Family Accommodation of Pediatric Irritability: Development and Psychometric Properties of the Family Accommodation Scale for Irritability

Irritability in children and adolescents is an important mental health concern that presents across a range of disorders. Family accommodation refers to the way families alter their behavior to prevent or reduce child distress. Despite its clinical relevance, the role of family accommodation in pediatric irritability remains underexplored. This study developed and validated a novel parent- and child-report form of the Family Accommodation Scale for Irritability (FASI). We recruited 131 youths (61.83% male, 36.64% female, 1.53% unknown sex; 63.36% White, 12.21% multiracial, 9.92% Black or African American, 3.05% American Indian/Alaska Native, 2.29% Asian, 9.16% unknown race) ages 8–17 years (M = 12.23, SD = 2.49) with varying irritability symptom severity. Both parents and their children completed the FASI and measures of child irritability, anxiety, and depression. Irritability was also assessed by clinician report. Confirmatory factor analyses (CFAs) were used to test factor structures. Internal consistency, convergent and divergent validity, and cross-informant agreement on the FASI were also assessed. CFA supported a two-factor model of family accommodation, representing “participation in behaviors” and “modification of family routines.” Internal consistency and convergent and divergent validity supported the reliability and validity of the scale. Child age showed a significant negative correlation with parent-reported, but not child-reported, family accommodation. Accommodation did not vary with child sex. These results show that family accommodation of irritability can be reliably and validly assessed using the parent- and child-reported FASI scales. Future studies may use this measure to advance understanding of the role that family accommodation plays in pediatric irritability, and its potential as an intervention target.