Psychosocial characteristics of preschool siblings of handicapped and nonhandicapped children

Growing up alongside a sibling with a disability: A phenomenological examination of growth and deficiency in adulthood

BACKGROUND

A growing literature underscores the role played by sibling throughout life particularly for siblings with disabilities. However, limited research focuses on how growing up with a sibling with a disability impacts adult personality and well-being.

AIMS

The current study is a qualitative examination of the long-term effects of growing up with a sibling who has a developmental disability, using both a deficiency and growth model perspective.

METHODS AND PROCEDURES

Participants included 20 adult siblings of individuals with disabilities interviewed using a semi-structured interview. Interviews were conducted via an online platform.

OUTCOMES AND RESULTS

Themes identified were: impact on personal character traits, social development through sibling and overcoming social challenges, impacts on religiosity, influence on career choice, influence on romantic relationships and finding a partner, and future planning and stress. Distinct patterns of growth were noted in areas of personal development, character traits, social development, and interpersonal skills. On the other hand, hardships and anxieties were noted in general with specific negative features relating to social embarrassment and concerns about how the sibling status will impact potential romantic partnerships and future family life.

CONCLUSIONS AND IMPLICATIONS

The current study highlights the long-term impact of growing up with a sibling with a developmental disability with empirical and clinical implications.

Quality of the sibling relationship when one sibling has autism spectrum disorder: A randomized controlled trial of a sibling support group

LAY ABSTRACT

The sibling relationship can be negatively impacted when one child has autism spectrum disorder. One way to improve the quality of that relationship is through typically developing sibling participation in a support group in which they learn about autism spectrum disorder and coping skills, develop a peer network, and discuss their feelings. Compared to participating in a similar group without a focus on autism spectrum disorder, siblings in the support group showed improvements in the quality of the sibling relationship. Findings suggest that sibling support groups can be a valuable resource to improve sibling relationship quality when one sibling has autism spectrum disorder.

Multi-informant assessment of siblings of youth with autism spectrum disorder: Parent-child discrepancies in at-risk classification

BACKGROUND

The behavioral and emotional functioning of typically-developing (TD) siblings of youth with autism spectrum disorder (ASD) has been frequently assessed in the literature; however, these assessments typically include only one informant, rarely considering differences between parent and self-reports of sibling adjustment.

AIMS

This study examined parent-youth reported informant discrepancies in behavioral and emotional functioning, including whether parent and youth reports yielded the same conclusions regarding TD sibling risk status.

METHODS, PROCEDURES, AND RESULTS

Among 113 parents and TD siblings of youth with ASD, TD siblings self-reported more overall, conduct, hyperactivity, and peer problems (compared to parent reports). Although few siblings were considered at-risk, those who were identified were not usually identified as at-risk on both informants' reports. Moreover, ASD symptoms, broader autism phenotype symptoms, parent mental health concerns, and social support from parents were all related to differences in at-risk classification between parent- and sibling self-report.

CONCLUSIONS AND IMPLICATIONS

This paper highlights the necessity of multi-informant reporting when considering TD sibling psychological functioning.

WHAT THIS PAPER ADDS

This study helps to address gaps in the literature on assessment of emotional and behavioral functioning of TD siblings of youth with ASD. The results highlight the importance of utilizing both parent- and self-report when identifying TD siblings at-risk for maladjustment. Although few siblings were considered at-risk, those who were identified were not usually identified as such on both informants' reports, and a variety of sibling- and parent-factors were associated with differences in at-risk classification. Thus, inclusion and examination of both parent- and self-report of TD sibling psychological functioning is vital for accurately identifying numbers of TD siblings at-risk of maladjustment.

Psychosocial factors and chronic illness in childhood

Chronic illness in a child requires successful organisational and emotional adjustment of the child and the family. The way in which the child and the family adapt to the illness will affect their psychological well-being and their quality of life. This review summarizes recent research findings on the relationship between illness factors, individual and family functioning, coping strategies and psychosocial adjustment. The findings are presented within the framework of three complementary theoretical models: the family developmental approach; the psychosocial typology of illnesses; and the process model of stress and coping. These models are useful for a better understanding of the complex interactions between illness, family and coping and offer to the professionals engaged in the care of chronically sick children, guidelines for assessment and the development of intervention programs. The review starts with examining the impact of chronic illness on the psychosocial adjustment of the sick child, his/her siblings and parents. Then psychosocial Stressors and risk factors in terms of illness and family related characteristics are discussed. Coping resources and strategies are presented which have been shown to be related to child and parental adjustment; and finally, successful intervention programs are described.

