Parent Accommodations and Pediatric OCD treatment: How to know when to stop

While the term “accommodations” has generally been positive for the neurodiverse community, in the realm of OCD, it is a problematic family behavior that exacerbates symptoms.  By accommodating the child’s desires, a family is essentially enabling the OCD or anxiety to flourish.  

In the short term, accommodations help the family unit experience less distress, but long term, they are highly destructive for anxiety cycles. 

Pediatric OCD treatment will include significant parental training to interrupt these accommodation patterns.  

Common forms of problematic parental accommodations for OCD and anxiety that I have seen are:

• Stopping date nights because the child feels too afraid that something bad will happen to their parents 

• Giving children constant reassurance about their continued health, safety, and love

• Allowing a child to stay home from school due to their fear of vomiting 

• Picking up a dog-phobic child every time a dog walks by

• Waiting for a child to complete their hand-washing rituals before leaving the house

• Providing the child with dozens of options of “safe” foods rather than having them eat the family meal

• Ordering/Speaking on behalf of a socially phobic child at restaurants 

• Answering endless questions to soothe/comfort their anxious child

• Listening to a child’s compulsive confessions and “absolving” them of the mistakes

• Modifying family routines to account for compulsions

• Co-sleeping with an older child due to their fears

Personally, as a mom, I have done half of these accommodations with my own anxious children.  It is important to hold a space of non-judgment for yourself and your partner, and simply move on to a more helpful plan.  

It is important to remember that parental accommodations should be reduced in a gradual way, just as exposures are increased slowly but surely.  OCD treatment is a marathon not a sprint.  

We want to be honest with our children that we are reducing accommodations and explain how and why.  We also want to remain boundaried and confident, as our children may react in ways that are aggressive, guilt-invoking, or defiant.  Remember that this is the OCD fighting back, not your child.  

The internal OCD monologue manipulates your child into compliance with unhealthy rules, and will do the same for you.  

There is a clear difference between being supporting and enabling during pediatric OCD treatment.  

Supportive means assisting the child in growing and feeling empowered for success in OCD treatment.  Enabling is allowing the child to cling to unhelpful behaviors.  

Supportive parenting might sometimes look messy, as a child can have extreme reactions to not being able to do their compulsions.  

Supportive parenting (that is not accommodating) only works if parents are a united front.  If one parent is helping defeat the OCD and the other is conceding to the OCD, then the child will begin to seek out the enabling parent.  

The child can easily triangulate parents who are not united against OCD, and through an effort to maintain their compulsions, learn skills of manipulation.  

It is incredibly important that both parents consult frequently with their OCD therapist to ensure that they are fully aligned with OCD treatment goals.     

To seek OCD treatment for your child and family guidance and support, please contact us today.