Adjustment of Siblings of Children with Mental Health Problems: Behaviour, Self-Concept, Quality of Life and Family Functioning

This study examined the adjustment of siblings of children with mental health problems. The participants had brothers or sisters receiving treatment at a Child and Adolescent Mental Health Service within the Hunter New England Health Service, New South Wales, Australia. Seventy-five siblings completed questionnaires on their self-concept, quality of life and family functioning. Their carers completed questionnaires on the sibling’s behaviours, family demographics and family functioning. The diagnosis and severity of disability of index children were attained from the treating clinician. The study revealed the siblings had significantly higher rates of psychopathology, poorer quality of life and lived in more dysfunctional families than normally developing children. Regression modelling predicted variables related to the three main behaviour scales of the Child Behaviour Checklist (CBCL). Family functioning, family communication and the extreme ends of family cohesion and balance, were the most significant contributors to regression model. The sibling self-concept domains of global self-worth, athletic competence and behavioural conduct, contributed to the model. Additionally, a smaller family size was associated with more internalising behaviour disorders in the siblings. The diagnosis and severity of mental health problem of the index child and other family demographic factors did not impact on the sibling’s behavioural functioning. This study highlights that siblings of children with mental health difficulties are a group vulnerable to adjustment difficulties regardless of the index child’s diagnosis or the severity of impairment. Overall, family functioning had a greater impact on the siblings than other factors.     

Response inhibition difficulties in preterm children aged 9–12 years: Relations with emotion and behavior

Previous studies with children have demonstrated inhibition difficulties associated with prematurity, but the question of potentially catching up with a delay in inhibition processes before adolescence still remains. Moreover, preterm adolescents are more at risk than their term-born peers for presenting behavioral problems such as emotional difficulties and attention deficit/hyperactivity disorder. In addition to examining response inhibition, this study addressed, for the first time, the impact of an emotional context on response inhibition abilities and its relation to behavioral problems in late school-aged preterm children. Fifty-eight preterm children aged 9–12 years were compared with 61 controls on two versions of a stop-signal task, the Delay Frustration Task, and the Strengths and Difficulties Questionnaire. Results showed general difficulties in inhibiting a response, rather than a specific impact of emotional context in preterm children. Compared with controls, these children exhibited more and longer button presses in a delay situation, as well as faster go reaction times associated with lower probability of inhibition in the stop-signal tasks. These difficulties reflected impulsivity and were associated with higher hyperactivity/inattention and conduct problems. Additionally, intrauterine growth restriction was found to be an additional perinatal risk factor for hyperactivity/inattention symptoms. These findings suggest that remaining inhibition difficulties in the preterm population at preadolescence could reveal increasing behavioral issues.     

Can the Family Assessment Device (FAD) Be Used with School Aged Children?

This article examines the usefulness of the Family Assessment Device(FAD) in assessing family functioning with school-aged children (under 12 years of age) compared to children 12 and older and mothers. FAD reports from 194 children with asthma (132 under 12 years; 62 12 years and older) were evaluated in comparison to mothers' FAD reports as well as mothers' reports on two other family functioning measures: the Family Inventory of Life Events (FILE) and the Impact on Family (IOF) scale, both relevant to functioning in families with children with asthma. Although FAD scale reliabilities were lowest in younger children (alpha = 48-.79), good concurrent validity was found with mothers' reports on the three different measures of family functioning. Older childrens' FAD scales showed good reliability (> .70) but poorer agreement with the various maternal measures. With modifications to make items more structured and simplified, the FAD could be tried with younger children, although documentation of improved reliability is needed before more widespread use with school-aged children is advocated. The measure already shows good agreement with maternal report in this younger age group, which likely would be strengthened with improved reliability. FAD reports in older children correlated less well with maternal measures, but may represent nonredundant information on family health from an independent perspective and are worth considering in addition to mothers' perspectives.     

Adaptation to juvenile rheumatic disease: a controlled evaluation of functional disability with a one-year follow-up.

