Brief report: empathy and psychological adjustment in siblings of children with cancer

Adolescent Young Carers Who Provide Care to Siblings

A child's disability, long-term illness, or mental ill-health is known to affect siblings' health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018-2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15-17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling-Parent Carers. Sibling Carers and Sibling-Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support.

A qualitative investigation of the impact that therapeutic recreational camps have on the psychological wellbeing of siblings of individuals with health conditions

BACKGROUND

The siblings of individuals with health conditions are often overlooked, despite being at risk of experiencing psychological difficulties. There is a lack of literature investigating interventions which could promote siblings' psychological wellbeing. Therapeutic recreational (TR) camps promote self-perception and self-worth, yet there are currently no UK studies qualitatively investigating siblings' experiences of TR camps.

AIMS

This study aims to understand siblings' lived experiences of attending TR camps, providing a greater depth of understanding of whether these camps have a positive impact on siblings' wellbeing.

METHOD

Due to the paucity of qualitative research regarding individuals' experiences of TR camps, semi-structured interviews were conducted with eight individuals who had attended TR sibling camps. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Analysis revealed three superordinate themes. The first, an environment that facilitates autonomous challenge, demonstrated the importance of siblings having a place where they felt autonomous in a fun, care-free environment. This encouraged participants to engage in challenges, feeling determined to overcome them. The second, an inclusive and supportive environment, highlighted the importance of connectedness. Facing challenges and reflecting on this within a supportive team, encouraged a sense of belonging. The final superordinate theme, a transformational journey, revealed that siblings gained determination and a positive outlook to facing challenges in daily life. Additionally, they gained self-acceptance and a positive self-image, becoming more confident with, and accepting of, their identity.

CONCLUSIONS

This study presents a novel contribution to the existing literature and highlights the importance of camp providers ensuring their TR model incorporates autonomous challenge, success and reflection. These encourage positive youth development and self-determination in young people. In addition, recommendations include implementing teams, promoting positive volunteer-camper relationships and implementing reflective sessions. These recommendations could potentially enhance the positive impact that TR camps have on siblings' psychological wellbeing.

Living with a child who has a life-limiting condition: The functioning of well-siblings and parents

BACKGROUND

Living with a child who has a life-limiting condition (LLC) is likely to have a major impact on all family members. There is a need to have a clearer understanding of the nature and extent of this impact on parents and well-siblings. The current study aimed to investigate the psychosocial functioning of well-siblings and parents living with a child with an LLC. Further, the study aimed to assess the resilience resources of both well-siblings and parents, giving consideration to how these relate to psychosocial functioning.

METHODS

Participants included 48 well-siblings (6-21 years) and 42 parents of children with LLCs. Parents and well-siblings independently completed validated measures of child and adult functioning and personal resilience. Parents provided demographic information about the patient and family.

RESULTS

The emotional, social and school functioning of well-siblings in the current study was found to be significantly poorer than published norms (all p's < .01). Parental self-reported depression, anxiety and stress scores were also all significantly poorer than published norms (all p's < .01). There was negligible agreement between well-sibling self-reported functioning and parental proxy-report of the well-siblings functioning (all r's < .126, all p's > .464). Sibling self-reported resilience was positively correlated with each of the measures of psychosocial functioning (all r's > .318, p's < .05). Parental resilience was significantly negatively correlated with depressive symptoms (r = -.369, p < .05) and anxiety symptoms (r = -.473, p < .01) but not stress scores (r = -.074, p = .644).

CONCLUSION

Family members living with a child who has an LLC were found to have significantly poorer psychosocial functioning than published norms. Although one cannot infer a causal direction from the current study, greater self-reported well-sibling and parental resilience were associated with aspects of better self-reported psychosocial functioning. Future studies should assess the impact of psychosocial interventions aimed at enhancing the resilience and functioning of both well-siblings and parents.

Featured Article: Caregiver Perceptions of Stress and Sibling Conflict During Pediatric Cancer Treatment

Objective

The current study examined the effect of stress on sibling conflict during the first year of pediatric cancer treatment.

Method

Families (N = 103) included a child with cancer (aged 2-17 years, Mage = 6.46, SD = 3.52) and at least one sibling aged <5 years of the child with cancer (Mage = 8.34, SD = 5.61). Primary caregivers completed monthly questionnaires throughout the first year of treatment assessing five sources of stress (i.e., general life, cancer-related, financial, perceived treatment intensity, and life threat) and level of sibling conflict. Using multilevel modeling, we explored the effects of these stressors on conflict both at the within- and between-family levels to examine if changes in stress resulted in concurrent changes in conflict within an individual family, and whether greater average stress affected the trajectory of conflict between families, respectively.

Results

At the between-family level, higher average levels of cancer-related stress, general life stress, and financial stress were associated with higher sibling conflict at the end of the first year of treatment. Perceived treatment intensity and life threat were not associated with conflict. No stressors were associated with conflict at the within-family level.