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

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

Developmental disabilities: effects on well siblings

BACKGROUND

Forty studies performed between 1970 and 1995 indicated that 60% of parents with children with developmental disabilities reported manifestations of increased risk or negative effects on the well siblings.

METHOD

A secondary data analysis was performed using qualitative data gathered during the baseline of a randomized controlled clinical trial of an intervention for siblings/families of children with long-term conditions, including developmental disabilities. Content analysis was used to identify themes from responses of 151 parents to an open-ended question on their perceptions of the effects on well siblings of living at home with a brother/sister with developmental disabilities.

RESULTS

Of 363 themes identified, 61.1% reflected negative manifestations of increased risk in well siblings; 1.7% indicated no risk; and 37.2% reflected positive outcomes, suggesting the continued need for potential interventions.

CONCLUSION

Contemporary family life in these families, as portrayed by parents' descriptions, reflects need in child health care for more intervention research on this vulnerable population.

The Adjustment of Non-Disabled Siblings of Children with Autism

This study compared the psychosocial and emotional adjustment of siblings of children with autism and siblings of non-disabled children. In addition, differences between self and parent reports, as well as various demographic characteristics were examined. Fifty-one siblings of children with autism and 35 siblings of non-disabled children, between the ages of 7 and 17, along with one parent of each sibling, participated. Results indicated that the presence of a child with autism appears to enhance the psychosocial and emotional development of non-disabled siblings when demographic risk factors are limited. However, the presence of a child with autism appears to have an increasingly unfavorable impact on the non-disabled sibling as demographic risk factors increase.

Behavioural problems, social competence and self-concept in siblings of children with autism

INTRODUCTION

This study investigated the psychological adjustment of siblings of children with high-functioning autism (HFA) in comparison with siblings of normally developing children in the domain of behavioural problems, social competence and self-concept.

METHOD

Twenty-nine siblings of children with HFA and 29 siblings of children without a disorder participated in the study. Standardized, written questionnaires were used.

RESULTS

Siblings of children with HFA, especially brothers and sisters between 6 and 11 years old, had more behavioural problems than siblings of the control group. Sisters of children with HFA ascribed higher social competence to themselves. Sisters of children with HFA between 12 and 16 years old had a more positive self-concept. In both groups siblings with a more negative self-concept had less social skills and siblings with a more positive self-concept scored better in the social domain. Finally, in accordance with the control group, the perception of the siblings' social competence of parents of children with HFA broadly matched the perception siblings had of themselves.

DISCUSSION

Overall, siblings of children with HFA are not more susceptible to adaptation problems than siblings of children without a disorder. Implications for practice and further research are discussed.

Psychosocial adjustment and peer competence of siblings of children with Attention-Deficit/Hyperactivity Disorder

Preliminary data examined the relationships between mothers, their sons with Attention-Deficit/Hyperactivity Disorder (ADHD), and younger siblings. We hypothesized that the conflict between the mother and the son with ADHD would also occur in the relationship between the child with ADHD and the younger sibling. Significant associations were found among ADHD behaviors, family conflict variables, conflict in the relationship between mother and child with ADHD, conflict in the relationship between mother and younger sibling, and conflict in the relationship between the child with ADHD and the younger sibling. Further, significant associations were found between behavior symptoms associated with ADHD and more problematic family relationships. Of particular interest was the finding of an unexpected inverse association between siblings' peer competence and mother-ADHD conflict; specifically, that conflict occurring at home from ADHD accounted for a greater percentage of the variance in peer competence as rated by teachers. Recommendations are made for future research with larger samples, alternative designs, older siblings, and fathers.

Supporting positive sibling relationships during childhood

This paper reviews the research literature focusing on the interpersonal relationships between siblings when one child has a disability. Descriptive findings are presented that compare and contrast sibling warmth and positivity, engagement, and conflict in sibling pairs with and without a child with a disability. The social roles assumed by siblings are examined, as are developmental changes in role relationships. Research on the development of the sibling relationship in the family context is reviewed, as are findings concerning the effects of parent differential attention on the quality of the sibling relationship. MRDD Research Reviews 7:134-142, 2001.

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.

A longitudinal study of siblings of children with chronic disabilities

OBJECTIVE

To examine the unaffected siblings of 2 different groups with chronic disabilities, pervasive developmental disorder (PDD) and Down syndrome (DS), over 3 years, comparing their adjustment with each other and with the siblings of a nondisabled group.