Compared the adaptation of 165 patients with juvenile rheumatic disease (JRD) to that of their healthy siblings. Patients were divided into those with mild functional disability and those with moderate/severe disability. Adaptation in several domains was assessed by parents and children on two occasions 1 year apart. The adjustment difficulties of the JRD children were limited primarily to social functioning but appeared also in the psychological and family problems domains. Compared to "mild" patients, "moderate/severe" patients had more adjustment difficulties; in some areas, mild patients functioned as well as their healthy siblings. Some Time 1 differences were replicated at Time 2. The results help to delineate (a) the specific domains in which children with chronic disease have adjustment difficulties and (b) the factors that put children at risk for developing adjustment problems.     

National Origin and Behavioural Problems of Toddlers: The Role of Family Risk Factors and Maternal Immigration Characteristics

In many societies the prevalence of behavioural problems in school-aged children varies by national origin. We examined the association between national origin and behavioural problems in 1½-year-old children. Data on maternal national origin and the Child Behavior Checklist for toddlers (n?=?4943) from a population-based cohort in the Netherlands were used. Children from various non-Dutch backgrounds all had a significantly higher mean behavioural problem score. After adjustment for family risk factors, like family income and maternal psychopathology, the differences attenuated, but remained statistically significant. Non-Dutch mothers with immigration risk factors, such as older age at immigration or no good Dutch language skills, reported significantly more behavioural problems in their offspring. In conclusion, the present study indicated more behavioural problems in immigrant toddlers from various backgrounds. Researchers and policymakers aiming to tackle disparities in behavioural problems should take into account that risks associated with national origin are intertwined with unfavourable family and immigration characteristics.     

Modeling Family Dynamics in Children with Fragile X Syndrome

Few studies have examined the impact of children with genetic disorders and their unaffected siblings on family functioning. In this study, the reciprocal causal links between problem behaviors and maternal distress were investigated in 150 families containing a child with fragile X syndrome (FXS) and an unaffected sibling. Both children's behavior problems appeared to have strong, direct effects on maternal distress, but maternal distress did not appear to have any reciprocal causal effects on either child's behavior problems. Surprisingly, there were no significant differences in the effects of the two children's behavior problems on maternal distress. These data suggest that the problem behaviors of children with FXS, as well as their unaffected siblings, can have a substantial and additive impact on maternal depression and anxiety. Future research efforts should employ longitudinal research designs to confirm these findings.     

Adoption and cognitive development: a meta-analytic comparison of adopted and nonadopted children's IQ and school performance

This meta-analysis of 62 studies (N=17,767 adopted children) examined whether the cognitive development of adopted children differed from that of (a) children who remained in institutional care or in the birth family and (b) their current (environmental) nonadopted siblings or peers. Adopted children scored higher on IQ tests than their nonadopted siblings or peers who stayed behind, and their school performance was better. Adopted children did not differ from their nonadopted environmental peers or siblings in IQ, but their school performance and language abilities lagged behind, and more adopted children developed learning problems. Taken together, the meta-analyses document the positive impact of adoption on the children's cognitive development and their remarkably normal cognitive competence but delayed school performance.     

Sisterhood-Brotherhood is Powerful: Sibling Sub-Systems and Family Therapy

Sibling interaction is an often overlooked aspect of family functioning. Individual development and many family behavior patterns may be attributed to autonomous activities within the sibling sub-system.
A number of phenomena in which siblings have profound influence upon one another are explored. Siblings collude and align with each other, at times help each other resist the powerful vertical influences of parents. Other sibling systems serve to enmesh the youngsters even more with parents. Important sib-behavior patterns include: the death or departure of siblings; the interplay between the sibling sub-system and the parenting system; and the roles that "well" siblings play vis-à-vis their "sick" siblings during family crises. The sibling relationship is seen as a life-long process, highly influential throughout the life cycle.
Understanding of sibling sub-system structure and dynamics can lead to more flexible therapeutic interventions. Direct work with siblings provides the therapist with more options and greater leverage in producing change for all siblings, as well as for other family members.     

