Benefits of Including Siblings in the Treatment of Autism Spectrum Disorders

Having a brother or sister with an autism spectrum disorder (ASD) can significantly impact the life of a typically developing sibling. These relationships are generally characterized by less frequent and nurturing interactions than are evident in sibling constellations with neurotypical children or children with other developmental disabilities. One way to address this issue is to teach typically developing siblings skills to participate in a brother or sister's treatment. Including siblings in behavioral interventions is documented to be beneficial to both children, and is associated with generalization of skills for the sibling with ASD. Here we review this body of literature, present case examples from clinical practice, and make treatment recommendations for utilizing sibling-mediated behavioral approaches.     

Relationship Quality as a Moderator of Anxiety in Siblings of Children Diagnosed with Autism Spectrum Disorders or Down Syndrome

The purpose of this study was to examine typically-developing adolescents’ perceived relationship quality with their developmentally-disabled sibling, specifically siblings diagnosed with an autism spectrum disorder (ASD) or Down syndrome (DS). The 119 eleven through seventeen-year-old adolescent participants (M = 13.32, SD = 1.90) completed an online survey that assessed demographics, sibling relationship quality, and anxiety. Results showed that siblings of children with DS have a greater overall sibling relationship quality than do siblings of children with an ASD. Results further indicated that reporting more negative interchanges within the sibling relationship was related to higher levels of anxiety regardless of sibling disability type. Lastly, sibling relationship quality moderated the relation between sibling disability type and anxiety. These findings promote greater understanding of the sibling dynamic in families with children with developmental disabilities and suggest the need for establishing more research and greater clinical evaluation in this area. Furthermore, the current study suggests that therapeutic intervention to address the sibling relationship quality within children diagnosed with ASDs and their typically-developing siblings would be beneficial in order to increase social support within the relationship as well as decrease the amount of negative interchanges within the sibling relationship. Results also suggested that decreasing the amount of negative interchanges within the sibling relationship may decrease the level of anxiety the typically-developing sibling reports.     

Siblings of individuals with autism spectrum disorders across the life course

In this article, we review the literature on siblings of individuals with autism spectrum disorders (ASD) from a lifespan developmental perspective, from infancy through adulthood, focusing on the sibling relationship and sibling well-being. We situate this review within the larger body of research on siblings of individuals with developmental disabilities (DD) across the lifespan. We then consider the genetic aspects of ASDs and their implications for siblings. We conclude that there is an evidence of atypical social and communication development in some siblings of children with an ASD during infancy. During childhood and adolescence, siblings describe both positive and negative aspects of their sibling relationship and there is some evidence that siblings of children with an ASD may be at heightened risk for social and behavioral adjustment problems. The limited research on adulthood suggests that lack of closeness in the sibling relationship and social and emotional difficulties may continue. We encourage more attention focused on developmental issues, specifically with respect to samples in narrower age groups and in longitudinal research. Finally, we note the variability in sibling outcomes, and suggest further examination of potential moderating and mediating factors, including genetic predispositions.     

Impact of End-of-Life Circumstances on the Adjustment of Bereaved Siblings of Children Who Died from Cancer

The aim of this study was to examine the impact of end-of-life (EoL) circumstances on grief and internalizing symptoms among bereaved siblings. Bereaved families (N?=?88) were recruited from three sites 3–12 months (M?=?11.57, SD?=?3.48) after their child’s death from cancer. One sibling per family aged 8–17 years (M?=?12.41, SD?=?2.64) was randomly selected to participate. Families completed measures of siblings’ grief and internalizing symptoms, as well as a structured interview about circumstances surrounding the death. Mother and sibling reports of EoL circumstances were generally concordant, except there was a discrepancy between mothers and children about whether or not children expected their sibling’s death (t(75)?=?1.52, p?=?.018). Mother reports of sibling internalizing symptoms were above the normative mean (t(83)?=?4.44, p?≤?.001 (M?=?56.01?±?12.48), with 39% (n?=?33) in the borderline/clinical range. Sibling opportunity to say goodbye was associated with greater grief-related growth (t(79)?=?? 1.95, p?=?.05). Presence at the death and wishing they had done something differently were both associated with greater grief (t(80)?=?? 2.08, p?=?.04 and t(80)?=?? 2.24, p?=?.028, respectively) and grief-related growth (t(80)?=?? 2.01, p?=?.048 and t(80)?=?? 2.31, p?=?.024, respectively). However, findings were primarily unique to sibling report, with few mother-reported effects. The adjustment of bereaved siblings may be affected by certain modifiable circumstances surrounding the death of their brother or sister. A proportion of bereaved siblings had elevated internalizing symptoms irrespective of circumstances at EoL. Further work is needed to understand predictors of adjustment among bereaved siblings to provide better support and optimize their outcomes.