Conclusions

During pediatric cancer treatment, some stressors may spill over into family relationships and contribute to increases in sibling conflict.

Quality-of-life Evaluation of Healthy Siblings of Children with Chronic Illness

Background:

Chronic disease of children can cause changes in the health-related quality of life (HrQoL) of the family members.

Aims:

To evaluate the HrQoL of healthy siblings of children with chronic disease.

Study Design:

Cross-sectional study.

Methods:

The study included healthy sibling of children with chronic disease (cerebral palsy, epilepsy, diabetes, celiac disease, hematologic/oncologic disease, or asthma) and healthy sibling of healthy children to evaluate the quality of life. We used the Pediatric Quality of Life Inventory questionnaire; the physical health and psychosocial health scores were calculated using the responses of the sibling and parent. The primary endpoint was the comparison of HrQoL scores of healthy siblings of children with chronic disease and that of healthy siblings of healthy children.

Results:

This study included a respective healthy sibling of 191 children with chronic disease and healthy sibling of 100 healthy children. The physical health, psychosocial health, and total health scores of healthy siblings of children with chronic disease were significantly lower than that of healthy siblings of healthy children (p<0.001). Among the healthy siblings of children with chronic disease, the lowest psychosocial health score was found in the siblings of children with cerebral palsy, hematologic/oncologic disease, and asthma (p<0.001). The global impact on the quality of life for healthy siblings of children with chronic disease was significantly higher in the self-report of the children than that of the parents (30.4% versus 15.1%, p<0.05).

Conclusion:

Most healthy siblings of children with chronic disease are physically and psychosocially affected and there is low parental awareness of this condition. This can increase the risk of emotional neglect and abuse of these children. Therefore, special support programs are needed for the families of children with chronic diseases.

Empathy and perceptions of their brother or sister among adolescent siblings of individuals with and without autism spectrum disorder

BACKGROUND

Although clinicians have hypothesized that siblings of individuals with intellectual and developmental disabilities, including autism spectrum disorder (ASD), may exhibit more empathy and understanding of others, no studies have yet examined empathy among siblings of individuals with ASD.

AIMS

The current study examined self- reported empathy and feelings about adolescents' brothers or sisters with and without ASD.

METHODS AND PROCEDURES

Adolescent siblings (age 12-18) of individuals with (n=26) or without ASD (n=48) completed an online survey with measures of empathy and their feelings about their brother or sister, as well as an open ended task asking them for three "magic wishes."

OUTCOMES AND RESULTS

Siblings of individuals with ASD (ASD- Sibs) reported significantly more perspective-taking than did siblings of typically-developing individuals (TD-Sibs). Perspective-taking was significantly related to feelings of positive affect toward the brother/sister for both groups. ASD-Sibs also were significantly more likely to report wishes related to their family, while TD-Sibs reported more wishes for themselves.

CONCLUSIONS AND IMPLICATIONS

Findings suggest that potentially higher levels of perspective-taking ability among ASD-Sibs may contribute to better understanding of and therefore more positive affect toward their brother or sister with ASD. More research is needed to understand patterns of empathy among ASD-Sibs.

Well siblings' experiences of living with a child following a traumatic brain injury: a systematic review protocol

BACKGROUND

The aim of this systematic review is to synthesize the available evidence identified through a systematic search on well siblings' experiences of living with a child following a traumatic brain injury (TBI). Brain injuries in children have been referred to as the "silent epidemic" of current times. Brain injuries in children are also recognized as a global public health concern, with the impact on children, effects on family life, and caregiving markedly misunderstood and underestimated. It is widely recognized that a serious brain injury impacts on the whole family, both immediate and extended regardless of the age of the individual who experiences the brain injury. While some research refers to parental experiences of children with TBIs and caregivers experiences, there is a dearth of literature relating to the impact on well siblings and their perspectives. Well siblings' experiences regarding the impact of living with a child post-TBI are not well understood. In order to advance the delivery of family nursing care in the home, an understanding of the well siblings' experiences is fundamental.

METHODS

The search will be conducted using seven medical and healthcare databases for articles published up until February 2019. Two reviewers will independently screen the articles for inclusion and assess for study quality using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Two reviewers will extract data from each study and carry out data analysis to uncover themes within the literature. Data synthesis of findings will be carried out using JBI-QARI.

DISCUSSION

It is anticipated that the findings of the proposed review will be of interest to health and social care professionals, particularly those working in units where children have suffered TBIs, their well siblings, and families. The aim is to identify well siblings' experiences which can inform enhanced care delivery to the families of children following a TBI. The findings of this review will provide evidence to aid professionals with the assessment of siblings' needs to enhance their sense of self within the family unit. Future directions, in addition to potential limitations of the approach, will be discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2018 CRD42018111036.

