Siblings of Youth with Autism Spectrum Disorders: Theoretical Perspectives on Sibling Relationships and Individual Adjustment

Determinants of sibling relationships in the context of mental disorders

Many studies have been conducted on sibling relationships to explore the well-being of siblings of persons with mental disorders. In this research project, two mediation models were tested. Model 1 examined whether a sibling's distress and the quality of the parent-typically developing sibling relationship would mediate the path between sibling-focused parentification and sibling relationships. Model 2 tested the same paths by comparing siblings of persons with mental disorders (n = 262) and siblings of typically developing persons (n = 303). From March to May 2021, 565 siblings of persons with and without mental disorders were asked to fill in an online survey. Aged 19 to 26 years, most of the siblings who participated in the study were older females. Cross-sectional results showed that the lower sibling-focused parentification was, the higher quality sibling relationships were, through the mediating role of lower distress and higher-quality parent-typically developing sibling relationships (Model 1). Siblings of persons with mental disorders reported low-quality sibling relationships (Model 2). Females and young siblings showed high distress. The findings of this study could become instrumental in promoting high-quality sibling relationships and best practices.

The older sibling effect: comparing social functioning outcomes for autistic children with typically developing siblings, no siblings, and autistic siblings

Background

Previous research showed that having older, typically developing (TD) siblings is associated with better social functioning in autistic children. Modeling by older siblings and the fact that siblings provide a social companion to practice social skills were suggested as explanations.

Objectives

To investigate whether having older autistic siblings is associated with a similar or an opposite pattern.

Methods

The Azrieli National Centre for Autism and Neurodevelopment Research in Israel database was used to retrieve data of autistic children who completed the Autism Diagnostic Observation Scale [ADOS-2] for secondary analyses. A cohort of 1,100 children was scanned to identify autistic children with no siblings (No-Sib; n = 146), older TD siblings (Older-TD-Sib; n = 300), and older autistic siblings (Older-Autistic-Sib; n = 40). Each Older-Autistic-Sib child was matched to (1) Older-TD-Sib, and (2) No-Sib, by sex, age, and cognitive scores, resulting in 29 triads of matched participants (N = 87). The three groups were compared on the ADOS-2 Social Affect sub-domain [a lower score (0-10) indicates less severe social-communication symptoms (better social functioning)].

Results

Group comparisons revealed that autistic children with older TD siblings showed better social functioning than those with no siblings (p = 0.002, adjusted p = 0.007, d = 0.62). Autistic children with older autistic siblings showed a similar but weaker trend compared to those with no siblings (p = 0.082, adjusted p = 0.247, d = 0.40), and no difference was found between children with older TD versus autistic siblings (p = 0.647, d = -0.13; BF₀₁ = 4.55).

Conclusion

Autistic children with autistic siblings demonstrated an "intermediate pattern," implying a possible positive effect of having an older autistic sibling on social functioning, similar to that of having an older TD sibling, albeit smaller. This could be explained by complex relationships between sibling modeling and companionship or the impact of parenting measures, such as experience. These speculative explanations should be directly examined in future research.

A Systematic Review of Family Accommodation in Autistic Youth: Anxiety Disorders, Obsessive-Compulsive Disorder, and Restricted and Repetitive Behaviors

Family accommodation (FA) is a term describing the change in behavior seen in parents and caregivers as they attempt to effect change in their child or adolescent's anxious behavior-usually by allowing avoidance, attempting distraction, or attempting to manage distress. FA has been well-documented in children and adolescents with anxiety and obsessive-compulsive disorders; however, there has been less summarized on the degree to which autistic youth and families engage in accommodation. This review aims to establish the phenomenology of FA in autistic youth related to comorbid anxiety, obsessive-compulsive disorders, and restricted and repetitive behaviors (RRBs). This review also aims to summarize how FA is currently addressed in treatment within this population. Using PRISMA guidelines, peer-reviewed articles were included if (a) participants included caregivers of autistic youth, (b) there was a clearly delineated autism participant group, and (c) at least one quantitative outcome measure of FA was included. Seventeen articles were included in the review. Several themes emerged including (1) high rates of FA in autistic youth across OCD, anxiety, and RRBs, (2) some form of parental involvement in treatment, and (3) decreased rates of FA post-treatment. Overall, family accommodation appears to be present to at least the same degree, if not more so, in families of anxious autistic children and adolescents as their non-autistic but anxious counterparts. Family accommodation also often appears to be an important consideration with treatments for anxiety and OCD in autistic youth.