     

An Initial Look at Sibling Reports on Children's Behavior: Comparisons with Children's Self-Reports and Relations with Siblings' Self-Reports and Sibling Relationships

The authors examined siblings' reports of children's depression, anxiety, and aggression, and their reports of the sibling relationship, and compared them with children's self-reports. In two samples, including 169 sibling pairs (age M = 9.98 years, SD = 1.51), no significant differences emerged in the levels of depression and anxiety found in siblings' reports of children's behavior and children's self-reports, although siblings reported children to have significantly higher levels of aggression than the children self-reported. Age, the difference in ages between siblings, sex, and sibling sex were not related to siblings' reports of children's behavior. The relations between children's and siblings' reports of children's behavior were significant, yet moderate (average r = .22). Both siblings' self-reports of internalizing behavior and their perceptions of aspects of the sibling relationship (affection, rivalry, hostility, and satisfaction with the sibling relationship) explained significant, and unique, variance in siblings' reports of children's internalizing behavior. The findings for aggressive behavior were similar, although siblings' perceptions of affection in the sibling relationship were not significantly related to their reports of children's aggression. The potential uses and benefits of sibling reports of children's behavior, and sibling and family relationships, are discussed.     

A Child With Autism Spectrum Disorder Teaches Siblings to Skateboard: Effects on Sibling Skills and Family Social Behavior

Abstract

Children with autism spectrum disorder (ASD) may have few common activities with their siblings who do not have ASD, and this can limit their opportunities for social play. In this study, we used a multiple-baseline across skills design to assess the effects of a boy with ASD following an activity schedule to teach his favorite activity of skateboarding to his two siblings who do not have ASD. Family social behavior was also measured before and after sibling training. After training by the boy with ASD, both of the siblings’ skateboarding skills improved, and measures of family social behavior also increased. Results suggest that sibling relationships may benefit when a child with ASD teaches siblings to play.     

Parentification of Adult Siblings of Individuals with Autism Spectrum Disorder

Many typically-developing (TD) siblings provide care for their siblings with autism spectrum disorder (ASD), both as children and as adults. Research on parentification (i.e., when children assume responsibilities typically reserved for adults) has been mixed, with some studies supporting positive outcomes for TD siblings and others indicating negative outcomes. Some of these discrepancies may be due to inconsistencies in differentiating types of parentification. The current study examined how different types of parentification during childhood (retrospectively-reported) related to distress outcomes and attitudes about sibling relationships among 41 TD adult siblings of individuals with ASD. Results indicated that parent-focused parentification was positively related with anxiety and stress among TD siblings. Sibling-focused parentification was positively related to stress but was also related to more positive sibling relationship attitudes. Accounting for demographic variables and the other form of parentification, parent-focused parentification was a unique predictor of distress, whereas sibling-focused parentification was a unique predictor of positive sibling relationship attitudes. Although parentification is often viewed negatively, sibling-focused parentification and perceived benefits of parentification may predict positive outcomes. Results suggest that parentification may prove important in understanding the complex nature of sibling relationships. Specifically, strengthening the sibling bond and reducing parent-focused parentification during childhood may curtail sibling relationship problems and general distress in TD siblings later in life.     

