Sensory Family Accommodation for Autistic and Sensory Overresponsive Children: The Mediating Role of Parenting Distress Tolerance

Importance: Family accommodation of anxiety disorders is associated with poorer outcomes; therefore, they are important to detect. A child’s sensory problems often cause anxiety and disrupt family routines, which can increase family accommodation. Objective: To compare family sensory accommodation among children with autism spectrum disorder (ASD), children with sensory overresponsiveness (SOR), and typically developing children (TD). To examine the role of parenting distress tolerance in explaining the relation between SOR and family accommodation. Design: Cross-sectional case control design involving nonrandomized sampling and a survey methodology. Setting: Internet. Participants: Parents of 57 ASD children, 54 SOR children, and 48 TD children. Groups were matched on child age and ethnicity. Outcomes and Measures: The Short Sensory Profile 2, Adapted SensOR Inventory (total SOR), Family Accommodations Scale for Sensory Over-Responsivity (FASENS), and the Parenting Distress Tolerance Scale (P–DTS). Results: The groups with ASD or SOR (clinical groups) had a higher frequency of family sensory accommodation, and these accommodations showed greater interference with child and family well-being than among the TD group. The clinical groups had significantly more bothersome sensations and lower P–DTS scores than the TD group. In the clinical groups, the P–DTS mediated the relation between total SOR and FASENS scores, controlling for mother’s years of education. Conclusions and Relevance: Family sensory accommodation was more frequent among families of children with ASD or SOR and interfered more with child and family well-being. For clinical groups, being bothered by more sensations reduced parenting distress tolerance, which increased family accommodation. Plain-Language Summary: When children have strong reactions to sensory experiences, families often change their routines to prevent discomfort. This is called family sensory accommodation—when family members adjust their behaviors to avoid or minimize their child’s sensory challenges and the associated distress. Although this may reduce stress in the short term, it can also reinforce anxiety and limit a child’s ability to cope. We found that parents of children with autism spectrum disorder or sensory overresponsiveness were more likely to make these accommodations compared with parents of typically developing children. These accommodations were linked to greater disruptions in both child and family well-being. We also found that parents who had more difficulty managing their own stress were more likely to engage in family sensory accommodation. These findings highlight the need for occupational therapists to support families in reducing restrictive accommodations while helping children build independence and coping skills.