Effects of a support group for siblings of children with special needs

Psychosocial Interventions and Support Groups for Siblings of Individuals with Neurodevelopmental Conditions: A Mixed Methods Systematic Review of Sibling Self-reported Mental Health and Wellbeing Outcomes

Siblings of persons with neurodevelopmental conditions (NDCs) have increased risk of poorer psychosocial functioning. This systematic review evaluated quantitative and qualitative evidence on sibling mental health and wellbeing outcomes following psychosocial interventions and the risk and protective factors associated with post-intervention outcomes. From 2025 identified studies published from 1991 to 2022 across ten databases, 24 studies were included. The largest immediate post-intervention improvements were in self-esteem, social wellbeing and knowledge of NDCs. The most sustained improvements in intervention groups at follow-up periods were in emotional and behavioural adjustment and NDC knowledge. There were positive, but small, differences in favour of the intervention groups on knowledge of NDCs, self-esteem, coping and the sibling relationship as compared to waitlist control groups. Psychosocial interventions for siblings are heterogeneous, and more data, including consideration of unique family circumstances, are needed to improve reporting and replicability, to measure effectiveness and tailor necessary supports.

Programs to Prepare Siblings for Future Roles to Support Their Brother or Sister with a Neurodevelopmental Disability: a Scoping Review

Purpose of Review

To identify and map the characteristics and outcomes of programs designed to prepare siblings for their future roles with their sibling with a neurodevelopmental disability.

Recent Findings

Existing programs to support siblings of individuals with a neurodevelopmental disability often focus on providing information about neurodevelopmental disabilities, creating a community for siblings to connect with each other, and connecting siblings to resources and services to support them in their roles. Some programs are offered to the whole family with specific sessions for siblings. While these program descriptions are provided in the literature, there is limited understanding about the impacts and outcomes of these programs on siblings of an individual with a neurodevelopmental disability.

Summary

Fifty-eight articles (published between 1975 and 2020, with > 50% published since 2010) met the inclusion criteria, representing 54 sibling programs from 11 countries. Extracted data represented 1033 (553 females) sibling participants, between 4 and 67 years old. Twenty-seven programs focused on the outcome of knowledge acquisition for the siblings and thirty-one programs focused on the outcome of empowerment for the siblings to teach skills to their sibling with a neurodevelopmental disability. While there is an increasing number of programs for siblings of individuals with a neurodevelopmental disability in the past decade, there is a lack of siblings as co-developers or facilitators. Future research should consider the various roles that siblings can have in programs to address their needs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40474-023-00272-w.

Listening to parents to understand their priorities for autism research

Involving the autism community in research increases the real-world translation and impact of findings. The current study explored the research priorities of parents of school-aged children on the autism spectrum across the home, school, and community settings. A combination of content analysis of an online questionnaire (n = 134) and Q-sort methodology (n = 9) was used. The most commonly identified research priorities in the online questionnaire were child health and well-being (home setting), socialisation and social support (school), and community awareness and understanding of autism (community). The Q-sort method highlighted different top priorities, with understanding the parent, sibling, child and family impact and stress the highest ranked priority for home, teacher/staff education and support for the school, and recognizing and supporting anxiety for the community. The implications of the findings are discussed in relation to shifting the framework of autism research to align research agendas with parental priorities.

Randomized controlled trial of a sibling support group: Mental health outcomes for siblings of children with autism

LAY ABSTRACT

Typically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.

Augmenting Sibling Support with Parent-Sibling Training in Families of Children with Autism

Background: Typically developing (TD) siblings are an important part of the family system, but may show strained relationships in families of children with ASD. Objective: We augmented a sibling support group with parent-sibling training in which parents learned (through instructions, modeling, rehearsal, and feedback) how to prompt and reinforce prosocial behaviors in their TD children. Method: We examined the effects of parent-sibling training on parent and TD sibling behaviors in a multiple baseline across families design. Results: Parent prompting and reinforcement of TD sibling prosocial behaviors increase. TD sibling prosocial behaviors such as sharing with and talking to their sibling with ASD also increased. Broader measures of the sibling relationship showed some improvements. Conclusion: Findings suggest ways to support families of children with ASD with future investigations of parent-sibling training examining longer intervention, all family members' adjustment and relationships, and sibling characteristics that influence response to parent-sibling training.

