Parental perceptions of sibling relationships in families rearing a child with a chronic condition

Down syndrome or Rett syndrome in the family: Parental reflections on sibling experience

BACKGROUND

Siblings of children with intellectual disability have unique family experiences, varying by type of disability.

METHODS

Parents of children with Down syndrome (156) or with Rett syndrome (149) completed questionnaires relating to sibling advantages and disadvantages, experiences of holidays and recreation, and perceived availability of parental time. Qualitative responses were analysed using thematic analysis.

RESULTS

Positive personality traits, an optimistic outlook, enhanced skills, and rich relationships were strong and consistent parental perceptions for siblings in both disability groups. Parents of children with Rett syndrome were more likely to rank themselves lower on time availability, and to report sibling difficulties with social engagement and family holidays.

CONCLUSIONS

Parental responses appeared to be influenced by disability type, and reflective of child capabilities. Perceptions of sibling experience should be supplemented by data collected directly from siblings to fully understand their unique perspective, and the ways in which their experiences could be enhanced.

Siblings of young people with chronic illness: Caring responsibilities and psychosocial functioning

Siblings of young people with chronic illness commonly undertake caring responsibilities for their affected brother/sister, which may encourage maturation, yet may also be perceived as a burden. Our study determined (1) siblings' caring responsibilities, (2) siblings' current emotional distress and psychosocial functioning, and (3) how siblings' caring responsibilities and psychosocial functioning related to familial relationships and coping strategies. Siblings completed questionnaires which contained Sibling Inventory of Behavior, Sibling Inventory of Differential Experiences, PedsQL, emotion thermometers, Brief COPE, and a checklist of caregiving responsibilities. We analyzed the data with t-tests and multi-level models. Forty-five siblings (mean age = 15.40 years, SD = 3.31 years; 60.0% female) participated. Siblings who had caring responsibilities (n = 26, 57.8%) reported lower anxiety symptoms, lower need for help, greater use of problem-focused coping, and more companionship and teaching/directiveness with their affected brother/sister than siblings without caring responsibilities. Siblings reported lower psychosocial and physical functioning when they perceived their parents provided them with less affection than their affected brother/sister. Family-based psychosocial interventions may aim to improve the sibling-parent relationship (including expressing affection) and the sibling-sibling relationship. Future interventions may also focus on increasing siblings' use of problem-focused coping strategies.

Children's psychosocial and behavioural consequences during their siblings' hospitalisation: A qualitative content analysis from caregivers' perspectives

AIMS AND OBJECTIVES

This study aimed to comprehensively describe the psychosocial and behavioural consequences experienced by siblings of hospitalised children from the caregivers' perspective.

BACKGROUND

After children are diagnosed with a major illness, their siblings may begin to exhibit psychological and behavioural problems, coupled with decreased quality of life.

DESIGN

This study employed qualitative content analysis to describe the perspectives of 147 caregivers of siblings of hospitalised children, following the COREQ guidelines.

METHODS

From January to March 2015, data were collected from 33 medical institutions in Japan using a survey that utilised an open-ended question.

RESULTS

Four themes comprising 13 comprehensive categories were extracted: (1) maintaining their usual self, (2) internalising difficulties, (3) externalising difficulties, and (4) personal growth. During data analysis, value judgments were avoided, with the focus instead placed on dividing the perspectives into positive and negative categories.

CONCLUSIONS

The neutral data analysis enabled us to describe the psychosocial and behavioural adjustments that siblings make to 'maintain their usual self'.

RELEVANCE TO CLINICAL PRACTICE

This study's results can be used to educate healthcare providers, teachers and families about the psychosocial and behavioural effects of hospitalisation on siblings of hospitalised children to ensure that siblings struggling with psychosocial conflicts receive the necessary support.

Children and young people's experiences of having a sibling with complex health needs: a literature review

Children with complex health needs require significant healthcare input for one or more conditions. Much of the literature on the effects of living with children with complex heath needs focuses on parents, and there is little research into the effects on siblings. This article reports on a literature review that examined the experiences of siblings growing up with a brother or sister with complex health needs and how this affects their lives. Three main themes were identified: emotional experiences; coping strategies and support; and family life. The findings identified in relation to mixed emotions, coping strategies and support systems are similar to those of studies of siblings of autistic children and children with cancer. However, in most countries the provision and availability of support for this group of siblings is inadequate.

Impact of congenital heart disease on siblings: A review

Congenital heart disease (CHD) is the most common birth defect. Little is known of the impact of having a sibling with CHD. Available literature documents negative impact of having a sibling with other chronic conditions. This literature review considers empirical evidence investigating the impact of having a sibling with CHD. Twelve databases were searched, and 202 articles retrieved. Eleven articles met the inclusion criteria and were subject to data extraction, quality appraisal, and narrative synthesis. Three themes emerged: changes in normal life, impact on siblings, and factors affecting the extent of impact on siblings. Only one intervention study was identified, 5 of 10 studies were conducted over 20 years ago, and only 4 studies included children as participants. Evidence suggests siblings of children with CHD experience adverse life changes which lead to negative impacts in several domains. Evidence is inconclusive regarding mitigating factors of these impacts. Further research is needed to understand the experiences of being a sibling of a child with CHD.