A child-centred exploration of the relevance of family and friends to theory of mind development

Theory of Mind (ToM) is said to develop at around 4 years old. But some studies suggest it develops considerably earlier than this, with others suggesting it develops much later. Although several recent studies have found that social factors (like gender, family size, number of siblings, and number of friends) can impact on ToM, other studies contradict those findings. We wondered whether addressing several procedural issues and ensuring the task concerns real protagonists in real time, would bear on the above issues. Here, 114 children of 3-6 years completed four ToM tasks incorporating controls from experimental psychology, including randomly varying the order of ToM and non-ToM questions across participants. Now, children passed ToM tasks from around 5 years old, rather than 4 years or earlier. Girls did not develop ToM any earlier than boys. There was clear correlational evidence for the older-sibling effect and effects of friends but no reliable effects of nuclear or extended family. However, when these factors were set in the context of one another, the sibling effect was driven by a negative influence from younger siblings (as opposed to older siblings) and the friends effect was driven by friends at school (as opposed to friends at home). Finally, "friends" was a stronger predictor than siblings but memory (a cognitive factor) and age (a maturational factor) were the strongest predictors of all.     

Siblings of children with mental retardation: Family characteristics and adjustment

Siblings of children with mental retardation may be at greater risk for adjustment problems because of family stress related to the needs of the child with mental retardation. Family dimensions were investigated to determine their relationship to sibling adjustment. Adjustment of 12 siblings of children with mental retardation was examined in relationship to family dimensions. These relationships were compared to those for children from families without a disabled child. For both groups, self concept was positively associated with family cohesion, and social competence was positively associated with family promotion of independence. For only the siblings of the mentally retarded children, family conflict was inversely related to social competence, and family organization was positively related to sibling self concept. Our results suggest that family conflict and disorganization appear to have a more negative effect in families with a child with mental retardation.     

Psychosocial risk and resistance factors among children with chronic illness,healthy siblings,and healthy controls

Psychosocial risk and resistance factors within the domains of parental functioning, family Stressors, and family resources were examined as predictors of psychological adjustment and physical problems in juvenile rheumatic disease patients (N=93), their healthy siblings (N=72), and demographically matched healthy controls (N=93). Family socioeconomic status and background variables showed few consistent relationships with child functioning. However, a constellation of risk and resistance factors tended to show comparable associations with functioning for patients, siblings, and controls. Higher parental depression and medical symptoms and more family Stressors, sibling problems, and burden of illness on the family predicted more problems among the patients. These relationships held when disease duration and severity were controlled. For the siblings, increased parental and patient dysfunction, more family Stressors, and less family cohesion and expressiveness were associated with more problems. Although the associations were not as strong, mothers' depression and lack of family cohesion and expressiveness also were related to more adjustment problems among the control children. These findings imply that there may be a general association between certain risk and resistance factors and childhood adaptation.This research was supported in part by NIH Multipurpose Arthritis Center Grant AM20610, NIMH Grant MH16744, and Veterans Administration Medical and Health Services Research and Development Service Research funds. Jan Gottlieb provided valuable help in all phases of the research. We appreciate the help of the staff of the Pediatric Rheumatology Clinic at Children's Hospital at Stanford and the families who participated in this study.     

Placement shift, sibling relationship quality, and child outcomes in foster care: a controlled study.

Sibling unity during family transitions is considered a protective factor for child behavior problems, but there is little empirical support for the widespread child protection policy of placing siblings together in foster care. In a prospective study of 156 maltreated children, siblings were classified in 1 of 3 placement groups: continuously together (n = 110), continuously apart (n = 22), and disrupted placement (siblings placed together were separated; n = 24). Changes in child adjustment as a function of sibling relationship and placement group were examined. Sibling positivity predicted lower child problems at follow-up (about 14 months later), while sibling negativity predicted higher child problems. Placement group did not affect child behavior problems at follow-up; however, compared to siblings in continuous placement (either together or apart), siblings in disrupted placement with high initial behavior problems were rated as having fewer problems at follow-up, while siblings in disrupted placement with low initial behavior problems were rated as having more problems at follow-up. These findings highlight the importance of considering relationships between siblings and the risk that one poses to another before early placement decisions are made.     