METHOD

This study examines 137 siblings of children with PDD, children with DS, and developmentally normal children (control group) initially and 127 siblings at follow-up 3 years later. Their adjustment is measured by the Survey Diagnostic Instrument (SDI), completed by caregivers and teachers. Predictor variables include sibling self-perception, social support, and relationship with sibling, as indicated by siblings; caregiver psychosocial factors such as parental stress, caregiver depression, and marital relationship; family systems characteristics as viewed by both caregiver and sibling; and difficulty that disabled child causes as perceived by the primary caregiver.

RESULTS

Significantly more adjustment problems are found in the siblings of PDD children at both times when compared with siblings of DS and control children. Caregivers of PDD children report the highest levels of distress and depression, and this persists over time. Parent distress was found, at both times, to be related to sibling adjustment problems, regardless of study group.

CONCLUSION

These results have implications for preventive intervention for the unaffected siblings of PDD children.

Sind Geschwister behinderter oder chronisch kranker Kinder in ihrer Entwicklung gefährdet? Ein Überblick über den Stand der Forschung

Zusammenfassung. Einleitend werden fünf potentielle Risiken für Kinder mit behinderten oder chronisch kranken Geschwistern herausgestellt: (1) die Übernahme von Verantwortung für die Betreuung und Versorgung des behinderten/chronisch kranken Geschwisters sowie die verstärkte Mithilfe im Haushalt, (2) eine eingeschränkte elterliche Verfügbarkeit, (3) überhöhte elterliche Leistungserwartungen, (4) die Überidentifikation mit dem behinderten/chronisch kranken Geschwister sowie (5) indirekte Risikofaktoren wie die erhöhte Belastung der Eltern oder Stigmatisierungsprozesse gegenüber der Familie. Auf der Basis von 36 kontrollierten Studien wird der Forschungsstand zur Frage einer möglichen Gefährdung von Geschwistern behinderter oder chronisch kranker Kinder dargestellt. Die Befundlage ergibt keine Anhaltspunkte für eine allgemeine Gefährdung von Kindern mit behinderten oder chronisch kranken Geschwistern. In einigen Untersuchungen wird der Frage nachgegangen, welche Bedingungen die psychosozialen Auswirkungen des gemeinsamen Aufwachsens mit einem behinderten oder chronisch kranken Geschwister moderieren. Die Ergebnisse verweisen auf ein erhöhtes Risiko für die älteren Schwestern behinderter oder chronisch kranker Kinder.

Social functioning among girls with fragile X or Turner syndrome and their sisters

Social behaviors among two genetically homogeneous groups--girls with fragile X (fraX) or Turner syndrome (TS)--were examined to address the role of family environment versus biological determinants of social dysfunction in girls with these disorders. Using a sibling pair design, girls with fraX or TS were compared with their own sisters on measures of IQ and social functioning. The 8 girls with fraX and the 9 girls with TS had lower FSIQ scores and higher ratings of social and attention problems relative to their own sisters. Girls with fraX also had higher ratings of withdrawn behaviors, relative to their own sisters. The unaffected sisters were not rated as demonstrating any difficulties in these areas, relative to controls. Correlations between problem ratings and FSIQ were not statistically significant. Although these preliminary findings do not indicate a lack of familial impact on social development in girls with either disorder, the results provide preliminary evidence that social dysfunction reported for girls with fraX or TS cannot be attributed solely, nor primarily, to global aspects of the family environment.

Siblings and pediatric chronic illness: a review of the literature

Over forty studies published between 1970 and 1995 are reviewed to identify the extent and nature of risks to siblings of chronically ill children, and the factors that may increase or lower the risks. A considerable amount of research is available in this area within the Untied States, but is relatively understudied elsewhere. About 60% of the studies reported an increase in sibling risk, while 30% reported no risk; and 10% had positive and negative outcomes. Interventions need to focus on the entire family system.

Risk and protective factors affecting the adjustment of siblings of children with chronic disabilities

OBJECTIVE

To examine the adjustment of nondisabled siblings of handicapped children.

METHOD

In a 3-year longitudinal study, 46 siblings of children with pervasive developmental disorder (PDD), 45 siblings of children with Down syndrome, and 46 siblings of developmentally normal children (serving as controls) were examined at time 1 using the sibling, primary caretaker, and teacher as informants. Both direct and indirect variables related to sibling adjustment were considered.

RESULTS

Significantly more difficulties were found in the siblings of children with PDD compared with the other two groups. Different correlates of adjustment were present in the siblings of the disabled compared with nondisabled children, and mediating factors differed in parent and teacher reports of internalizing difficulties in siblings of children with PDD. Marital satisfaction, lack of parental depression, a cohesive family, and a warm, nonconflictual sibling relationship were protective for normal control and Down syndrome siblings but not for PDD siblings.