Siblings of Young People With Cancer in NZ: Experiences That Positively and Negatively Support Well-Being

Siblings of young people with cancer experience significant distress and these effects often exist long after their sibling's treatment has successfully been completed. In New Zealand, many families must travel several hours to receive treatment, with some having to live away from home for extended periods which can create additional strains. We interviewed 10 siblings of pediatric cancer survivors drawn from a larger quantitative study, to investigate what made siblings' experiences more difficult and to find out what was helpful in supporting their adjustment. The selected participants came from across New Zealand, represented a mix of gender and age, and had a range of depression scores. Our thematic analysis found that experiences that were associated with the most distress included concurrent stressors, and feeling left out, rejected, or isolated. Experiences that were most helpful to their well-being were feeling involved, knowing that they were still important and a priority for their parents, connecting with people through their experiences, and focusing on positive experiences. Our findings suggest that professionals working with these families could help siblings of a child with cancer by promoting hope, acknowledging positive growth, drawing attention to positive events to promote benefit finding, and providing opportunities to have fun. Increasing parental awareness of the impact of differential treatment and improving the public understanding of sibling issues might also be helpful.

Evaluation of quality of life of healthy siblings of children with chronic disease

The quality of life determination of children with chronic disease is closely related to treatment success. Quality of life assessment studies revealed that it was not limited to the individual, the quality of life of the family members also had to be assessed. Along with the child being diagnosed with chronic illness, some changes occur in the family structure, and in family roles. Quality of life assessment studies in healthy siblings generally indicate a global influence. These children live in different senses such as closure, aggression, depression, anxiety, guilt, and isolation. Psychosocial impact (short or long-term) of healthy siblings have been associated with disease type, severity, disease duration, age, sex, and ability to cope. Further comprehensive studies among healthy siblings of children with chronic disease about quality of life are needed. Building support groups (especially family support groups) to express feelings and thoughts freely for healthy siblings can positively affect the well-being and self-esteem of the child.

Influence of oncology nurses' empathy on lung cancer patients' cellular immunity

Background

Medical staff’s empathy is closely related to patients’ outcome. This research aimed to verify the influence of Chinese oncology nurses’ empathy on the cellular immunity of lung cancer patients.

Materials and methods

The study included 365 lung cancer patients, who were attended by 30 oncology nurses between October 2016 and May 2017. At the time of admission and discharge, flow cytometric analysis was used to measure the cellular immunity of patients, including T-cell subsets and natural killer (NK)-cell activity. The level of empathy of the oncology nurses was measured by the Jefferson Scale of Empathy (JSE, Chinese version). The nurses were divided into high, moderate, and low empathy groups based on JSE scores. Associations between the empathy shown by nurses and the cellular immunity of patients were examined.

Results

On admission, there was no statistical difference in the cellular immunity of the patients taken care of by the three groups of nurses (P>0.05). At discharge, patients whose nurses were in the high empathy group reported significantly higher B-cell and NK-cell percentages than those whose nurses were in the low empathy group (P<0.001). There was a positive correlation between nurse empathy and percentage of B cells (P=0.003) and NK cells (P<0.001), but no correlation was found between empathy and percentage of CD3+, CD4+, and CD8+ cells. Multiple linear regression analyses indicated that nurse empathy significantly contributed to patient percentage of B cells and NK cells after controlling for patient demographics, disease conditions, and lifestyle.

Conclusion

The effect of oncology nurses’ empathy on cellular immunity was confirmed in lung cancer patients, suggesting empathy education, such as narrative medicine education, should be strengthened to improve patient outcome.

The Role of Resilience in the Sibling Experience of Pediatric Palliative Care: What Is the Theory and Evidence?

Siblings of children with life limiting conditions (LLC) are an important part of the broader family system and require consideration in the holistic care of the family. There can be considerable variation in the functioning and adjustment of these siblings. The current paper explores the resilience paradigm, particularly in the context of siblings of children with LLC and serious medical conditions. The potential impact of children living with a seriously ill brother or sister will be overviewed, and a range of functional outcomes considered. Factors contributing to sibling resilience are detailed, including individual, family, and broader external and social factors. Given the limited research with siblings of children with LLC, literature has also been drawn from the siblings of children with serious and/or chronic medical conditions. Implications for clinical practice and future research are considered. Pediatric palliative care services may be well placed to contribute to this body of research as they have commonly extended relationships with the families of children with LLC, which span across the child’s disease trajectory.

Trajectories of marital, parent-child, and sibling conflict during pediatric cancer treatment

OBJECTIVE

The stress of having a child with cancer can impact the quality of relationships within the family. The current study describes the longitudinal trajectory of marital, parent-child, and sibling conflict beginning around the time of diagnosis through the first year of treatment. We examined the average level of marital, parent-child, and sibling conflict at each monthly time point in the first year of treatment; the proportion of families that fall into the distressed range of marital, parent-child, and sibling conflict at each time point; the typical trajectory of conflict during the first year of treatment and whether there are differences in trajectories across families.