Siblings of disabled children: Birth order and age-spacing effects

Whereas older siblings of children with congenital disability have lived their earliest years in a normal family environment, younger siblings, especially those in a close age-spacing relationship, were born into families marked by the presence of a disabled child. In this paper, 237 siblings of disabled children are compared to 248 siblings from a random sample of families to examine whether the early family environment of siblings of disabled children, as indexed by relative birth order and age-spacing, has a unique influence on psychological functioning. The findings partially confirmed the expected relationships: Younger male siblings, specifically those in close age-spacing relationship to the disabled child, scored higher on psychological impairment than older male siblings. Among female siblings, a similar influence was not in evidence: Younger female siblings were psychologically better off than older female siblings and their age-spacing was not significantly related to psychological functioning. However, the results suggest that siblings' later response to early life experience may be sex-contingent, with males demonstrating interpersonal aggression and females experiencing depressive-anxious feelings.This study was supported by grants from the Cleveland Foundation and the C. S. Mott Foundation. The helpful comments of Joanne C. Gersten are gratefully acknowledged.     

“Eat your Hamburger!”—“No, I don’t Want to!” Argumentation and Argumentative Development in the Context of Dinner Conversation in Twenty Swedish Families

The aim of the present study was to analyse family dinners as context of argumentation and argumentative development by using a context-sensitive model of basic argumentative structures in every day conversations. The data consisted of 40 argumentative sequences in dinner conversations in twenty Swedish families with children aged 7 to 17 years. The families were divided in two groups depending on the children's ages (10–11 years with younger siblings and 10–12 years with older siblings). The model revealed characteristic structures of argumentation appearing as co-text and suggested differences between family groups depending on contextual factors such as age of the children. The groups of older children produced longer argumentative sequences, more exchanges per sequence and higher rate of turns. The older children also engaged in non-instrumental deliberations and disputations significantly more often and they performed more elaborated expansions (through a higher quantity of backing arguments). The groups of younger children on the other hand were more often involved in negotiations on topics relevant in the immediate context. Less expected was, however, the lack of more complex and varied arguments, even in the groups of older children.     

Developmental changes of parental-reported sleep disturbance symptoms in children with attention deficit disorder

The primary goal of this retrospective study was to assess parental report of current sleep disorders in school-aged attention deficit disorder (ADD) children, as well as recalled sleep problems from when the children were infants (0–12 months) and toddlers (1–3 years). Results of a sleep questionnaire completed by mothers of 48 ADD children and a comparison group of 30 patients with school problems indicate that ADD children were perceived to have significantly more sleep problems and that these problems had onset in infancy. Specific items in the questionnaire which were increased included latency to sleep onset of more than 30 min at least 3 nights per week, fatigue upon awakening, and recall of nightmares. Pediatric clinicians should be alert to possible sleep disorders in children suspected of attention disorders and should consider sleep hygiene measures as a component of treatment.     

Prevalence of problematic behaviors in four-year-olds

Prevalence rates for specific behaviors in the Problem Behavior Questionnaire (PBQ; Behar & Stringfield, 1974) and for four psychosomatically related behaviors (soiling, day and night wetting, and complaints about bodily aches) were estimated in a sample of 377 Swedish 4-year-olds described by their parents (mainly mothers). The results showed that several of the behaviors classified as outgoing conduct problems were common in this age group; boys showed more problematic behaviors than girls, as did children with older siblings. Firstborn children with younger siblings were more fearful and worried. No systematic differences between children in different types of day care were found. Maternal education had no relationship to reported child behaviors. The findings were discussed in terms of the four-year-age period as a period of transition and with regard to different family situations.     

