Parentification, distress, and relationship with parents as factors shaping the relationship between adult siblings and their brother/sister with disabilities

(Non)specific interaction patterns in families raising a child with disability or chronic illness: a latent profile analysis

Introduction

The presence of a child with a disability significantly affects family dynamics introducing new responsibilities and altering roles. However, research also highlights the positive outcomes, such as increased family cohesion and stronger bonds among family members. Siblings face unique challenges, including emotional burdens and adjustment difficulties, which are influenced by factors such as age, severity of the disability, and parental attitudes. While some siblings develop empathy and nurture traits, others struggle with internalizing and externalizing problems. This study investigated whether families exhibit distinct interaction patterns based on the presence and type of a child's disability, considering the perspectives of healthy siblings and parents.

Methods

The study comprised 179 dyads, each consisting of a healthy adolescent sibling of a child with a disability or chronic illness and one of their parents (N = 358). The sample included 49 families of children with diabetes, 49 with intellectual disabilities, 28 with motor disabilities, and 53 healthy children. To assess interaction patterns within families, the following measures were used: the Questionnaire of Relationships with Siblings to evaluate relationships between healthy adolescents and their siblings, the Parentification Questionnaire for Youth to measure emotional and instrumental parentification, the KidScreen-27 to assess quality of life, the Parental Attitude Scale-2 to assess parental attitudes, and the Family Rating Scales to evaluate family dynamics, including the structure and quality of family interactions. Latent Profile Analysis (LPA) was used to analyze data.

Results

We identified two latent profiles: "Strained Families" profile, which featured lower-quality family interactions with parents displaying greater rejection, inconsistent, and overdemanding attitudes, and the "Resilient Families" profile reflected balanced functioning with greater cohesion and flexibility. The "Strained Families" profile was more prevalent (57%). No significant differences in profile frequencies were found across the groups.

Conclusion

Both profiles included families with children with motor disabilities, intellectual disabilities, or diabetes and healthy children. Therefore, the results suggest that family interaction patterns varied independently of the presence of a child with a disability. Notably, 64% of the families with healthy children exhibited the "Strained Families" profile, marked by lower-quality interactions and family functioning, suggesting that such interactions are not exclusive to families of children with disabilities.

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.

Siblings of Persons with Disabilities: A Systematic Integrative Review of the Empirical Literature

The systematic review aimed to systematize the empirical literature on the psychological impact of disability on the siblings of persons with disabilities, to inform research and provide clinical recommendations. Two research questions addressed the review: (1) What are the main psychological constructs investigated in siblings of persons with disability? (2) What is the main role of each psychological construct in siblings of persons with disability experience? The electronic search was conducted in 7 databases and the PRISMA diagram was used. The inclusion criteria were: Papers published in English and in peer-reviewed journals; papers published between January 2014 and June 2024; qualitative, quantitative, and mixed studies; and papers on the psychological impact of disabilities and/or chronic illnesses on the experience of siblings of persons with disabilities. The standardized Mixed Method Appraisal Tool protocol was used to appraise the methodological quality of the studies. To summarize the findings, a narrative approach was adopted. A total of 60 studies have been reviewed. According to the methodological quality appraisal of studies, most of them reported a high (n = 45) and medium (n = 15) quality. They involved 10,146 participants. Findings revealed that sibling relationships, sibling-focused parentification, and emotional/behavioral adjustment are the main psychological constructs investigated by existing literature. Few studies focused on siblings' well-being. Studies exploring more than a psychological construct were included as a hybrid. Only one study examined the siblings' psychological experience during the COVID-19 pandemic. The quality of the sibling relationship ranged from good to poor; the caregiver is the main role played by siblings of persons with disabilities; anxiety, depression, and aggressive behaviors are the main emotional/behavioral symptoms revealed. Most studies (n = 39) recruited participants with brothers or sisters with mental disorders. The findings of this systematic review may play a role in the clinical field, as they might help to design gender- and age-specific intervention programs.