METHOD

A total of 160 families of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective longitudinal study. Primary caregivers provided monthly reports of marital, parent-child, and sibling conflict.

RESULTS

Using multilevel modeling (MLM), most families showed stability in quality of family relationships, although considerable between-family variability was observed. For married couples, 25-36% of couples were in the distressed range at one time point over the first year of treatment. For married couples, more distress occurred at earlier months, particularly month 3. For parent-child and sibling dyads, the most difficult time periods were during later months.

CONCLUSION

Implications for development of interventions that target at-risk family relationships are discussed. Identifying processes that predict between-family variability in trajectories of family relationships is an important next step, particularly for the marital relationship. (PsycINFO Database Record

Effects of Art Intervention Program for Siblings of Children With Cancer: A Pilot Study

Siblings of children with cancer often experience negative feelings, and art intervention can help them express their feelings and overcome hardships. This study aimed to develop an Art Intervention Program to improve the psychological adaptation of siblings of children with cancer and to evaluate its effects. Participants were seventeen 7- to 10-year-old siblings of children with cancer. The program comprised 12 sessions conducted once a week. The effects of the intervention were assessed in terms of self-esteem, anxiety, depression, and problem behavior. Self-esteem significantly improved after intervention compared with pretest. Children showed improved scores in externalizing problems and total behavior problems; however, anxiety and depression did not change. The study results indicated that the art intervention program helped improve the self-esteem and helped reduce somatic symptoms, aggressiveness, externalizing problems, and emotional instability among problem behaviors of siblings of children with cancer. However, the study was limited by its small sample size and the lack of a control group. Therefore, the study design allows no firm conclusions, and a randomized controlled trial is needed to investigate the effectiveness of the program.

Parenting in Childhood Life-Threatening Illness: A Mixed-Methods Study

BACKGROUND

Parenting children with life-threatening illness (LTI) and their healthy siblings requires parents to consider their various needs.

OBJECTIVE AND METHODS

We conducted a concurrent, cross-sectional mixed-methods study to describe challenges parents face prioritizing tasks and goals for each child with qualitative data, compare parents' tasks and goals for children with LTI and healthy siblings with quantitative data, and describe parenting in terms of the process of prioritizing tasks and goals for all children in the family.

RESULTS

Participants included 31 parents of children with LTI who have healthy siblings and were admitted to a children's hospital. Qualitative interviews revealed how parents managed children's needs and their perceptions of the toll it takes. Quantitative data revealed that parents prioritized "making sure my child feels loved" highest for ill and healthy children. Other goals for healthy siblings focused on maintaining emotional connection and regularity within the family and for ill children focused on illness management. Mixed-methods analysis revealed that parents engaged in a process decision making and traded-off competing demands by considering needs which ultimately transformed the meaning of parenting.

DISCUSSION

Future research can further examine trade-offs and associated effects, how to support parent problem-solving and decision-making around trade-offs, and how to best offer social services alongside illness-directed care.

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.

School Experiences of Siblings of Children with Chronic Illness: A Systematic Literature Review

PROBLEM

Siblings of children with chronic illness have unique experiences that can affect their school functioning, such that they may miss ongoing periods of school, experience difficulties with schoolwork or experience changes in their peer and teacher interactions. This review provides an overview of these siblings' school experiences.

ELIGIBILITY CRITERIA

Six databases (Medline, PsychINFO, CINAHL, ERIC, Embase and The Cochrane Library) were systematically searched for studies examining the school experiences and peer relationships of siblings of children with chronic illness, as well as school-based interventions for these siblings. Studies were included if they were published in or after 2000 and were published in English.

SAMPLE

We identified 2137 articles upon initial search. From these, we identified 28 eligible studies examining the school experiences of >1470 siblings of children with chronic illness.

RESULTS

Three key themes were identified throughout the reviewed articles. The literature described 1) the psychological impact on siblings at school; 2) decreases in school attendance and academic functioning, and; 3) changes or perceived differences in peer and teacher interactions. Siblings value teacher and peer support, and this support may contribute to better sibling school functioning.

CONCLUSIONS

Many siblings are socially resilient, yet overlooked, members of the family who may present with psychological, academic and peer related difficulties at school following diagnosis of a brother or sister with chronic illness.

IMPLICATIONS

Future research is needed to further delineate the sibling school experience to better facilitate the development of targeted sibling support interventions within the school environment.

Psychosocial Well-being of Siblings of Adolescents with Anorexia Nervosa

OBJECTIVE

Anorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed.

METHOD

Eighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment.

RESULTS

Mothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT.

CONCLUSIONS

Siblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

The psychophysiological impact of childhood autism spectrum disorder on siblings

OBJECTIVE

The negative impact of caring for a child with autism spectrum disorder (ASD) on parents' psychophysiological functioning has been widely evidenced. However, siblings, who also face emotional, social and physical challenges associated with having a brother/sister with ASD, have been less widely studied. This study examined the psychophysiological impact of childhood ASD on siblings.