Sibling Relationships in Families of Autistic and Typical Children: Similarities and Differences in the Perspectives of Siblings and Mothers

This study investigates mothers' and siblings' perspectives regarding similarities and differences in siblingships with and without autism. Twenty-nine typical children (Mage = 8.78 years, SD = 2.05) whose younger siblings have a diagnosis of autism and their mothers constituted the 'autism group.' Forty-six typical children (Mage = 9.12 years, SD = 2.06) with younger typical siblings and their mothers constituted the 'typical group'. Children and mothers completed the Sibling Relationship Questionnaires and were interviewed. Children's reports illustrated similarities in sibling relationships across groups, with no between-group differences in overall warmth, conflict, rivalry, or relative power in the sibling relationship. Mothers of autistic children reported their children to have less warmth and closeness (F(1,72) = 5.63, p = .02, η2 = .073) and less conflict (F(1,72) = 6.66, p = .012, η2 = .085) with their siblings than mothers of typical children. More disagreement was found between mothers and children in the autism group than in the typical group. Mothers and children reported less intimacy and less quarreling between the siblings in the autism group than in the typical group. The qualitative analysis suggests that siblings focused on the present experience, while mothers also referred to processes in the sibling relationship. Interviewees in the autism group referred to various specificities in the siblingships without explicitly using the term "autism". The findings highlight a typical-like experience for siblings of autistic children. At the same time, mothers' perspectives emphasize differences and challenges in siblingships, reporting a pattern of decreased involvement. It is important to consider both perspectives in research and clinical work with families of autistic children.

"Filling in the gap": A qualitative case study about identity construction of siblings of youth with a neurodisability

INTRODUCTION

In families of children with a neurodisability, siblings have unique experiences that can shape their identity. There is limited information about the developmental process of how siblings form their identity. This study aims to understand the identity construction of young siblings who have a sibling with a neurodisability.

METHODS

As part of a patient-oriented research program, we engaged with our Sibling Youth Advisory Council in Canada. In this qualitative case study, data from semi-structured interviews augmented by photo elicitation and graphic elicitation of relational maps were analyzed using reflexive thematic analysis.

RESULTS

Nineteen sibling participants (median age = 19 years, range = 14-33 years) reflected on the uniqueness of their role during childhood. During adolescence and emerging adulthood, they became closer with their sibling with a neurodisability and increased communication with their parents about how to care for their sibling with a neurodisability. These experiences influenced how they explored and began to reconcile their sibling identity with their professional and social identities.

CONCLUSION

Siblings of youth with a neurodisability discover their unique identity and require support in this developmental process. Future interventions could evaluate how supports for siblings can have an impact on the positive development of their identity.

The impact of individuals with profound intellectual and multiple disabilities on peer relationships of typically developing siblings

INTRODUCTION/BACKGROUND

This study aims to determine the impact of a person with profound intellectual and multiple disabilities on peer relationships of their siblings.

METHODS

Information obtained from typically developing siblings of individuals with profound intellectual and multiple disabilities served as research material for this study. There were a total of 18 participants in the study. The analysis and interpretation were based on the procedures of grounded theory.

RESULTS AND CONCLUSION

The results of the study show that young adults with a brother or sister with profound intellectual and multiple disabilities have some difficulties in establishing relationships with their peers, especially those more intimate such as friendships or romantic endeavors. At the same time, research confirms that siblings of individuals with profound intellectual and multiple disabilities have high levels of empathy and understanding for others as well as sincere attachment to family.

Experiences of siblings of individuals with autism spectrum disorders

Several studies have focused on the impact of autism spectrum disorders (ASD) on parents, with very few exploring the experiences of siblings in the Accra Metropolis of Ghana. The purpose of this study was to explore the experiences of siblings of individuals with ASD. Using a qualitative approach, semi-structured interviews were conducted with eight (8) siblings of individuals with ASD who were purposively selected through parents in some support groups. Findings indicate that siblings largely have concerns about understanding the nature of ASD in addition to challenges with communication with their sibling with ASD. However, they used adaptive coping strategies to effectively deal with their challenges and had plans for the future of their sibling with ASD. These findings offer insights into the experiences of siblings and the appropriate support to be given to them by parents and professionals.

