(PS3-26) Psychometrically Examining the Family Accommodation Scale-Anxiety (FASA) in a Multi-study Sample of Treatment-seeking Anxious Youth

Abstract Text: Family accommodation (FA) is defined as any (typically well-intentioned) behavior on the part of family members, including parents and caregivers, that functions to facilitate maladaptive anxiety-related avoidance in youth. Although FA alleviates youth distress in the short term, due to cycles of negative reinforcement, FA is a key mechanism underpinning youth anxiety as well as a critical treatment target. Family members’ awareness of FA and attempts to reduce such behaviors can help break the negative reinforcement cycle, ultimately improving quality of life in youth afflicted with anxiety. The Family Accommodation Scale-Anxiety (FASA) is a parent-report questionnaire designed to capture facets of FA involving youth anxiety-related modification of familial routines and participation in child anxiety-driven behaviors. In the current study, we psychometrically examined the FASA using a multi-study sample (k = 4 studies, N = 379 total) of treatment-seeking anxious youth and their caregivers. Results of confirmatory factor analysis indicated that a bifactor model (with Participation and Modification subscales) fit the data reasonably well (CFI = .93; TLI = .90; RMSEA = .09; SRMR = .05). The FASA also demonstrated evidence of optimal internal consistency (α = 0.86). Findings of convergent validity revealed theory-consistent correlations between the FASA and measures of youth anxiety severity (r = .45, p < .01), caregiver-reported strain (r = .52, p < .01), and youth externalizing symptomology (r = .47, p < .01). The FASA also demonstrated measurement invariance across varying levels of stringency for the following variables: sex-at-birth (male vs. female), age (12 or younger vs. 13 or older), ethnicity (Hispanic vs. non-Hispanic), and presence (vs. absence) of autism. Evidence of treatment sensitivity was also provided via theory-consistent significant reductions in FA from pre- to post-treatment for both interventions directly targeting FA (d = 1.17) and for those targeting it more peripherally (d = 0.64). These findings demonstrate the ability of the FASA to validly track changes in FA over the course of treatment, with nuanced differences depending on the degree to which FA is targeted. Our results indicate that the FASA is a psychometrically sound measure for assessing FA in clinical settings with youth representing a range of diversity factors. This broad applicability of the FASA is especially promising in terms of understanding the role of FA in the treatment of youth anxiety across a wide range of populations in the hopes of reducing mental healthcare disparities. By doing so, this may promote access to evidence-based interventions for targeting FA for afflicted youth and their families.