Siblings of Children with disabilities: Psychological and behavioural characteristics

The purpose of the current study was to assess the behavioural and psychological characteristics of siblings of children with disabilities and the perceptions of parents and children regarding sibling relationships. Participants included 32 children between 6 and 13 years of age, one-half with a younger sibling with a disability and one-half with a younger sibling without a disability. Analyses revealed a difference in children's perceptions of maternal partiality, with siblings of children with disabilities perceiving their mothers to be more partial to their siblings than did siblings of children without disabilities. Further, parents of children with disabilities indicated a greater difference in status/power between their child and his/her younger sibling than did parents of children without disabilities. No significant differences were found between groups on measures of behaviour problems, social competence, or self-esteem, supporting other research that has failed to find negative outcomes for siblings of children with disabilities. The implications of these results for parents and professionals are discussed.     

Families of persons with Down syndrome: new perspectives, findings, and research and service needs

To understand the families of offspring with Down syndrome, this article begins by describing the change in orientation--from "negative" to "stress-and-coping" perspectives--in studies of families of offspring with disabilities. In reviewing the existing studies, mothers, fathers, and siblings cope slightly better than family members of persons with other disabilities, a phenomenon called the "Down syndrome advantage." Beyond this more general finding, however, much remains unknown. Most studies examine only parental or sibling levels of stress or coping, leaving unknown the marital, occupational, health, educational, and other "real-world" outcomes for these family members. Increased research attention is needed to understand the life-span needs of families of persons with Down syndrome and the impact of cultural and sociocultural diversity on family outcomes. It will also be important to relate family outcomes to differences in the offspring's behaviors, development, relationships, medical conditions, psychopathology, and the presence (and effectiveness) of needed support services. Although these families have received some research attention over the past several decades, we now need to make family research in Down syndrome more concrete, more life-span, and more tied to characteristics of the individual with the syndrome and the family's surrounding support system.     

Co-Sleeping among School-Aged Anxious and Non-Anxious Children: Associations with Sleep Variability and Timing

Little is known about the co-sleeping behaviors of school-aged children, particularly among anxious youth who commonly present for the treatment of sleep problems. The current study examined the occurrence of co-sleeping in both healthy and clinically anxious children and its associated sleep patterns. A total of 113 children (ages 6–12), 75 with primary generalized anxiety disorder and 38 healthy controls, participated along with their primary caregiver. Families completed structured diagnostic assessments, and parents reported on their child’s co-sleeping behaviors and anxiety severity. Children provided reports of anxiety severity and completed one week of wrist-based actigraphy to assess objective sleep patterns. A significantly greater proportion of anxious youth compared to healthy children co-slept, and greater anxiety severity was related to more frequent co-sleeping. Co-sleeping in anxious youth was associated with a delay in sleep timing and with greater sleep variability (i.e., more variable nightly sleep duration). All analyses controlled for child age, race/ethnicity, family income, and parental marital status. Co-sleeping is highly common in anxious school-aged children, with more than 1 in 3 found to co-sleep at least sometimes (2–4 times a week). Co-sleeping was even more common for youth with greater anxiety severity. Increased dependence on others to initiate and maintain sleep may contribute to poorer sleep in this population via shifted schedules and more variable sleep patterns.     

Predicting Growth Curves of Early Childhood Externalizing Problems: Differential Susceptibility of Children with Difficult Temperament

Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2–3 years for having high levels of externalizing problems. Parenting was measured using observational methods, and maternal reports were used for the other variables. Overall, mean levels of externalizing problems decreased over time, and higher initial levels (intercept) were related to a stronger decrease (negative slope) in externalizing problems. Results showed that higher levels of maternal psychopathology were related to less decrease in early childhood externalizing problems. Parental sensitive behavior predicted a stronger decrease in externalizing problems, but only for children with difficult temperaments. A stronger decrease of externalizing problems in children with older siblings also pertained only to children with difficult temperaments. Thus, temperamentally difficult children appear to be more susceptible to environmental influences on the development of externalizing behaviors. Our results indicate that the role of siblings in early childhood externalizing problems deserves more research attention, and that intervention efforts need to take into account temperamental differences in children’s susceptibility to environmental influences.