METHODS

A sample of 25 siblings of children with ASD (and their mothers) and a control group of 20 siblings of neuro-typical children (and their mothers) completed questionnaires assessing: (a) demographic and lifestyle information, (b) family characteristics, (c) child behaviour problems, (d) social support and (e) depressive symptomology. Saliva samples were collected at several time points on two consecutive days, and estimates of the cortisol awakening response (CAR), diurnal cortisol slope and mean diurnal cortisol output were derived.

RESULTS

Total depressive symptoms were higher in siblings of children with ASD compared with controls. Group differences with respect to depressive symptomology were driven more by emotional than functional problems. With respect to physiological functioning, groups were comparable on all cortisol indices. In siblings of children with ASD, social support, especially from parents and close friends, predicted total depressive symptoms, as did the behaviour problems of their brother/sister with ASD.

CONCLUSION

Siblings of children with ASD experience greater emotional problems and overall depressive symptoms compared with a control group. Interventions that enhance social support, as well as helping siblings better understand the behaviour problems of their brother/sister with ASD, might be effective for alleviating depressive symptoms.

Supporting Siblings as a Standard of Care in Pediatric Oncology

In this study, evidence is provided for supporting siblings as a standard of care in pediatric oncology. Using Medline, PsycInfo, and CINAHL, a systematic search of articles published over the past two decades about siblings of children with cancer was conducted. A total of 125 articles, which were primarily descriptive studies, were evaluated by the four investigators using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. There is moderate-quality evidence, as well as support from community stakeholders, to justify a strong recommendation that siblings of children with cancer should be provided with psychosocial services and that parents and professionals are advised about how to meet siblings' needs.

Factors Related to Healthy Siblings’ Psychosocial Adjustment to Children With Cancer

Purpose: To identify factors related to the psychosocial adjustment of healthy siblings of children with cancer (HSCC). Design and Method: An integrative review was conducted. Controlled vocabularies relevant to siblings, pediatrics, children, neoplasms, and psychosocial adaptation were used to search Cumulative Index to Nursing & Allied Health Literature and PubMed. Articles that met inclusion criteria (eg, quantitative studies related to HSCC’s psychosocial adjustment; had sample sizes of at least 30; and HSCC age between 1 and 19 years) were reviewed. Key findings of selected articles were analyzed according to sibling characteristics, social support, and contextual factors. Results: Seven nonexperimental and 5 quasi-experimental studies were reviewed. HSCC’s characteristics (eg, age, gender), perceived social support from family and summer camp, and perceived contextual factors (eg, role overload, family adaptability) were significant factors that correlated with HSCC’s psychosocial adjustment. Conclusion: When caring for a child diagnosed with cancer, nurses need to include HSCC in the assessment of a family unit’s adaptation to cancer distress and provide appropriate interventions to promote HSCC’s psychosocial well-being.

Psychological Well-Being and Family Environment of Siblings of Children with Life Threatening Illness

BACKGROUND

The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings.

OBJECTIVE

We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings.

METHODS

We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment.

RESULTS

Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05).

DISCUSSION

Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported.

The social functioning of siblings of children with cancer: a multi-informant investigation

OBJECTIVE

This study examined social functioning among siblings of children with cancer.

METHOD

A case-control design was applied to school- and home-based data from multiple informants (peers, teachers, mothers, and self). Social reputation and peer acceptance within the classroom was compared for 87 siblings (aged 8-16 years) and 256 demographically matched peers. Self-perceptions of peer relationships and parent-reported social competence were examined among 67 siblings and 67 matched comparisons.

RESULTS

Peer reports (N = 1,633) indicated no differences between siblings and comparisons for social reputation, number of friendships, reciprocated friendships, or peer acceptance. Self-reported prosocial behavior and teacher-reported likability were higher for siblings than comparisons. Self-reported loneliness, friendship quality, and perceived social support did not differ between groups. Mothers reported less involvement in activities and poorer school performance for siblings than comparisons.

CONCLUSIONS

Peer relationships of siblings of children with cancer are similar to classmates, though they experience small decrements in activity participation and school performance.