Examining clinical characteristics of autism and links with parent perceptions of sibling relationship quality

LAY ABSTRACT

Sibling relationship quality is important for the well-being of children on the autism spectrum and their siblings. Little is known, however, about how varied behavior and abilities of children on the autism spectrum may be associated with parent perceptions of domains of sibling relationship quality. We drew data from a subsample of 119 children on the autism spectrum (ages 10-11 years), participating in an ongoing longitudinal study. We looked at how three clinical characteristics (autism symptoms, behavioral difficulties, and communication ability) related to four areas of parent-reported sibling relationship quality (warmth/closeness, conflict, relative status/power, and rivalry). We also examined whether the strength of the association between behavioral difficulties and parent-reported sibling relationship quality was influenced by communication ability. We found that more severe autism symptoms were associated with less conflict and rivalry, and higher communication ability was associated with more relative status/power. We also found that children on the autism spectrum with more behavioral difficulties and weaker communication ability had less warmth/closeness in their sibling relationships. Our findings highlight that it is important to consider autism symptoms, behavioral difficulties, and communication ability, as well as multiple domains of relationship quality, to better understand how parents view the relationships between autistic children and their siblings. Clinically, methods for improving sibling relationships may include teaching conflict resolution strategies to children on the autism spectrum with stronger communication abilities and their siblings, and fostering sibling connection for those with lower communication abilities.

"Sometimes I Feel Grateful…": Experiences of the Adolescent Siblings of Children with Autism Spectrum Disorder in Malaysia

Sibling relationships remain understudied in typically developing adolescents who have siblings with autism spectrum disorder (ASD). This study explored the lived experiences and perceptions of adolescents who have a brother or a sister with a diagnosis of ASD using semi-structured interviews. Using thematic analysis, the participants reported having difficulties communicating with their siblings. Feeling a mixture of emotions was common when interacting with their siblings with ASD and emotional self-regulation was a typical coping strategy utilized by these adolescents. Despite the challenges, having a sibling with ASD led to closer relationships between the siblings. These findings offer insights into these adolescents' needs and how they may be best supported, informing the practice of speech-language pathology and other health professions.

Predictors of Suicide Attempts of Individuals with Autism and Their Siblings

The occurrence of mood- and anxiety-related conditions among family members of individuals diagnosed with autism spectrum disorder (ASD) increases the risk of suicide attempts and has also created assessment and treatment issues for clinicians and parents. Recorded rates of mental health disorders comorbid with suicide attempts among individuals on the spectrum range from 29% to 52%. The purpose of this study was to investigate the presence of predictors of suicide attempts among sibling dyads (pairs of siblings in which one sibling is on the autism spectrum). Growing evidence in the literature indicates a link between a diagnosis of autism and mental health. A web-based survey was used to collect data from individuals on the spectrum and their siblings. A sample of 144 individuals was finalized for the analyses. Logistic regression analysis was conducted to assess the predictors of suicide attempts in the sample. Depression, anxiety, sexual orientation, and marital status were all used as predictors in the logistic regression analyses. Both levels of anxiety and sexual orientation were found to be significant predictors for suicide attempts. Recommendations for future research, assessment, and treatment are presented.

High School Math and Motivation for autistic students

Analyzing data from students in the NCES High School Longitudinal Study dataset, we drew upon expectancy-value theory to examine the role of student motivation (measured by self-efficacy, identity, utility, and interest), as mediators between 9th grade math test scores and final math GPA for autistic students. In predicting final high school math GPA, math identity was the strongest predictor for autistic students with above average test scores. Findings for autistic students contrast with results for non-autistic students whose final math GPA is strongly predicted by the direct effects of 9th grade test scores. These results suggest that seeing oneself as a "math person" may be particularly influential for autistic students with higher 9th grade math performance.

Lived Experiences of Siblings of Individuals with Autism Spectrum Disorder in India: An Interpretative Phenomenological Analysis

BACKGROUND

Autism spectrum disorder (ASD) can impact the individual and their families. The impact on siblings is unique because they evolve from being another child in the family to a future adult who can be a potential resource to the family in supporting a member with ASD. Since the quality of care and support can be affected by the lived experiences of the carer and there are not many studies on siblings, this study examined the lived experiences of siblings of individuals with ASD.

METHODS

Fourteen siblings of individuals with ASD, aged 15-36 years, were recruited from a tertiary hospital, schools, and private institutes. A semistructured interview schedule was used to explore the lived experiences. Interpretative phenomenological analysis (IPA) was used to identify the themes.

RESULTS

The themes based on IPA indicated that the siblings have very basic concerns like understanding the condition and complex issues such as coping, preparing for current and future roles, personal needs and expectations, need for a support system, and positive aspects of the sibling relationship. Nonetheless, the siblings minimized reporting their difficulties and focused more on the needs of the sibling with ASD.