The experiences of living with a sibling who stutters: a preliminary study

Stuttering impacts on the child in a variety of ways, notably in terms of communicative impairment and psychosocial impact. In addition, the stuttering disorder has a holistic impact, affecting those with whom the child who stutters lives. Within the family constellation, the closest person to the individual who stutters is often their sibling. This study investigated the experiences of fluent siblings of children who stutter to examine the impact that stuttering may have on their lives. A mixed methods research design incorporated qualitative semi-structured interviews and quantitative questionnaires. The results of the qualitative investigation revealed four aspects of children's lives that were affected by having a sibling who stuttered: the relationship between siblings, the impact on the fluent sibling, the impact on the parent relationship with both children, and the impact on the sibling's relationship with others. Findings revealed that siblings of children who stutter exhibited strongly negative emotions, and differing levels of responsibility associated with their involvement in the actual stuttering management programme. Furthermore, for the fluent sibling, secondary to having a brother or sister who stuttered, communication with and attention from their parents was variable. The results of the quantitative component of the study revealed children who stutter and their siblings demonstrated significantly greater closeness, and concurrently, increased conflict and status disparity than did the control fluent sibling dyads. The parents of the experimental sibling dyads also demonstrated significantly greater partiality towards a child, namely the child who stuttered, than did the parents of the control sibling dyads. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) identify the themes associated with having a sibling who stutters; (2) identify how the quality of the sibling relationship differs between sibling dyads that do and do not consist of a sibling who stutters; and (3) discuss the clinical implications of the results with regards to working with children who stutter and their families.     

Sibling Relationships and Family Functioning in Siblings of Early Adolescents,Adolescents and Young Adults with Autism Spectrum Disorder

The purpose of the study was to investigate how family functioning (defined as the ability that family members hold to manage stressful events, and intimate and social relationships), the degree to which family members feel happy and fulfilled with each other (called family satisfaction), and the demographical characteristics of siblings (age and gender) impacted on sibling relationships. The Circumplex Model of Marital and Family Systems and Behavioral Systems constituted the theoretical frameworks that guided our study. Eighty-six typically developing adolescents and young adults having a sister or a brother with autism spectrum disorder were enrolled. Results indicated that the youngest age group (early adolescents) reported to engage more frequently in negative behaviors with their siblings with ASD than the two older age groups (middle adolescents and young adults). No significant differences were found among the three age groups regarding behaviors derived from attachment, caregiving and affiliative systems. Family satisfaction and age significantly predicted behaviors during sibling interactions. Suggestions on prevention and intervention programs were discussed in order to prevent parentification among typically developing siblings and decrease episodes of quarrels and overt conflicts between brothers and sisters with and without ASD.     

The influence of gender,age, Psychological resilience and family interaction factors upon anxiety and depression in non-autism spectrum disorder siblings of children with an autism spectrum disorder

The influence of gender, age, Psychological resilience and family interaction factors upon generalised anxiety disorder (GAD) and major depressive disorder (MDD) was investigated in 75 non-autism spectrum disorder (NASD) siblings who had a brother or sister with an autism spectrum disorder (ASD). GAD and MDD were much more prevalent than in comparable age group samples, and adolescent females had the highest MDD rates. Several Psychological resilience skills were significantly associated with lower GAD and MDD, particularly being able to recognise mistakes in their thinking (for children) and being able to remain in control of their anger (for adolescents). Suggestions are made for ways of encouraging NASD siblings to develop skills that may assist them in avoiding these disorders.     

同胞共情：特点、影响因素及理论机制

同胞之间的交流和互动更能促进彼此共情的发展。随着“全面二孩”政策的实行,同胞共情成为国内外研究者共同关注的焦点。本文在同胞的视角下总结了同胞共情的共性特点和特异性特点,从个体、同胞、家庭三个维度阐述了同胞共情的影响因素。未来研究需要进一步注重文化,回归本土研究;加强双向机制研究,夯实理论框架;重视干预性研究,探索提升同胞共情的方法。     

Family Dynamics and Changes in Sibling of Origin Relationship After Lesbian and Gay Sexual Orientation Disclosure