Impact of Well-being Interventions for Siblings of Children and Young People with a Chronic Physical or Mental Health Condition: A Systematic Review and Meta-Analysis

Siblings of children and young people with a chronic illness are at increased risk of poor psychological functioning. A number of studies have attempted to implement and evaluate interventions targeting the psychological well-being of this at-risk group. This systematic review summarises the evidence regarding psychological functioning of siblings following an intervention targeting their well-being. The meta-analysis considered behaviour and knowledge, two of the most frequently studied outcomes. The following databases were used: PsycINFO, EMBASE, CINAHL, PubMed, Scopus and Web of Science. Seventeen studies were eligible to be included in the systematic review and eight in the meta-analysis. Results from the systematic review reflected the inconsistency of intervention evaluations in this area with a high level of heterogeneity and a total of 23 outcomes considered across the 17 included studies. The meta-analysis estimated effect sizes using a standardised mean difference (SMD) approach. Pre-post analysis suggested significant improvement in behavioural outcomes and knowledge of their sibling's health conditions with a SMD of - 0.44 [95% CI (- 0.6, - 0.29); p = 0.000] and 0.69 [(95% CI = 0.42, 0.96); p = 0.000], respectively. The SMD was not significant for behavioural outcomes when considering treatment-control studies. In conclusion, the findings suggest interventions for well-being have a positive effect on the psychological functioning of siblings of children and young people with a chronic illness, but their specificity needs to be established. There is a need for further, more methodologically robust research in this area.

Sibling self-management: Programming for generalization to improve interactions between typically developing siblings and children with autism spectrum disorders

The present study taught typically developing (TD) siblings of children with autism spectrum disorders (ASD) social-communicative and self-management skills. The authors' hypothesized that the acquisition of self-management skills would support generalization of targeted social-communicative responses. A multiple baseline probe design across sibling dyads was used to decrease exposure to unnecessary sessions in the absence of intervention. Four TD siblings were taught self-management of a social skills curriculum using behavioral skills training, which consisted of instructions, modeling, practice, and subsequent feedback. Results indicated that TD siblings learned to self-manage the social skills curriculum with some generalization across novel settings and over time. Comparisons of social-communicative responses to their typical peers provided some support for the social validity of the intervention outcomes. These results support the use of self-management, when explicitly programming for generalization, which continues to be a key consideration when including TD siblings in interventions with their siblings with ASD.

Support group programme for siblings of children with special needs: predictors of improved emotional and behavioural functioning

PURPOSE

A pilot study to identify the predictors of improvement in emotional and behavioural functioning of siblings of children with special needs following participation in SibworkS, a six-week manual-based, cognitive-behavioural group programme.

METHOD

Data from 36 participants from a recent evaluation of the SibworkS programme was used. Measures were administered pre-intervention, immediately post-intervention and three months post-intervention. Treatment effects were measured using change scores for siblings on the Strengths and Difficulties Questionnaire - Parent Version (SDQ). Seven predictors were analysed: symptom severity of the child with special needs, participant age and gender, sibling birth order, family socio-economic status, participant baseline SDQ score and participant use of additional support services.

RESULTS

The overall model significantly predicted change in SDQ scores at post-intervention and follow-up (adjusted R(2) = 0.41 and 0.40). At both evaluation points, SDQ change scores were significantly predicted by baseline SDQ score. Furthermore, symptom severity of the child with special needs was a significant predictor at three months post-intervention.

CONCLUSIONS

Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects. These results indicate that SibworkS is likely to be beneficial for siblings who have difficulties adjusting, and siblings of children with more severe special needs. Implications for Rehabilitation Siblings of children with disability are at increased risk of emotional and behavioural difficulties. Sibworks is a manualised group-based intervention for the siblings of children with a disability. Poorer emotional and behavioural functioning among participants and symptom severity of the child with special needs were associated with greater intervention effects. SibworkS is likely to be beneficial for siblings who have difficulties adjusting and siblings of children with more severe disabilities.