CONCLUSION

Siblings have diverse lived experiences, with a small element of positive experiences. Appropriate supports are needed to address the complexities of the lived experiences.

Child/adolescent caring for the disabled sibling in the family world

OBJECTIVE

To understand the meaning for the child/adolescent of participating in the care of the disabled sibling.

METHOD

Research in the light of the Heideggerian phenomenological approach, carried out in the northern region of Rio Grande do Sul - Brazil. Twenty children/adolescents who lived with their disabled sibling participated. The information was collected through phenomenological interviews, interpreted in the light of hermeneutics from Paul Ricoeur.

RESULTS

The child/adolescent helps the family in caring for the disabled sibling, in feeding, bathing, dressing, among other activities, at sometimes there is excessive responsibility of the child/adolescent for the care of the sibling.

FINAL CONSIDERATIONS

The inclusion of the child/adolescent who lives with a disabled sibling and their families in the planning and implementation of health care activities is essential. It stands out as a research contribution to the qualification of the practice of health professionals, especially the nurse in the scope of care for the child/adolescent who experience this phenomenon.

Sibling Adjustment and Sibling Relationships Associated with Clusters of Needs in Children with Autism: A Novel Methodological Approach

We tested a novel methodological approach to examine associations between characteristics of autistic children and outcomes for siblings. Cluster analysis was used to define five groups of children with autism (n = 168) based on autism symptoms, adaptive behavior, pro-social behavior, and behavior problems. Primary and secondary parent carers, and siblings themselves, reported on sibling relationship quality and psychological adjustment. Siblings of autistic children with a mild symptom profile, high levels of adaptive skills, but high internalizing and externalizing problems had the highest level of these problems themselves and more conflict in their relationship. Siblings of autistic children with the most complex support needs (adaptive skills deficits, severe autism symptoms) reported lower warmth relationships but not elevated internalizing and externalizing problems.

Canadian Resources for Siblings of Youth With Chronic Health Conditions to Inform and Support With Healthcare Management: A Qualitative Document Analysis

Background: As children and adolescents with a chronic health condition (CHC) age and transition to adulthood, many will increasingly assume responsibilities for the management of their healthcare. For individuals with CHCs, family members including siblings often provide significant and varied supports. There are a range of resources in Canada to support siblings of individuals with a CHC, but these resources are not synthesized and the extent to which they relate to healthcare management remains unclear.

Purpose: The purpose of this document review was to identify, describe, and synthesize the types of resources currently available to provide general information and healthcare management information about how siblings can provide support to individuals with CHCs in Canada.

Methods: Print and electronic resources were systematically identified and retrieved from the websites of organizations, treatment centers, and children's hospitals that are part of Children's Healthcare Canada. Each unique resource was treated as a text document. Documents that met the following inclusion criteria were included: addressed the topic of siblings of individuals with a CHC and written in English. Data were extracted from included documents and qualitative conventional content analysis was conducted. Throughout the process of this review, we partnered with a Sibling Youth Advisory Council.

Results: The systematic search yielded 1,628 non-duplicate documents, of which 163 documents met the inclusion criteria. Of the total of 163 documents, they were delivered in the following formats: 17 (10%) general informational products (e.g., booklets, videos) about a CHC and sibling relationships, 39 about support programs and workshops (24%), 34 news articles (21%) that described the roles of siblings, and 6 (3%) healthcare management informational products (e.g., toolkit, tipsheets), 31 blogs (19%) and 39 interviews (24%) with parents and siblings. In the blogs and interviews, siblings and parents described how siblings developed knowledge and skills for healthcare management, as well as their role and identity over time.

Significance: This study identified that there are limited resources available about healthcare management for siblings of CHC in Canada. Resources are needed to facilitate conversations in the family about the role of siblings with healthcare management of their sibling with a CHC.

Cultural Influences on Sibling Relationships, Roles, and Self-Concept in the Context of Autism: Perspectives of Latino/a/x and non-Latino/a/x Siblings

Siblings describe positive and negative aspects of autism and often assume lifelong support roles. Less is known about cultural influences on sibling relationships. This qualitative study characterizes processes linking siblings' autism conceptualizations, sibling relationships, and self-concept using a multicultural framework. Siblings (12 Latino/a/x, 9 non-Latino/a/x white) participated. Data were stratified by ethnicity and analyzed using applied thematic analysis. Latino/a/x and non-Latino/a/x siblings described processes linking autism, relationships, and self-concept differently. Latino/a/x siblings emphasized family roles and identified as caregivers and protectors. Non-Latino/a/x siblings emphasized general sensitivity toward individuals who differed from themselves. Findings may reflect cultural differences in familism, caregiving expectations, and autism conceptualizations, thereby illuminating foundations of siblings' lifelong caregiving roles and highlighting the importance of culturally-sensitive, family-centered care.