A relational understanding of sibling experiences of children with rare life-limiting conditions: findings from a qualitative study

Mucopolysaccharidoses (MPS) and Batten disease are rare life-limiting conditions (LLCs) characterised by progressive and permanent physical and cognitive decline. The impact of such conditions on families, and notably on siblings, has not yet been described or documented. This paper presents data from a UK-wide study that sought to understand the family experience of supporting a child with the rare degenerative LLCs of MPS and Batten disease. The aim of this paper is to report sibling experiences related to these rare degenerative and progressive conditions, in order to inform the future development of supportive interventions. Eight siblings of children with MPS (n = 7) and Batten Disease (n = 1) participated in semi-structured qualitative interviews. A card sort technique was utilised to support and engage the children. Siblings are clearly impacted emotionally, pragmatically and relationally by the ill health of another child in the family. The data indicate four key themes which demonstrate impacts on siblings: perceptions of the condition and its symptoms, impact on daily life, emotional consequences and ways of coping. Siblings often had considerable knowledge of the condition and took on important roles in symptom management. However, these experiences were in the context of managing relationships within the family (often protecting parents from an awareness of how much they knew) and relationships at school (including distraction from learning and being bullied by peers). The data highlight how sibling experiences are generated through a combination of negative disability discourses and support through peers and family members. The data indicate how these features shift as a consequence of witnessing the advancement of their brother's or sister's condition and the emotional sequelae of disease progression. Exploration of siblings' experiences of living with such rare progressive and degenerative LLCs suggest the focus of interventions to support this group should address their emotional health and ways to overcome isolation and build connections with other siblings who share their unique experiences. Critically, the data suggest that sibling support should be cognisant of the trajectory of the illness as well as the family, school and peer relational contexts that siblings inhabit.

The Structure of Bryant's Empathy Index for Children: A Cross-Validation Study

The present study examined the structure of Bryant's Empathy Index (BEI) using different samples for conducting exploratory and confirmatory analyses. The BEI was administered to a sample of 2,714 children (mean age 11.12, SD = 1.59). Exploratory and confirmatory factor analyses showed a three-factor structure: Feelings of Sadness, Understanding Feelings and Tearful Reaction. The results revealed both the multidimensionality of the instrument and appropriate fit indices for the model proposed. Although these results were very similar to those reported in other studies with a Spanish population, the analyses were conducted in a more robust way: with a larger sample and using polychoric correlations and cross validation estimation.

The impact of participation in genetic research for families with cleft lip with and without cleft palate: a qualitative study

Despite being the most common congenital facial anomaly, little is understood about the genetic contribution to isolated clefts of the lip with or without cleft palate (CL/P). 'OzCleft', a family-based genotype/phenotype study, is investigating this further. Participation for families involves various clinical investigations of the child with the cleft, and their unaffected sibling(s) and parents. Informal feedback from individuals involved in OzCleft suggested that participation in this research programme had benefits for families. Taking a qualitative approach, this study sought to investigate this hypothesis further. Semi-structured in-depth interviews were conducted with nine parents who had participated in OzCleft. All parents described participation as a positive experience for themselves and their families. Perceived benefits included a greater appreciation of the cleft treatment experience by unaffected family members. Being involved in a genetic study raised issues for parents regarding the cause of clefting in their child. While some parents found the possibility of a genetic component reassuring, it also raised questions about the potential implications for future generations. Parents were largely unsure about how to communicate this information to their children and the predictive value of this information. This study suggests a lack of genetic understanding and/or perceived value of genetic information by parents of children with CL/P that, in turn, highlights the need for increased support from genetic health professionals in this area.

Prevalence and predictors of risky and heavy alcohol consumption among adult siblings of childhood cancer survivors

OBJECTIVE

To describe alcohol consumption patterns and risk factors for risky and heavy alcohol use among siblings of childhood cancer survivors compared with survivors and national controls.

METHODS

Secondary analysis of prospectively collected data from two national surveys was performed including a cohort of 3034 adult siblings of childhood cancer survivors (age 18-56 years) and 10,398 adult childhood cancer survivors, both from the Childhood Cancer Survivor Study, plus 5712 adult participants from the population-based National Alcohol Survey. Cancer-related experiences, self-reported current health, and mental health were examined in relation to alcohol consumption patterns including heavy and risky drinking.

RESULTS

Adult siblings of childhood cancer survivors were more likely to be heavy drinkers (OR adj = 1.3; 1.0-1.6) and risky drinkers (OR adj = 1.3; 1.1-1.6) compared with controls from a national sample. Siblings were also more likely to drink at these two levels compared with survivors. Factors associated with heavy drinking among siblings included being 18-21 years old (OR adj = 2.9; 2.0-4.4), male (OR adj = 2.3; 1.7-3.0), having a high school education or less (OR adj = 2.4; 1.7-3.5), and drinking initiation at a young age (OR adj = 5.1; 2.5-10.3). Symptoms of depression, (OR adj = 2.1; 1.3-3.2), anxiety (OR adj = 1.9; 1.1-3.3), and global psychiatric distress (OR adj = 2.5; 1.5-4.3) were significantly associated with heavy alcohol use.

CONCLUSIONS

Siblings of children with cancer are more likely to be risky and heavy drinkers as adults compared with childhood cancer survivors or national controls. Early initiation of drinking and symptoms of psychological distress should be identified during early adolescence and effective sibling-specific interventions should be developed and made available for siblings of children with cancer.