A controlled trial of the SibworkS group program for siblings of children with special needs

Siblings of children with a disability are an at risk group for emotional and behavioral problems. This study evaluated an intervention to promote the emotional and behavioral functioning of siblings of children with disabilities and chronic health conditions. SibworkS is a six-week manual-based, cognitive-behavioral group support program focussed on strengthening siblings' perceived social support, self-esteem, problem-solving skills, adaptive coping behaviors and positive sibling relationships. Fifty-six children aged 7-12 were allocated to either the SibworkS program (n=30) or waitlist control (n=26) in alternating sequence. The primary outcome was siblings' emotional and behavioral functioning. Additional outcomes were self-esteem, perceived social support, the sibling relationship and coping behaviors. Siblings were followed-up immediately after the intervention and at 3-months. Siblings participating in the SibworkS intervention were reported to have fewer emotional and behavioral difficulties than siblings in the control group immediately following the intervention and at the 3-month follow-up. Participation in SibworkS was associated with fewer emotional and behavioral difficulties for siblings. Implications for practice and future research include recommendations for improving program participation.

A community support program for children with autism and their typically developing siblings: Initial investigation

Siblings are a critical part of lifelong support for individuals with autism spectrum disorder (ASD). But siblings face their own social-emotional adjustment needs. These needs may be addressed through programs that include support groups specifically for the siblings. This study examined the effects of a community program on typical siblings' depression, anxiety, ASD knowledge, and peer network as well as reciprocal interactions between the typical sibling and sibling with ASD. The program provided a sibling support group, a skills intervention for children with ASD, and an inclusive recreation time. Siblings reported significant decreases in depression and physiological anxiety and improvements in their peer network. Autism knowledge increased but only approached significance. Direct observations revealed improvement in reciprocal interactions by most children that did not reach statistical significance. Parents, typical siblings, and interventionists indicated positive reactions to the program and its goals and outcomes. Findings are discussed in terms of the need to continue to explore interventions for siblings of children with ASD.

Facilitating support groups for siblings of children with neurodevelopmental disorders using audio-conferencing: a longitudinal feasibility study

BACKGROUND

Siblings of children with chronic illness and disabilities are at increased risk of negative psychological effects. Support groups enable them to access psycho-education and social support. Barriers to this can include the distance they have to travel to meet face-to-face. Audio-conferencing, whereby three or more people can connect by telephone in different locations, is an efficient means of groups meeting and warrants exploration in this healthcare context. This study explored the feasibility of audio-conferencing as a method of facilitating sibling support groups.

METHODS

A longitudinal design was adopted. Participants were six siblings (aged eight to thirteen years) and parents of children with complex neurodevelopmental disorders attending the Centre for Interventional Paediatric Psychopharmacology (CIPP). Four of the eight one-hour weekly sessions were held face-to-face and the other four using audio-conferencing. Pre- and post-intervention questionnaires and interviews were completed and three to six month follow-up interviews were carried out. The sessions were audio-recorded, transcribed and thematic analysis was undertaken.

RESULTS

Audio-conferencing as a form of telemedicine was acceptable to all six participants and was effective in facilitating sibling support groups. Audio-conferencing can overcome geographical barriers to children being able to receive group therapeutic healthcare interventions such as social support and psycho-education. Psychopathology ratings increased post-intervention in some participants. Siblings reported that communication between siblings and their family members increased and siblings' social network widened.

CONCLUSIONS

Audio-conferencing is an acceptable, feasible and effective method of facilitating sibling support groups. Siblings' clear accounts of neuropsychiatric symptoms render them reliable informants. Systematic assessment of siblings' needs and strengthened links between Child and Adolescent Mental Health Services, school counsellors and young carers groups are warranted.

A systematic review of interventions to support siblings of children with chronic illness or disability

AIM

  Chronic illness or disability in children can have a deleterious effect on the psychosocial health of well siblings. This systematic review synthesised evidence from studies evaluating sibling-oriented care aimed at improving behavioural and emotional outcomes in well siblings of children with chronic illness or disability.