Examination of the Effectiveness and Acceptability of a Play-Based Sibling Intervention for Children with Autism: A Single-Case Research Design

Complementary and reciprocal interactions are a defining feature of sibling relationships for young children. However, the social and communication difficulties of children with autism spectrum disorder (ASD) can make reciprocal play more difficult and play between siblings can be less rewarding. Sibling play can serve an important role in intervention and family cohesiveness, but there is no consistent method for involving siblings in intervention benefitting the sibling dyad. This study evaluated a novel treatment package including training siblings on play strategies to increase positive sibling play in combination with a sibling support group to offer social support for the neurotypical sibling (NT). The effects of the treatment package on NT sibling play and fidelity of implementation of naturalistic play strategies was examined using a concurrent multiple-baseline design across six dyads, five of whom completed the intervention. After behavior skills training, all NT siblings increased the number of strategies they used, and increased the frequency of initiations towards their sibling with ASD. In addition, the percentage of reciprocal play between siblings increased. Generalization probes and follow-up probes demonstrated above-baseline levels of performance across most dyads, indicating that the skills learned generalized across other toys and were maintained over time. Only three of the sibling support group sessions were completed due to the COVID-19 pandemic. Although the effectiveness of the sibling support group cannot be determined, social validity questionnaires suggest siblings and parents valued and liked the support group.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43494-021-00043-5.

The Effects of Parenting and Temperament Similarity Among Adolescent Siblings on Positive Family Relationships

The detrimental effects of parental differential treatment have been shown in previous research, but fewer researchers have pointed out that differential treatment does not always lead to negative outcomes. Thus, the present study examines the role of temperament similarity on the association between parenting similarity and positive family relationship qualities over 1 year in 145 adolescent sibling dyads (M_first−born = 14.97 and SD = 1.68 years; M_{second−born} = 12.20 and SD = 1.92 years). Latent moderator structure models (LMS) showed that a higher level of parenting similarity was related to more positive family relationships when siblings were more similar in their temperaments; however, a lower level of parenting similarity was related to more positive relationship qualities with family members 1 year later in the context of less sibling temperament similarity.

Programmes to prepare siblings for future roles to support their brother or sister with a neurodisability: protocol of a scoping review

INTRODUCTION

Siblings share a lifelong bond in their relationship, and they may choose to provide support to their brother or sister with a neurodisability. Previous reviews summarised programmes that only focused on the behavioural, emotional and psychological outcomes of the siblings. There is a need to synthesise existing evidence and enhance our understanding about programmes for siblings to acquire knowledge, develop skills and become empowered that can help them to provide support to their brother or sister with a neurodisability. The objective of this review is to identify and map the characteristics and outcomes of programmes designed to prepare siblings in their future roles to support their brother or sister with a neurodisability.

METHODS AND ANALYSIS

This review will be conducted using the Joanna Briggs Institute methodology for scoping reviews. An integrated knowledge translation approach will be used by partnering with the Sibling Youth Advisory Council comprised of siblings of individuals with a disability throughout all review phases. Databases to be searched include PsycINFO, Cumulative Index of Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, EMBASE, Web of Science, MEDLINE (Ovid) and SPORTDiscus, from date of inception to November 2020. Studies of programmes designed for siblings of individuals with neurodisabilities, with no exclusion on the age of siblings or context, and published in English will be included. Extracted data will include details of programme structure and content, eligibility criteria and participants, context, study methods and outcomes. A summary of the results will be presented in a tabular form to provide an overview of the programmes with an accompanying narrative summary to address the research questions of this review.

DISSEMINATION

Findings from this review will be shared using dissemination strategies in partnership with the Sibling Youth Advisory Council. We will share the findings with key stakeholders such as healthcare providers, researchers, and patient and family advocacy groups.

