Establishing a clinical cutoff score for the Family Accommodation Scale-Anxiety (FASA)

Family accommodation is a well-established maintaining factor in childhood anxiety disorders and a target of evidence-based interventions. Despite widespread clinical and research use of the Family Accommodation Scale-Anxiety (FASA), no empirically derived clinical cutoff score has been established. The present study aimed to determine a cutoff score on the parent-rated FASA indicative of clinically meaningful accommodation of child anxiety.

Participants were 1,185 youth (1,055 clinical; 130 community) aged 5-17 years, and their parents. Measures included the FASA, Screen for Child Anxiety Related Emotional Disorders (SCARED), and Anxiety Disorders Interview Schedule for Children and Parents (ADIS-C/P). Receiver operating characteristic (ROC) analyses were conducted to establish cutoffs for the FASA against the established clinical threshold on the SCARED in the full sample (i.e. clinical and community), and against anxiety disorder diagnoses in the clinical sample. Benchmarking in the community sample provided an independent, norm-referenced indicator of elevated accommodation.

ROC analyses identified an optimal cutoff of 11 (out of 36) on the FASA against the parent-report SCARED criterion and a cutoff of 9 against a SCARED criterion met by either youth or parent. A criterion based only on the child-report SCARED produced an area under the curve (AUC) below acceptable thresholds. Confirmatory analysis against ADIS-C/P diagnostic data supported both SCARED-based cutoffs (AUC = 0.76; sensitivity = 0.76 at cutoff of 9, 0.69 at cutoff of 11). Normative benchmarking placed a score of 9 at the 90th percentile of the community distribution.

A FASA total score of 9 to 11 provides an empirically derived indicator of clinically significant family accommodation. A cutoff of 9 is recommended for screening and research contexts, while 11 may be more appropriate when higher specificity is desired.