Family accommodation of restricted and repetitive behaviors and emotion regulation in early childhood: Associations across autistic, developmentally delayed, and non-diagnosed groups

Family accommodation (FA) of restricted and repetitive behaviors (RRBs) is common in autism and associated with child and family outcomes, yet its relationship to emotion regulation (ER) in both children and parents remains unexamined. This study investigated associations between FA, RRBs, child temperament traits (surgency, negative affect, effortful control), and parental ER strategies (cognitive reappraisal, expressive suppression) across autistic (n = 146), developmentally delayed (DD; n = 44), and non-diagnosed (ND; n = 98) groups of young children (23–60 months). All the children were referred for suspected autism prior to evaluation, and underwent standardized diagnostic assessments (ADOS-2, Mullen/WPPSI). Parents completed measures of FA-RRBs, child temperament (CBQ), and parental ER strategies (ERQ). FA-RRBs were positively associated with child negative affect across all three groups (ρ =.37–.54, all p ≤ .021; four of six parent-group combinations survived FDR correction). These associations were observed across a spectrum of autistic, DD, and ND groups, establishing a broadly relevant link between child emotional distress and parental accommodation of RRBs. Parental ER strategies were not significantly associated with FA-RRBs in any group after FDR correction, and this null result was confirmed under multiple imputation. This is the first study to situate family accommodation of RRBs within the emotion-regulation ecology of the family, and the first to test whether the construct is specific to autism or extends to developmentally delayed and non-diagnosed children referred for the same concerns. These findings establish FA-RRBs as a construct that is not reducible to level of autism characteristics, and identify child negative affect as its most consistent correlate across diagnostic boundaries.