A systematic review of the experience of being a sibling of a child with an autism spectrum disorder

Difficulties associated with Autism Spectrum Disorders can cause considerable impact on personal, familial, social, educational and occupational functioning. Living with a child who has an Autism Spectrum Disorder can therefore pose a challenge to family members, including typically developing siblings. However, it is only in recent years that the experience of typically developing siblings has become a focal point. A systematic review using keywords across six databases was undertaken to summarise qualitative studies that focused on the experience of being a sibling of a child with an Autism Spectrum Disorder. Fifteen studies met inclusion criteria and a thematic synthesis was completed. The synthesis found that having a sibling who has an Autism Spectrum Disorder can impact typically developing sibling's self-identity and personal development in a number of ways. Similarly, interactions with the sibling who has Autism Spectrum Disorders and with other individuals can evoke a myriad of experiences that can both benefit and challenge typically developing siblings. The ability of typically developing siblings to cope with adverse experiences needs to remain a focus. This synthesis concludes that further research is needed to identify which methods are the most effective in supporting typically developing siblings of children with Autism Spectrum Disorders.

A parent-sibling dyadic interview to explore how an individual with Autism Spectrum Disorder can impact family dynamics

BACKGROUND

Autism Spectrum Disorder (ASD) is a life-long condition which affects the individual and their family system. Little research understands the impact of an ASD upon families, how this may change over time and how COVID-19 has impacted these dynamics.

AIMS

To explore the impact of an ASD on the lived experiences of parents and neurotypical adult siblings, including during the UK COVID-19 lockdown.

METHODS

Eight parent-sibling dyads (16 individuals) completed semi-structured interviews discussing their family before, during and after receiving the ASD diagnosis, and in relation to the first UK lockdown. Interview transcripts were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three super-ordinate themes were identified: Dominated by ASD; Family Cohesion; and the Need for Support.

CONCLUSIONS

The data suggested a closeness within the families and an adoration towards the individual with ASD (IWA). Dyads were, to an extent, consumed by the diagnosis both presently and in the future, implicating the need for a stretch in services to support parents and neurotypical siblings. In terms of the first UK lockdown, the IWA added an extra layer of difficulty to the dyads work-life balance yet there was an essence of family cohesion. Future research should consider longitudinal methods and explore the impact of ASD co-morbidities upon family dynamics.

The Protective Role of Social Support Sources and Types Against Depression in Caregivers: A Meta-Analysis

The protective effects of social support for caregiver mental health are well documented, however the differential impact of support providers (partner, child, family, siblings, friends, professionals) and types (perceived, received) remain unclear. Observational data from 21 independent studies, involving a pooled sample of 2273 parents, stepparents and grandparents of children (aged ≤ 19) with autism spectrum disorder (ASD) were examined. Pearson's r, publication bias and heterogeneity were calculated using random effects modelling. Significant associations were noted between lowered depressive symptoms and positive sources of support, regardless of support type. Parental mental health can be enhanced by strengthening close personal relationships alongside connections with formal support services. Longitudinal research is needed to explore support need and perceived helpfulness over time.

In their own words, in their own photos: Adolescent females' siblinghood experiences, needs and perspectives growing up with a preverbal autistic brother or sister

Thus far very little research has focused on siblings in early adolescent years growing up with an autistic sibling. Adopting a community-based participatory research (CBPR) approach, 11 typically developing sisters actively collaborated in the study to collect and analyse data as well as disseminate their experiences, needs and perspectives in their local communities. This is the first study to use a modified Photovoice methodology which provided typically developing sisters an active participatory role. The results highlighted the feelings, needs and thoughts the sisters expressed in their role as siblings, friends, but also as students and citizens with a passion for advocacy, and limited support in the community due to unhelpful attitudes of members of their community towards autism. The findings indicated that the current method used can successfully co-generate research findings with family members by ensuring pathways for engaging local community. This is crucial in shifting the balance between vulnerability and resilience in families raising an autistic child. Furthermore, when knowledge about the lived experience is drawn directly from the perspective of the actual people (siblings) involved in the phenomenon (siblinghood and autism), a more appropriate, responsive and need-fulfilling strategy of supportive and proactive support systems can be initiated.