Despite the knowledge that the entire family system plays a role in the development of an individual, research on the disclosure of LG sexual orientation to the family of origin is mostly concentrated on the parental reaction. Siblings are rarely a focus of such research. Thus, the purpose of this qualitative study was to provide an understanding of the experiences of 14 heterosexual biological siblings of LG persons after they learn that their sister or brother is LG. More specifically, this study explored the changing family dynamics with a focus on the sibling of a LG sister or brother and the ways in which sexual orientation disclosure affects the sibling relationship. Data analysis identified ten themes: personal reaction to disclosure, suspecting sibling was LG based on stereotyping, protectiveness/concern, gay equals being different, anger/disappointment in how parent(s) handled LG sibling coming out, sibling relationship changes, increased comfort with having a LG sibling, disclosure of LG sibling sexual orientation to others, dealing with and challenging heterosexism, and changes to self as a result of sibling sexual orientation.     

Psychological Adjustment,Social Responsiveness and Parental Distress in an Italian Sample of Siblings of Children with High-Functioning Autism Spectrum Disorder

The psychosocial adjustment of siblings of children with autism spectrum disorder (ASD) is a relatively recent field of study, but results in literature are often inconsistent, and studies specifically focused on samples of siblings of children with high-functioning ASD are very few. This paper analyzes the level of social impairment (index of broader autism phenotype), the risk of internalizing and externalizing problems (index of psychological adjustment) and the parenting distress in an Italian sample of siblings of children with high-functioning ASD (n = 26). The presence of risk factors (birth order, sex and number of siblings in the family) and the role of the siblings’ age are also explored. The data were collected through self-report instruments administered to parents. The results do not show higher average risk levels for psychosocial adjustment problems, even though a minority of the cases is at risk for social impairments (7.7 %), internalizing (23.1 %), externalizing (3.8 %) and total difficulties (11.5 %) and for distress in the parent–child system (15 %). Distress in the parent-sibling system seems to be modulated by the sibling’s features and to be higher when the sibling is older than the child with ASD. Additionally, a link between difficulties in psychological adjustment and broader autism phenotype is suggested.     

Caregiving Attitudes,Personal Loss,and Stress-Related Growth Among Siblings of Adults with Mental Illness

As parents age, well siblings are often asked to assume caregiving responsibilities for their brother or sister with mental illness. However, relatively little is known about how well siblings prioritize sibling caregiving responsibilities with other life demands. We examined well siblings’ attitudes toward self-care and caregiving for their sibling with mental illness (self- and sibling-care) using two cross-sectional samples. The first sample of well siblings (N?=?242) was used to examine the psychometric properties of the self- and sibling-care measure (SSCM), designed to assess the degree to which siblings prioritize their own needs and the needs of their sibling with mental illness. A second sample (N?=?103) was used to determine the relative contribution of self- and sibling-care attitudes in accounting for variation in well siblings’ reports of personal loss and stress-related personal growth. Results support the psychometric validity of the SSCM and suggest that self- and sibling-care attitudes account for greater variance in scores on perceived personal loss and stress-related growth than demographic or caregiving factors. Our findings support the need to address family care responsibilities and resource limitations through recovery-oriented mental health policies, services, and programs.     

BEHAVIORAL TRAINING FOR SIBLINGS OF AUTISTIC CHILDREN

The present study was conducted to investigate the effectiveness of a program designed to teach behavior modification procedures to normal siblings of autistic children. Three sibling pairs participated in a multiple-baseline analysis of the effects of training the normal siblings to use behavior modification procedures to teach their autistic brother or sister a variety of learning tasks. Results indicated that the siblings learned to use the behavioral procedures at a high level of proficiency, they used the procedures in a generalization setting, and there were observed improvements in the behavior of the autistic children. In addition, a social validation assessment of the normal siblings' statements about their autistic sibling indicated a decrease in negative statements and an increase in positive statements after training. These results are discussed in terms of the potential for incorporating siblings into the treatment plan in intervention programs with autistic children.     

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.     