Parental Perspectives of the Impact of Epilepsy and Seizures on Siblings of Children with Epilepsy

INTRODUCTION

To assess parental perspectives of the impact of epilepsy and seizures on siblings of children in the Seizures and Outcomes Study.

METHODS

Parents completed surveys about their child with epilepsy, their own health and well-being, and the impact of epilepsy on unaffected siblings.

RESULTS

The most common parental responses about the sibling were witnessing a seizure, protectiveness of the child with epilepsy, worry about seizures, belief that seizures cause pain, and pride toward the child with epilepsy. Embarrassment and keeping epilepsy a secret were rare. Parent reports supported that siblings that worried were more likely to have witnessed a seizure, feel sad or angry, think seizures cause pain, and have a parent with anxiety disorder.

DISCUSSION

Some siblings of children with epilepsy are at risk for psychosocial problems. Primary and specialty care providers are well positioned to identify and monitor these children through evaluations and referrals as necessary.

Maternal Perspectives of Well Siblings' Adjustment to Family Life With a Technology-Dependent Child

Technology-dependent (TD) children require complex care and are dependent on medical technology. Approximately 75% of families, in the United States, who are caring for a TD child, also care for a well child. Well siblings are likely to be affected by the experience of living with a TD sibling as the process of family normalization is described as a family affair. The experiences of well siblings are not well described. The purpose of this qualitative analysis was to describe the experiences of well siblings who are living in a family with a TD child. Mothers were interviewed about the experiences of their well children and were digitally audio recorded. The interviews were transcribed, and content analysis was conducted. Content analysis from the interviews revealed the major themes of well sibling adjustment within the family unit, upside (altruistic, prosocial behaviors) and downside (negative internal and external processing behaviors). These results can be applied to advance the delivery of family nursing care offered to these families.

Siblings of children with life-limiting conditions: psychological adjustment and sibling relationships

BACKGROUND

This study explored psychological adjustment and sibling relationships of siblings of children with life-limiting conditions (LLCs), expanding on previous research by defining LLCs using a systematic classification of these conditions.

METHODS

Thirty-nine siblings participated, aged 3-16 years. Parents completed measures of siblings' emotional and behavioural difficulties, quality of life, sibling relationships and impact on families and siblings. Sibling and family adjustment and relationships were compared with population norms, where available, and to a matched comparison group of siblings of children with autistic spectrum disorder (ASD), as a comparable 'high risk' group.

RESULTS

LLC siblings presented significantly higher levels of emotional and behavioural difficulties, and lower quality of life than population norms. Their difficulties were at levels comparable to siblings of children with ASD. A wider impact on the family was confirmed. Family socio-economic position, time since diagnosis, employment and accessing hospice care were factors associated with better psychological adjustment.

CONCLUSIONS

Using a systematic classification of LLCs, the study supported earlier findings of increased levels of psychological difficulties in siblings of children with a LLC. The evidence is (i) highlighting the need to provide support to these siblings and their families, and (ii) that intervention approaches could be drawn from the ASD field.

Maternal perceptions of sibling adaptation in Korean families of children with Down syndrome

BACKGROUND

It is estimated that more than 500 infants with Down syndrome (DS) are born each year in Korea. DS affects not only these individuals, but family members as well. Some siblings deal successfully with the challenges of living with a child with DS and adapt well while others struggle or fail to adapt. The aims of this descriptive study were to explore how Korean mothers of children with DS perceive the adaptation of their typically developing (TD) children aged 4 to 19 and how family variables contribute to sibling adaptation.

METHOD

This descriptive, cross-sectional study was conducted with 105 Korean mothers.

RESULTS

Most mothers indicated that their TD children were not experiencing psychological or behavioural problems; however, many described problems in the sibling relationship. It was found that family factors (i.e. condition management effort, condition management ability, child's daily life, parental mutuality, family hardiness and social support) were strong predictors of sibling psychological, behavioural and relational adaptation. Demographic characteristics of the child with DS, the mother and the family appeared to significantly influence sibling adaptation.

CONCLUSIONS

These findings highlight the importance of familial contexts in understanding sibling adaptation. Knowledge of family factors associated with better adaptation in Korean siblings of child with DS will facilitate the development of culturally appropriate interventions for these children and their families. In addition, an awareness of demographic characteristics associated with sibling adaptation will help health care professionals identify siblings who are at increased risk of experiencing difficulties in adapting.

Perspectives of adolescent siblings of children with Down syndrome who have multiple health problems

Authors of this qualitative descriptive study interviewed 21 adolescent siblings of children with Down syndrome (DS) who also had additional health problems rated as requiring extensive care by parents. Analysis revealed positive/negative aspects of the experience; however, participants emphasized the positive rather than negative experiences and focused more on the fact that the child had DS rather than health problems requiring additional care. Most said they would not change anything about their experience and did not believe the child with DS would ever live independently. They did, however, acknowledge their family was affected by the caregiving needs of the child which often required extra vigilance or specific care depending on the health problem. Information gained can help improve understanding of adolescent sibling perceptions about living with a child with DS who also requires additional care because of ongoing health problems so more appropriate and individualized nursing interventions can be provided.