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

This study examined sibling relationships in families raising children with autism, Down syndrome, orthopedic conditions, and diabetes. Parents from 108 families independently completed the 28-item Schaefer Sibling Inventory of Behavior. Parents rated siblings as very empathetic, fairly often kind and involved, and rarely avoidant. Mothers rated sibling empathy higher than fathers did and older siblings more avoidant than younger siblings. Fathers rated male siblings kinder than female siblings; they also rated siblings of children with Down syndrome or autism more kind and involved than siblings of children with orthopedic conditions or diabetes. Sibling intervention efforts should consider these findings and be individualized according to the need of each child and family.

A two-session psychological intervention for siblings of pediatric cancer patients: a randomized controlled pilot trial

BACKGROUND

Since siblings of pediatric cancer patients are at risk for emotional, behavioral, and social problems, there is considerable interest in development of early psychological interventions. This paper aimed at evaluating the effectiveness of a two-session psychological intervention for siblings of newly diagnosed pediatric cancer patients.

METHODS

Thirty siblings age 6-17 years were randomly assigned to an intervention group or an active control group with standard psychosocial care. The manualized intervention provided to siblings in the first 2 months after the cancer diagnosis of the ill child included medical information, promotion of coping skills, and a psychoeducational booklet for parents. At 4 to 6 weeks, 4 months, and 7 months after the diagnosis, all siblings and their parents completed measures (from standardized instruments) of social support, quality of life, medical knowledge, posttraumatic stress symptoms, and anxiety.

RESULTS

At follow-up siblings in the intervention group showed better psychological well-being, had better medical knowledge, and reported receiving social support from more people. However, the intervention had no effects on posttraumatic stress symptoms and anxiety.

CONCLUSIONS

The results of this pilot trial suggest that a two-session sibling intervention can improve siblings' adjustment, particularly psychological well-being, in the early stage after a cancer diagnosis.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00296907.

Family functioning and coping styles in families of children with cancer and HIV disease

Disease-specific characteristics of pediatric illnesses may influence the functioning of families and the coping responses they enact. This study compared family functioning and coping styles within and between 2 different medical groups: families of children with cancer (n = 44) and HIV disease (n = 65). Most caregivers reported healthy family functioning, and no between-group differences in functioning emerged. However, with regard to coping, more reliance on social support was indicated among the cancer group. Also, the HIV group largely sought support from family, whereas both family and nonfamily support were sought among the cancer group. Better functioning was related to reframing, an active coping style, within the cancer group and passive coping within the HIV group. Thus, coping strategies and their implications for family functioning vary by condition. Researchers should avoid combining various illness groups indiscriminately. Likewise, clinicians should be sensitive to disease-specific factors when helping families learn to cope with illness-related stressors.

Psychological functioning of siblings in families of children with chronic health conditions: a meta-analysis

OBJECTIVE

The aim of this meta-analysis was to provide an up-to-date review of the literature to enhance our understanding of how chronic health conditions (CHCs) affect siblings, both positively and negatively.

METHODS

PsycINFO and Medline were systematically searched. Inclusion criteria were as follows: (a) peer-reviewed, empirical research report; (b) sample n ≥ 10; and (c) reports statistics on siblings' internalizing problems, externalizing problems, and/or positive self-attributes.

RESULTS

Overall, there was a significant small negative effect of CHCs on siblings (d(+) = -.10). Siblings of children with CHCs had more internalizing problems (d(+) = .17), more externalizing problems (d(+) = .08), and less positive self-attributes (d(+) = -.09) than comparisons. Older siblings and siblings of children with life-threatening and/or highly intrusive CHCs were more at risk for psychological problems.

CONCLUSIONS

This study identified several mechanisms through which CHCs affect siblings. Future research should focus on parent-child dynamics and the longitudinal development of positive self-attributes and internalizing problems as well as on identifying what works in services for siblings of children with CHCs.

Psychosocial adjustment of siblings of children with cancer: a systematic review

OBJECTIVES

To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children.

METHODS

Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary.

RESULTS

Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy.

CONCLUSIONS

Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.

Factors associated with positive adjustment in siblings of children with severe emotional disturbance: the role of family resources and community life

This study builds on the scant research involving siblings of children with severe emotional disturbances (SED) and examines: associations between adversity experiences and adjustment among 5- to 10-year-old siblings, and relations among family resources, community life, and sibling adjustment. Caregivers from 100 families completed standardized indicators of sibling adjustment and scales reflecting multiple contextual variables. Results document negative associations between stress exposure and sibling adjustment. Regression models also indicate positive associations between the caregiver-child relationship and broader family resources on sibling behavioral and emotional strengths, even after accounting for adversity experiences; adversity exposure was the prime correlate in regression models involving sibling oppositional behavior. Analyses also suggest that strain related to parenting a child with SED is associated with sibling adjustment. This work documents the needs of these siblings and their family systems and highlights the relevance of not only core proximal influences (e.g., child-caregiver relationship) but also elements of their broader contexts. Implications and recommendations are described, including the need to support plans of care that involve services, supports, or preventive strategies for these siblings.