CONCLUSION

Findings underline the risks for the siblings of children with PDD and suggest the importance of a transactional mechanism rather than identification of single risk or protective factors in predicting sibling adjustment. Subsequent data analysis in this longitudinal study will assist in defining these mechanisms and allow for improved intervention strategies.

Pre-operative parental anxiety

This study attempts to identify the incidence and specific sources of anxiety in the parents of children admitted to hospital for elective surgery, to isolate factors associated with increased anxiety and to identify useful ameliorative measures. One hundred parents were interviewed and completed a questionnaire before their child's surgery. Parental anxiety levels were measured using the Leeds scale for self-assessment of anxiety. Anxiety-related illness was identified in 47% of parents, who were significantly more concerned than others about all aspects of their children's hospitalisation. No factors were identified which could predict which parents were at high risk of developing an anxiety state. When questioned about educational and interventional measures which they felt would be reassuring, the same factors were identified by 'anxious' and 'non-anxious' parents. As all parents agree on useful ameliorative factors, a general advice and education programme would be appropriate.

Psychosocial adjustment of thalassaemic children's siblings

beta-Thalassaemia is a chronic disease causing serious symptoms to the patients and considerable burden to their families. The psychopathology and psychosocial adjustment of 71 siblings of thalassaemic patients and 71 matched control subjects were investigated. Siblings of thalassaemic patients were found to have significantly more psychiatric disorders than the control subjects (p < 0.05). The frequency of psychopathology among the patients' siblings, when compared to the controls, was significantly greater after the age of 10 years (p < 0.01), with no difference between the two groups before the age of 10. Siblings of thalassaemic patients also scored significantly lower on sports and nonsports activities and on social functioning in terms of number of friends and number of contacts with them. These findings show that siblings of thalassaemic patients are at risk for psychiatric symptomatology and for impaired psychosocial functioning.

Siblings of a child with autism, with mental retardation and with a normal development

A total of 60 children between 8 and 15 years of age participated in this project, 20 of whom had a sibling with autism, 20 a sibling with mental retardation and 20 a non-disabled sibling. The children were questioned about their sibling relationship and their experiences of stress. The children with a sibling with autism also completed a questionnaire on their knowledge of the autistic syndrome. Analyses revealed that the three groups were basically similar in their ratings of the frequency of stressors involving their siblings. There was a trend for children with a disabled brother or sister to rate their relationship with the sibling more positively. Correlational analyses revealed an association between both stressor frequency and appraisal and the evaluation of the relationship with the brother or sister. Siblings of children with autism had a fair understanding of the autistic syndrome. In this group, there was also an association between the children's knowledge of the autistic disorder and the quality of the sibling relationship.

Sibling empathy and behavioural adjustment of children with chronic illness

This study investigated the relationship of healthy siblings' empathy to the psychosocial adjustment of children with a congenital heart disease (CHD) in 28 sibling dyads aged 3.5-11 years, as well as the perceived quality of sibling interactions, reported by mothers and children with illness. As in previous studies, children with CHD were reported to have more behaviour problems in the clinical range than either siblings or normative populations. On the basis of a task unconnected with illness issues, siblings were assigned to a high or low empathy group. Children with illness, but not their mothers, saw the siblings with high empathy more positively than those with low empathy. However, the adjustment of the children with illness did not differ between high and low empathy groups. Findings suggest the need to seek children's points of view when studying psychosocial effects of paediatric conditions.

The school-aged siblings of children with disabilities

A retrospective cohort study was performed of the school-aged siblings of children with severe learning difficulties. Index siblings demonstrated restricted contact with friends, behaviour difficulties, increased anxiety and increased acceptance towards disability compared with comparison siblings. Boys older than the disabled child demonstrated increased acceptance, whereas older girls demonstrated high rates of behaviour difficulty. Younger siblings demonstrated higher levels of anxiety, and those near in age demonstrated restricted contact with friends and behaviour difficulties. Those with no other normally developing siblings had restricted contact with friends. The 'burden of care' experienced by the mother had a significant positive correlation with the adverse effect on siblings.

Depression and social adjustment in siblings of boys with autism

Compared 22 siblings of autistic boys and 34 other siblings on measures of depression, social adjustment, and the amount of child care and domestic responsibility the siblings carry within the family. The relationship between sibling gender, age, birth order, qualities of the boy with autism, and family characteristics, and siblings' scores on the above measures were examined. Results of this research showed that siblings of autistic boys scored significantly higher on depression than the comparison group, but not on problems of social adjustment. There were no statistically significant gender differences; however, different gender-related patterns emerged on the correlates which may be of theoretical significance for future studies.