METHODS

  Twenty electronic databases were searched. Study selection, data extraction and assessment of methodological quality were performed by two independent reviewers.

RESULTS

  Five controlled and nine uncontrolled studies were included. In higher-quality controlled trials, benefits of sibling-oriented care included reduced anxiety, improved mood and behavioural adjustment; however, these findings were not consistently demonstrated across studies. Study differences made it difficult to determine which sibling care features were most salient.

CONCLUSIONS

  Study findings highlight the potential for enhancing emotional and behavioural outcomes in well siblings. Future evaluations need to clearly identify the intended purpose of the care (what improvements are intended) and which types of siblings are most likely to benefit. This approach may yield more consistent and clinically important results.

Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children

OBJECTIVE

To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life.

METHODS

A total of 259 healthy children (4-16 years, M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n= 777).

RESULTS

Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r=-0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations.

CONCLUSIONS

Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling.

Sibling Peer Support Group for Young People with a Sibling Using Drugs: A Pilot Study

Siblings of young people abusing drugs are at particular risk for drug abuse and other health compromising behaviors. A Sibling Peer Support Group was developed by the Centre for Adolescent Health (Melbourne, Australia) for young people aged 13 to 18 years with a problematic drug user in their family. Groups aimed to provide support and information, promote harm minimization, and reduce the sense of isolation. The project emanated from the recognized need for specific support for adolescent siblings of problematic drug users. Evaluation of two pilot groups indicated positive benefits for group members, who reported feeling better informed, more supported, and having a reduced sense of isolation. Parents reported that their adolescent attending the group demonstrated improved communication with, and greater understanding and tolerance of, the family member using drugs. Promising indicators at a community level were manifested in enthusiastic collaboration among schools, police and local service agencies, and the organization of a local drug forum. There appeared to be little evidence that the groups inadvertently encouraged drug use. Recruitment of young people into groups was the major challenge for the project, but among drug and alcohol and family organizations there was support for the concept of a Sibling Peer Support Group. A new model to overcome the challenge of recruitment is proposed.

Die Beziehung zwischen behinderten und nichtbehinderten Geschwistern

Zusammenfassung. In der Forschung zur Beziehung zwischen behinderten und nichtbehinderten Geschwistern stehen vier Beziehungsaspekte im Vordergrund: (1) die Rollenbeziehung zwischen den Geschwistern, (2) das Ausmaß des Kontaktes zwischen den Geschwistern, (3) qualitative Aspekte des Geschwisterkontaktes und (4) die Art des Spielverhaltens. Kennzeichnend für die Beziehung zwischen behinderten und nichtbehinderten Geschwistern ist eine im Vergleich zu nichtbehinderten Geschwisterpaaren größere Rollenasymmetrie. Unabhängig von seiner Geburtsposition nimmt das nichtbehinderte Geschwisterkind eine dominante Stellung gegenüber dem behinderten Geschwisterkind ein. Der Kontakt zwischen den Geschwistern ist im allgemeinen nicht eingeschränkt, die Geschwisterbeziehung wird von den nichtbehinderten Geschwistern ebenso wie von den Eltern überwiegend positiv bewertet. Im Spielverhalten zeigt sich, daß die nichtbehinderten Geschwister bemüht sind, Unterschiede im Spielniveau zu überbrücken und so die Voraussetzungen für ein gemeinsames Spiel mit ihrem behinderten Geschwister zu schaffen. In der Forschung wurden drei Faktoren aufgegriffen, die sich auf die Geschwisterbeziehung zwischen behinderten und nichtbehinderten Geschwistern auswirken könnten: (1) Die differentielle Zuwendung der Eltern für die Geschwister, (2) die Übertragung von Verantwortung für die Betreuung auf das nichtbehinderte Geschwisterkind sowie (3) die Art der Behinderung. Der Forschungsstand zum Einfluß dieser drei Faktoren auf die Geschwisterbeziehung wird dargestellt. Abschließend wird auf mögliche Konsequenzen für die psychosoziale Unterstützung von Familien mit behinderten Kindern hingewiesen.