Experiences of siblings of children with chronic pediatric conditions: a qualitative systematic review

The needs of well siblings of children with chronic pediatric conditions (CPCs) are often overlooked as parents tend to direct their attention toward the child with CPC. This highlights the need to explore the experiences of these siblings to better inform the implementation of healthcare services. To consolidate the most up-to-date qualitative evidence regarding well siblings' perceptions and experiences of living with children with CPC. This qualitative systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was conducted on eight electronic databases from their respective dates of inception to March 2024. Sandelowski and Barroso's (2007) two-step approach was used to synthesize findings. Review findings were assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. In total, 23 studies (published between 2014 and 2023) were included. This review included 269 well siblings (aged between 7 and 23 years old) and 74 parents (mostly mothers). Four highly connected themes were identified: (1) A whirlpool of emotions, (2) Coping behaviors, (3) Growing up way too early, and (4) Doing and hoping for the best.

CONCLUSION

This review emphasizes the necessity for healthcare professionals to attend to the emotional and psychosocial needs of well siblings, and educate parents on how to better address well siblings' needs. Future research could look into the experiences of siblings of children with less common CPCs.

WHAT IS KNOWN

• The specific needs of well siblings of children with chronic pediatric conditions are unexplored. • Well siblings have difficulty comprehending and adapting to their sibling's chronic condition upon diagnosis.

WHAT IS NEW

• Interactions between family members and healthcare professionals play a crucial role in shaping how well siblings understand their siblings' chronic conditions. • Well siblings adopt various ways to help them cope with these challenging circumstances. • Well siblings are at risk for psychological distress upon learning about their sibling's chronic conditions.

Brief report: caregivers' well-being in families with neurodevelopmental disorders members during COVID-19: implications for family therapy

Neurodevelopmental disorders affect the lifespan of diagnosed individuals and their families. COVID-19 challenged these families with daily routine unpredictability requiring rapid adaptations. Moreover, associations and schools were closed, leaving these families without regular social support. Here, we investigate which individual and family factors can predict the caregiver's depressive state and overall burden. An online study took place between 2021 and 2022. A total of 32 caregivers (30 women; 48 ± 8.22 years old; range 26 to 63 years old) reported having a family member with a neurodevelopmental disorder, the majority diagnosed with autism spectrum disorder. Caregivers responded to a protocol to assess the burden, resilience, depressive, anxious, and stress symptomatology, as well as the behavior of the diagnosed individual. Hierarchical multiple regressions were performed to identify protective and risk factors for the caregivers' well-being. Caregivers' depressive state was explained by 29.3% of the variance of the family cohesion factor, indicating that high levels of balanced family cohesion represent a crucial protective factor for reducing the caregiver's depressive state. Additionally, overall caregiver burden was explained by 17.8% of the variance due to self-perception and 26.4% due to family cohesion, with the caregiver's self-perception playing an important protective role in the overall perception of burden. The proportion of male and female respondents seems to corroborate the significant role of women in caregiving. These results emphasize the importance of considering both individual and family factors of caregivers during interventions, which have implications for family therapy with families of members diagnosed with neurodevelopmental disorders, specifically with autism.

The experiences and perceptions of healthy siblings of children with a long-term condition: Umbrella review

PROBLEM

The lives of healthy siblings living with a sibling with a long- term condition are often shaped by the family, type of illness, length of illness, age of the child, caregiver demands, and support provided to the family, ill sibling, and healthy sibling. While the experiences of healthy siblings are documented in the literature by parent proxy, literature on healthy siblings self-reported experiences of living with a sibling who has a long-term condition remains scarce.

PURPOSE

This umbrella review aims to synthesize reviews on the self-reported experiences of healthy siblings of children living with a sibling who has a long-term condition.

ELIGIBILITY CRITERIA

Published peer-reviewed reviews in English language exploring the self-reported experiences of healthy siblings under 24 years old, whose siblings are diagnosed with a long-term condition.

SAMPLE

Using a developed search strategy, seven electronic databases (CINAHLPlus, Scopus, PubMed, PsycINFO, Cochrane Database of Systematic Reviews, Clinical Key, and Google Scholar) were searched from 2018 till December 2023. Eleven reviews met the inclusion criteria and were subjected to narrative synthesis.

RESULTS

Four themes (adjusting to changes, wanting to help, living the ups and downs, living the changes), and eight subthemes were generated from the syntheses.

CONCLUSION

This is the first umbrella review undertaken on healthy siblings self-reported experiences of living with a sibling who has a long-term condition. The impact of a long-term condition on healthy siblings of children with a long-term condition suggests a need for healthcare providers and organisations to provide better emotional, psychological, and informational support to healthy siblings and their families.

IMPLICATIONS

Findings from this review will inform healthcare providers, organisations, researchers, and policymakers on the development of future clinical practices and research for healthy siblings.