Developmental Changes in Pretend Play from 22- to 34-Months in Younger Siblings of Children with Autism Spectrum Disorder

Developmental trajectories of children’s pretend play and social engagement, as well as parent sensitivity and stimulation, were examined in toddlers with an older sibling with autism spectrum disorder (ASD, high risk; HR) and toddlers with typically-developing older siblings (low risk; LR). Children (N = 168, 97 boys, 71 girls) were observed at 22, 28, and 34 months during free play with a parent and elicited pretend play with an examiner. At 28 and 34 months, children were asked to imagine the consequences of actions pantomimed by the examiner on a pretend transformation task. At 36 months children were assessed for ASD, yielding 3 groups for comparison: HR children with ASD, HR children without ASD (HR-noASD), and LR children. Children in all 3 groups showed developmental changes, engaging in more bouts of pretend play and obtaining higher scores on the elicited pretend and transformation tasks with age, but children with ASD lagged behind the other 2 groups on most measures. Children with ASD were also less engaged with their parents or the examiner during play interactions than either LR or HR-noASD children, with minimal developmental change evident. Parents, regardless of group, were highly engaged with their children, but parents of HR-noASD children received somewhat higher ratings on stimulation than parents of LR children. Most group differences were not accounted for by cognitive functioning. Instead, lower social engagement appears to be an important correlate of less advanced pretend skills, with implications for understanding the early development of children with ASD and for early intervention.     

Case–contrast study about parent–infant interaction in a Brazilian sample of siblings of children with autism spectrum disorders

Siblings of children with autism spectrum disorders (ASD) present greater susceptibility to developmental problems, in comparison with siblings of typically developing children. The greater prevalence of mental health disorders among parents of children with ASD increases younger siblings’ vulnerability to emotional problems. The aim of this study is to compare the interaction between carers and babies aged 2 to 26 months (M = 11.7, SD = 6.9) who are siblings of children with ASD (ASD dyads) with the interaction of dyads of siblings of typically developing children (TD dyads). The protocol of Clinical Indicators of Risk for Child Development and the Coding Interactive Behaviour measures were used to evaluate interaction. ASD dyads presented higher scores of constriction in their interaction, P = .024, with babies presenting higher scores of withdrawal behavior, P = .003, and carers presenting higher scores of depressive mood, P = .008, when compared to TD dyads. The ASD dyads have interactive impairments more frequently than do the TD dyads.     

The Role of Contextual Threat in Predicting Self-Reported Distress among Siblings of Children with Cancer

Each year, 14,000 children are diagnosed with cancer in the United States. Prolonged, intensive treatment regimens disrupt the entire family system, but effects on siblings are poorly understood. In this preliminary investigation, we employed a risk and resistance framework to study adjustment among 30 siblings (aged 10–17) of children undergoing cancer treatment. We examined whether or not objective stress associated with the cancer experience (contextual threat) predicted sibling distress and explored demographic and disease-related predictors of sibling adjustment. Contextual threat was positively associated with sibling-reported distress, independent of sibling age, gender, birth order relative to the child with cancer, and cancer treatment intensity. From among the demographic and disease-related factors, only younger birth order relative to the child with cancer was independently associated with sibling distress. These results suggest that a subset of siblings may be at increased risk for elevated distress in the face of their brother’s or sister’s illness.     

Jealousy and emotional responsiveness in young children with ASD

We investigated manifestations of jealousy in preschoolers (n=32) with autism spectrum disorder (ASD) and in a group of typically developing children (n=18) matched on mental age, verbal mental age, nonverbal mental age, and mother's education. Main results revealed explicit indices of jealousy in two thirds of the children with ASD compared with 94.5% in the typical group. In addition, different manifestations of this emotion emerged in the ASD group compared with the matched control group. Regarding mental and affective correlates of jealousy, expressions of jealousy correlated with IQ only for the children in the ASD group, and the ASD group revealed deficient emotional responsiveness (ER) capabilities. Significant correlations emerged between jealousy and ER in both the ASD and control groups. Discussion focuses on implications of these findings for understanding the core emotional deficit in autism.