A Psychoanalytical Perspective on the Co-therapeutic Relationship With a Group of Siblings of Children With Autism: An Observational Study of Communicative Behavior Patterns

A child diagnosed with autism may have a negative psychological and behavioral impact on their siblings, whose participation in a group with children in the same situation is a preventive measure. Our group study was conducted by two therapists (T1 and T2) assigned to co-therapy (CT) work. Both therapists shared the theoretical bases and understanding of the group and the needs of the individual subjects, and complemented each other in terms of the direction of their interventions, given that shared impressions and continuous exchanges that integrate countertransference aspects are essential to successful co-therapy. The objectives of this study were as follows: (a) to detect patterns of clarification, confrontation, and interpretation interventions by T1 and T2 in the group; and (b) to detect patterns of clarification, confrontation and interpretation interventions considering T1 and T2 as the only focal subject of the CT. Design was mixed-methods based on systematic observation, for which we developed a qualitative ad hoc instrument that combined a field format and a categorizing system. Interobserver agreement was analyzed quantitatively using Cohen's kappa and Krippendorf's canonical concordance. Once data reliability was confirmed, lag sequential analysis using GSEQ5 software was performed to search for behavior patterns. The results show (a) different behavior patterns in the clarification, confrontation, and interpretation interventions by T1 and T2; and (b) different behavior patterns when T1 and T2 are considered as the focal subject (CT). Our study offers a new perspective on the impact of therapist interventions on participants in this kind of group.

Autism Spectrum Disorder and Sibling Relationships: Exploring Implications for Intervention Using a Family Systems Framework

Purpose There is currently a very limited scope of research in the field of speech-language pathology on sibling involvement in the treatment of children with autism spectrum disorder (ASD). Principles of family systems theory (FST) recognize the interrelatedness and dynamic nature of the family unit, making it a relevant and useful guiding framework for future research and practice on sibling involvement in intervention. Method In this article, core principles of FST are reviewed, followed by the state of research related to sibling relationships in ASD, and roles of typically developing siblings and siblings with ASD in intervention programs. Implications for adopting an FST framework as well as considerations and future directions in this area of research and clinical practice are discussed. Results According to the principles of FST on the inclusion of siblings in treatment, there are several considerations to be made at the level of the child with ASD, the sibling(s), and the family unit. Factors such as developmental level, communication status, and areas of strength, challenge, and interest are key features of the children and family that will need to be addressed in order to promote positive sibling involvement and family functioning. Conclusions The development of family-centered sibling intervention programs for individuals with ASD is an area of research that warrants further exploration. With the guidance of the FST framework, researchers and clinicians can work to develop innovative interventions that consider the unique characteristics of each family to optimize outcomes at the levels of each individual, the sibling relationship, and the family as a unit.

A Model of Family and Child Functioning in Siblings of Youth with Autism Spectrum Disorder

The potential clinical needs of typically developing (TD) siblings of youth with autism spectrum disorder (ASD) remain disputed. A total of 239 mothers of youth aged 6-17, including one youth with ASD (M = 11.14 years; simplex families) and at least one other youth (M = 11.74 years) completed online standardized measures of various familial factors and TD youth outcomes. Overall, only 6-23% of siblings were identified within the clinical range of emotional, behavioral, or social functioning. Both maternal depression and sibling relationship were identified as key pathways in predicting siblings' functioning within a good-fitting path analysis model. The current model is presented as a novel base for the development of future research and services for this unique population of children.

Adult Siblings Who Have a Brother or Sister with Autism: Between-Family and Within-Family Variations in Sibling Relationships

Prior research on the sibling relationship in the context of autism spectrum disorder (ASD) has included only one sibling per family. We used multi-level modeling to examine aspects of the sibling relationship in 207 adults who have a brother or sister with ASD from 125 families, investigating variability in sibling relationship quality and pessimism within and between families. We found that there was greater variability in aspects of the sibling relationship with the brother or sister with ASD within families than between families. Sibling individual-level factors were associated with positive affect in the sibling relationship, while family-level factors were associated with the sibling's pessimism about their brother or sister's future. The findings illustrate the unique experiences of siblings within families.

Siblings' experiences of growing up with children with autism in Taiwan and the United Kingdom

BACKGROUND

A child's diagnosis of autism impacts their whole family, in both positive and negative ways, that may be influenced by cultural beliefs.

AIMS

We aimed to describe the experiences of mothers and typically-developing siblings of children with autism in two cultural contexts.

METHODS

Fourteen mother-sibling dyads from Taiwan and the UK participated in semi-structured interviews.

RESULTS

Whilst there were similarities in sibling experiences, a negative tone regarding the influence of autism was more evident in Taiwan, where families also cited societal judgement and cultural-specific expectations. In the UK, a more balanced tone was apparent: mothers emphasised educating and involving the siblings. It is speculated that UK siblings had a greater understanding of their parents' stress, leading to more adaptive family dynamics. Various types of support service were mentioned in the UK, whereas the availability of social services and support appeared to be relatively limited in Taiwan.