Psychological adjustment of well siblings of children with Type 1 diabetes

AIMS

Studies of siblings of children with Type 1 diabetes (Type 1 DM) have shown either increased levels of maladjustment or, alternatively, increased levels of pro-social behaviour according to whether the sibling or parent was interviewed. The purpose of this study was to examine the psychological adjustment of Type 1 DM siblings using both parent and sibling report and to assess the concordance between child and parent reports.

METHODS

Ninety-nine siblings aged 11-17 years and parents of children with Type 1 DM treated at the Royal Children's Hospital, Melbourne were recruited sequentially. The Strengths and Difficulties Questionnaire (SDQ) was used to assess well siblings' emotional and behavioural functioning using data collected within a semi-structured interview. SDQ data between the sibling cohort and normative data sample were compared using independent-samples t-tests. Sibling reports and parent reports were compared using a series of paired-sample t-tests and correlation analyses.

RESULTS

Type 1 DM siblings did not report greater emotional or behavioural maladjustment or more pro-social behaviour than norms. Parents rated siblings' pro-social behaviour as being comparable with that of youth from the general community; however, parents rated healthy siblings as having lower levels of maladjustment; specifically, significantly fewer conduct problems, hyperactive behaviour and peer-related problems (all P < 0.01). There were no significant differences between parent ratings and sibling ratings on peer-related problems or pro-social behaviour.

CONCLUSIONS

Type 1 DM siblings did not report increased behavioural or emotional dysfunction relative to children in the general population and, according to their parents, were even better adjusted than their peers.

Impact of childhood chronic illnesses on siblings: a literature review

BACKGROUND

Childhood illness can have a significant impact on families, particularly on the ill child's siblings. There is a dearth of published literature focusing on the needs of siblings of ill children.

AIM

This literature review aims to provide an overview of the current healthcare literature in relation to the impact of childhood chronic illness or disability on siblings.

METHOD

A literature review was undertaken by searching the databases CINAHL, PsycINFO, ProQuest and Cochrane Library for relevant articles in English using the search terms: 'siblings', 'chronic illness', 'disability', 'cancer', 'sibling relations', 'sibling adjustment', 'coping', 'family-centred care', 'sibling interventions', 'camps', 'autism', 'Down's syndrome'. Seventeen research studies in total were reviewed.

RESULTS

This review focuses on three sibling groups related to children suffering from autism, cancer and Down's syndrome, and are discussed under the following headings: sibling adjustment; family functioning and sibling's coping resources; and intervention programmes.

CONCLUSION

The literature revealed that siblings of children with Down's syndrome were well adjusted to living with their brother or sister. However, there was conflicting information on the adjustment of siblings of children with cancer and autism. An awareness of the harmful effect that living with childhood illness and disability can have on some siblings is essential to enable healthcare professionals to provide supportive interventions to protect siblings' physical and emotional wellbeing.

Young siblings of children with cancer deserve care and a personalized approach

The youngest siblings may be both emotionally vulnerable and often neglected members of the family of a childhood cancer patient. The prompt identification of signs of distress in these subjects allows trained caregivers to intervene with personalized, age-appropriate, attention, and care. A narrative approach, based on personalized listening, writings, and spontaneous drawings, can provide the means to elicit markers of psychological maladjustment in even the youngest of siblings. Two exemplary cases are reported to illustrate this approach.

Siblings of children with severe emotional disturbances: risks, resources, and adaptation

This study examines risks, resources, and adjustment among siblings of children with severe emotional disturbances (SED) involved in an initiative to develop family centered Systems of Care in North Carolina. These siblings experience many of the same risks as the children who have been diagnosed with SED (i.e., "targets"), but have received relatively little attention from the system or researchers. This first systematic study of these siblings describes an early sample (n = 56), compares them to their system-identified brothers and sisters, and explores contextual factors related to sibling resources and adjustment. Findings suggest the siblings, much like the targets: (a) have been exposed to extremely high levels of adversity, and (b) evidence substantial variability in behavioral and emotional strengths and social-emotional adjustment. Although many siblings exhibit significant strengths and positive adjustment, a substantial proportion displays levels of competencies or problem behaviors on par with those targeted to receive services. Factors associated with positive sibling adjustment are consistent with those identified in prior risk and resilience work. Additional systematic study of these children could have implications for service delivery and preventive interventions.

Evidence-based assessment in pediatric psychology: family measures

OBJECTIVE

To provide a review of the evidence base of family measures relevant to pediatric psychology.

METHOD

Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: "Well-established", "Approaching well-established", or "Promising."

RESULTS

Nineteen measures met "well-established" criteria and the remaining ten were "approaching well-established." "Well-established" measures were documented for each of the broad assessment categories named above.

CONCLUSIONS

Many measures deemed "well-established" in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures.