognosis of anxiety in pediatric populations, we conducted a meta-analysis to estimate the magnitude and potential moderators of the relationship between accommodation and anxiety severity. Study selection criteria were: (1) included quantitative measures of accommodation and anxiety severity, (2) sampled participants younger than 19 years, (3) a sample size greater than 10, (4) reported statistical data needed to compute effect sizes, and (4) be in English or Spanish. Search procedures included assessment of electronic databases, systematic reviews and empirical studies, and email inquiries. Effect size was Pearson correlation coefficient, assuming a random-effects model. Positive moderate association was observed for measures administered to parents. This was moderated by the percentage of children with separation anxiety and selective mutism. Global effect sizes were small for measures administered to children and when accommodation was reported by parents and anxiety by children. Implications for assessment and treatment are discussed.

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We acknowledge the contributions of Catherine Christian.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Marina Iniesta-Sepúlveda.

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Drs. Marina Iniesta-Sepúlveda and Tíscar Rodríguez-Jiménez report no financial interests or potential conflicts of interest. Dr. Eli R. Lebowitz receives research support from NIH. He has received royalties from John Wiley and Sons. Dr. Goodman has received research support from the NIH, Biohaven, and the Simons Foundation. He has served as a consultant for Biohaven. Dr. Storch has received research support from the National Institutes of Health (NIH), the Red Cross, the Greater Houston Community Foundation, Rebuild Texas, Mental Health America-Houston, and the Texas Higher Education Coordinating Board. He has served as a consultant for Levo Therapeutics. He has received book royalties from Elsevier, Lawrence Erlbaum, Springer, Jessica Kingsley, Oxford, Wiley, and the American Psychological Association.

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See Table 2 .

Table 2 Main characteristics and effects sizes for individual studies included in the meta-analysis

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Iniesta-Sepúlveda, M., Rodríguez-Jiménez, T., Lebowitz, E.R. et al. The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators. Child Psychiatry Hum Dev 52, 1–14 (2021).

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  • Meta-analysis
  • Family accommodation
  • Anxiety severity
  • Pediatric