IMPLICATIONS

Our data suggest that cultural context may have a significant impact on the responses of the family members. This is mediated by both differences in attitudes and traditions, and availability of resources. Support for family members needs to be sensitive to such cultural differences, as well as recognising positive experiences.

The early development of infant siblings of children with autism spectrum disorder: Characteristics of sibling interactions

Although sibling interactions play an important role in children's early development, they are rarely studied in very young children with an older brother or sister with autism spectrum disorder (ASD). This study used a naturalistic, observational method to compare interactions between 18-month-old infants and their older sibling with ASD (n = 22) with a control group of 18-month-old infants and their typically developing (TD) older sibling (n = 29). In addition, role (a)symmetry and the influence of gender were evaluated. Sibling interactions in ASD-dyads were characterized by higher levels of negativity. Although somewhat less pronounced in ASD-dyads, role asymmetry was present in both groups, with the older child taking the dominant position. Finally, siblings pairs with an older sister were characterized by more positive behaviours. Since differences in sibling interactions may alter the developmental trajectories of both siblings, these early relationships should be taken into account in future ASD research and interventions.

The Role of the Broader Autism Phenotype and Environmental Stressors in the Adjustment of Siblings of Children with Autism Spectrum Disorders in Taiwan and the United Kingdom

The influence of the broader autism phenotype (BAP) on the adjustment of siblings of children with autism has previously been researched mainly in Western cultures. The present research evaluated a diathesis-stress model of sibling adjustment using a questionnaire study including 80 and 75 mother-typically developing sibling dyads in Taiwan and the United Kingdom (UK). UK siblings reported elevated adjustment difficulties compared to the Taiwanese sample and to normative data. Whilst higher BAP levels were generally associated with greater adjustment difficulties, differences were found across cultures and respondents. Although significant diathesis-stress interactions were found, these were in the opposite direction from those predicted by the model, and differed across cultural settings. Implications for culturally-sensitive sibling support are considered.

Siblings of Children with Autism: the Siblings Embedded Systems Framework

Purpose of Review

A range of interacting factors/mechanisms at the individual, family, and wider systems levels influences siblings living in families where one sibling has autism. We introduce the Sibling Embedded Systems Framework which aims to contextualise siblings’ experience and characterise the multiple and interacting factors influencing family and, in particular, sibling outcomes.

Recent Findings

Findings from studies that have reported outcomes for siblings of children with autism are equivocal, ranging from negative impact, no difference, to positive experience. This is likely due to the complex nature of understanding the sibling experience. We focus on particular elements of the framework and review recent novel literature to help guide future directions for research and practice including the influence of culture, methodological considerations, and wider participatory methods.

Summary

The Siblings Embedded System Framework can be used to understand interactive factors that affect sibling adjustment and to develop clinically, educationally and empirically based work that aims to enhance and support sibling adjustment, relationships, and well-being in families of children with autism.

Adolescent Siblings of Individuals With and Without Intellectual and Developmental Disabilities: Self-Reported Empathy and Feelings About Their Brothers and Sisters

Siblings of brothers or sisters with intellectual and developmental disabilities (IDD) are important but understudied family members. As many previous studies have relied on parent report of sibling outcomes, the use of sibling self-report is an important addition to the research. This study assessed the feelings of adolescent siblings toward their brothers or sisters with and without IDD, as well as broader aspects of sibling empathy. Data were collected via a national, online survey from 97 parent-sibling pairs. Siblings of individuals with IDD reported higher levels of anxiety toward the target child than did siblings of typically developing individuals. Sibling feelings toward the target child were related to both parental and target child factors, but only among families of individuals with IDD.

Theory of mind in children with and without autism spectrum disorder: Associations with the sibling constellation

The two prior studies that have examined associations between the sibling constellation and theory of mind in autism spectrum disorder yielded discrepant findings. Thus, efforts to better understand the sibling-theory of mind link in autism spectrum disorder are necessary. This study examined a sample of prekindergarten- and kindergarten-aged (i.e. 4-6 years) typically developing children ( n = 39) and verbal children with autism spectrum disorder ( n = 61). Sibling presence, number of siblings, and having younger and older siblings were positively associated with theory of mind in typically developing children, but not in the full sample of children with autism spectrum disorder. However, in the subgroup of children with autism spectrum disorder without sibling recurrence, the presence of at least one older sibling was positively associated with theory of mind. Findings expand previous limited research on the sibling-theory of mind link in children with autism spectrum disorder by demonstrating a potential difference in the influence of the sibling constellation between children from simplex and multiplex families.